沙盘游戏治疗学龄前儿童注意缺陷多动障碍的研究

通过对学龄前注意缺陷多动障碍(ADHD)儿童进行沙盘游戏治疗,研究沙盘游戏对学龄前儿童ADHD治疗的有效性及可行性。采用随机对照研究方法,将使用conners父母问卷筛查、并经DSM-V诊断的3岁~5岁ADHD儿童28例随机分为两组。试验组进行12周(每周1次)的沙盘游戏治疗,对照组不予干预。试验结束后再次行conners父母问卷调查,将各组间及组内进行ADHD得分及其他行为问题得分的比较。试验组沙盘游戏治疗后多动指数及多动-冲动得分均较前显著下降(P0.05),品行问题和学习问题也较前显著下降(P0.05)。沙盘游戏能显著改善学龄前儿童ADHD的主要症状,适宜学龄前儿童ADHD的治疗。     

7—10岁儿童不同亚型ADHD行为与共病问题

摘要：通过流行病学测查,探讨不同亚型ADHD儿童的情绪、行为和社会功能的差异。采用SDQ（长处与困难问卷）对4500名7-10岁儿童进行大样本筛查,应用K-SADS-PL量表和DSM-Ⅳ诊断标准对其中263名高危儿童进行临床评估,诊断出119名儿童ADHD。诊断出的ADHD儿童中,男性与女性的比率大约为2.22︰1,存在显著的性别差异。混合型儿童ADHD的多动性不能得分显著高于注意缺陷性;混合型ADHD的社会功能得分显著低于注意缺陷型和多动型。7岁儿童ADHD的多动情况显著低于8岁、9岁。ADHD共病率为12.6%,ADHD儿童伴有学习困难的比例为43.2%。     

“热”执行对注意缺陷多动障碍和阅读障碍儿童言语工作记忆的影响

ADHD儿童在与背外侧前额叶(DLPFC)相关的"冷"执行功能上的缺陷已大量证实,但在与眼眶和中前额叶皮层(OMPFC)相关的"热"执行功能上,ADHD儿童是否存在缺陷则未可知。与儿童赌博任务实验范式(该任务中"热"启动对"冷"执行起到抑制作用)不同,本研究考察趣味言语N-back任务是否对ADHD和阅读障碍儿童的成绩有促进作用。枯燥N-back任务考察的是言语工作记忆的纯认知特征,而趣味任务则卷入了"热"执行对"冷"执行的影响。结果表明,在枯燥任务上,ADHD和阅读障碍儿童的成绩均明显低于正常儿童,二者之间差异不显著,在趣味任务成绩上,ADHD儿童与正常儿童的成绩没有显著差异,而阅读障碍儿童成绩落后于正常控制组和ADHD组,在成绩变化的趋势上,ADHD儿童在趣味任务上成绩明显提高,而阅读障碍儿童则无明显改善。结果说明ADHD和阅读障碍儿童的言语工作记忆均存在明显的缺陷,但是机制不同,"热"执行对提高ADHD的言语工作记忆有明显的促进作用,ADHD的"冷"执行缺陷能够通过"热"执行的调节得到改善。     

正常与多动儿童的创造力、学习适应性比较研究

本研究比较ADHD儿童和正常儿童在创造性思维测验、学习适应性测验以及教师对其创造力评价上的差异。结果表明：(1)ADHD儿童和正常儿童在数字和图形创造性思维测验上的成绩没有显著的差异。表明ADHD和创造力是彼此独立的两个特质;(2)ADHD儿童在学习态度、学校环境(主要是师生关系和同伴关系)、独立性和毅力等维度上明显偏低;(3)不同学科教师对于ADHD儿童和正常儿童在创造力水平高低的评价上没有显著性差异;(4)对于正常儿童。不同学科教师对其创造力的评价与儿童在创造力测验上的得分呈显著性相关;对于ADHD儿童则没有显著性相关。     

