【作者】 叶蓓；

【导师】 耿耀国；

【作者基本信息】 郑州大学 ， 应用心理学， 2010， 硕士

【摘要】 目的探讨伴及不伴对立违抗性障碍的注意缺陷多动障碍儿童行为与心理社会因素的关系,为儿童注意缺陷多动障碍行为干预提供依据。方法根据是否合并ODD,我们把55名ADHD儿童分为合并组(n=25)和单纯型(n=30)两组,采用病例对照研究分别与130名正常对照组儿童进行研究,采用一般资料调查表、Barratt冲动量表(Barratt’s impulsivity scale,简称BIS)、Achenbach儿童行为量表(Child Behavior Checklist,简称CBCL)、子女教育心理控制源量表(The Parenting Locus of Control Scale,PLOC)、Piers-Harris儿童自我意识量表(Children’s Self-concept Scale,PHCSS)、家庭环境量表(Family Environment Scale,FES)及IVA测试进行评定。并对儿童ADHD的多种心理社会影响因素进行t检验、方差分析和Binary Logistic回归分析。结果1.合并组(ADHD+ODD组)父亲吸烟者明显多于单纯组(ADHD组),其具有显著性差异(t=2.510,P=0.015)。2.合并组、单纯组与对照组比较,注意因子、运动因子及缺少计划因子均存在显著性差异(P<0.05)；合并组与单纯组比较,缺少计划因子差异显著(P<0.05)；三组总分之间无显著性差异。3.合并组比对照组社交情况、抑郁、交往不良、强迫性、社交退缩、多动、攻击性、违纪因子及总得分均高,差异具有统计学意义(P<0.05)；单纯组与对照组相比,社交情况、强迫性、体诉、社交退缩、多动、攻击性、违纪因子及总得分明显高于对照组,差异具有显著性(P<0.05)；合并组与单纯组比较,攻击性、违纪及总得分更高,且具有显著性差异(P<0.05)。4.合并组、单纯组与对照组相比,在父母对子女行为控制因子分存在差异,且具有统计学意义(P<0.05),其他因子各组之间差异不显著。5.合并组行为、智力与学校情况因子及总分低于对照组,差异具有显著性(P<0.05)；其他因子分三组之间无显著性差异。6.合并组矛盾性及道德宗教观因子分明显高于对照组,成功性、知识性及娱乐性因子分明显低于对照组,且差异均具有显著性(P<0.05)；合并组与单纯组相比,各因子之间差异不显著。7.合并组与单纯组各商数分在P<0.05水平无显著性差异,但合并组综合反应商数、听觉反应商数、综合注意力商数、视觉注意力商数、听觉谨慎商数、听觉一致性商数、视觉一致性商数、听觉持久性商数、视觉持久性商数、视觉警醒商数、听觉注意集中商数及视觉注意集中商数均比单纯组低。8. ADHD儿童Binary Logistic回归分析,最终依次进入回归方程的是攻击性、缺少计划因子、父母对子女行为控制、成功性四个因子均具有统计学意义(P<0.05)。结论1.父亲吸烟的儿童更容易罹患ODD、ADHD;ADHD儿童家庭中父亲吸烟的较多,且吸烟量更大。2.伴或不伴ODD的ADHD儿童比正常儿童表现出更多的冲动行为、攻击性行为、脾气更暴躁,特别是合并ODD的ADHD儿童。3.ADHD儿童比正常儿童存在更多的内、外向性问题及适应问题；特别需要指出的是,合并ODD的ADHD儿童更容易出现负性情绪,甚至发展为情绪障碍。4.父母教育心理控制源与伴或不伴ODD的ADHD患儿的不良行为发生、发展有一定联系,ADHD儿童的父母更倾向于控制子女的行为,ADHD的行为问题与父母不良心理控制方式有关,提示改善父母养育方式有利于减少ADHD儿童不良行为。5.ADHD儿童自我意识普遍下降且存在更多问题,更容易出现学业不良。6.ODD儿童的家庭存在高度的矛盾性,这是儿童发生ODD的危险因素。7.伴及不伴ODD的ADHD儿童在注意力缺陷症状上差异不显著,但仍存在差异,且伴ODD的ADHD儿童比单纯ADHD儿童更严重。8.儿童ADHD与攻击性行为、做事缺少计划、父母对子女负性行为控制及家庭成功性有关。攻击性行为及家庭成功是危险因素,可增加儿童患ADHD的危险；缺少计划因子及父母对子女行为控制是保护因素。目的探讨儿童注意缺陷多动障碍可能的易感基因。方法采用病例对照研究的方法,对59名注意缺陷多动障碍,其中28名合并对立违抗性障碍与46名正常对照组,采用RFLP技术检测三组5-HTTLPR和MAOA-μVNTR多态性,对其基因型及等位基因频率进行关联分析,以探讨其与注意缺陷多动障碍的关联。结果1、5-HTTLPR多态性分析共出现三种5-HTTLPR多态性基因型分别为SS、SL及LL,三组比较5-HTTLPR的SS基因型、SL基因型及LL基因型在P<0.05水平差异均不显著(分别为χ2=2.074,P=0.355；χ2=3.571,P=0.168；χ2=1.400,P=0.497)。2、基因型SS可能增加儿童患ODD并ADHD的风险,其OR值为1.812,即合并组儿童5-HTTLPR多态性的基因型为纯合子SS而发生ODD伴ADHD的风险度是对照组的1.812倍。也可能增加儿童患ADHD的风险,其OR值为1.641。另外,合并组儿童5-HTTLPR多态性的基因型为纯合子SS而发生ODD伴ADHD的风险度是单纯ADHD儿童的1.104倍；SL基因型也可能增加共病的风险,其OR值为1.120。3、S及L等位基因频率三组比较,在P<0.05水平差异具有显著性(χ2=6.148,P=0.046；χ2=6.059,P=0.048)。4、等位基因S可能增加儿童患ODD并ADHD的风险,其OR值为1.703,即合并组儿童5-HTTLPR多态性等位基因S越多,发生ODD伴ADHD的风险度越高,是对照组的1.703倍；也可能增加儿童患ADHD的风险,其OR值为1.432。5、MAOA-μVNTR多态性分析共发现三种基因型：3-30bp-μVNTR基因型(321bp,简称3.5R)、4-30bp-μuVNTR基因型(351bp,简称4.5R)及杂合子(321bp/351bp,简称3.5R/4.5R)。合并组、单纯组3.5R/3.5R基因型频率多于对照组,但不具有统计学意义(χ2=1.127,P=0.569)；4.5R/4.5R基因型合并组、单纯组频率低于对照组,在P<0.05水平也不具有显著性差异。6、基因型3.5R/3.5R可能增加儿童患。ODD并ADHD的风险,其OR值为1.733,即合并组儿童MAOA-μVNTR多态性的基因型为3.5R/3.5R而发生ODD伴ADHD的风险度是对照组的1.733倍。也可能增加儿童患ADHD的风险,其OR值为1.579。另外,合并组儿童MAOA-μVNTR多态性的基因型为3.5R/3.5R而发生ODD伴ADHD的风险度是单纯ADHD儿童的1.098倍；基因型4.5R/4.5R也可能增加共病的风险,其OR值为1.010。7、三组比较MAOA-μVNTR多态性等位基因3.5R频率无显著性差异(χ2=1.552,P=0.460)；MAOA-μVNTR多态性等位基因4.5R频率差异显著,且在P<0.05水平上具有统计学意义(χ2=6.151,P=0.046)。8、等位基因3.5R可能增加儿童患ODD并ADHD的风险,其OR值为1.525,即合并组儿童MAOA-μVNTR多态性等位基因3.5R越多,发生ODD伴ADHD的风险度越高,是对照组的1.525倍；也可能增加儿童患ADHD的风险,其OR值为1.348。结论1、5-HTTLPR多态性三组比较5-HTTLPR的SS基因型、SL基因型及LL基因型在P<0.05水平差异均不显著。2、5-HTTLPR的S及L等位基因频率三组比较,在P<0.05水平差异具有显著性。3、合并组、单纯组3.5R/3.5R基因型频率多于对照组,在P<0.05水平也不具有显著性差异。4、三组比较MAOA-μVNTR多态性等位基因4.5R频率差异显著,且在P<0.05水平上具有统计学意义。5、以上结果提示5-HTTLPR和MAOA-μVNTR多态性与儿童注意缺陷多动障碍有关联。更多还原

