基于改进的视觉CPT范式对注意缺陷多动障碍患儿额区ERPs的研究

采用事件相关电位（ERPs）来研究注意缺陷多动障碍（ADHD）患儿在选择注意任务下额区的神经活动。实验采用高密度的脑电采集仪来记录受试在执行改进的视觉持续性操作测试（Visual-CPT）范式下的ERPs,12名患儿（ADHD组）及13名健康儿童（对照组）参加本次试验。在Go和No-go条件下,分别对两组受试的行为学及ERPs进行分析和比较,并对结果进行双样本t检验。结果发现,ADHD组在实验过程中表现得较差,漏报率和错误率明显增加,而且反应时间明显延长;无论是Go条件还是No-go条件,潜伏期未见显著性差异,但是ADHD组相比对照组在额区表现出幅值显著低的N2成分（P<0.05）;此外,ADHD组在No-go条件下具有幅值显著高的P2成分（P <0.05）。结果表明,ADHD患儿在认知功能执行中产生障碍,而这种障碍可能与其额叶区域的ERPs波形幅值异常有关。     

注意缺陷多动障碍患儿的事件相关电位改变

目的：研究注意缺陷多动障碍（attention deficit hyperactivity disorders, ADHD）患儿与正常儿童相比,事件相关电位（ERP）的变化。方法：21例确诊为ADHD的患儿及19名年龄、性别相匹配的健康志愿者进行ERP测试。以颜色不同而大小相同的圆形图片为刺激材料,两张图片颜色相同为匹配状态,不同为冲突状态。两种状态出现的机率相同。按照国际10-20系统粘贴头皮电极,在刺激序列呈现过程中按要求按键并同步记录脑电活动。结果：冲突状态的刺激时诱发出N270。与对照组相比,ADHD组患儿N270的潜伏期显著延长,差异有统计学意义。而ADHD组患儿的N190、P300的潜伏期及平均电压与对照组相比差异无统计学意义。结论：ADHD患儿ERP相对于健康儿童发生改变,其中N270更敏感。     

注意缺陷多动障碍患儿的血清胆固醇测定

注意缺陷多动障碍患儿的血清胆固醇测定常州市德安医院袁浩龙，顾汉萍常州市红十字医院周蓓蓓为探讨攻击性与非攻击性注意缺陷多动障碍（ＡＤＨＤ）之间的生化差别，本文测定了两组患者的血清胆固醇（Ｔｃｈ）水平，并与正常同龄儿童作一比较。对象与方法对象６～１１岁的...     

注意缺陷多动障碍(ADHD)患儿的遗传学研究进展

注意缺陷多动障碍（ADHD）是儿童期常见的一种行为障碍,因其对学习、生活有明显的影响,而且有些症状可持续到成年期,所以引起了人们广泛的关注。近年来,关于ADHD的遗传学研究成为一个热点,学者们做了大量的工作,获得了比较丰富的研究结果,一些关于ADHD的遗传理论在此基础上建立起来,增加了人们对该行为障碍本质的认识。本文拟对近年来ADHD遗传学领域的研究结果作一概述。     

百优解分散片与利他林治疗儿童注意缺陷多动障碍的临床研究

目的了解百优解分散片与中枢神经兴奋剂利他林治疗儿童注意缺陷多动障碍（ADHD）的疗效及副反应。方法33例ADHD随机分为观察组和治疗组,进行一般观察,于治疗前用多动指数量表（CIH）评定。百优解分散片与利他林均于1周内达到治疗量,并持续6个月。结果两组治疗后多动指数量表（CIH）CornnerRs部分均显著下降,两组治疗后CornnerRs评分与治疗前相比,部分有统计学意义（P〈0.05）;两组治疗后CornnerRs评分比较,差异无统计学意义（P均〉0.05）,显示两种药物的疗效相仿。两组的不良反应症状量表TESS总分分别为（0.4±0.4）分和（1.4±0.9）分,百优解分散片组TESS部分显著低于利他林组（P〈0.05）。结论百优解分散片组副反应轻,耐受性好,依从性高,起效快,因而对于ADHD,百优解分散片值得临床研究。     

