目的 分析5~6岁注意缺陷多动障碍(ADHD)共患发育性协调障碍(DCD)儿童的智力结构特征,旨在为学龄前ADHD共患DCD儿童的针对性干预提供理论依据。方法 2020年7月—2022年4月对就诊于福建省妇幼保健院确诊为ADHD的儿童进行发育性协调障碍问卷(DCDQ)筛查,结果为可疑和异常的儿童以美国精神医学学会精神障碍诊断与统计手册(第5版)(DSM-5)为诊断标准,确诊DCD者共70例,另单纯ADHD患儿50例为对照组,均进行韦氏幼儿智力量表测试,对比两组儿童智力结构特征。结果 ADHD共患DCD组儿童的总智商(t=2.884)、言语理解(t=3.059)、视觉空间(t=2.198)、工作记忆(t=2.345)、加工速度指数(t=3.314)均显著低于单纯ADHD组(P＜0.05);两组流体推理指数比较,差异无统计学意义(t=0.997,P＞0.05)。比较10个核心分测验的得分,共患DCD组均较单纯ADHD组低,其中常识(Z=2.285)、类同(t=2.645)、拼图(t=2.225)、动物家园(Z=3.307)、找虫(t=3.033)和划消分测验(t=2.299)的得分差异有统计学意义(P＜0.05)。结论 共患DCD的ADHD儿童的总智商较单纯ADHD儿童低,主要表现在言语理解、视觉空间、工作记忆、加工速度指数方面,故对共患DCD的学龄前ADHD儿童除传统的心理行为治疗外,在训练和教育中还应注意对该共患病进行针对性的干预。
Abstract
Objective To analyze the characteristics of intelligence structure in preschool children with attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD), in order to provide theoretical basis for targeted intervention of preschool children with ADHD and DCD. Methods From July 2020 to April 2022, preschool children diagnosed with ADHD in Fujian Provincial Maternity and Children′s Hospital were screened with Developmental Coordination Disorder Questionnaire (DCDQ). Children with suspicious and abnormal results were diagnosed using the American Psychiatric Association′s Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) as the diagnostic criteria. Finally, 70 ADHD children were diagnosed with DCD, and 50 children with ADHD were taken as the control group. Wechsler Infant Intelligence Scale was used to test the intelligence structure of all children in this study. Results The full scale intelligence quotient (IQ) (t=2.884), verbal comprehension (t=3.059),visual spatial (t=2.198),working memory (t=2.345)and processing speed index (t=3.314) of ADHD children comorbid with DCD were significantly lower than those with simple ADHD(P＜0.05). There was no significant difference in fluid reasoning index between children in the two groups (t=0.997, P＞0.05). Compared with the scores of 10 core subtests, the scores of ADHD children comorbid with DCD were lower than those of children with simple ADHD, among which the scores of information (Z=2.285), similarities (t=2.645), object assembly (t=2.225),zoo locations (Z=3.307),bug search (t=3.033) and cancellation (t=2.299) were significantly different (P＜0.05). Conclusions The total intelligence quotient of ADHD children comorbid with DCD is lower than that of simple ADHD children, which is mainly manifested in speech comprehension, visual space, working memory and processing speed index. Therefore, in addition to the traditional psychological behavior therapy, targeted intervention should be strengthened for preschool ADHD children comorbid with DCD in training and education.
关键词
注意缺陷多动障碍 /
发育性协调障碍 /
智力结构 /
学龄前儿童
Key words
attention deficit hyperactivity disorder /
developmental coordination disorder /
intelligence structure /
preschool children
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 注意缺陷多动障碍早期识别、规范诊断和治疗的儿科专家共识[J].中华儿科杂志,2020,58(3):188-193.
Consensus on pediatric clinical practice of early identification, standardized diagnosis and treatment of attention deficit hyperactivity disorder[J].Chin J Pediatr,2020,58(3):188-193
[2] 岳小静,王承芯,李洪华,等.学龄期注意缺陷多动障碍共患特定学习障碍儿童智力结构与临床特征分析[J].中国当代儿科杂志,2020,22(11):1178-1182.
Yue XJ,Wang CX,Li HH,et al. Intelligence structure and clinical features of school-age children with attention deficit hyperactivity disorder and specific learning disorder[J].Chin J Contemp Pediatr,2020,22(11):1178-1182.
[3] 余珍珠,杨斌让,张姗红,等.注意缺陷多动障碍共患发展性阅读障碍儿童的智力特征[J].中国当代儿科杂志,2021,23(2):148-152.
Yu ZZ,Yang BR,Zhang SH, et al. Intellectual characteristics of children with attention deficit hyperactivity disorder and developmental dyslexia[J].Chin J Contemp Pediatr,2021,23(2):148-152.
