注意缺陷障碍患儿执行功能抑制机制的神经心理学研究现状

近些年来。大脑额叶功能障碍,尤其是注意和执行功能的失调被认为在注意缺陷障碍（ADHD）患儿认知困难中起着关键作用。研究发现。不同类型和不同年龄的ADHD患儿均存在一项或几项执行功能的缺陷,特别是与神经抑制有关的功能,提示抑制机制缺陷可能是导致ADHD患儿执行功能障碍的基本原因之一。该文就此方面的研究现状作一简介。     

多巴胺转运体与儿童注意缺陷障碍研究进展

注意缺陷障碍(ADHD)是儿童期尤其是学龄期最常见的行为障碍，确切病因和发病机制不明。有效改善ADHD症状的中枢兴奋剂哌醋甲酯主要作用于多巴胺转运体(DAT)，所以多年来国内外学者从各个方面对：DAT进行了研究，认为DAT等位基因多态性与ADHD的患病存在一定的关联性，而在患者和动物模型的研究上也出现了DAT数量和功能的改变。对DAT与ADHD关系的进一步研究将对ADHD的病因分析、诊断确立及药物治疗等方面有重要的理论和实践意义。     

多巴胺转运体与儿童注意缺陷障碍研究进展

注意缺陷障碍(ADHD)是儿童期尤其是学龄期最常见的行为障碍,确切病因和发病机制不明。有效改善ADHD症状的中枢兴奋剂哌醋甲酯主要作用于多巴胺转运体(DAT),所以多年来国内外学者从各个方面对DAT进行了研究,认为DAT等位基因多态性与ADHD的患病存在一定的关联性,而在患者和动物模型的研究上也出现了DAT数量和功能的改变。对DAT与ADHD关系的进一步研究将对ADHD的病因分析、诊断确立及药物治疗等方面有重要的理论和实践意义。     

儿童注意缺陷障碍和睡眠障碍关系的研究进展

注意缺陷障碍（ADHD）是生物、心理、社会等因素共同作用导致的儿童行为障碍,病因目前仍不清楚。这些患儿中很多存在睡眠障碍,而睡眠障碍也可引起和加重ADHD的症状。因此,睡眠障碍可能是ADHD的病因之一,对睡眠障碍进行治疗有可能改善ADHD的症状,这就为ADHD的病因研究及治疗提供了新的思路。该文从ADHD患儿睡眠障碍的临床表现、睡眠周期的改变、ADHD与周期性肢体运动障碍、多动腿综合征及睡眠呼吸紊乱的关系、中枢兴奋性药物对ADHD睡眠结构的影响以及ADHD共患病对睡眠的影响等方面阐述ADHD与睡眠障碍关系的研究进展。     

儿童注意缺陷障碍临床干预的综合策略

注意缺陷障碍是一种高度异质性的行为障碍，迄今仍然是儿童保健门诊中的一个热点病种，且很容易共患其他行为问题。任何单一的治疗措施往往难以达到显著而持久的效果，需要建立“个体化的药物治疗、行为矫治、支持性心理干预、父母咨询及教学干预”的综合干预模式进行多方位的、综合的临床干预。     

儿童注意缺陷多动障碍的冲动行为

近年来,冲动症状在注意缺陷多动障碍诊疗与研究中的地位与作用受到重视.文章回顾了冲有关动的行为学方面的研究,认为冲动个体有行为抑制缺陷、不能忍受延迟强化以及可能存在时间知觉方面的问题.同时指出,冲动是注意缺陷障碍的核心症状与本质特征,对儿童的影响涵盖了从认知、情绪、运动到社会等的所有领域,并比较了两种关于冲动行为作用机制的理论:行为反应抑制理论和适时假说.文章提出加强心理学、神经生物学及精神病学等不同研究领域的协作,共享研究资料,会为冲动行为的研究带来新的进展.     