注意缺陷多动障碍患儿的脑电图与临床特点

目的:分析注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患儿脑电图改变,探讨注意缺陷多动障碍患儿临床与脑电图改变的关系。方法:将在本院儿童神经专科确诊的116例注意缺陷多动障碍患儿的脑电与临床特点进行分析总结。结果:116例ADHD脑电图中正常24例(20%),正常范围29例(25%),异常63例(54.3%)异常脑电图均表现为枕区α波的频率慢于该年龄组正常标准2Hz以上。基本波不规则,间有大量多形性θ波或中高幅θ活动阵发性出现。结论:注意缺陷多动障碍(ADHD)患儿脑电图检查显示脑电的非特异性改变。可为临床诊断和鉴别诊断提供一定的辅助诊断参考价值。     

注意缺陷多动障碍综合征患儿睡眠结构的初探

目的 探讨注意缺陷多动障碍（ADHD）综合征患儿的睡眠结构，睡眠中痢性放电及睡眠周期性肢体运动（PLMS）的情况；比较ADHD各亚型问睡眠结构的差异。方法 利用多导睡眠监护仪对2005年6月至2006年11月在首都儿科研究所神经科门诊就诊的符合DSM-Ⅳ诊断标准的58例ADHD患儿及30名正常儿童进行整夜睡眠结构监测。结果 ADHD组58例，其中4例睡眠监测未完成，实际完成54例。ADHD组中混合型（ADHD—C）31例（57．4％，31／54），注意缺陷型（ADHD-I）15例（27．8％，15／54），多动／冲动型（ADHD．H）8例（14．8％，8／54）。①与对照组比较，ADHD组快速动眼期（REM）潜伏期短、睡眠潜伏期延长和睡眠效率降低，差异有统计学意义（P〈0．05）；②ADHD-C患儿睡眠Ⅱ期百分比较ADHD-I增加，差异有统计学意义（P〈0．05）；③ADHD组PLMS发生率为37．0％（20／54），对照组PLMS发生率为13．3％（4／30），差异有统计学意义（P〈0．05）；④ADHD组和对照组EEG未见痢性放电。结论 ①ADHD患儿存在REM睡眠结构的改变、入睡困难及睡眠效率降低；②睡眠Ⅱ期百分比的增多可使ADHD-C较ADHD-I有更多和更重的症状；③ADHD患儿睡眠过程中PLMS发生率较对照组显著升高，PLMS也是导致ADHD患儿睡眠质量下降的原因之一。     

注意缺陷多动障碍儿童在不同情绪面孔刺激下的持续注意任务事件相关电位

目的:了解不同情绪面孔刺激下注意缺陷多动障碍(ADHD)患儿执行持续注意任务时的事件相关电位特征。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的混合型ADHD患儿32例(年龄9~15岁)及年龄、性别匹配的正常对照组儿童32例,要求被试在高兴、中性、恐惧和愤怒等4种情绪面孔刺激随机呈现后执行注意与选择任务,同时记录事件相关电位。观察ADHD患者和正常对照组儿童面孔诱发的N170电位及靶刺激诱发的P300电位的特征。结果:ADHD组患儿在4种不同情绪面孔刺激下颞枕区面孔特异性N170波波幅均低于对照组[如恐惧面孔,(17.7±9.5)μv vs.(25.8±14.0)μv,P0.05],顶枕区P300潜伏期长于对照组[如恐惧面孔,[(454.2±51.3)ms vs.(433.0±29.8)ms,P0.05]。ADHD患儿组在四情绪面孔诱发的N170波幅和潜伏期差异无统计学意义(P0.05),诱发的P300在四种情绪刺激中以恐惧面孔刺激后执行注意任务的P300波幅最低,潜伏期最长。结论:ADHD儿童在4种不同情绪面孔刺激下,以恐惧面孔刺激引起的P300波幅最低,且P300潜伏期延长最明显。提示恐惧面孔可能影响ADHD患儿情绪调节,并影响其持续注意过程。     

注意缺陷多动障碍患儿执行功能特征

目的:探讨注意缺陷多动障碍患儿的执行功能特征。方法:符合DSM-Ⅳ诊断标准的ADHD儿童114名,正常对照组76名。采用威斯康星分类卡片测验、持续性操作测验、STROOP字色干扰测验评定其执行功能。结果:WCST测验ADHD组总应答数、完成第一个分类所需应答数和持续性应答数得分均高于正常对照组(P0.05);而其完成分类数、正确思考时间和不能维持完整分类数得分均显著低于正常对照组(P0.01);CPT测验ADHD组错误数和漏报数得分均明显高于正常对照组(P0.01);STROOP测验ADHD组色词阅读错误数、颜色命名错误数和颜色干扰命名错误数得分均明显高于正常对照组(P0.01);差异均具有统计学意义。结论:ADHD患儿存在执行功能的缺陷,以持续性注意缺陷、行为抑制为主要特征。     