儿童攻击行为的短期追踪干预研究:从社会信息加工的角度

以社会信息加工模型(Social Information-Processing Model,简称SIP)为理论依据设计社会认知干预方案,将被试(包括132名攻击性儿童)分为实验组、安慰剂(阅读)组和控制组进行短期追踪干预研究,在此基础上考察该干预方案对减少儿童的攻击行为以及提高社会信息加工能力的作用。研究结果表明:(1)该干预方案对提高攻击性儿童的社会信息加工能力有明显的即时效果和持续效果,具体表现为该方案有效地减少了攻击性儿童的敌意归因偏见和攻击行为的产生,有助于攻击性儿童建立关系目标并正确认知攻击行为的后果;(2)班主任评定三组儿童的攻击行为显著减少,评定结果可能受到期望效应的影响。     

国内注意缺陷/多动障碍儿童干预效果的元分析

对国内过去12年间的62项注意缺陷/多动障碍干预研究结果进行了元分析,结果显示：（1）国内现有的ADHD干预措施取得了显著的干预效果;（2）在不同干预措施中,药物治疗与行为疗法或认知行为疗法相结合具有最佳疗效,单独的药物治疗次之,单独的行为疗法或认知行为疗法效果较低;（3）在各种效果指标中,学业指标上的效果量是最大的,这一结果与国外已有的元分析研究发现不一致;（4）在各种效果信息来源中,来自客观观察的效果量最高,来自父母评价的效果量次之,来自教师评定的效果量最差。（5）各种干预措施在不同效果指标上有不同的表现。药物治疗对于学业和行为指标的效果最强烈,而认知行为疗法和脑电反馈疗法对认知指标的效果最明显。最后,结合干预措施的选择、效果指标的采用以及研究质量问题进行了讨论     

注意缺陷多动障碍儿童教育康复线上模式的构建

注意缺陷多动障碍(简称ADHD)是一种常见的儿童神经发育性障碍。当前用于儿童ADHD的传统(线下)教育康复模式存在缺少学业实效、教师低参与、学校管理经验不足以及遇到特殊情况(如疫情)无法服务等问题。本研究在脑电生物反馈认知训练的基础上, 以解决问题和循证研究为设计思路, 为中国ADHD患儿构建教育康复线上模式并进行初步应用。本研究分为3个子研究：研究1采用访谈法和问卷调查法对中国儿童ADHD教育康复的现状调查并分析患儿及关键相关人(家长和教师)需求; 研究2采用随机对照单盲试验(干预组和对照组各为50人), 评价基于脑电生物反馈认知训练(NCT)的教育康复线上模式的有效性; 研究3采用一个更大被试样本量(每组n = 100)的(家长为中介人干预组/教师为中介人干预组/对照组)×(诊断组/亚诊断组)随机对照研究评价由干预中介人(家长或教师)参与的线上模式的有效性, 以及一个纵向质性研究发现关键相关人对于线上模式的接受情况。研究旨在为中国ADHD患儿提供一个有效且好用的教育康复形式。     

体感游戏促进儿童的执行功能：运动强度和认知参与的作用

为了考察体感游戏促进儿童执行功能的作用机制, 采用2(运动强度：高/低) × 2(认知参与：高/低) × 3(测量时间：前测、一次性训练后测、长期训练后测)的三因素混合实验设计, 对122名4~6岁儿童进行6周(每周3次)的体感游戏训练。结果发现：在一次性训练中, 体感游戏中的运动强度而不是认知参与显著促进儿童执行功能, 尤其是工作记忆; 在长期干预中, 体感游戏中的运动强度和认知参与都显著促进儿童执行功能, 且认知参与的作用大于运动强度。这一结果不但验证了体感游戏对儿童执行功能的益处, 并且阐明了体感游戏中的哪些特征能对儿童执行功能具有短期的和长期的效果。     

