【作者】 陈言钊；

【导师】 文飞球；

【作者基本信息】 暨南大学 ， 儿科学， 2009， 硕士

【摘要】 目的:1.分析不同亚型注意缺陷多动障碍(ADHD)患儿的临床特征。2.探讨盐酸哌甲酯控释片(OROS-MPH)对不同亚型ADHD患儿的疗效差异。3.与OROS-MPH对照,研究脑电生物反馈对ADHD患儿的疗效及其特点。方法:1.不同亚型ADHD患儿的临床特征分析:对符合美国《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)ADHD诊断标准的ADHD-I(82例)、ADHD-HI(24例)和ADHD-C(69例)三组患儿,分别进行性别组成、起病年龄、危险因素、共患疾病、智力水平和Conners父母症状问卷等方面的比较。2.OROS-MPH对不同亚型ADHD患儿的疗效研究:对符合DSM-ⅣADHD诊断标准的ADHD-I(35例)、ADHD-HI(19例)和ADHD-C(38例)三组患儿,均采用OROS-MPH治疗6周,并分别于治疗前、治疗2周末、治疗4周末、治疗6周末采用家长评定的IOWAConners量表和Conners父母症状问卷对患儿进行疗效评估。3.脑电生物反馈对ADHD患儿疗效的对照研究:将符合DSM-Ⅳ中ADHD诊断标准的60例患儿,随机分为生物反馈组(n=30)和OROS-MPH组(n=30),分别给予脑电生物反馈及OROS-MPH治疗1～3个月,并于治疗结束2个月后随访。采用家长评定的IOWA Conners量表、整合视听连续执行测试(IVA-CPT)于治疗前、治疗后及随访时对两组患儿进行疗效评估。结果:1.不同亚型ADHD患儿的临床特征分析:各亚型男女性别组成无显著性差异(P＞0.05);ADHD-I、ADHD-C和ADHD-HI三组起病年龄、就诊年龄依次减低;ADHD-I组和ADHD-C组分娩异常的发生率高于ADHD-HI组,ADHD-HI组和ADHD-C组家庭教育方式不当的发生率高于ADHD-I组;三组言语智商、操作智商和总智商无显著性差异(P＞0.05),但ADHD-I组智力发展不平衡发生率高于其它两组;ADHD-HI组和ADHD-C组对立违抗障碍、抽动障碍的共患率高于ADHD-I组,ADHD-I组和ADHD-C组学习困难的共患率高于ADHD-HI;Conners父母症状问卷中,ADHD-HI组和ADHD-C组品行问题、冲动-多动、多动指数均高于ADHD-I组,而ADHD-I组学习问题最显著。2.OROS-MPH对不同亚型ADHD患儿的疗效研究:治疗后三组家长评定的IOWA Conners量表注意缺陷/多动(I/O)、对立/违抗(O/D)及总分均较治疗前显著性降低,差异有统计学意义(P＜0.05);三组I/O、O/D及总分治疗前后差值差异有统计学意义(P＜0.05)。ADHD-C组和ADHD-HI组I/O、O/D及总分治疗前后差值大于ADHD-I组,ADHD-C组和ADHD-HI组则无显著性差异。Conners父母症状问卷中,三组各因子治疗后较治疗前均有显著降低,差异有统计学意义(P＜0.05)。ADHD-HI组和ADHD-C组品行问题、冲动-多动和多动指数治疗前后差值大于ADHD-I组。ADHD-I组学习问题治疗前后差值大于其他两组。3.脑电生物反馈对ADHD患儿疗效的对照研究:治疗后两组IVA-CPT显示综合反应控制商数、综合注意力商数较治疗前显著增加,生物反馈组低于OROS-MPH组(P＜0.05);IOWA Conners量表I/O、O/D及总分较治疗前均显著减少,生物反馈组高于OROS-MPH组(P＜0.05)。停止治疗后,生物反馈组IOWA Conners量表总分持续性减低,而OROS-MPH组评分有反弹。随访时OROS-MPH组IOWA Conners量表总分高于生物反馈组,差异具有统计学意义(P＜0.05)。结论:1.不同亚型ADHD在共患疾病、智力水平和行为问题等方面存在一定的差异。ADHD-C和ADHD-HI患儿ODD和TD共患率较高,多动-冲动等破环性行为突出,ADHD-I患儿学习问题和智力发展不平衡显著。不同亚型ADHD患儿的临床特征不同,提示可能存在不同的发病机理。2.OROS-MPH治疗ADHD安全有效,对不同亚型ADHD患儿的疗效存在显著性差异。OROS-MPH对ADHD-C和ADHD-HI患儿的疗效整体优于ADHD-I患儿。不同亚型症状改善的主要方面也有所不同,ADHD-C和ADHD-HI患儿多动-冲动等破环性行为问题改善显著,而ADHD-I患儿学习问题改善显著。3.脑电生物反馈与OROS-MPH治疗相比虽然近期疗效较差,但是作用相对持久,无明显副作用,是治疗ADHD的一种有效方法。更多还原

