不同治疗方案对6～9岁注意缺陷多动障碍患儿疗效的对比研究OA
Comparative study of therapeutic efficacy of different treatment regimens in children aged 6-9 years with attention deficit hyperactivity disorder
目的 探究不同治疗方案对 6～9 岁注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患儿的治疗效果.方法 采用病例对照研究方法,选取 2020 年 3 月至 2022 年 1 月于广西壮族自治区妇幼保健院治疗的 218 例ADHD患儿为研究对象,按照治疗方法不同将其分为家长培训组(n=35)、联合执行功能训练组(n=40)、联合药物治疗组(n=75)、综合治疗组(n=68).家长培训组:只对ADHD患儿的家长进行培训;联合执行功能训练组:在家长培训的基础上,再对ADHD患儿进行执行功能训练;联合药物治疗组:在家长培训的基础上,给予ADHD患儿盐酸哌甲酯缓释片(Methylphenidate sustained-release tablets,MPH)药物治疗;综合治疗组:在家长培训的基础上,联合MPH药物治疗和执行功能训练.比较 4 组患儿治疗前后在视听整合持续操作测验(Integrated Visual and Auditory Continuous Performance Test,IVA-CPT)、韦氏儿童智力量表第四版(Wechsler Intelligence Scale for Children-Fourth Edition,WISC-Ⅳ)、中文版SNAP-IV量表(Swanson,Nolan,and Pelham,SNAP-Ⅳ)父母版中的评分差异.统计学方法采用方差分析、LSD-t检验和χ2 检验.结果 治疗后,IVA-CPT评分结果显示,联合执行功能训练组、联合药物治疗组及综合治疗组患儿的多动商数和注意商数均显著高于家长培训组[多动商数:(94.38±26.37)分、(94.48±18.02)分、(101.37±15.27)分与(67.03±16.03)分,F=28.927,P<0.001;注意商数:(80.08±19.28)分、(82.36±25.32)分、(86.69±20.99)分与(72.11±26.53)分,F=3.121,P=0.027)];联合药物治疗组及综合治疗组患儿的注意商数优于联合执行功能训练组,差异均有统计学意义(P值均<0.05).治疗后,WISC-Ⅳ评分结果显示,联合执行功能训练组、联合药物治疗组和综合治疗组患儿的言语理解指数、知觉推理指数、加工速度指数和总智商均高于家长培训组[言语理解指数:(84.90±10.65)分、(89.76±12.80)分、(88.43±10.95)分与(77.89±10.47)分,F=9.446,P<0.001);知觉推理指数:(90.00±12.74)分、(96.52±11.10)分、(99.74±14.42)分与(84.40±15.00)分,F=12.612,P<0.001);加工速度指数:(90.95±10.53)分、(94.09±11.30)分、(95.43±11.03)分与(82.91±12.45)分,F=10.637,P<0.001);总智商:(86.80±8.51)分、(92.16±9.36)分、(95.29±10.78)分与(78.54±9.90)分,F=25.338,P<0.001)],且联合药物治疗组与综合治疗组患儿的上述指标均优于联合执行功能训练组,(P值均<0.05).治疗后,SNAP-Ⅳ评分结果显示,联合执行功能训练组、联合药物治疗组和综合治疗组患儿的注意力、多动冲动、对立违抗症状改善程度均优于家长培训组[注意力:(1.29±0.53)分、(1.15±0.40)分、(1.08±0.51)分与(2.29±0.49)分,F=57.167,P<0.001);多动冲动:(1.15±0.49)分、(0.99±0.63)分、(1.01±0.40)分与(1.51±0.41)分,F=9.633,P<0.001);对立违抗:(1.24±0.42)分、(1.00±0.49)分、(0.86±0.50)分与(1.70±0.33),F=28.158,P<0.001)],且联合药物治疗组与综合治疗组患儿的上述指标均优于联合执行功能训练组,(P值均<0.05).结论 对于6～9岁ADHD患儿,综合治疗及MPH药物治疗效果最佳,执行功能训练效果中等.执行功能训练作为一种非药物治疗手段,为ADHD早期干预提供了新方向.