心理干预对轻中度脑瘫儿童综合功能和生活质量的影响*

采用对照组和干预组前测、后测设计,对80名脑瘫儿童的综合功能和生活质量进行了测量,分析了心理干预对脑瘫儿童康复疗效的影响。结果表明:(1)四组脑瘫儿童后测综合功能评定效果存在显著差异。(2)生活质量问卷中,在使用特殊器具感觉维度上,四个组别间的追踪水平逐级显著递增;在对疼痛和困扰感觉维度上,四个组别间的后测水平、追踪水平均逐级显著递减;在其它四个维度上,四个组别间的后测水平、追踪水平均逐级显著递增。(3)在使用特殊器具感觉维度上,三个干预组内的追踪水平显著高于前测和后测水平;在对疼痛和困扰感觉维度上,三个干预组内的前测、后测和追踪水平均呈逐级显著递减趋势;在其它四个维度上,三个干预组内的前测、后测和追踪水平均逐级显著递增。干预组比对照组能显著提升脑瘫患儿的综合功能和生活质量。     

奖惩对注意缺陷多动障碍儿童情感决策的影响

采用简化版儿童赌博任务,其中操纵了奖励和惩罚的强度,探察两种亚型（注意缺陷型和混合型）ADHD儿童的情感决策能力,同时采集儿童在任务中的皮肤电活动以探析ADHD儿童在情感决策中的生理机制。结果发现,在不同的奖惩强度下,ADHD儿童情感决策模式不同,在即刻奖励条件下,ADHD儿童情感决策的能力明显弱于正常对照组儿童,倾向于不利选择,所产生的预测性皮电振幅也明显低于正常对照组;在即刻惩罚条件下,ADHD儿童的情感决策能力未见异常。两种亚型ADHD儿童的表现模式相似。上述结果证明,ADHD儿童仅存在对奖励的异常敏感性,并确实影响了其决策能力,而其回避惩罚的能力正常。两种亚型ADHD儿童存在的问题相似     

Parent-Reported Attention Deficit/Hyperactivity Symptomatology in Preschool-Aged Children: Factor Structure, Developmental Change, and Early Risk Factors

Although Attention Deficit/Hyperactivity Disorder (ADHD) has increasingly been studied in preschool-aged children, relatively few studies have provided a comprehensive evaluation of the factor structure and patterns of developmental changes in parent-reported ADHD symptomatology across the early childhood period. This study used confirmatory factor analyses to test for longitudinal measurement invariance of ADHD symptoms and semi-parametric finite mixture models to identify prototypic patterns of developmental changes in ADHD symptomatology from 3 to 5?years of age. Participants were 1155 children and their parents who participated in a prospective longitudinal study involving a representative sample of children who resided in six non-metropolitan counties in the United States. Results indicated that (1) ADHD symptomatology was best represented by a single latent factor that exhibited partial measurement invariance from 3 to 5?years of age, (2) 8.5?% of children exhibited sustained high levels of ADHD symptoms from age 3–5?years, and (3) a variety of risk factors differentiated children with sustained high from those with sustained low levels of ADHD, relatively few (most notably caregiver education) were able to differentiate children with sustained high levels of ADHD symptoms from all other groups. Children who exhibit persistent ADHD symptomatology across the early childhood period may define a clinically important group for etiologic research and/or early intervention efforts.     

Grade effects on teacher ratings of ADHD symptoms among primary school students

Several studies have reported that being younger for grade increases the risk of having attention deficit hyperactivity disorder (ADHD) diagnosis and being on ADHD medication among students. The aim of this study was to investigate this association in a low‐middle income country setting. Sample included 2,627 children from first to fourth grades. We compared students who were older than the 75th and younger than the 25th percentiles in consecutive grades. Teachers completed SNAP‐4 scale. Results indicated that teacher rated ADHD symptoms were 2.5 to 3.6 times more common in students who were younger for their grade, after age, gender, and Fluid IQ scores were controlled. Teacher SNAP‐4 scores were also significantly associated with grade. Our results suggested that the phenomenon of higher rates of teacher rated ADHD symptoms among younger for grade students was not limited to Western countries and that the teacher reported symptom loads were higher in these children.     

