Objective To explore the improvement of symptoms and executive dysfunction in children with attention deficit hyperactivity disorder (ADHD) by multimodal therapy and medication alone,so as to provide evidence reference for the treatment of ADHD. Methods A total of 61 children with ADHD from Shanghai Mental Health Center were enrolled in this study from January 2018 to February 2019,and were randomly divided into multimodal group and medication group.The changes of symptoms and executive function were evaluated. Results 1) After treatment,scores of attention deficit,hyperkinetic and oppositional factor in SNAP-IV in the multimodal intervention group were significantly lower than those before treatment (t=7.339,5.637,7.211,P<0.001).The accuracy of Stroop Test B after treatment was significantly higher than that before treatment (t=-3.036,P<0.001).And the number of persistent errors (t=5.961,P<0.001) was lower than that before treatment.The scores of classification,conceptualization and sustained response were significantly higher than those before and after treatment (t=-2.465,-5.585,-3.524,P<0.05).2) After treatment,attention deficit,hyperkinetic,and oppositional factors in SNAP-IV in multimodal therapy group were significantly lower than those in drug treatment group (F=8.270,6.818,10.786, P<0.05).There were significant differences on Stroop color-word Test A between the two groups (F=11.125,P=0.001).And the sustained errors of WCST were significantly lower in the Stroop test group than in the drug treatment group (F=5.567,P<0.05).The level of conceptualization and the number of sustained response were significantly higher than those in the drug treatment group (F=5.775,4.436,P<0.05). Conclusionss Multimodal therapy can improve the core symptoms and executive dysfunction of ADHD children,which can be the priority for ADHD treatment.
Key words
attention deficit hyperactivity disorder /
multimodal therapy /
parent-child group therapy
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References
[1] 美国精神医学学会,张道龙.精神障碍诊断与统计手册[M].北京:北京大学出版社,2016.
[2] 李福轮,谢晴牧,赵乾龙,等.中国儿童注意缺陷多动障碍患病率的Meta分析[J].临床荟萃,2017,32(12):1079-1083.
[3] Fleming M,Fitton CA,Steiner MFC,et al.Educational and health outcomes of children treated for attention-deficit/hyperactivity disorder[J].JAMA Pediatrics,2017,171(7):e170691.
[4] Meppelink R,De Bruin EI,BÖgels SM.Meditation or medication mindfulness training versus medication in the treatment of childhood ADHD:a randomized controlled trial[J].BMC Psychiatry,2016,16(1):267.
[5] Frisch C,Tirosh E,Rosenblum S.Parental occupation executive training(POET):an efficient innovative intervention for young children with attention deficit hyperactive disorder[J].Phys Occup Ther Pediatr,2019,17(7):1-15.
[6] Catalá-López F,Hutton B,Núñez-Beltrán A,et al.The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents:a systematic review with network meta-analyses of randomized trials[J].PLoS One,2017,12(7):e0180355.
[7] Raman SR,Man KKC,Bahmanyar S,et al.Trends in attention-deficit hyperactivity disorder medication use:a retrospective observational study using population-based databases[J].Lancet Psychiatry,2018,5(10):824-835.
[8] 郑毅,刘靖.中国注意缺陷多动障碍防治指南[M].北京:中华医学电子音像出版社,2015.
[9] NICE.National Institute for Health and Care Excellence(NICE)guidelines:attention deficit hyperactivity disorder:diagnosis and management[EB/OL].[2018-12-06].https://www.nice.org.uk/guidance/ng87.
[10] Feldman ME,Charach A,Bélanger SA.ADHD in children and youth:part 2—treatment[J].Paediatr Child Health,2018,23(7):462-472
[11] Crunelle CL,Van d BW,Moggi F,et al.International consensus statement on screening,diagnosis and treatment of substance use disorder patients with comorbid attention deficit/hyperactivity disorder[J].Eur Addict Res,2018,24(1):43.
[12] 杜亚松.注意缺陷多动障碍多模式干预[M].北京:人民卫生出版社,2014.
[13] 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-父母版的信效度[J].中国心理卫生杂志,2013,27(6):424-428.
[14] Lezak MD,Howieson DB,Loring DW.Neuropsychological assessment 4th ed[M].New York,Oxford University Press,2004:366
[15] 何淑华,静进.威斯康星卡片分类测验用于注意缺陷多动障碍的meta分析[J] .中国实用儿科杂志,2006,18(12):754-757.
[16] Reale L,Bartoli B,Cartabia M,et al.Comorbidity prevalence and treatment outcome in children and adolescents with ADHD[J].Eur Child Adolesc Psychiatry,2017,26(12):1443-1457.
[17] Tung I,Li JJ,Meza JI,et al.Patterns of comorbidity among girls with ADHD:a meta-analysis[J].Pediatrics,2016,138(4):e20160430.
[18] Canals J,Morales-Hidalgo P,Jane MC,et al.ADHD prevalence in spanish preschoolers:comorbidity,socio-demographic factors,and functional consequences[J].J Atten Disord,2018,22(2):143-153
[19] Efron D,Gulenc A,Sciberras E,et al.Prevalence and predictors of medication use in children with attention-deficit/hyperactivity disorder:evidence from a community-based longitudinal study[J].J Child Adolesc Psychopharmacol,2019,29(1):50-57.
[20] Danielson ML,Visser SN,Chronistuscano A,et al.A national description of treatment among united states children and adolescents with attention-deficit/hyperactivity disorder[J].J Pediatr,2018,192(1):240-246.
[21] 陆林.沈渔邨精神病学[M].6版.北京:人民卫生出版社,2018.
[22] Martínez-Núñez B,Quintero J.Update the multimodal trea tment of ADHD(MTA):twenty years of lessons[J].Actas Esp Psiquiatr,2019,47(1):16-22.
[23] Lorena FC,Simonoff E,James JM,et al.Treatment of children with attention-deficit/hyperactivity disorder(ADHD) and irritability:Results from the multimodal treatment study of children with ADHD (MTA)[J].J Am Acad Child Adolesc Psychiatry,2015,54(1):62-70,e3.
[24] 费春华,杜昊,卫霞,等.哌甲酯控释片联合认知行为治疗对儿童注意缺陷多动障碍疗效的对照研究[J].临床精神医学杂志,2017,27(3):188-190.
[25] Bethan AR,Michelle MM,Joel TN.Are there executive dysfunction subtypes within attention-deficit/hyperactivity disorder？[J].J Atten Disord,2017,21(4):284-293.
[26] Krieger V,Amador-Campos JA.Assessment of executive function in ADHD adolescents:sontribution of performance tests and rating scales[J].Child Neuropsychol,2018,24(8):1063-1087.
[27] Elos MR,Del Olmo S,Contreras MJ.Differences in executive functioning in children with attention deficit and hyperactivity disorder (ADHD)[J].Front Psychol,2017,8(6):976.
[28] 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
[29] Lan S,David D,Yu-Feng W,et al.Executive function training for children with attention deficit hyperactivity disorder[J].Chin Med J (Engl),2017,130(5):549-558.
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