成人注意缺陷多动障碍在内外源冲突时的表现:眼动的证据

在注意定向与维持上,注意缺陷多动障碍(ADHD)个体更容易受到外部刺激的干扰而导致目标任务加工进程受阻,表现出了注意定向反应的缺陷,但导致任务失败的原因是由于对突然出现的外部无关刺激的过度兴奋还是对内源性目标刺激的持续维持能力减弱,尚不清楚。研究采用反向眼跳范式、记忆导向眼跳范式和视觉导向眼跳范式,来探索成人ADHD内外源注意定向反应的情况,以及当二者发生冲突时,成人ADHD失败的可能机制。结果发现,在反向眼跳任务上,成人注意缺陷多动障碍组错误率更高,并且差异性显著。但在记忆导向眼跳任务中,成人注意缺陷多动障碍组与正常组的差异不显著。在视觉导向眼跳任务中,成人注意缺陷多动障碍组的正确眼跳潜伏期比正常组要短,且二者之间的差异显著。这说明,在内外源刺激反应的冲突导致的情境中,成人注意缺陷多动障碍的反应明显落后于正常个体,这种缺陷并非由于其维持内源性注意产生定向反应落后所导致的,而是与其外源注意定向反应过强有关。     

注意缺陷多动障碍的神经机制及干预

注意缺陷多动障碍是一种常见的神经性、发展性障碍。大脑异常被认为是注意缺陷多动障碍的病因之一。随着脑成像技术的发展,当前对该障碍的脑解剖结构病变、脑神经发育迟缓和脑网络连接异常等方面都展开了深入研究。文章从以上三个方面介绍最新研究成果,并指出目前的不足和未来研究方向,在此基础上为提高诊断精确性和发展新型有效的治疗干预方法提供建议。     

国内注意缺陷多动障碍研究的综述

本文对国内近年来有关注意缺陷多动症的研究进行综述。首先介绍注意缺陷多动症的定义、诊断及成因。其次从执行功能、智力、共病性及发展性等四个方面阐述现有注意缺陷多动症研究的主要内容以及治疗该病症的主要方法,如生理治疗、亲子培训和学校辅导等。最后针对国内注意缺陷多动障碍研究不足和发展方向展开讨论。     

阅读障碍与注意缺陷多动障碍儿童的语言加工和反应抑制

阅读障碍与注意缺陷多动障碍(ADHD)高度共病,以往研究结果显示两种障碍在语言加工、执行功能等领域的缺陷既相似又不同。本研究采用语音意识测验、快速命名测验、语素意识测验和停止信号任务,以及阅读广度测验,分别考察四组被试（阅读障碍组、ADHD组、双重障碍组、正常控制组）的基础语言加工、反应抑制和言语工作记忆能力,结果发现：阅读障碍组和双重障碍组在语言加工任务上的成绩均显著差于ADHD组和正常组;ADHD组和双重障碍组在停止信号任务上的成绩显著差于阅读障碍组和正常组;所有障碍组在阅读广度测验上的成绩显著差于正常组。表明阅读障碍的特异性缺陷体现在语言加工过程上,而注意缺陷多动障碍的特异性缺陷体现在反应抑制上。这对于今后单一障碍的研究及临床诊断和干预具有重要的参考价值。     

注意力缺损多动障碍与巴克利的行为反应抑制模型

长期以来,人们一直认为ADHD(注意力缺损多动障碍)的主要表现在于注意力过程的缺损,将焦点放在多动和注意过程上。20世纪90年代以来,人们对此症有了新发现。巴克利等人认为注意力后面的自控能力的低下和自我管理的缺陷才是本症的实质所在。该文从这一新的视角分析并阐明了该障碍的实质:行为执行机制的缺陷,并据此对该障碍的矫正提出了新看法。     