【Abstract】 ObjectivesWe explore the relationship between children with ADHD or ADHD comorbid ODD and social psychological factors, to provide a basis for intervention of Attention Deficit Hyperactivity Disorder.Methods25 ADHD comorbid ODD children,30 ADHD children and 130 normal children were researched by case-control study with the general information list, Barratt’s impulsivity scale(BIS), Achenbach Child Behavior Checklist(CBCL), the Parenting Locus of Control Scale(PLOC), Piers-Harris Children’s Self-concept Scale(PHCSS), Family Environment Scale(FES) and IVA test. The multiple influence factors were analyzed by t-test, analysis of variance and Binary Logistic regression analysis.Results1.The number of children whose fathers have cigarette in ADHD+ODD group were significantly higher than in normal group(t=2.510,P=0.015).2. The scores of Attentional Key, Motor Key, Non-Planning Key in ADHD+ODD group and ADHD group were significantly higher than the normal group(P< 0.05);The scores of Non-Planning Key in ADHD+ODD group were also significantly higher than ADHD group(P<0.05); The total scores of the three groups have no significantly differences.3.The scores of internalizing, depressed, social problems, thought problems, social-withdrawal problems, attention problems, aggressive behavior, delinquent behavior and total problems in ADHD+ODD group were significantly higher than in normal group(P<0.05); Compared with the normal group, the scores of internalizing, thought problems, somatic problems, social-withdrawal problems, attention problems, aggressive behavior, delinquent behavior and total problems in ADHD group were significantly higher(P<0.05); The scores of aggressive behavior, delinquent behavior and total problems in ADHD+ODD group were significantly higher(P<0.05) than in ADHD group.4. The scores of parental behavior control factor were significant differences between ADHD+ODD group, ADHD group and the normal group(P<0.05); There were significant no difference in the scores of other factors in three groups.5.The scores of behavior, intellectual status and overall scores in ADHD+ODD group were significant lower than in the normal group(P<0.05); There were significant no difference in the scores of other factors in three groups.6. The scores of conflict and moral-religious factors in ADHD+ODD group were significant higher than the normal group, the scores of achievement, intellectual-cultural and social-recreative in ADHD+ODD group were significant lower than the normal group(P<0.05); There were no differences between ADHD+ODD group and ADHD group in other factors.7.There were no significant differences between ADHD+ODD