目的 探讨剑桥自动化神经心理测验包(CANTAB)在注意缺陷多动障碍(ADHD)儿童中的应用,分析ADHD儿童临床症状、智力水平与执行功能损害之间的关系。方法 2017年9月—2020年9月,选取就诊于深圳市儿童医院保健与心理健康中心的441名ADHD儿童为研究对象,同时选取85名健康儿童为对照。所有儿童采用剑桥自动化神经心理测验包(CANTAB)中的持续注意任务、加工速度任务、反应抑制任务和空间工作记忆任务进行评估。同时采用ADHD症状评定量表(父母版)评估ADHD症状严重程度,Conners量表评估ADHD儿童的行为问题,以及WISC-Ⅳ评估ADHD儿童的各项智商指数。采用协方差分析比较ADHD组与对照组各项执行功能指标的差异,偏相关分析ADHD症状严重程度和智商指数与CANTAB指标的相关性,并利用中介模型探讨各项指标之间的因果关系。结果 ADHD儿童对比对照组在执行功能各项指标中除快速信息加工错误率(RVPPFA)外,其他均存在明显的执行功能缺陷(F值: 4.46~25.90,P<0.05)。ADHD儿童的临床核心症状严重程度与其执行功能损害无显著相关(r值:-0.017~0.130,P>0.05)。反之,各项智商指数与多个执行功能指标存在显著相关(r值:-0.36~0.24,P<0.05)。智力水平是ADHD患儿执行功能损害的有效中介因子 (P<0.05)。结论 ADHD儿童的执行功能缺陷受智力水平影响,利用全自动化的神经心理测验包CANTAB能有效检测ADHD儿童的执行功能缺陷。
Abstract
Objective To explore the validity of Cambridge Neuropsychological Test Automated Battery (CANTAB) in detecting executive function deficits in children with attention deficit hyperactivity disorder (ADHD), and to analyze the correlation among ADHD symptoms, intellectual level and executive function deficits. Methods A total of 441 children with ADHD in Children′s Care and Mental Health Center, Shenzhen Children′s Hospital were selected into this study from September 2017 toSeptember 2020, meanwhile 85 healthy children were enrolled as controls. All children were assessed using the continuous performance task, processing speed task, response inhibition task, and spatial working memory task from the CANTAB. The severity of ADHD symptoms was evaluated using the ADHD Symptom Rating Scale (parent version), behavioral problems in children with ADHD were assessed using the Conners′ Rating Scales, ana Covariance analysis was used to compare differences in executive function measures between the ADHD group and the control group. Partial correlation analysis was used to examine the correlations of the severity of ADHD symptoms with IQ indices and CANTAB measures. Mediation models were built to explore causal relationships among these measures. Results Compared with the control group, children with ADHD performed worse in all executive function domains, except for the RVPPFA (F= 4.46 - 25.90, P <0.05). There were no significant correlations between the ADHD core symptom severity and the executive function deficits (r: -0.017 - 0.13, P>0.05). However, IQ was significantly associated with executive function performances (r=-0.36 - 0.24, P <0.05). IQ served as an effective mediating factor for executive function impairments in children with ADHD(P<0.05). Conclusions CANTAB is a valid tool for detecting executive function deficits in children with ADHD. The executive function in ADHD children is affected by their IQ.
关键词
注意缺陷多动障碍 /
执行功能 /
智力水平 /
剑桥自动化神经心理测验包
Key words
attention deficit hyperactivity disorder /
executive function /
intelligence cevel /
Cambridge Neuropsychological Test Automated Battery (CANTAB)
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基金
国家自然科学基金(82101613);广东省高水平医院建设专项经费(2022);深圳市科技计划(RCYX20221008092849069,JCYJ20220530155416036)
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