注意缺陷多动障碍儿童威斯康星卡片分类测验的临床价值

目的探讨中国文化背景下汉族注意缺陷多动障碍(ADHD)儿童在威斯康星卡片分类测验(WCST)中的反应特征。方法对2003-04—2004-03在中山大学附属三院儿童发育行为中心确诊的汉族ADHD儿童57例和63例正常儿童，采用修订版WCST进行了测试分析。结果WCST的13个指标中ADHD组儿童有7个指标成绩都显著比正常对照组儿童差(P<005，P<001)。ADHD儿童与正常儿童在WCST中持续性错误数(RPE)分别为(2684±1087)与(2283±1035),P<005，总错误数(RE)分别为(5758±1806)与(4933±1855),P<005，持续性反应数(RP)分别为(3039±1388)与(2549±1268),P<005，完成总应答数(RA)分别为(12760±177)与(12286±1104)，P<001，完成分类数(CC)分别为(286±146)与(378±181),P<001，正确应答数百分比(RCP)分别为(5496±1400)与(6050±1338),P<005，概念化水平(RFP)分别为(4080±1761)与(4777±1772),P<005。控制年龄的偏相关分析显示症状、诊断都分别与WCST的多个指标相关，其中完成分类数(CC)与症状、诊断均相关。结论汉族ADHD儿童的认知功能、认知转移能力、抽象概括能力、概念形成的洞察力不足。推测汉族ADHD儿童可能存在额叶功能缺陷。WCST可以考虑作为ADHD临床诊断的参考测验，其中较稳定的指标是完成分类数。

The experiment of wisconsin card sorting test in children with attention deficit hyperactivity disorder.

To analyze characteristics of WCST when applied to handle children with ADHD under Chinese cultural background and to explore the function of prefrontal cortex in ADHD.MethodsFrom April 2003 to March 2004,we tested 57 children with ADHD (average age 944±197) and 63 normal control children (average age 931±182) by revised edition WCST to evaluate the set shifting,working memory,response inhibition,cognitive conversion and abstracting ability of subjects.ResultsThe performance of 7 among 13 scores on WCST among children with ADHD was significantly poorer than that of normal children(P<005,P<001).Children with ADHD had significantly more RA(12760±177 vs12286±1104,P<001),RPE(perseverative errors)(2684±1087 vs2283±1035,P<005),RE(5758±1806 vs4933±1855,P<005),and RP(Perseverative responses)(3039±1388 vs2549±1268,P<005)and less CC(Categories control)(286±146 vs378±181,P<001),RCP(5496±1400 vs6050±1338,P<005) and RFP(4080±1761 vs4777±1772,P<005) than that of normal children.The analysis of partial correlations controlling for age showed that the symptom of attention deficit was related to RA,CC,RCP,RE and RPE;the symptom of hyperactivity was related to CC,RP and RPE;diagnosis was related to RA,CC,RCP,RE and RFP.ConclusionChildren with ADHD have the deficiency of cognitive function,cognitive conversion and abstracting and insight of concept forming ability.The ADHD may be a brain disorder primarily affecting the prefrontal cortex or the regions projecting to the prefrontal cortex.It suggests that WCST is helpful for the diagnosis of ADHD,and CC(Categories control) is relatively steady scores.