group and ADHD group in the scores of each quotient, but the scores of full scale response control quotient, audition response control quotient, attention quotient, vision attention quotient, audition prudence quotient, audition consistency quotient, vision consistency quotient, audition stamina quotient, vision stamina quotient, vision vigilance quotient, audition focus quotient and vision focus quotient in ADHD+ODD group were lower than in ADHD group.8. The children with ADHD were analyzed by Binary Logistic Regression analysis, whom entered the regression equation are aggressive behavior, Non-Planning Key, parental behavior control and achievement. Each factors had statistical significance(P<0.05). Conclusions1.Children whose father had cigarette are more susceptible to ODD and ADHD. In the families of ADHD children, fathers had more cigarette.2.Children with ADHD or ADHD comorbid ODD had more impulsive behavior, more behaviorally aggressive acts and more dysfunctional anger, especially children with ADHD comorbid ODD.3.Children with ADHD had more internalizing, externalizing and adaptation problems than the normal children. Children with ADHD comorbid ODD were more susceptible to negative emotion, even may develop to mood disorder.4. The parenting locus of control may have relationship with ADHD or ADHD comorbid ODD. Parents of ADHD children tend to control children’s behavior. Behavior problems of ADHD were affected by negative parenting locus of control and the deviation education cognitive should be improved.5.The self-concept of children with ADHD decreases generally and has more problems. Children with ADHD have more learning problems.6. Family of children with ODD has more conflict. Despite this, family functioning seems to be a risk factor for oppositional defiant disorder in adolescents.7. The symptom of Children with ADHD or ADHD comorbid ODD had no significant differences.8.ADHD was related to some factors which include aggressive behavior, non-planning, parental behavior control and family achievement. Aggressive behavior and family achievement were dangerous factors, Non-planning and parental behavior control were protective factors. ObjectivesWe detected the potential predisposing genes of children with Attention Deficit Hyperactivity Disorder.Methods28 ADHD comorbid ODD children,31 ADHD children and 46 normal children were studied by the approach of case-control study. We detected the polymorphism of two sets 5-HTTLPR and MAOA-μVNTR with restriction fragment length polymorphism technology (RFLP), and then the genotype and allele frequency were analyzed by association analysis in order to detect the association of Attention Deficit Hyperactivity Disorder and predisposing genes.Results1.In the investigated group, the genotype of 5-HTTLPR polymorphism is SS, SL and LL. There is no statistical significance in the comparison of genotype in the three groups(χ2=2.074,P=0.355,χ2=3.571,P=0.168,χ2=1.400,P=0.497).2. Genotype SS may increase the risk of children suffering from ADHD