两种符号检索条件下注意缺陷多动障碍和阅读障碍儿童的表现

在传统工作记忆刷新和选择性注意任务上,在匹配反应阶段均涉及符号检索的心理加工过程,注意缺陷多动障碍和阅读障碍儿童的工作记忆和注意缺陷已经被证实,本研究关注于两种障碍儿童是否存在符号检索能力的缺陷。研究比较了18名ADHD儿童、11名阅读障碍儿童和17名控制组儿童在RSVP任务中序列搜索和平行搜索的成绩差异,搜索条件通过实验材料（字母和数字）和呈现方式加以操控。结果表明,在平行搜索和序列搜索条件下,障碍儿童的成绩均低于正常控制组,两组障碍儿童成绩差异不显著;在搜索效应上,三组儿童的差异不显著,这说明注意缺陷     

注意缺陷多动障碍(ADHD)儿童的工作记忆:基础加工缺陷还是执行功能问题

为探索注意缺陷多动障碍(ADHD)儿童言语工作记忆缺陷的机制,研究采用了言语n-back任务比较了正常儿童与注意缺陷多动障碍儿童的工作记忆成绩。结果表明:在更新水平为0次时,ADHD儿童与正常儿童的成绩没有显著差异,但在更新水平为1次和2次时,ADHD儿童的记忆成绩均显著低于正常儿童,效应量指标(Cohen′d)分别达到了1.31和1.63;另外,在更新难度对记忆成绩的影响上,ADHD儿童表现出了更大的更新代价,效应量指标(Cohen′d)达到了1.54,处在很高的水平。结论认为ADHD儿童在记忆的基础性加工上并不存在明显缺陷,其更大的更新代价表明ADHD儿童在言语工作记忆的执行加工(更新操作)上的缺陷。     

儿童注意缺陷多动障碍(ADHD)的“冷”“热”执行功能

近30多年来,对注意缺陷多动障碍(ADHD)的认知缺损机制的关注一直停留在"冷"执行功能领域,为更全面地揭示其执行缺损机制,文章旨在从"冷""热"执行功能的角度来探讨ADHD的缺陷。论文简要回顾了注意缺陷多动障碍的界定、生理基础和若干理论模型,着重阐述ADHD儿童在经典"冷""热"两类执行功能任务上的表现差异。总结认为ADHD儿童并非在所有类型的"热"执行任务上表现落后,ADHD儿童的表现要视情感和动机的卷入对不同任务情景的作用性质是消极还是积极而定,文章也比较分析了几位研究者相关的理论解释。     

注意力缺损多动障碍的影响因素研究

本研究利用自编的儿童注意力缺损多动障碍量表对一到六年级的433名被试进行了测试.对注意缺损多动障碍儿童的年龄、年级、性别、成绩及其父母的年龄、文化程度、受教育年限、职业等影响因素进行了探讨.     

儿童多动综合症

多动综合症又称注意缺陷障碍,常见于儿童,特别是小学年龄的男孩。该病对儿童的发育、学习、心理等方面均有很大影响,因此引起医学界人士和心理学家的广泛注意。与大多数其它儿童行为失调疾病相比,多动症受到了更深入的研究。本文就多动症的术语、诊断、病因、预后及治疗作一综合介绍,目的是加深对儿童多动症的认识,并对当前的研究工作提出一点看法。     

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%。     

The role of a lifetime history of oppositional defiant and conduct disorders in adults with ADHD: implications for clinical practice

IntroductionAttention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are frequently co-occurring disorders in children and adolescents. However, their clinical status among adults is still under discussion. This study analyzes how the current clinical presentation of adult ADHD might be influenced by a lifetime history of CD and ODD. METHODS: We compared three groups of patients: ADHD without history of CD/ODD (n = 178), ADHD + history of ODD (n = 184), and ADHD + history of CD (n = 96). RESULTS: A history of CD (and to a lower extent ODD) is associated with a more severe and externalizing profile.ConclusionPast CD and ODD entail a significant negative mental health impact on persistent ADHD, reinforcing the importance of actively assessing the developmental history of adult ADHD patients.     

Attention Deficit Hyperactivity Disorder in Adults: Implications for Theories of Diagnosis

The diagnosis of attention deficit hyperactivity disorder (ADHD) in adults has been a source of controversy, with some prominent researchers questioning its very existence and others suggesting it is an urgent clinical problem. This article reviews five domains of data addressing the validity of adult ADHD: clinical correlates, family history, treatment response, laboratory studies, and long-term outcome. It then shows how the debate over adult ADHD reflects a clash of theoretical paradigms and concludes by suggesting ways in which psychological science can collect the data needed to clarify the validity of adult ADHD.     