儿童注意缺陷障碍临床干预的综合策略

注意缺陷障碍是一种高度异质性的行为障碍,迄今仍然是儿童保健门诊中的一个热点病种,且很容易共患其他行为问题。任何单一的治疗措施往往难以达到显著而持久的效果,需要建立"个体化的药物治疗、行为矫治、支持性心理干预、父母咨询及教学干预"的综合干预模式进行多方位的、综合的临床干预。     

注意缺陷多动障碍儿童血清甲状腺激素变化的意义

目的探讨血清甲状腺激素(TH)、促甲状腺激素(TSH)在注意缺陷多动障碍(ADHD)儿童发病中的作用。方法ADHD患儿32例。其中混合型(ADHD-C)19例,注意缺陷型(ADHD-I)9例,多动-冲动型(ADHD-HI)4例。采用全自动微粒子化学发光法分别测定各组TH、TSH水平,且与15例健康儿童(对照组)进行比较。结果1.ADHD组游离三碘甲腺原氨酸(FT3)水平均正常,但与对照组相比显著升高(Pa<0.01);ADHD-I组及ADHD-HI、ADHD-C亚型组三碘甲腺原氨酸(T3)水平均正常,但与对照组相比显著升高(Pa<0.05);ADHD-I、ADHD-HI、ADHD-C组间相比,TH水平均无显著性差异(Pa>0.05)。2.ADHD组及不同亚型组TSH、游离甲状腺素(FT4)、甲状腺素(T4)水平与对照组相比,差异均无显著性意义(Pa>0.05)。结论FT3、T3可能参与ADHD的发病,TSH水平与ADHD的发病无关。     

ADHD儿童目标指向-反应抑制的认知行为训练

注意缺陷多动障碍(attention deficit hyperactivitv disorder,ADHD)是一种常见的儿童时期发病的神经精神病学综合征,具有明显的注意集中困难、目标指向行为难以维持、注意持续时间短暂以及活动过度或冲动等症候群.     

注意缺陷障碍的动物模型

注意缺陷障碍(ADHD)又称儿童多动症，主要表现为注意缺陷、多动、冲动等，常伴程度不等的学习困难、动作不协调和行为或性格上的异常，确切病因及发病机制至今尚不清楚。精神兴奋剂利他林、右旋苯丙胺等治疗有效。建立有效的动物模型将有利于阐明ADHD的病因和发病机制，并为治疗提供新思路。目前国内鲜有关于ADHD动物模型的研究报道，国外近年则做了大量的研究工作，并获得了多项有意义的结果。该文就常用的ADHD动物模型的特点作一综述。     

The Effect of Stress Management Program Using Cognitive Behavior Approach on Mental Health of the Mothers of the Children With Attention Deficit Hyperactivity Disorder

Background:

Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in children.

Objectives:

The study aimed to evaluate the effectiveness of stress management program using cognitive behavior approach on mental health of the mothers of the children with attention deficit hyperactivity disorder.

Patients and Methods:

In this interventional study, 90 mothers of the children with attention deficit hyperactivity disorder were randomly allocated into three intervention, placebo, and control groups. The general health questionnaire was used to measure mental health. Besides, stress was assessed through the depression-anxiety-stress scale. The two instruments were completed at baseline, immediately after, and one month after the intervention by the mothers. Afterwards, within group comparisons were made using one-sample repeated measurement ANOVA. One-way ANOVA was used for inter group comparisons. Mothers in the placebo group only participated in meetings to talk and express feelings without receiving any interventions.

Results:

At the baseline, no significant difference was found among the three groups regarding the means of stress, anxiety, depression, and mental health. However, a significant difference was observed in the mean score of stress immediately after the intervention (P = 0.033). The results also showed a significant difference among the three groups regarding the mean score of mental health (P < 0.001). One month after the intervention, the mean difference of mental health score remained significant only in the intervention group (P < 0.001).

Conclusions:

The study findings confirmed the effectiveness of stress management program utilizing cognitive behavior approach in mental health of the mothers of the children with attention deficit hyperactivity disorder.     

