目的 评估对注意缺陷多动障碍(ADHD)儿童进行低频度计算机执行功能训练的可行性,为ADHD的临床治疗提供依据。方法 于2017年10月-2018年5月选取44例儿少门诊就诊符合DSM-5诊断标准的6~12岁ADHD儿童,按照家长意愿分为训练组和药物组,以患儿治疗前后症状和执行功能改善情况、对治疗方案的接受程度作为可行性分析指标。采用SNAP-Ⅳ量表对症状进行评估;Stroop色词关联测试、威斯康辛卡片分类测试(WCST)、WISC-Ⅳ的数字广度测试、译码测验进行执行功能评估。结果 低频度执行功能训练结束后患儿的ADHD症状改善,SNAP-Ⅳ的对立性、注意缺陷、多动冲动分量表得分差异均有统计学意义(t=3.386、2.976,Z＝-2.026,P<0.05或<0.01);部分执行功能指标改善,患儿Stroop甲表正确数、乙表错误数、乙表时间差异均有统计学意义(t/Z=-2.727、2.368、-2.987,P<0.05或<0.01);WCST持续错误数、概念化水平差异有统计学意义(t=2.375、-2.614,P<0.05);WISC-Ⅳ顺背数字得分和译码得分差异有统计学意义(t=-3.093、-2.723,P<0.05)。患儿对训练的接受程度较高,脱落率低。药物组患儿8周末,SNAP-Ⅳ对立性和注意缺陷因子得分降低,治疗前后的差异均有统计学意义(P<0.01);Stroop 乙表正确数增加,乙表时间减少,差异均有统计学意义(t=4.833、3.360,P<0.001)。结论 低频度的计算机执行功能训练有效、可行,可改善ADHD患儿的症状和部分执行功能,患儿接受程度高,可在医疗机构临床上广泛推广。
Abstract
Objective To evaluate the feasibility of low-frequency computerized executive function training for attention deficit hyperacivity disorder (ADHD) children. Methods Totaly 44 ADHD children aged 6-12 years who met the DSM-5 diagnostic criteria were selected from the outpatient clinic from October 2017 to May 2018,and were divided into the training group and the drug group according to their parents' wishes.The improvement of symptoms and executive function before and after treatment,as well as the acceptance degree of the treatment plan,were taken as the feasibility analysis indicators.Children's symptoms were assessed by SNAP-Ⅳ scale.The executive functions of ADHD children were assessed by digit span test and coding tests of Stroop color-word test,WISC-Ⅳ, Wisconsin Card Sorting Test (WCST). Results The ADHD symptoms of the children improved after the low-frequency executive function training,and the scores of SNAP-Ⅳ subscale of oppositions,attention deficit and hyperactivity were different significantly(t=3.386,2.976,Z＝-2.026,P<0.05 or＜0.01).Some indicators of executive function were improved,including the correct number of Stoop test A,the wrong number of test B,and the time of test B(t/Z=-2.727,2.368,-2.987,P<0.05 or＜0.01).WCST persistent error number and conceptualization level were significantly different after training (t=2.375,-2.614,P<0.05).There were statistically significant differences on the digit span test score and coding test score of WISC-Ⅳ (t=-3.093,-2.723,P<0.05).The children received a higher acceptance of low-frequency training and the drop-out rate was lower.At the end of 8 weeks, the scores of SNAP-Ⅳ oppositions and attention deficit factor in the drug group were decreased,and the difference before and after treatment was highly significant(P<0.01).The correct number in Stroop test B was increased while the time in Stroop test B were decreased,and the difference was statistically significant(t=-4.833,3.360,P<0.01)。 Conclusions Low-frequency computerized executive function training is effective and feasible that can improve the symptoms and partial executive function of ADHD children.Moreover,children's acceptance for computerized executive function training is high,so it can be widely promoted in clinical practice.
关键词
注意缺陷多动障碍 /
执行功能 /
计算机执行功能训练
Key words
attention deficit hyperactivity disorder /
executive function /
computerized executive function training
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参考文献
[1] Jin WL,Li GZ,Du YS,et al.ADHD symptoms in children aged 5 to 15 years in Zhabei District,Shanghai[J].Eur J Psychiatry,2016,30(3):173-182.
[2] Kofler MJ,Irwin LN,Soto EF,et al.Executive functioning heterogeneity in pediatric ADHD[J].J Abnorm Child Psychol,2019,47 (2):273-286.