多动症儿童教育方式研究

本文选取35名多动症儿童为被试,采用《康纳多动症评分量表》对经医学确诊的多动症儿童进行可疑程度分析。采用姚树桥、龚耀先编制的《儿童适应行为评定量表》对被试的社会适应行为进行评量。结果表明:多动症儿童在不同程度上存在适应行为问题,特别是在社会责任方面的水平较低,从年龄发展来看多动症儿童在小学三、四年级时适应水平最低。据此提出教育训练的重点和教育建议。     

Mental contrasting with implementation intentions enhances self-regulation of goal pursuit in schoolchildren at risk for ADHD

Self-regulation is an important prerequisite for successful academic achievement, particularly for children who are at risk for Attention Deficit Hyperactivity Disorder (ADHD). We taught Mental Contrasting with Implementation Intentions (MCII), a technique that is known to facilitate the self-regulation of goal pursuit, to schoolchildren (sixth- and seventh-graders) both at risk and not at risk for ADHD. Parents rated their children’s level of self-regulation 2 weeks after the intervention. Children at risk and not at risk benefited from MCII more than from a learning style intervention only and the benefits of MCII were particularly strong for children at risk for ADHD. The results have implications with respect to supporting children’s self-regulation in their everyday school lives.     

Longitudinal Pathways to Reading Achievement at Age 7 Years: Child and Environmental Influences

Using a bioecological perspective, this longitudinal study examined the contribution of child and environmental factors to the prediction of reading achievement at age 7. Participants were 99 boys and their parents. Child factors included 24-month temperament (reactivity and self-regulation), 36-month language level, and 7-year ADHD symptoms; environmental factors included quality of the home environment (54 months), maternal education, and learning disability (LD) in the family. There were direct and indirect pathways to reading achievement. Direct pathways included language skills, home environment, ADHD symptoms, and LD in the family. Unexpectedly, the direct pathway from self-regulation was negative. Indirect pathways included self-regulation, maternal education, and reactivity. Given the stability of the trajectory of reading skills and academic performance from first grade onward, the early identification of those children most at risk for reading difficulties has implications for the type of intervention most appropriate for individual children.     

A friendship intervention for children with Attention-Deficit/Hyperactivity Disorder: preliminary findings

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are known to experience difficulty in peer relationships. Neither standard interventions for ADHD nor peer acceptance-oriented interventions fully remedy this problem. We propose that interventions targeting ADHD children's dyadic friendships may be more realistic strategies for improving peer relationships. Hence, a friendship intervention, implemented within the context of an intensive behavioral treatment program with 209 ADHD children, is described. A model is proposed in which the friend's antisocial behavior relates to parental compliance with the friendship intervention, and both the friend's antisocial behavior and parental compliance predict friendship quality and treatment response. Results indicate that children paired with peers lower on antisocial behavior and children whose parents had higher levels of compliance with the friendship intervention achieved higher quality friendships and were rated by teachers as more improved.     

Verbal Working Memory as a Longitudinal Mechanism of Vocabulary Problems in Preschoolers with ADHD

Elucidation of early potential risk factors of Attention-Deficit/Hyperactivity Disorder (ADHD) is important to allow for early identification of ADHD and targeted early intervention for children with ADHD. Delayed language skills, particularly poor vocabulary, is an early-developing potential risk factor that is thought to be involved in developmental pathways to ADHD; however, mechanisms explaining the relationship between poor vocabulary skills and ADHD symptoms are unclear and warrant investigation. The present study examines the relationship between poor vocabulary skills and ADHD symptoms by testing cognitive mechanisms, namely verbal working memory (WM), that might account for this link. Participants were 109 young children between the ages of three and six and their primary caregivers. Diagnostic information on ADHD symptoms was available from parents and teachers/daycare providers via standardized rating forms. Vocabulary skills and WM were measured through child performance on laboratory tasks. Mediation analyses found poor verbal working memory significantly partially explained the vocabulary-ADHD association for both parent and teacher-rated ADHD symptoms. Further, effects of verbal WM on the association between poor vocabulary and increased ADHD symptoms largely held at one-year follow-up. Development of early interventions targeting verbal WM may be a promising new direction for early ADHD intervention work.     

