注意缺陷多动障碍的研究与治疗

注意缺陷多动障碍(ADHD)的发病群体多为5岁以后的儿童,主要临床表现是多动、冲动,注意力无法集中,对一项任务不能够有规划进行下去,而且脾气暴躁、易怒.近年来.心理学界、神经科学界和教育学界等对ADHD的研究取得了很多进展.本文概括性地介绍了ADHD病症的基本特征,目前对于患者脑机制损害的研究,并从药理学和行为学等方面讨论了ADHD的治疗方法和手段.     

正念冥想在ADHD儿童干预中的应用

正念冥想是有意识、非评判地将注意集中于当下经验的方法。近年来,正念冥想作为一种潜在的方法被引进到ADHD儿童干预领域。因为ADHD儿童的特异性,为了增加正念冥想方案对ADHD儿童的适切性,研究者从练习设置、奖励系统、解释方式和家长纳入几个方面对标准的正念减压训练方案做了改编。越来越多的研究证据表明,正念冥想训练能有效地减轻ADHD儿童的核心缺陷、改善其内外化症状和亲子关系。本文通过对已有相关实证研究的分析认为这些积极的影响可能与ADHD儿童的执行功能与去中心化等心理功能的改善有关,而大脑相关区域激活模式的变化和结构的积极改变可能是正念冥想影响ADHD儿童的神经基础。文章也提出已有研究在内容和方法学上的不足及其以后的探究方向。     

不同亚型ADHD儿童的视通道时距估计能力

本研究选取ADHD混合型儿童11名,ADHD注意缺损型儿童13名以及正常儿童15名,通过"平均估计长度"、"平均估计误差百分比"、"估计变异值"三个指标,考察不同亚型ADHD儿童在时距复制和言语估计上的稳定性和精确性。研究发现,在视觉刺激条件下,ADHD儿童的时距估计缺损并不受时距长度的影响;ADHD混合型儿童在多项任务中所表现的稳定性和精确性都差,而ADHD缺损型儿童只是稳定性差,说明ADHD混合型是ADHD中更严重的亚类型;ADHD儿童在时距估计任务中稳定性差,反映了其状态调节能力的落后。     

认知能量模型--一种更为综合的ADHD认知理论

认知能量模型是J.A.Sergeant等人提出的一种解释ADHD缺陷机制的综合性实证理论。该模型基于信息加工理论,结合了状态因素理论和几种相对成熟的模型,尝试对ADHD提供一种较为理想的解释。本文在此对该模型的基本观点、模型结构及其有关的实证研究进行介绍,并探讨认知能量模型对于未来ADHD研究的启示。     

两种亚型ADHD儿童的促进和抑制加工

采用图片Stroop任务,对两种亚型ADHD儿童的促进和抑制加工进行了研究。结果发现,不论在反应时还是错误率上,ADHD儿童和正常儿童在促进效应上的表现模式相似,但ADHD儿童在错误率上比正常儿童表现出更大的抑制效应,混合型ADHD儿童的抑制效应更大于注意缺陷型儿童。由于ADHD儿童仅选择性地在抑制加工上受损,而促进加工正常,这一结果提示,促进和抑制可能是具有不同机制的、分离的加工过程。     

ADHD的抑制缺陷和厌恶延迟—来自双通道理论的解释

行为抑制理论认为抑制功能的落后是ADHD的核心缺损所在,Sonuga-Barke的厌恶延迟理论认为ADHD起因是厌恶延迟而非抑制缺损,但该理论并不能解释ADHD的全部症状,Sonuga-Barke将厌恶延迟理论作了修正,提出了双通道模型。该模型认为ADHD的抑制缺陷和厌恶延迟同时存在,相互独立,模型的认知发展通道关注抑制控制缺陷对ADHD的影响,而动机发展通道则认为ADHD儿童是因奖励回路紊乱而引起异常的厌恶延迟的动机风格。本文介绍了双通道理论及相关的研究及其应用于ADHD诊断和干预的价值和局限性。     

基于直线临摹的ADHD儿童眼手协调能力研究

ADHD儿童在精细动作方面通常伴随眼手协调运动障碍。以往采用的研究方法多为定性研究,且未在ADHD儿童的运动协调性与同龄正常儿童的差异上得出统一结论。本研究针对精细动作中眼手协调能力进行定量分析。实验要求被试在计算机触摸屏上分别临摹水平线、垂直线和斜线,通过记录临摹直线与呈现直线的偏差程度和拐点数,以分析ADHD儿童眼手协调能力与正常儿童之间的差异。结果表明,ADHD儿童在眼手协调和空间知觉能力上与正常儿童存在显著性差异。此外,本研究表明,改进的定量方法具有良好的可行性。     

