目的 研究共患注意缺陷多动障碍(ADHD)对抽动障碍(TD)儿童抽动严重程度的影响,探讨先兆冲动在二者关联中的中介作用。方法 纳入2022年11月—2023年10月于福建省儿童医院儿童保健/发育行为科门诊就诊的TD共患ADHD(TD+ADHD)患儿68例,单纯TD患儿150例,采用先兆冲动量表(PUTS)、耶鲁综合抽动严重程度量表(YGTSS)评估患儿的先兆冲动及抽动严重程度,采用Pearson相关分析变量间的关联,通过PROCESS软件检验中介效应。结果 1)TD+ADHD组PUTS总分高于单纯TD组(t=2.22,P＜0.05),运动性抽动的频率(t=2.20)及复杂性(t=2.05)、发声性抽动的强度(t=2.19)及复杂性(t=2.64)在TD+ADHD组与单纯TD组间的差异存在统计学意义(P<0.05);2)PUTS总分与YGTSS的运动性抽动(包括种类、复杂性、干扰性、总运动抽动的严重程度)、发声性抽动、总损害率、总的严重程度之间呈正相关(r=0.170～0.354,P＜0.05);3)控制儿童年龄、性别等混杂因素后,PUTS总分在共患ADHD与TD发声强度关联间的中介作用为25.70%,在共患ADHD与TD发声复杂性关联间的中介作用为14.32%。结论 TD+ADHD患儿先兆冲动明显,先兆冲动是共患ADHD影响TD发声强度及复杂性的中介因素。
Abstract
Objective To examine the effect of comorbidity with attention-deficit/hyperactivity disorder (ADHD) on tic severity in children with tic disorder (TD), and to explore the mediating role of premonitory urge in the association. Methods A total of 68 TD children comorbid with ADHD (TD+ADHD) and 150 children with TD were recruited from the Child Health Care/Developmental Behavior Outpatient Department of Fujian Children′s Hospital between November 2022 and October 2023. The Premonitory Urge for Tics Scale (PUTS) and the Yale Global Tic Severity Scale (YGTSS) were administered to assess premonitory urges and tic severity, respectively. Pearson correlation analysis was used to examine the associations among variables, and the PROCESS software was used to test the mediation effect. Results The TD+ADHD group scored significantly higher on the PUTS compared to the TD group (t= 2.22, P<0.05). Statistically significant differences were also found between the two groups in terms of frequency (t=2.20) and complexity (t=2.05) of motor tics, as well as intensity (t=2.19) and complexity (t=2.64) of vocal tics (P<0.05). 2) Positive correlations were found between total PUTS scores and motor tics (including number, complexity, disruptiveness, and severity of total motor tics), vocal tics, total impairment rate, and total severity of the YGTSS (r=0.170 - 0.354, P<0.05). 3) After controlling the confounding factors such as children′s age and gender, it was found that the total PUTS score mediated 25.70% of the association between comorbid ADHD and TD vocal intensity and 14.32% of the association between comorbid ADHD and TD vocal complexity. Conclusion Premonitory urge is evident in children comorbid TD and ADHD, and premonitory urge is a mediator of the effect of comorbidity with ADHD on the strength and complexity of TD vocalizations.
关键词
抽动障碍 /
注意缺陷多动障碍 /
先兆冲动 /
抽动严重程度 /
中介效应
Key words
tic disorder /
attention-deficit/hyperactivity disorder /
premonitory urge /
tic severity /
mediating effect
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