广东省肇庆市小学生注意缺陷多动障碍流行病学调查

了解肇庆市小学生注意缺陷多动障碍(ADHD)流行病学情况,为预防和治疗小学生ADHD提供数据参考。采用美国精神障碍诊断与统计手册(第5版)(DSM-5)ADHD诊断量表、Conners儿童行为量表对肇庆市1974名小学生进行调查分析。结果显示,小学生ADHD初筛阳性人数为100人,检出率为5.1%,男生为7.0%,女生为2.7%,男生初筛阳性率显著高于女生(χ~2=19.204,P<0.05)。父母受教育程度低的初筛阳性率显著高于父母受教育程度高的初筛阳性率(P<0.05)。Logistic回归分析显示,夫妻关系、教养方式、母亲在怀孕期间是否服药、是否剖宫产、是否独生子女是小学生ADHD初筛阳性者的危险因素(P<0.05)。结论,肇庆市小学生ADHD初筛阳性率与国内公认的调查数据相符,与广东省调查数据的中高程度接近;要重视母孕期因素对ADHD小学生的影响;要重视家庭因素对ADHD小学生的影响。     

Spatial orienting and focused attention in attention deficit hyperactivity disorder

Seventeen children with attention deficit disorder (ADHD) and 10 normal controls performed two tasks while event-related potentials were recorded. ADHD subjects took part in two more sessions under methylphenidate (MP) or placebo. In the spatial orienting task, invalidly cued targets elicited a longer reaction time (RT) and a P₃ that was longer in latency and greater in amplitude than did validly cued targets. Performance was similar for both groups, but the early portion of P₃ (300–400 ms) was lower in amplitude for invalidly cued targets in ADHD subjects. MP increased accuracy without affecting RT and shortened P₃ peak latency and increased the amplitude of its early portion. In the focused attention task, accuracy was greater for controls and MP, but there were no RT differenees. Attended stimuli elicited greater amplitude P₁, N₁, and P₃ than did nonattended stimuli, but these measures were unaffected by diagnosis or medication.     

Attentional capacity, a probe ERP study: differences between children with attention-deficit hyperactivity disorder and normal control children and effects of methylphenidate

In the present study it was investigated whether the smaller P3s in attention-deficit hyperactivity disorder (ADHD) children are caused by a shortage of capacity underlying P3 processes or whether they are due to a capacity allocation problem. Also, effects of methylphenidate on these processes were investigated. Performance and event-related potentials (ERPs) of 14 ADHD and 14 control children were measured using an irrelevant-probe technique. Three types of task irrelevant visual probes (standards, deviants, and novels) were presented against the background of two visual tasks that varied in task difficulty. The parietal P3 wave was measured in response to task stimuli and probes. ADHD subjects made significantly fewer correct detections than normal controls in both the easy and the hard tasks. Controls showed an enhanced P3 to task-relevant stimuli in the hard task, whereas ADHD children did not. Probe (novel) P3 amplitudes decreased from the easy to the hard task to the same extent in both groups. Methylphenidate enhanced the percentage of correct responses and task P3 amplitudes in both the easy and the hard task but probe P3 amplitudes were not influenced by methylphenidate. It was concluded that ADHD children do not suffer from a shortage in attentional capacity; rather, the evidence is in favor of a problem with capacity allocation. Furthermore, methylphenidate had enhancing effects on performance and ERPs, but did not improve the capacity-allocation deficit.     

The sleep of children with attention deficit hyperactivity disorder on and off methylphenidate: a matched case–control study