【Abstract】 Objective:1.To analyze the features of various subtypes of attention deficit hyperactivity disorder(ADHD) in children;2.To study the effects of methylphenidate extended-release tablets (OROS-MPH) on various Subtypes of ADHD;3.To evaluate the effects of EEG biofeedback on ADHD.Methods:1.Clinical features of Subtypes of ADHD in Children:Sex composition,age of onset, risk factors,comorbidities,intelligence quotient and behavioral problems were analyzed in 175 children with ADHD(82 ADHD-I,24 ADHD-HI and 69 ADHD-C) who met the 4th edition of Diagnostic Statistical Manual of Mental disorder criteria(DSM-Ⅳ).2.Effects of OROS-MPH on various Subtypes of ADHD:92 children with ADHD(35 ADHD-I,19 ADHD-HI and 38 ADHD-C) who met the DSM-Ⅳdiagnostic criteria were given OROS-MPH for 6 weeks.The efficacy of OROS-MPH was evaluated according to IOWA Conners Parents Rating Scale and Conners Parents Rating Scale every two weeks.3.Effects of EEG Biofeedback on Children with ADHD:60 children with ADHD who met the DSM-Ⅳdiagnostic criteria were randomly assigned to Electroencephalogram(EEG) biofeedback group(30 cases) and OROS-MPH group (30 cases).Effects of EEG biofeedback and OROS-MPH were compared before and after the interventions according to IOWA Conners rating scale and integrated visual and auditory continuous performance test(IVA-CPT).All the patients were followed-up for two months after the interventions.Results:1.Clinical features of Subtypes of ADHD in Children:There were no significantly differences on sex composition among the three subtypes(P＞0.05);Both the age of onset and age at diagnosis in the group with ADHD-HI were the youngest,then the group with ADHD-C and the group with ADHD-I in turn;The rates of birth abnormality in the ADHD-I and the ADHD-C were higher than those in the ADHD-HI,the rates of improper parent’s education in the ADHD-HI and the ADHD-C were higher than those in the ADHD-I;There were no significant differences for performance intelligence quotient(PIQ),verbal intelligence quotient(VIQ) and full intelligence quotient(FIQ) among the three subtype(P＞0.05).However,the incidences of imbalance between VIQ and PIQ in ADHD-I were the highest.For the ADHD-C and the ADHD-HI,the incidences of comorbidities with oppositional defiant disorder(ODD) and tic disorder(TD) were higher than those in the ADHD-I.Both the ADHD-I and the ADHD-C had higher incidence of comorbidity with learning disorder(LD) compared to the ADHD-HI; Implusive/hyperactive,conduct problem and hyperactivity index in the ADHD-C and the ADHD-HI were more than those in the ADHD-I based on Conners Parent Rating Scales,but the learning problems of ADHD-I were the worst among the three subtypes.2.Effects of OROS-MPH on various Subtypes of ADHD:The scores of I/O,O/D and the total of IOWA Conners Rating Scale after the OROS-MPH therapy were lower than those before the therapy in the three groups(P＜0.05).The difference values of the scores of IOWA Conners Rating Scale between before and after the interventions in the ADHD-C group and the ADHD-HI group were higher than those in the ADHD-I group,but no significant differences between the ADHD-HI group and the ADHD-C group.The scores of Conners Rating Scale reduced significantly after the therapy in the three groups(P＜0.05).The difference values of the scores between before and after the interventions in the ADHD-C group and the ADHD-HI group were higher than those in the ADHD-I group on conduct problem,actuation/hyperactivity and hyperactivity index,but no significantly difference between the ADHD-HI group and the ADHD-C group.The difference values of the scores on learning problem between before and after interventions in the ADHD-I group were higher than those in the ADHD-C group and the ADHD-HI group.3.Effects of EEG Biofeedback on Children with ADHD:There were significant differences before and after the EEG biofeedback training or OROS-MPH therapy for the scores of IOWA Conners Rating Scale and the indexes of IVA-CPT such as the full scale response control quotient and the full scale attention quotient(P＜0.05).But the indexes and the scores in the OROS-MPH group improved better than those in the EEG biofeedback group(P＜0.05).The scores of IOWA Conners Rating Scale rebounded when the OROS-MPH was discontinued in OROS-MPH group,however,EEG biofeedback group showed a persistent improvement.Conclusion:1.There are significant differences on comorbidities,intelligence quotient and behavioral problems among the three subtypes of ADHD.The incidences of comorbidities with ODD,TD and disruptive behavior problems in the ADHD-C group and the ADHD-HI group were higher than the ADHD-I group.But there are higher incidences of learning problems and imbalance between VIQ and PIQ in the ADHD-I group.It is suggested that different pathogenesises may play a role in various subtypes of ADHD.2.OROS-MPH is effective and safe for children with ADHD.There are significant differences of OROS-MPH’s efficacies among subtypes of ADHD in children.Generally,OROS-MPH shows better effects on both the ADHD-C group and the ADHD-HI group than those on the ADHD-I group.There are significant improvements on disruptive behavior problems both in the ADHD-C group and the ADHD-HI group,and on learning problems in the ADHD-I group.3.EEG biofeedback training is an effective treatment for children with ADHD.But the short term effects of EEG biofeedback is inferior to OROS-MPH.EEG biofeedback training shows slower but more stable and permanent effects compared to OROS-MPH.更多还原