Somatic and psychiatric co-morbidity in children with attention deficit hyperactivity disorder

AIM: To describe the prevalence of somatic and psychiatric co-morbidity in children diagnosed with ADHD and other behavioural problems compared to this prevalence in children seen at the outpatient department without either of these conditions. METHODS: A retrospective controlled case study was conducted in 369 children. All children with ADHD were diagnosed by a clinical psychologist in a hospital setting according to the DSM IV classification. Co-morbidity was determined by pediatricians. RESULTS: Somatic co-morbidity was seen in 94 % of the children. However, there was no significant difference in the prevalence of somatic co-morbidity in patients with ADHD nor in patients with behavioural problems other than ADHD when compared with the control group. Only two differences slight were observed. In the ADHD group and the group with behavioural problems motor impairment was seen more often and in the control group constipation was diagnosed more frequently. CONCLUSION: Except for motor impairment, somatic co-morbidity of any kind does not seem to occur more frequently in children with ADHD.     

The effect of methylphenidate and clonidine on response inhibition and state regulation in children with ADHD

The goal of this study was to evaluate the effect of methylphenidate (MPH) and clonidine in comparison with placebo on response inhibition and state regulation in children with Attention Deficit Hyperactivity Disorder (ADHD). The study utilised a double-blind cross-over design in which children were randomly assigned without replacement to placebo, MPH, and clonidine following baseline assessment. The primary dependent measures were derived from children's performance (reaction time and errors) on a GO-NO GO task under three conditions that altered the inter-stimulus interval (ISI) for presented GO-NO GO stimuli: ISI of 1 sec (fast condition), 4 sec (medium condition), and 8 sec (slow condition). Findings indicated no difference in task performance between groups treated for 7 weeks with placebo, MPH, and clonidine. We concluded that the state regulation problem in ADHD is resistant to MPH and clonidine.     

Parents' perception of mental development and behavioural problems in 8 to 9-year-old children

A slow maturational rate may be an underlying antecedent of a psychiatric disorder. If this is correct, differences in behavioural problems could be related to the maturity level in children of the same chronological age. The aim of the study was to compare the parents' perceptions and assessments of their children's maturational status and behavioural problems. A population based on a nationwide sample from the Swedish twin-register of 8 to 9-y-old children (n = 1079) was used. The parents completed a questionnaire including their views on their child's maturity level, the Swedish version of the Child Behaviour Checklist (CBCL) and an Attention Deficit Hyperactivity Disorder (ADHD) checklist based on the DSM-III-R criteria. Multivariate analyses showed a statistically significant relationship between immaturity reported by the parents and several behavioural problems reported on the CBCL: somatic complaints, anxious and depressed, social problems, thought problems, attention problems, behaviour problems and aggressive behaviour. There was also a statistically significant relationship between the maturity factor and the CBCL grouping of syndromes (internalizing, externalizing, total behaviour problems score) as well as between the maturity factor and ADHD. Conclusion: We conclude that at least from the parents' point of view the behaviour problems in their children may be related to maturity.     

Relationships Between Serum Free Fatty Acids and Zinc, and Attention Deficit Hyperactivity Disorder: A Research Note

The purpose of this study is to evaluate the relationships between serum free fatty acids (FFA) and zinc, and attention deficit hyperactivity disorder (ADHD). Forty eight children with ADHD (33 boys, 15 girls) were included in the patient group and 45 healthy volunteer children (30 boys, 15 girls) constituted the control group. The mean serum FFA level in the patient group was 0.176 ± 0.102 mEq/L and in control group, 0.562 ± 0.225 mEq/L ( p < .001). The mean serum zinc level of patient group was 60.6 ± 9.9 μg/dl and that of the control group. 105.8±13.2 μg/dl (p < .001). A statistically significant correlation was found between zinc and FFA levels in the ADHD group. These findings indicate that zinc deficiency may play a role in aetiopathogenesis of ADHD. Although we observed decreased FFA levels in ADHD cases, it is necessary to determine whether this condition is a principal cause of ADHD or is secondary to zinc deficiency.     