In the present study, we assessed the effects of regular use of methylphenidate medication in children diagnosed with attention deficit hyperactivity disorder (ADHD) on sleep timing, duration and sleep architecture. Twenty‐seven children aged 6–12 years meeting diagnostic criteria for Diagnostic and Statistical Manual version IV ADHD and 27 control children matched for age (±3 months) and gender. Two nights of standard polysomnographic (PSG) recordings were conducted. ADHD children were allocated randomly to an on‐ or 48 h off‐methylphenidate protocol for first or second recordings. Control children’s recordings were matched for night, but no medication was used. Mixed modelling was employed in the analyses so that the full data set was used to determine the degree of medication effects. Methylphenidate in ADHD children prolonged sleep onset by an average of 29 min [confidence interval (CI) 11.6, 46.7], reduced sleep efficiency by 6.5% (CI 2.6, 10.3) and shortened sleep by 1.2 h (CI 0.65, 1.9). Arousal indices were preserved. Relative amounts of stages 1, 2 and slow wave sleep were unchanged by medication. Rapid eye movement sleep was reduced (?2.4%) on the medication night, an effect that became non‐significant when control data were incorporated in the analyses. PSG data from ADHD children off‐medication were similar to control data. Our findings suggest that methylphenidate reduces sleep quantity but does not alter sleep architecture in children diagnosed with ADHD. An adequate amount of sleep is integral to good daytime functioning, thus the sleep side effects of methylphenidate may affect adversely the daytime symptoms the drug is targeted to control.     

哌甲酯控释剂治疗对注意缺陷多动障碍儿童父母压力的影响

目的:探讨哌甲酯控释剂(OROS-MPH)治疗对注意缺陷多动障碍(attention deficit hyper-activity disorder,ADHD)患者临床症状和父母压力的影响。方法:采用自身对照研究设计,对符合美国精神障碍诊断与统计手册第四版(Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition,DSM-IV)诊断标准的73名ADHD患者(年龄6~15岁),使用哌甲酯控释剂(18~54mg/d)治疗8周。以父母填写的IOWA Conners量表及研究者填写的ADHD症状评定问卷评估患者的临床症状,并作为主要临床疗效评价指标,以父母填写的父母压力指数量表(Parenting Stress Index,PSI)来评估父母的压力,分别在基线、治疗4周末和8周末用以上问卷进行评估。结果:66名ADHD患儿完成了8周的治疗。经哌甲酯控释剂治疗后,ADHD患者IOWA Conners量表中的注意缺陷/多动因子分、对立/违抗因子分和总分随治疗时间下降(均P<0.001);ADHD症状评定问卷的注意缺陷因子分、多动冲动因子分和总分较服药前下降(均P<0.001);PSI量表的压力总分随时间明显下降(P<0.01),PSI量表中儿童方面分量表中,适应性、父母的接受度、要求、心境、注意不能/多动、父母的强制性6个因子得分均随着时间下降(均P<0.01);在父母方面分量表中,抑郁、角色的限制、配偶关系、孤独、健康状况5个因子得分均随着时间显著下降(均P<0.01)。基线时PSI总分与IOWA Conners量表总分、ADHD症状评定问卷总分呈正相关(r=0.346~0.902,均P<0.01)。结论:哌甲酯控释剂治疗能有效改善ADHD患者的临床症状和改善患者及其父母的压力,提高社会功能。     

ERP differences in visual attention processing between attention-deficit hyperactivity disorder and control boys in the absence of performance differences

Event-related potentials (ERPs) were recorded during a visual two-choice reaction time (RT) task in attention-deficit hyperactivity disorder (ADHD) and control boys selected using strict inclusion and exclusion criteria. No group differences were found in mean RT and correct responses. Although early occipital ERPs were not affected in the ADHD group, the peak latency of early anterior ERPs (N1, P1, N2) was significantly delayed. ADHD showed a larger effect of stimulus type on the frontal negativity (N530) and the posterior late negativity (nSW) and a smaller effect of stimulus type on anterior N2 and posterior P3b amplitude. The development of N530 and P450 amplitude across blocks of five trials was analyzed using orthogonal polynomial trend analysis of variance software. In the control group, P450 amplitude to "frequent" stimuli reduced across blocks. In the ADHD group, N530 amplitude increased for "rare" stimuli across blocks. It is suggested that the ADHD group showed a lack of automatization of the categorization process with increasing time on task for which they compensated by controlled attentional processes.     

Perceptual and response interference in children with attention-deficit hyperactivity disorder, and the effects of methylphenidate.