[3] 杜亚松,曹阳,江文庆.注意缺陷多动障碍儿童的执行功能[J].中国儿童保健杂志,2019,27(5):465-468.
[4] Shuai L,Daley D,Wang YF,et al.Executive function training for children with attention deficit hyperactivity disorder[J].Chin Med J,2017,130(5):549-558.
[5] Jiang WQ,Li Y,Du YS,et al.Emotional regulation and executive function deficits in unmedicated chinese children with oppositional defiant disorder[J].Psychiatry Investig,2016,13(3):277-287.
[6] 王玉凤.注意缺陷多动障碍[M].北京:北京大学医学出版社,2019.
[7] Constantinidis C,Klingberg T.The neuroscience of working memory capacity and training[J].Nat Rev Neurosci,2016,17(7):438-449.
[8] Roche JD,Johnson BD.Cogmed working memory training product review[J].J Atten Disord,2014,8(4):379-384.
[9] 余雪,李开强,刘玥,等.比较两种工作记忆训练对ADHD儿童的干预效果[J].中国临床心理学杂志,2015,23(2):15-19.
[10] 李颖源,廖文静,周新林,等.注意缺陷多动障碍患儿多维计算机化执行功能训练的探索性随机对照研究[J].中华精神科杂志,2017,50(6):445-452.
[11] Thaler NS,Bello DT,Etcoff LM.WISC-Ⅳ profiles are associated with differences in symptomatology and outcome in children with ADHD[J].J Atten Disord,2013,17(4):291-301.
[12] 周晋波,郭兰婷,陈颖.中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版的信度[J].中国心理卫生杂志,2013,27(6):424-428.
[13] Scarpina F,Tagini S.The stroop color and word test[J].Front Psychol,2017,8:557.
[14] Arán Filippetti V,Krumm GL,Raimondi W.Computerized versus manual versions of the Wisconsin Card Sorting Test:Implications with typically developing and ADHD children[J].Appl Neuropsychol Child,2019.doi:10.1080/21622965.2019.1570198.
[15] 孙霞,苑成梅,王宇,等.轻症抑郁结构式团体认知行为治疗手册的编制与可行性分析[J].神经疾病与精神卫生,2016,16(5):517-521.
[16] Ahmed R,Aslani P.Attention-deficit/hyperactivity disorder:an update on medication adherence and persistence in children,adolescents and adults[J].Expert Rev Pharm Out,2013,13(6):791-815.
[17] Biederman J,Seidman LJ,Petty CR,et al.Effects of stimulant medication on neuropsychological functioning in young adults with attention-deficit/hyperactivity disorder[J].J Clin Psychiatry,2008,69(7):1150.
[18] Bikic A,Christensen TØ,Leckman JF,et al.A double-blind randomized pilot trial comparing computerized cognitive exercises to Tetris in adolescents with attention-deficit/hyperactivity disorder[J].Nord J Psychiat,2017,71(6):455-464.
[19] Van Dongen-Boomsma M,Vollebregt MA,Buitelaar JK,et al.Working memory training in young children with ADHD:a randomized placebo-controlled trial[J].J Child Psychol Psychiatry,2014,55(8):886-896.
[20] 李焱,江文庆,李梦瑶,等.计算机辅助的执行功能训练对注意缺陷多动障碍患儿的干预研究[J].中国儿童保健杂志,2017,25(3):237-241.
[21] Bikic A,Leckman JF,Christensen T,et al.Attention and executive functions computer training for attention-deficit/hyperactivity disorder (ADHD):results from a randomized,controlled trial[J].Eur Child Adoles Psy,2018,27(12):1573-1574.
[22] 孙雪莲.北京市中小学课业负担调查研究[J].上海教育科研,2015,35(9):31-35.
[23] Chacko A,Bedard AC,Marks DJ,et al.A randomized clinical trial of cogmed working memory training in school-age children with ADHD:a replication in a diverse sample using a control condition[J].J Child Psychol Psychiatry,2014,55(3):247-255.
[24] Tamm L,Epstein JN,Peugh JL,et al.Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD[J].Dev Cogn Neurosci,2013,4:16-28.
基金
国家自然科学基金面上项目(81771477);上海市虹口区临床医学优秀青年人才培养计划(HKYQ2018-19);青年科学基金项目(81901386);上海市医学重点专科建设计划(ZK2019A06);上海市精神卫生中心院课题(2018-YJ-14)
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