comorbid ODD, the OR is 1.812. That means in the ADHD+ODD group, the risk of suffering from ADHD comorbid ODD is 1.812 times than the normal group when the genotype of 5-HTTLPR is homozygote S/S.Genotype SS may also increase the risk of suffering from ADHD, the OR is 1.641.In addition, in the ADHD+ODD group, the risk of suffering from ADHD comorbid ODD is 1.104 times than in ADHD group when the genotype of 5-HTTLPR is homozygote S/S.Genotype SL may increase the risk of comorbidity, the OR is 1.120.3.The frequency of 5-HTTLPR allelomorphic gene S and L have significance differences compared in the three groups (χ2=6.148, P=0.046,χ2=6.059, P=0.048).4. Allelomorphic gene S may increase the risk of suffering from ADHD comorbid ODD, the OR is 1.703.That means in the ADHD+ODD group, the risk of comorbidity is 1.703 times than the normal group when the allelomorphic gene is S.It may also increase the risk of suffering from ADHD, the OR is 1.432.5.In the investigated group, the genotype of MAOA-μVNTR polymorphism is genotype S-30bp-μVNTR (321bp,3.5R), genotype 4-30bp-μVNTR (351bp, 4.5R) and genotype 3.5R/4.5R. There is no statistical significance in the comparison of genotype in the three groups.6. Genotype 3.5R/3.5R may increase the risk of children suffering from ADHD comorbid ODD, the OR is 1.733.That means in the ADHD+ODD group, the risk of suffering from ADHD comorbid ODD is 1.733 times than the normal group when the genotype of MAOA-μVNTR is homozygote 3.5R/3.5R. Genotype 3.5R/3.5R may also increase the risk of suffering from ADHD, the OR is 1.579. In addition, in the ADHD+ODD group, the risk of suffering from ADHD comorbid ODD is 1.098 times than in ADHD group when the genotype of MAOA-μVNTR is homozygote 3.5R/3.5R. Genotype 4.5R/4.5R may increase the risk of comorbidity, the OR is 1.010.7. The frequency of MAOA-μVNTR allelomorphic gene 3.5R has significance differences compared in the three groups (χ2=1.552,P=0.460). The frequency of MAOA-μVNTR allelomorphic gene 4.5R has no significance differences compared in the three groups(χ2=6.151,P=0.046).8. Allelomorphic gene 3.5R may increase the risk of suffering from ADHD comorbid ODD, the OR is 1.525.That means in the ADHD+ODD group, the risk of comorbidity is 1.525 times than the normal group when the allelomorphic gene is 3.5R. It may also increase the risk of suffering from ADHD, the OR is 1.348. Conclusions1.There is no statistical significance in the comparison of genotype SS,SL and LL of 5-HTTLPR in the three groups.2. There is statistical significance in the comparison of the frequency of 5-HTTLPR allelomorphic gene S and L in the three groups.3.The genotype 3.5R/3.5R of ADHD+ODD group and ADHD group is higher than the normal group, but there is no significant difference.4. There is statistical significance in the comparison of the frequency of MAOA-μVNTR polymorphism gene 3.5R in the three groups(P<0.05).5.The upper results indicate there is association about 5-HTTLPR and MAOA-μVNTR and Attention Deficit Hyperactivity Disorder of children.更多还原