Fourteen children with attention-deficit hyperactivity disorder (ADHD) and 14 normal control children were compared with respect to stimulus- and response-related processes. Subjects with ADHD took part in two additional sessions under methylphenidate or placebo. In both experiments, performance and electrophysiological measures such as the P2, N2, and P3 components of event-related potential and electromyogram (EMG) activity were measured during an Eriksen flanker task. In both groups of children, reaction times (RTs) to arrow stimuli incongruent with the target were longer than those to neutral stimuli (response interference), which were again slower than RTs to target-alone stimuli (perceptual interference). Children with ADHD made more errors to incongruent stimuli and showed more response interference. For correct responses, no differences between the groups in response interference effects on reaction time, P2, N2, and P3 latency, or EMG onset were found. Methylphenidate had a general enhancing effect on accuracy but did not specifically reduce interference from the flanking stimuli. Methylphenidate had no effects on RT, N2 and P2 latency, P3 amplitude or latency, or EMG activity. The conclusion that methylphenidate did not influence response processes contrasts sharply with findings reported by authors using the Sternberg memory search task.     

Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study

STUDY OBJECTIVES: Sleep problems are frequently associated with childhood ADHD, as indicated by numerous polysomnographic investigations showing increased nocturnal movements, reduced sleep efficiency, and decreased percentage of REM sleep (although findings are not consistent over all studies). Data on objective and subjective sleep parameters in adults with ADHD are sparse, and to date the impact of stimulants, the most widely used pharmacological treatment for ADHD, on sleep in adults with ADHD has not been examined. Thus the objectives of our study were to assess objective and subjective sleep parameters in adults with ADHD and the impact of stimulant medication on sleep. DESIGN: Two-group comparison and open-label therapy study. PARTICIPANTS: We enrolled 34 nonmedicated patients with ADHD, of whom 24 were without current comorbid psychiatric disorders, and 34 sex- and gender-matched control subjects without current psychiatric disorders or psychotropic medication. INTERVENTIONS: Ten patients were treated with methylphenidate over > or =26 days with a mean daily dose of 36.7 +/- 11.2 mg. MEASUREMENTS: Polysomnographic recording over 2 consecutive nights as well as assessments of subjective sleep parameters were performed in all patients and controls before treatment and reassessed in those patients receiving methylphenidate. RESULTS: Compared to controls untreated patients showed increased nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and reduced percentage of REM sleep. Treatment with methylphenidate resulted in increased sleep efficiency as well as a subjective feeling of improved restorative value of sleep. CONCLUSIONS: Sleep problems in patients with ADHD continue from childhood to adulthood, with similar objective sleep characteristics in adults and children with ADHD. Medication with methylphenidate appears to have beneficial effects on sleep parameters in adults with ADHD.     

注意缺陷多动障碍儿童的工作记忆损害特征

目的:探讨注意缺陷多动障碍(ADHD)儿童工作记忆功能特征。方法:本研究为横断面研究。根据美国精神疾病诊断和统计手册第4版(DSM-IV),对符合ADHD诊断标准的未经治疗的100名门诊患儿及年龄、性别相匹配的100名正常儿童分别采用韦氏儿童智力测验量表中国修订本(C-WISC)及其中的顺背数字(反映言语存贮、加工)、倒背数字(反映言语存贮、加工、中央执行)、Corsi木块和空间n-Back任务(反映视空间存贮和中央执行)进行言语及空间工作记忆测试。结果:ADHD组儿童在顺背数字最高位数及总得分、倒背数字最高位数及总得分、Corsi木块最多木块数及总得分均低于对照组儿童,空间2-Back任务反应时短于对照组儿童(均P0.05)。结论:ADHD儿童存在工作记忆功能缺陷,此缺陷涉及言语环路、视空间存贮系统及中央执行。     

注意缺陷多动障碍儿童的脑功能磁共振成像研究

【摘要】目的对正常儿童和注意缺陷多动障碍（ADHD））L童进行对比研究,观察2者的脑功能结构是否有生理性差异,从而加深对注意缺陷多动障碍病理机制的理解与认识,为诊断和治疗提供可靠的依据。方法利用脑功能磁共振成像（fiR[）技术,对2组儿童进行数据采集（一组为正常儿童,一组为注意缺陷多动障碍患者）,每组各5名;并对采集的数据分别用独立成分分析和统计参数映射技术进行处理分析,以研究这2种方法在处理数据过程中的优劣和差异。结果2种方法虽分别从数据和模型化2个不同方面对数据进行处理,各有优缺点,但都显示出ADHD患者与正常组被试的大脑激活区域的明显差异。ADHD患者的小脑扁桃体激活区增强,前额叶系统功能激活区减弱。结论通过不同方法对比fMRI结果各组之间的差异,进一步验证了ADHD患者的反应抑制缺陷。