| 操小兰,吴赵敏,刘娟,李颖,张琳琳,杨斌让.注意缺陷多动障碍儿童的生态执行功能特点[J].四川精神卫生杂志,2025,(4):295-301.Cao Xiaolan,Wu Zhaomin,Liu Juan,Li Ying,Zhang Linlin,Yang Binrang,Characteristics of ecological executive function in children with attention deficit hyperactivity disorder[J].SICHUAN MENTAL HEALTH,2025,(4):295-301 |
| 注意缺陷多动障碍儿童的生态执行功能特点 |
| Characteristics of ecological executive function in children with attention deficit hyperactivity disorder |
| 投稿时间：2024-11-21 |
| DOI：10.11886/scjsws20241121001 |
| 中文关键词: 生态执行功能 注意缺陷多动障碍 智商 亚型 |
| 英文关键词:Ecological executive function Attention deficit hyperactivity disorder Intelligence quotient Subtypes |
| 基金项目:深圳市优秀科技创新人才培养项目（项目名称：利用多模态遗传影像学数据预测儿童注意缺陷多动障碍临床诊断分型及预后的有效性研究，项目编号：RCYX20221008092849069）；深圳市医疗卫生三名工程项目 |
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| 中文摘要: |
| 背景 执行功能缺陷是注意缺陷多动障碍（ADHD）的核心问题。既往对ADHD患儿执行功能的评估多依赖于实验室环境下实施的操作性神经心理测验，对日常功能的预测效度有限。生态执行功能侧重于评估个体在现实情境中处理复杂任务的能力，能更有效地预测ADHD患儿在实际生活中的功能适应表现（如多任务处理、环境应变等）。目前，关于ADHD患儿生态执行功能特点的研究证据不足。目的 从生态学维度了解ADHD患儿执行功能的特点，从而为制定针对ADHD患儿生态执行功能改善的干预措施提供参考。方法 采用病例对照研究，选取2017年6月—2020年12月在深圳市儿童医院儿童保健与心理健康中心就诊的、符合《精神障碍诊断与统计手册（第4版）》（DSM-IV）诊断标准的277例ADHD患儿为研究对象。同期在深圳市普通中小学招募98名正常儿童作为对照组。采用韦氏儿童智力量表第4版（WISC-IV）和执行功能行为评定量表（BRIEF）父母版进行评定。比较ADHD患儿组与对照组WISC-IV评定结果和BRIEF评分的差异，并进一步比较不同性别和不同亚型的ADHD患儿BRIEF评分。结果 在277例ADHD患儿中，注意缺陷型（ADHD-I）136例（49.10%），多动冲动型（ADHD-HI）6例（2.17%），混合型（ADHD-C）135例（48.73%）。ADHD患儿WISC-IV总智商及4个指数（言语理解、知觉推理、工作记忆和加工速度）得分均低于对照组（t=3.698~9.335，P均<0.01）。将总智商作为协变量进行控制后，ADHD组BRIEF行为管理指数维度（抑制、转换、情感控制共3个因子）和元认知指数（任务启动、工作记忆、计划、监控和组织共5个因子）维度的各因子评分均高于对照组，差异均有统计学意义（F=46.563~290.475，P均<0.01）。不同性别的ADHD患儿BRIEF行为管理指数和元认知指数维度的各因子评分比较，差异均无统计学意义（t=0.105~1.190，P均>0.05）。ADHD-C型患儿BRIEF的抑制、情感控制、组织及监控因子评分均高于ADHD-I型患儿，差异均有统计学意义（t=2.481~7.343，P<0.05或0.01）。结论 ADHD患儿的生态执行功能存在多维度缺陷，且不同亚型的ADHD患儿生态执行功能存在差异。 |
| 英文摘要: |
| Background Executive function deficits constitute a core problem in attention-deficit/hyperactivity disorder （ADHD）. Previous assessments of executive function in children with ADHD have predominantly relied on performance-based neuropsychological tests conducted in laboratory settings， though their predictive validity for real-world functional outcomes remains limited. In contrast， ecological executive function emphasizes the evaluation of complex task management in naturalistic contexts， demonstrating a stronger predictive power for functional adaptation in daily living among children with ADHD， such as multitasking performance， social interactions and so on. However， current empirical evidence regarding ecological executive function in this population remains insufficient.Objective To investigate the executive function characteristics of children with ADHD from an ecological perspective， thereby providing references for developing targeted interventions.Methods A case control study was conducted， including 277 ADHD children who met the Diagnostic and Statistical Manual of Mental Disorders， fourth edition （DSM-IV） criteria and were selected at the Child Health Care and Mental Health Center of Shenzhen Children's Hospital from June 2017 to December 2020， as well as 98 healthy controls were recruited from primary and secondary schools in Shenzhen. All participants were assessed using Wechsler Intelligence Scale for Children， fourth edition （WISC-IV） and Behavior Rating Inventory of Executive Function （BRIEF）. Differences in WISC-IV and BRIEF scores were compared between ADHD group and control groups， followed by the comparison of BRIEF scores by gender and ADHD subtypes.Results Among the 277 children with ADHD， 136 cases （49.10%） had predominantly inattentive type （ADHD-I）， 6 cases （2.17%） had predominantly hyperactive-impulsive type （ADHD-HI）， and 135 cases （48.73%） had combined type （ADHD-C）. ADHD group demonstrated significantly lower scores on both the WISC-IV total IQ and four index scores （verbal comprehension， perceptual reasoning， working memory and processing speed） than control group （t=3.698~9.335， P<0.01）. After controlling for WISC-IV total IQ as a covariate， the scores of each factor in the dimensions of behavioral regulation index （inhibition， shifting， emotional control） and metacognition index （task initiation， working memory， planning， monitoring and organization） were all higher in ADHD group than in control group， and the differences were statistically significant （F=46.563~290.475， P<0.01）. In terms of gender， no statistically significant difference was found in BRIEF composite scores （behavioral regulation index or metacognition index） of children with ADHD （t=0.105~1.190， P>0.05）. In terms of ADHD subtypes， children with ADHD-C reported significantly higher scores than those with ADHD-I on the scores of inhibition， emotional control， organization and monitoring in BRIEF （t=2.481~7.343， P<0.05 or 0.01）.Conclusion Children with ADHD have multidimensional deficits in ecological executive function， which vary across different subtypes. ［Funded by Shenzhen Excellent Science and Technology Innovation Talent Training Project （number， RCYX20221008092849069）； the Sanming Project of Medicine in Shenzhen］ |
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