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。     

“冷”/“热”执行功能缺陷影响ADHD儿童核心症状的作用机制

注意缺陷多动障碍(ADHD)是一种以注意缺陷和(或)多动、冲动为核心症状的神经发育障碍,与前额叶发育异常所致的执行功能缺陷密切相关。基于此,从神经-认知-行为的发展途径提出执行功能缺陷可能是认知层面上导致ADHD核心症状的发病机理,其中与背侧前额叶相关的“冷”执行功能缺陷可能是导致注意缺陷核心症状的主导因素,而与腹内侧前额叶相关的“热”执行功能缺陷可能是导致多动、冲动核心症状的主导因素。一方面,“冷”执行功能缺陷主要引起工作记忆表征维持失败、抑制控制能力不足、认知转换困难等方面,这些缺陷进一步导致了个体在注意持续、注意选择和注意转移上受到限制;另一方面,“热”执行功能缺陷则带来厌恶延迟、奖赏加工异常、动机失调等问题,使得个体行为抑制失败,更容易做出冲动性选择,从而表现出多动、冲动等核心症状。未来研究应进一步检验和完善“冷”、“热”执行功能缺陷影响ADHD核心症状的理论模型以及从认知神经层面上提供更多的实证证据,同时还需从生态层面考察“冷”和“热”执行功能缺陷对ADHD核心症状的交互影响,并基于执行功能开发对ADHD核心症状具有个性化、精准化、长效化的干预方案。     

注意缺陷多动症与犯罪的关系及其司法启示

注意缺陷多动症(Attention deficit hyperactivity disorder, ADHD) 是一种常见于儿童期的精神障碍, 也可能持续到青少年及成年阶段, 其症状表现为难于集中注意力、难于控制其行为及活动过度等, 这些缺陷可能会增加患者犯罪的几率。轻微脑功能障碍、自我调节学说、强化敏感性理论、相关人格特质等在一定程度上可解释ADHD与犯罪的关系。ADHD作用于犯罪存在三种不同的可能路径, 即独立作用、间接作用和无作用。文中特别指出ADHD患者在刑事司法过程中表现的特点及其司法启示。未来研究应从基因、神经心理机制及其与环境的交互作用上进一步探讨ADHD与犯罪的关系, 并提示在犯罪预防、审讯、法庭审判以及罪犯矫治中需要考量ADHD的可能影响。     

A Twin Study of ADHD Symptoms in Early Adolescence: Hyperactivity-impulsivity and Inattentiveness Show Substantial Genetic Overlap but Also Genetic Specificity

A previous paper in this journal revealed substantial genetic overlap between the ADHD dimensions of hyperactivity-impulsivity and inattentiveness in a sample of 8-year old twins drawn from a UK-representative population sample. Four years later, when the twins were 12 years old, more than 5,500 pairs drawn from the same sample were rated again on the DSM-IV based Revised Conners’ Parent Rating Scale to assess symptoms on both ADHD dimensions. Heritabilities were high (around 70%) for both hyperactivity-impulsivity and inattentiveness and evidence for etiological sex differences was absent. The critical finding was a genetic correlation of 0.55, indicating that hyperactivity-impulsivity and inattentiveness are substantially influenced by the same genes but that the two dimensions also show large and significant unique genetic effects. These results in early adolescence confirm our findings in middle childhood, providing evidence for substantial genetic overlap as well as genetic heterogeneity of the ADHD dimensions. Future genetic studies should investigate the ADHD dimensions separately.     

Response inhibition in children with and without ADHD after traumatic brain injury

Children with attention‐deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S‐ADHD). Similarity in inhibitory control in children with TBI, S‐ADHD, and ADHD would implicate impaired frontal‐striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre‐injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6–14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S‐ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S‐ADHD.     

The Predictive Validity of Parent and Teacher Reports of ADHD Symptoms

The objectives were to evaluate the ability of the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV to differentiate children with ADHD from a control group and to discriminate children with different subtypes of ADHD. Also, we sought to determine optimal cutoff scores on the teacher and parent versions of this scale for making diagnostic decisions about ADHD. In a sample of 92 boys and girls 6 to 14 years of age referred to a regional ADHD program, we assessed ADHD diagnostic status using categorical and dimensional approaches as well as parent- and teacher-report measures. Logistic regression analyses showed that the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV were effective in discriminating children with ADHD from a control group and differentiating children with ADHD, Combined Type from ADHD, Inattentive Type. Although both teacher and parent ratings were significantly predictive of diagnostic status, teacher ratings made a stronger contribution to the prediction of subtype membership. Using symptom utility estimates, optimal cutoff scores on the Inattention and Hyperactivity–Impulsivity scales for predicting subtypes of ADHD were determined.     

Impulsivity and Attention Deficit-Hyperactivity Disorder: Subtype Classification Using the UPPS Impulsive Behavior Scale

This study examined the classification accuracy of the UPPS Impulsive Behavior Scale (UPPS) in discriminating several attention deficit/hyperactivity disorder (ADHD) subtypes, including predominantly inattentive type (ADHD/I), combined type (ADHD/C), and combined type with behavioral problems (ADHD/ODD), between each other and a non-ADHD control group using logistic regression analyses. The sample consisted of 88 children ranging in age from 9.0 years to 12.8 years, with a mean of 10.9 years. Children were predominantly male (74%) and Caucasian (86%) and in grades 3–7. Results indicated that the UPPS performed well in classifying ADHD subtypes relative to traditional diagnostic measures. In addition, analyses indicated that differences in symptoms between subtypes can be explained by specific pathways to impulsivity. Implications for the assessment of ADHD and conceptual issues are discussed.     

