目的 比较美国精神障碍诊断与统计手册第4版(Diagnostic and Statistical Manual of Mental Disorder,4th ed,DSM-IV)和中国精神障碍分类及诊断标准(Chinese Classification of Mental Disorders,Third Edition,CCMD-3)在诊断注意缺陷多动障碍(attention deficit and hyperactive disorder,ADHD)上的异同。方法 以172例由高年资精神科医生诊断为ADHD的门诊患儿为研究对象,由家长填写由两个诊断标准制成的量表,按照两个诊断标准对患儿进行诊断和分型。结果 172例患者中,162例符合DSM-IV诊断标准,而所有样本均符合CCMD-3诊断标准;对同时符合两个诊断标准的注意缺陷为主型或混合型的156例患儿进行两量表分型的吻合度检验显示中等吻合度(Kappa=0.587),McNemar检验显示两个诊断分型的差异有统计学意义(P=0.000);对两个量表注意缺陷为主型和混合型的构成比比较显示CCMD-3中混合型的构成比高于DSM-IV(P=0.023);CCMD-3的条目阳性率比DSM-IV高,两者均在学习问题描述的条目阳性率高。 结论 CCMD-3较DSM-IV在诊断ADHD上更为宽松,且更多的将患儿判定为混合型;就诊患儿中注意缺陷症状较多动冲动症状更为明显。

Objective To examine the differences on diagnosing attention deficit and hyperactivity disorder (ADHD) between Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) and Chinese Classification of Mental Disorders,Third Edition (CCMD-3). Methods 172 highly suspected ADHD patients diagnosed by senior psychiatrists and referred to psychiatric clinic were enrolled in the study,and their parents were requested to fill in two scales based on DSM-IV and CCMD-3 criteria.All these children were divided into three subtypes according to the diagnostic criteria,including Predominantly Inattentive Type(PI),Hyperactive/Impulsive Type(HI),and Combined Type(CT).Results 162 patients were conformed by the DSM-IV standard (PI=53,HI=6,CT =103),while all the patients met the CCMD-3 standard (PI=39,CT=133).The rate of CT subtype based on CCMD-3 was higher than that of DSM-IV criterion(77.3% vs 66%,P=0.023).The test based on 156 cases which both matched DSM-IV and CCMD-3 CT or PI subtypes standards showed that two scales had moderate goodness of fit on recognizing subtypes of ADHD(Kappa=0.587).Furthermore,McNemar Test also proved that the rates of subtypes of ADHD in DSM-IV were different from those of CCMD-3(P=0.00).The positive rates of items in CCMD-3 standards were higher than those of DSM-IV,and items related to learning problems had higher positive detection rates in both standards. 【Conclusions】 DSM-IV is more rigorous than CCMD-3 on diagnosing ADHD,and higher percentage of patients is clustered as CT type in CCMD-3 criterion.Attention deficit symptoms are more common than hyperactivity and impulsive symptoms in ADHD children.