Abstract:

Objective　To estimate the occurrence of attention deficit hyperactivity disorder comorbiding anxiety and depression and to compare the behavior characteristics of ADHD with and without anxiety or depression. Methods　A total of 105 children with ADHD meeting DSM-4 diagnostic criteria aged from 8 to 14 years were involved in this study. They were evaluated with the Screen for Child Anxiety Related Emotional Disorders（SCARED）， Depression Self-Rating Scale for Children（DSRSC） by self-report and Achenbach’s Child Behavior Checklist （CBCL） by their parents. Another 66（without diagnosis of ADHD） children aged from 8-14 years who were selected from a school as a control group were evaluated too，according to SCARED and DSRSC， a  ormal group （43 children） was selected from control group for analysis.  Results　Thirty-nine of 105 children with ADHD compared to 13 of 66 controls scored at or beyond the clinical cut off （25 points） of SCARED score . Thirty-three of 105 children with ADHD compared to 10 of 66（15.2%） controls reached the threshold（15 points） of DSRSC of Chinese Norm （χ2 = 5.704，P  = 0.017）. In ADHD group 16 of 105（15.2%） ADHD children comorbid both anxiety and depression，but none in controls. In ADHD children， all scores of social ability were lower while all CBCL behavior scores were higher than normal controls except somaticcomplaint； ADHD with anxiety had higher score in somatic complaint；ADHD with depression had higher score in anxious/depressed and ADHD with both anxiety and depression had higher score in Withdrawn， somatic complaint， Anxious/Depressed， thought problems，attention problems andinternalizing problems than ADHD without anxiety and depression. Conclusion　The children with ADHD have high occurrence of comorbidity ofanxiety and depression. Children comorbided both anxiety and depression have more behavior and internalizing problems， which implies that there is a need for further mental health services for this population.

Key words: ADHD, anxiety, depression, behavior

摘要：

评估注意缺陷多动障碍（ADHD）患儿共患焦虑和抑郁情况，同时探讨共患疾病对其行为的影响特点。方法　2007—2009年在中南大学湘雅二医院儿童精神卫生专科门诊收集105例ADHD患儿，年龄8～14岁，均符合DSM-IV诊断标准，但不存在对立违抗障碍、品行障碍和抽动障碍。于某学校选取66名同年龄段，无ADHD、对立违抗障碍、品行障碍和抽动障碍的学生作对照组。对所有研究对象采用ADHD诊断量表、Achenbach儿童行为量表（CBCL） 、儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）进行评定，对照组儿童经SCARED、DSRSC评定后选择正常的43名作为正常对照组用于分析。结果　105例ADHD中39例（37.1%）共患焦虑，66名对照组中13例（19.7%）共患焦虑，两者间差异有统计学意义（χ2 = 5.829，P = 0.016）。ADHD共患抑郁者33例31.4%），对照组10例（15.2%），差异有统计学意义（χ2 = 5.704，P = 0.017）。ADHD同时共患焦虑与抑郁者16例（15.2%），对照组中未发现共患焦虑与抑郁者。ADHD患儿CBCL社会能力得分均低于对照组，行为问题得分除躯体主诉外均显著高于正常对照组，差异有统计学意义（分别P = 0.000～0.010、P = 0.000～0.007）。ADHD单纯共患焦虑组CBCL躯体主诉得分显著高于单纯ADHD组，差异有统计学意义（P < 0.05）；ADHD单纯共患抑郁组CBCL焦虑/抑郁得分显著高于单纯ADHD组，差异有统计学意义（P < 0.05）；ADHD同时共患焦虑与抑郁组CBCL退缩、躯体主诉、焦虑/抑郁、思维问题、注意问题和内化性问题均显著高于单纯ADHD组，差异有统计学意义（P < 0.05）。结论　ADHD患儿有较高的抑郁和焦虑共患情况，同时共患抑郁与焦虑的ADHD患儿存在更多的行为问题，需要更多的精神卫生服务。

关键词: 注意缺陷多动障碍, 焦虑, 抑郁, 行为