【学位级别】医学博士

【论文完成日期】2004-05-09

【论文中文题名】共患对立违抗性障碍的注意缺陷多动障碍研究——临床特点、危险因素与临床干预

【论文外文题名】Study on Attention Deficit Hyperactivity Disorder Comorbid with Oppositional Defiant Disorder——Clinical Features, Risk Factors and Clinical Intervention

【论文著者】姓名：刘津 liu jin

【论文著者】学号：B00017202

【论文著者】系别：精神卫生研究所

【论文著者】专业：精神病与精神卫生学

【论文著者】研究方向：儿童精神卫生

【指导教师】姓名：王玉凤 wang yu feng

【指导教师】学校：北京大学医学部

【指导教师】系别：精神卫生研究所

【指导教师】专业：儿童精神卫生

【中文文摘】目的 探讨ADHD+ODD患儿的临床及病因学特点；探讨父母培训对ADHD+ODD的干预疗效，评价该方法在中国的适用性。 方法 以DSM-IV为诊断标准，以仅共患ADHD＋ODD的患儿及与之按年龄、性别匹配的单纯ADHD患儿、正常儿童为研究对象，采用自编的包括家庭一般情况、围产期情况、发育史等内容的调查问卷，及儿童感觉统合能力发展评定量表和脑电超慢涨落仪技术探讨危险因素和社会功能，采用中国韦氏儿童智力量表、韦氏记忆量表、数字划消、Stroop测验和瑞文标准推理测验评定认知功能；引进美国Barkley的方法培训部分ADHD＋ODD患儿的家长，评价该培训的疗效、过程、效益和方法。 结论 本研究验证了以下假说： 1． ADHD＋ODD儿童中男性多于女性；冲动症状比ADHD多；社会功能受损比ADHD重；认知、执行功能受损与ADHD类似； 2． 父母长期冲突、对孩子持久的严厉训导是ADHD＋ODD的危险因素； 3． 父母培训可减轻ODD及ADHD症状。 本研究首次发现了： 1． 多动冲动及对立违抗水平较美国儿童轻，ADHD+ODD亚型的构成特点与美国儿童及ADHD儿童不同； 2． 右额叶快α波增多、前庭功能失调是ADHD＋ODD的危险因素； 3． 父母培训法对ODD病例的改善优于ADHD病例。

【外文文摘】Objectives To explore features of clinic manifestations and etiology of ADHD+ODD; to evaluate effects of parent training on ODD and ADHD symptoms, and also its applicability in China. Methods Children with pure comorbid ADHD+ODD, pure ADHD and normal controls, group matched by sex and age, diagnosed with DSM-IV diagnostic criteria, were compared on a set of self-compiled investigation questionnaire, Child Sensory Integrative Ability Development Assessment Scale, and Encephalofluctuograph Technology to explore risk factors and social function; and on C-WISC, WMS, Number Cancellation Test, Raven's Standard Progressive Matrices, and Stroop Test to evaluate cognitive function. Some of the ADHD+ODD children’s parents were trained with Barkley’s parent training method, and its effectiveness, process, benefits and methods were evaluated. Conclusions This study validated the following hypotheses: 1. There are more ADHD＋ODD boys than girls; in ADHD＋ODD children, impulsivity symptoms are more than those in ADHD children; social functions are more impaired than in ADHD children; cognitive and executive dysfunction is similar in both ADHD＋ODD and ADHD children; 2. Long-term conflict between parents, and parents’ constant/stringent criticism to child are risk factors of ADHD＋ODD; 3. Parent training can alleviate both ODD and ADHD symptoms. This study found the following innovative results: 1. There are lower levels of hyperactivity/impulsivity and opposition than in the American children, composition of ADHD＋ODD subtypes is different from those in ADHD children and the American children; 2. Increase of rapid alpha wave in right frontal lobe and vestibular dysfunction are risk factors of ADHD＋ODD; 3. Parent training can decrease more ODD cases than ADHD cases.