Objective To investigate the therapeutic efficacy of different treatment regimens on children aged 6-9 years with attention deficit hyperactivity disorder(ADHD).Methods A case-control study was conducted,enrolling 218 children with ADHD treated in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from March 2020 to January 2022.Participants were divided into four groups based on different treatment regimens:parent training group(n=35),combined executive function training group(n=40),combined drug therapy group(n=75)and comprehensive treatment group(n=68).Parent training group:only parents of children with ADHD were trained.Combined executive function training group:on the basis of parental training,the children with ADHD were given executive function training.Combined drug therapy group:on the basis of parental training,children with ADHD were given Methylphenidate sustained-release tablets(MPH).Comprehensive treatment group:on the basis of parent training,MPH drug therapy and executive function training were combined.The scores of the Integrated Visual and Auditory Continuous Performance Test(IVA-CPT),Wechsler Intelligence Scale for Children-Fourth Edition(WISC-Ⅳ),and the Chinese version of Swanson,Nolan,and Pelham-Ⅳ scale(SNAP-Ⅳ)-parents in 4 groups were compared before and after treatment.Statistical analysis was performed using analysis of variance(ANOVA),LSD-t test and χ2 test.Results After treatment,the results of IVA-CPT scores showed that the hyperactivity quotient and attention quotient in the combined executive function training group,the combined drug therapy group,and the comprehensive treatment group were significantly higher than those in the parent training group[hyperactivity quotient:(94.38±26.37)points,(94.48±18.02)points,(101.37±15.27)points vs(67.03±16.03)points,F=28.927,P<0.001;attention quotient:(80.08±19.28)points,(82.36±25.32)points,(86.69±20.99)points vs(72.11±26.53)points,F=3.121,P=0.027].The attention quotient in the combined drug therapy group and the comprehensive treatment group was superior to that in the combined executive function training group,with statistically significant differences(all P<0.05).After treatment,the results of WISC-IV scores indicated that the verbal comprehension index,perceptual reasoning index,processing speed index,and full-scale intelligence quotient(IQ)in the combined executive function group,the combined drug therapy group,and the comprehensive treatment group were higher than those in the parent training group[verbal comprehension index:(84.90±10.65)points,(89.76±12.80)points,(88.43±10.95)points vs(77.89±10.47)points,F=9.446,P<0.001;perceptual reasoning index:(90.00±12.74)points,(96.52±11.10)points,(99.74±14.42)points vs(84.40±15.00)points,F=12.612,P<0.001;processing speed index:(90.95±10.53)points,(94.09±11.30)points,(95.43±11.03)points vs(82.91±12.45)points,F=10.637,P<0.001;full-scale IQ:(86.80±8.51)points,(92.16±9.36)points,(95.29±10.78)points vs(78.54±9.90)points,F=25.338,P<0.001].Moreover,the above indicators of the combined drug therapy group and the comprehensive treatment group were superior to those of the combined executive function training group(all P<0.05).After treatment,the results of SNAP-IV scores demonstrated that improvements in attention,hyperactivity-impulsivity,and oppositional defiant symptoms in the combined executive function training group,the combined drug therapy group,and the comprehensive treatment group were superior to those in the parent training group[attention:(1.29±0.53)points,(1.15±0.40)points,(1.08±0.51)points vs(2.29±0.49)points,F=57.167,P<0.001;hyperactivity-impulsivity:(1.15±0.49)points,(0.99±0.63)points,(1.01±0.40)points vs(1.51±0.41)points,F=9.633,P<0.001;oppositional defiance:(1.24±0.42)points,(1.00±0.49)points,(0.86±0.50)points vs(1.70±0.33)points,F=28.158,P<0.001].Additionally,the above indicators of the combined drug therapy group and the comprehensive treatment group were superior to those of the combined executive function training group(all P<0.05).Conclusion For children aged 6-9 years with ADHD,comprehensive treatment and MPH drug therapy yielded optimal therapeutic outcomes,whereas executive function training showed moderate effectiveness.As a non-pharmacological intervention,executive function training provides a novel direction for early ADHD management.
朱才荣;江蕙芸;蒙晓梅;沈榕;覃秋萍
广西壮族自治区妇幼保健院 儿童保健科,广西 南宁 530000广西壮族自治区妇幼保健院 儿童保健科,广西 南宁 530000广西壮族自治区妇幼保健院 儿童保健科,广西 南宁 530000广西壮族自治区妇幼保健院 儿童保健科,广西 南宁 530000广西壮族自治区妇幼保健院 儿童保健科,广西 南宁 530000
注意缺陷多动障碍家长培训综合治疗药物治疗执行功能训练
Attention deficit hyperactivity disorderParent trainingComprehensive treatmentDrug therapyExecutive function training
《发育医学电子杂志》 2026 (1)
20-27,8
广西壮族自治区卫生健康委科研计划课题(Z-A20230369)
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