Normative Data and Psychometric Properties of the Child Behavior Checklist and Teacher Rating Form in an Iranian Community Sample

Objective

The objective of this study was to determine the normative data and psychometric properties of the parent and teacher rating form of the child behavior checklist (CBCL) in an Iranian community sample.

Methods

A sample of 6-12 year old students was randomly selected from ten elementary schools in Tehran, Iran. The parent''s and teacher''s versions of CBCL were accomplished. Clinical interview and the kiddie schedule for affective disorders and schizophrenia – present and lifetime version, Persian version (K-SADS-PL-PV) were used to evaluate the validity and the cut-off point of CBCL and the teacher rating form (TRF).

Findings

Among 600 recruited students with mean age of 9.11 years (SD=1.45), 54.16% were girls (n=325). Girls had significantly lower scores in Attention Problems, Delinquent Behavior, Aggressive Behavior, Externalizing and Total Problems than boys (P<0.01). The relation was significant between the CBCL Internalizing and students'' ages (β=0.124, P=0.002). The Internal consistency, the correlation among the CBCL and TRF scales, and the inter-rater correlations for CBCL/TRF scales were good to high for most indices and subscales. Based on the receiver operating characteristics (ROC) analysis the best convergences were between the CBCL Attention Problems subscale and attention deficit hyperactivity disorder (ADHD) diagnosis, the CBCL Total Problems and any disorders, the CBCL Externalizing and ADHD+ODD diagnosis. The sensitivities and specificities of the CBCL subscales were higher than the TRF except for Externalizing/ADHD+ oppositional defiant disorder (ODD) which was reverse.

Conclusion

These results support the multicultural CBCL/TRF findings. CBCL is a useful instrument to consider ADHD and any disorders in community samples.     

Motor examination in children with Attention-deficit/hyperactivity Disorder and Asperger Syndrome

Aim: Evaluating whether motor skills could differentiate drug‐naive subjects with two neurodevelopmental disorders: Attention‐Deficit Hyperactivity Disorder (ADHD) and Asperger Syndrome (AS). Methods: Thirty‐six boys (12 with ADHD, 12 with AS and 12 with typical development) aged 8–12 were evaluated using the Physical and Neurological Examination for Subtle Signs. Three primary outcome variables were obtained as follows: (i) total speed of timed activities, (ii) total overflow and (iii) total dysrhythmia. Results: Children with AS performed more slowly than those with ADHD and healthy children independently of age and IQ. Total dysrhythmia differentiates ADHD and AS children from controls. Conclusion: Dysfunction of the fronto‐striatal–cerebellar networks related to motor control could be the physiopathological basis of the reported findings.     

Medium-term outcomes are comparable with short-term outcomes in children with attention deficit hyperactivity disorder treated with stimulant medication

OBJECTIVE: To compare the short- and medium-term effects of psychostimulant medication in children with attention deficit hyperactivity disorder (ADHD). METHODS: Seventy-three children with ADHD participated in a double-blind crossover study of dextroamphetamine (DEX) and methylphenidate (MPH; results previously reported). At the completion of this study, subjects continued to take the preferred stimulant. Subjects were restudied 6-9 months later. The principal outcome measures were the Revised Conners' Parent and Teacher Rating Scales. RESULTS: Fifty-three families (73%) returned the follow-up surveys. At 6-9 months, mean T scores were still significantly lower than the mean at baseline for all factors of both the CPRS-R and CTRS-R (P < 0.01). There were no statistically significant differences between scores at 6-9 months and scores at the completion of the corresponding medication period in the crossover trial. CONCLUSIONS: After 6-9 months treatment with stimulant medication, ratings remained significantly better than at baseline. This suggests that the early benefits of stimulants are sustained for at least 6 months.