Elevated attention deficit hyperactivity disorder symptoms in children who stutter

PurposeThis study described the proportion of children who stutter who exhibit Attention Deficit Hyperactivity Disorder (ADHD) symptoms, manifesting in inattentive and hyperactive/impulsive behaviours. Children who stutter with these challenging behaviours may not respond as quickly and successfully to stuttering treatment. A preliminary exploration of differences in treatment responsiveness for children with and without ADHD symptoms was undertaken.MethodParticipants were 185 preschool children who stutter who had completed stuttering therapy within 3 months prior to study commencement. Differences between groups of children who stutter with and without elevated ADHD symptoms were investigated, in terms of pre-treatment stuttering features (stuttering severity and typography), demographic variables (age at onset, time between onset and commencement of therapy, family history and sex) and treatment data (post-treatment stuttering severity and number of sessions to achieve discharge criteria).ResultsOne-half (50%) of participants exhibited elevated ADHD symptoms. These children required 25% more clinical intervention time to achieve successful fluency outcomes than children without elevated ADHD symptoms. Findings suggest that more ADHD symptoms, increased pre-treatment stuttering severity, and male sex were associated with poorer responsiveness to stuttering treatment.ConclusionThe large proportion of children exhibiting elevated ADHD symptoms, and the increase in clinical contact time required in this subgroup to achieve successful fluency outcomes, is suggestive of the need for clinicians to tailor stuttering intervention to address these concomitant behaviour challenges. Findings support the use of careful caseload management strategies to account for individual differences between children, and strengthen prognostic information available to parents and clinicians.     

注意缺陷多动障碍-发展性阅读障碍共患儿童的干预效果及其内在机理

注意缺陷多动障碍和发展性阅读障碍是两类常见的儿童神经发育障碍, 二者共患率高达25%~48%。共患问题不仅使儿童自身面临着严重的认知、行为和心理损害, 还给家庭、学校和社会带来了沉重的负担, 对共患儿童的干预是极为必要且重要的。以共患病理机制假说为基础, 可将既往共患儿童的干预研究划分为以下两大类：(1)基于表型假说的干预方案, 如药物干预、阅读干预以及二者联合干预, 相应方案干预效果的迁移性和稳定性均有待深入考究; (2)基于共同缺陷假说的干预方案, 如针对核心共同认知缺陷之一的加工速度问题的干预已初显成效, 但相关研究较少, 干预效果需更多研究进一步系统性地考察。最后就共患儿童的干预方案现状进行了反思和展望。     

Secondary attention-deficit/hyperactivity disorder following perinatal and childhood stroke: impact on cognitive and academic outcomes

This cross-sectional retrospective clinical research study examines a large group of children followed within a pediatric stroke program and a developmental attention-deficit/hyperactivity disorder (ADHD) clinic at the Hospital for Sick Children, between May 2004 and June 2016. All children with a history of stroke who participated in a neuropsychological assessment between the ages of 4 and 18 years were considered for inclusion. From a sample of 275 participants with a history of stroke, 36 children (13.1%) received a diagnosis of secondary ADHD. Children with secondary ADHD were younger at the time of stroke and more likely to be identified as having a presumed perinatal stroke and persistent seizures than children without secondary ADHD diagnoses. There were no differences in pattern of lesion, size, or laterality between children who developed secondary ADHD and those who did not. Children with secondary ADHD had the lowest scores across all cognitive and academic measures compared to children with stroke-only and developmental ADHD. Findings highlight the added risk of receiving a diagnosis of secondary ADHD following pediatric stroke. Implications for future research and directed intervention are discussed.