中国实用儿科杂志

中国实用儿科杂志

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注意缺陷多动障碍患儿748例各亚型的临床特点

钱秋谨,杨莉,王玉凤   

  1. 北京大学精神卫生研究所(100083)
  • 收稿日期:2005-03-02 修回日期:2005-05-28 出版日期:2005-09-25 发布日期:2005-09-25

Clinical features of the subtypes of attention deficit hyperactivity disorder in 748 Chinese children.

Qian Qiujin,Yang Li,Wang Yufeng.   

  1. Peking University Institute of Mental Health,Beijing 100083,China
  • Received:2005-03-02 Revised:2005-05-28 Online:2005-09-25 Published:2005-09-25

摘要： 目的比较美国《精神障碍诊断与统计手册》第4版(DSM-Ⅳ)注意缺陷多动障碍(ADHD)中以注意障碍为主型(ADHD-I)、以多动/冲动为主型(ADHD-HI)和混合型(ADHD-C)的临床特点。 方法将1999年9月至2004年4月北京大学精神卫生研究所门诊就诊的符合DSM-Ⅳ中的ADHD诊断标准者748例分为ADHD-I型398例，ADHD-C亚型307例和ADHD-HI亚型43例，比较3个亚型的共患疾病，以及Rutter和Conners儿童行为问卷(父母问卷)中的行为问题。 结果ADHD-C亚型对立违抗性障碍、品行障碍、双相障碍-躁狂发作的共患率显著高于ADHD-I和ADHD-HI亚型(P<0.01)；ADHD-I学习困难的共患率显著高于其它两组亚型(P<0.001)。Rutter儿童行为问卷中ADHD-C亚型伴有的总行为问题和A行为问题明显多于ADHD-I与ADHD-HI亚型；ADHD-I亚型伴有的M行为问题多于ADHD-C与ADHD-HI亚型(P≤0.001)。Conners儿童行为问卷中ADHD-C和ADHD-HI亚型出现品行问题、冲动和多动、多动指数问题的比例均高于ADHD-I亚型(P≤0.001)。 结论ADHD-C亚型的破坏性行为问题突出，而ADHD-I亚型的学习困难问题明显。

关键词: 注意缺陷多动障碍, 亚型, 共患病, 行为问题

Abstract: To explore the features of three clinical subtypes of attention deficit hyperactivity disorder (ADHD) in Chinese outpatient children. MethodsUsing DSM-Ⅳ Structured Clinical Diagnostic Interview Scale(CDIS),the 748 ADHD children were clascified into three subtypes,and identified 398 ADHD-I，307 ADHD-C,and 43 ADHD-HI.We compared the comorbidities in CDIS,the behavioral problems in Rutter and Conners Child Behavior Questionnaire completed by the parents among ADHD three subtypes. ResultsFor ADHD-C subtype,the frequencies of comorbidity with disruptive behavior disorder (oppositional defiant disorder and conduct disorder) and bipolar disorder,and the frequency of A-type behavior in Rutter's scale,were higher than those in the ADHD-I and ADHD-HI subtypes (P<0.01).For ADHD-I subtype,the frequencies of comorbidity with learning disability and M-type behavior in Rutter's scale,were significantly higher than those in the ADHD-C and ADHD-HI subtypes (P<0.001).The frequencies of conduct problems,implusive-hyperactive,and hyperactivity index in ADHD-C and ADHD-HI were greater than that in ADHD-I subtype(P≤0.001). ConclusionThere is a higher prevalence of comorbid disruptive behavior disorders in the ADHD-C subtype,but there is a higher prevalence of comorbid learning disability in the ADHD-I subtype.

Key words: Behavior disorder , Subtype, Comorbidity