[4] 胡华芸,吴婕翎,林文璇,等.注意缺陷多动障碍共患数学学习困难儿童韦氏儿童智力结构特征[J].中国儿童保健杂志,2015,23(8):811-813.
Hu HY,Wu JL,Li WX, et al. Intelligence structure characteristic of attention deficit hyperactivity disorder children with mathematical difficulties in WISC-Ⅳ[J].Chin J Child Health Care,2015,23(8):811-813.
[5] 冯莉娟,罗晓明,金华,等.发育性协调障碍儿童智力结构特点分析[J].中国儿童保健杂志,2015,23(9):980-982.
Feng LJ,Luo XM,Jin H,et al.Intelligence structure characteristic of children with developmental coordination disorder[J].Chin J Child Heal Care,2015,23(9):980-982.
[6] Parke EM,Thaler NS,Etcoff LM,et al.Intellectual profiles in children with ADHD and comorbid learning and motor disorders[J].J Atten Disord,2020,24(9):1227-1236.
[7] American Psychiatric Association.Diagnostic and statistical manual of mental disorders DSM-5(5th ed.)[M]. Arlington:American Psychiatric Publishing,2013.
[8] Hua J,Gu G,Zhu Q,et al.The reliability and validity of the developmental coordination disorder questionnaire′07 for children aged 4-6 years in mainland China[J].Res Dev Disabil,2015,47:405-415.
[9] Watkins MW,Beaujean AA. Bifactor structure of the Wechsler Preschool and Primary Scale of Intelligence-fourth edition[J].Sch Psychol Q,2014,29(1):52-63.
[10] Wang T,Liu K,Li Z,et al.Prevalence of attention deficit/hyperactivity disorder among children and adolescents in China:A systematic review and meta-analysis[J]. BMC Psychiatry,2017,17(1):32.
[11] Hua J,Du W,Dai X,et al.International clinical practice recommendations on the definition,diagnosis,assessment,intervention,and psychosocial aspects of developmental coordination disorder-Chinese (Mandarin) translation[J].Dev Med Child Neurol,2019,61(7):e1.
[12] Öztekin I,Garic D,Bayat M,et al.Structural and diffusion-weighted brain imaging predictors of attention deficit-hyperactivity disorder (ADHD) and its symptomology in very young (4-7-year-old) children[J].Eur J Neurosci,2022,10.doi:10.1111/ejn.15842.
[13] 吴德,唐久来.发育性运动协调障碍的诊疗研究[J].中国康复医学杂志,2020,35(5):513-516.
Wu D,Tang JL.Diagnosis and treatment of developmental motor coordination disorder[J].Chin J Rehabil Med,2020,35(5):513-516.
[14] Shaw P,Weingart D,Bonner T,et al.Defining the neuroanatomic basis of motor coordination in children and its relationship with symptoms of attention-deficit/hyperactivity disorder[J].Psychol Med,2016,46(11):2363-2373.
[15] Yam TTT,Fong SSM,Tsang WWN.Foot posture index and body composition measures in children with and without developmental coordination disorder[J].PLoS One,2022,17(3):e0265280.
[16] Cignetti F,Vaugoyeau M,Fontan A,et al. Feedforward motor control in developmental dyslexia and developmental coordination disorder:Does comorbidity matter?[J]. Res Dev Disabil,2018,76:25-34.
[17] 孙金磊,杜亚松,江文庆,等.185例注意缺陷多动障碍患儿韦氏智力测试第Ⅳ版测量结果分析[J].中国儿童保健杂志,2017,25(12):1192-1195.
Sun JL,Du YS,Jiang WQ, et al.Analysis on the results of the Wechsler Intelligence Scale for Chlidren-Ⅳ of 185 ADHD children in shanghai[J].Chin J Child Health Care,2017,25(12):1192-1195.
[18] Langevin LM,Macmaster FP,Crawford S,et al.Common white matter microstructure alterations in pediatric motor and attention disorders[J].J Pediatr,2014,164(5):1157-1164.e1.
[19] Langevin LM,MacMaster FP,Dewey D.Distinct patterns of cortical thinning in concurrent motor and attention disorders[J].Dev Med Child Neurol,2015,57(3):257-264.
[20] Thornton S,Bray S,Langevin LM,et al.Functional brain correlates of motor response inhibition in children with developmental coordination disorder and attention deficit/hyperactivity disorder[J].Hum Mov Sci,2018,59:134-142.
基金
福建省卫生健康中青年骨干人才培养项目(2019ZQN21)
PDF(556 KB)