How many fidgets in a pretty much: A critique of behavior rating scales for identifying students with ADHD

The school psychologist's role and responsibilities for meeting the needs of students with Attention-Deficit Hyperactivity Disorder (ADHD) have been expanding in recent years. Students with this disorder present refractory problems that may involve the school psychologist in the assessment and diagnosis of ADHD. Rating scales commonly are used, sometimes in conjunction with other techniques, for assessing and diagnosing ADHD. They often are presented as an objective way to quantify the severity of a child's behavior in comparison with a normative standard. Because rating scales have become such an integral component in the identification of children with ADHD, school psychologists should understand the limitations associated with this methodology. In this article we first describe behavior rating scales and difficulties in the use of cutoff scores to identify students as ADHD. Second, we describe how problems with interobserver agreement hamper the validity of rating scales and the subsequent conclusions that can be drawn about students' behavior. Finally, we present recommendations for obtaining more reliable and valid information from rating scales.     

Attention deficit hyperactivity disorder and the frontal lobe syndrome.

The usefulness of frontal lobe (FL) dysfunction as a conceptual model for Attention Deficit Hyperactivity Disorder (ADHD) was investigated. Twenty-four ADHD and 24 normal control (NC) children were tested using two batteries of tasks. The first was sensitive to FL deficits in motor control and problem solving skills. The second consisted of memory tasks sensitive to temporal lobe dysfunction. ADHD children differed significantly from NCs on measures of FL function, but not on tests of temporal lobe functions. Where norms were available for normal children on the same FL tests, ADHDs performed like 6- to 7-year-olds, despite their mean age of 10 years and minimum age of 8 years. The differential performance of ADHDs on tasks sensitive to FL and temporal lobe dysfunction supports the hypothesis that ADHD deficits are analogous to FL dysfunction and demonstrates that the children's deficits do not reflect generalized cognitive impairment.     

Interrelationships between Reading Disability and Attention-Deficit/Hyperactivity Disorder

Evidence from a number of investigations suggests a considerable overlap between reading disability (RD) and attention deficit-hyperactivity disorder (ADHD). We investigate the relationship between RD and ADHD in a cohort of 186 children 7.5–9.5 years of age, recruited explicitly to address classification and definitional issues in these disorders. Using multivariate methods, we examine the hypothesis that RD and ADHD represent separate diagnostic entities that frequently co-occur in the same individual. The results suggest that RD is characterized by deficits within the language system, in particular a subcomponent within that system, phonological processing; in contrast, such linguistic deficits are not characteristic of ADHD unless ADHD is associated with RD. When children with both RD and ADHD are examined, both the linguistic deficits associated with RD and the behavioral characteristics associated with ADHD are apparent, but these deficits are not synergistic. We conclude that RD and ADHD represent separate disorders that frequently co-occur.     

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.     

Risky decision-making in children with and without ADHD: A prospective study

Learning from past decisions can enhance successful decision-making. It is unclear whether difficulties in learning from experience may contribute to risky decision-making, which may be altered among individuals with attention-deficit/hyperactivity disorder (ADHD). This study follows 192 children with and without ADHD aged 5 to 10 years for approximately 2.5 years and examines their risky decision-making using the Balloon Emotional Learning Task (BELT), a computerized assessment of sequential risky decision-making in which participants pump up a series of virtual balloons for points. The BELT contains three task conditions: one with a variable explosion point, one with a stable and early explosion point, and one with a stable and late explosion point. These conditions may be learned via experience on the task. Contrary to expectations, ADHD status was not found to be related to greater risk-taking on the BELT, and among younger children ADHD status is in fact associated with reduced risk-taking. In addition, the typically-developing children without ADHD showed significant learning-related gains on both stable task conditions. However, the children with ADHD demonstrated learning on the condition with a stable and early explosion point, but not on the condition with the stable and late explosion point, in which more pumps are required before learning when the balloon will explode. Learning during decision-making may be more difficult for children with ADHD. Because adapting to changing environmental demands requires the use of feedback to guide future behavior, negative outcomes associated with childhood ADHD may partially reflect difficulties in learning from experience.     

Confirmation of an Inhibitory Control Deficit in Attention-Deficit/Hyperactivity Disorder

The objective of this study was to determine whether deficient inhibitory control distinguishes children with a diagnosis of attention-deficit/hyperactivity (ADHD) disorder, conduct disorder (CD), and comorbid ADHD + CD from normally developing children. Participants were rigorously diagnosed children (age 7 to 12 years) with ADHD (N = 72), CD (N = 13) or ADHD + CD (N = 47) and 33 control children (NC). We studied inhibitory control using the stop-signal paradigm, a laboratory task that assessed the ability to inhibit an ongoing action. The ADHD group had significantly impaired inhibitory control compared to NC, CD, and ADHD + CD children. These results indicate that children with ADHD have deficient inhibition as measured in the stop-signal paradigm and that ADHD occurring in the presence of ADHD + CD may represent a phenocopy of CD rather than a variant of ADHD.