Diagnosis and Treatment of Adults With Attention Deficit Hyperactivity Disorder

It is estimated that between 30% and 50% of children diagnosed with attention deficit hyperactivity disorder (ADHD) will continue to exhibit symptomatology that is disruptive throughout their adult lives. Identification and diagnosis of adult ADHD, as well as primary and secondary characteristics and comorbid disorders, are discussed in this article. Counseling strategies are suggested to help clinicians treat adults with ADHD, such as educating the client about the disorder and providing training in attention management techniques, self-management skills, interpersonal and social skills, stress and time management, anger management, and problem-solving skills. Clinicians are encouraged to prepare themselves for understanding, identifying, diagnosing, and treating the adult population with ADHD.     

Adult ADHD and/or Sleep Apnea? Differential Diagnostic Considerations with Six Case Studies

An increased interest in the persistence of attention-deficit hyperactivity disorder (ADHD) into adulthood brings concern that adult ADHD may become overdiagnosed. As with ADHD in childhood, various other adult psychological and medical disorders may be associated with ADHD in adulthood, and these related disorders may be mislabeled and mistreated as simple ADHD. One such medical condition is sleep apnea. This paper reviews similarities and differences between ADHD and sleep apnea and presents case histories of six adult patients diagnosed with ADHD who were subsequently found to have at least comorbid obstructive sleep apnea (OSA). Clinicians who diagnose and treat patients with ADHD are advised to become familiar with sleep apnea as a life-threatening condition that presents with overlapping symptoms.     

Confirming the Factor Structure of Attention Deficit Hyperactivity Disorder Symptoms in Adult, Nonclinical Samples

Three separate models have been proposed to describe the factor structure of attention deficit hyperactivity disorder (ADHD) in the past 20 years. The Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III, 1980) proposed 3 separate factors of inattention, hyperactivity, and impulsivity. The DSM-III-R (1987) proposed a single factor. The DSM-IV (1994) described the disorder as having 2 factors: hyperactivity/impulsivity and inattention. The following 2 studies employed confirmatory factor analysis to compare each of these models and 3 alternative models. University students completed questionnaires that assessed each of the 18 symptoms listed in the DSM-IV for ADHD. The 3-factor model fit the data significantly better than each of the other models in both studies. These findings suggest that a 3-factor model of inattention, hyperactivity, and impulsivity describes adult ADHD symptoms better than current alternatives.     

Adults With Attention‐Deficit/Hyperactivity Disorder: Assessment and Treatment Strategies

Attention‐deficit/hyperactivity disorder (ADHD) among adults is characterized by inattentiveness and impulsivity. This article provides counselors with information about the etiology, assessment, and treatment of adult ADHD. The identification of the genetic and neurological features of ADHD has led to improvements in evaluation and treatment. Assessment of ADHD requires knowledge of the defining characteristics, subtypes, comorbid features, and functional aspects of ADHD. Effective treatments include both medical management and counseling to address psychosocial deficits.     

Inhibition and attention deficit hyperactivity disorder in adults

The inhibitory account of attention deficit hyperactivity disorder (ADHD) was tested by examining the performance of college-aged adults on a variety of inhibitory tasks. The poorer performance of adults with ADHD compared with controls on negative priming, stopping, and continuous performance tasks, combined with similar group performances on a test of working memory capacity, indicates a specific inhibitory deficit as opposed to a general limitation in attentional capacity. Overall results provide evidence for extending the inhibitory deficit hypothesis to adult ADHD, not only for mechanisms of response (or motor) inhibition but also for mechanisms of cognitive inhibition.     

Employment Counseling for Adults With Attention-Deficit/Hyperactivity Disorder: Issues Without Answers

This article provides an overview of issues employment counselors will face in counseling adults with attention-deficit/hyperactivity disorder (ADHD). There is little research on counseling clients with ADHD, and counselors are often ill prepared to provide appropriate services for this growing and underserviced population. Reviewed is the evolution of the ADHD label and its prevalence in adults. Diagnostic criteria are presented, and a selected review of adult outcome and treatment research is provided. Strategies for counseling adults with ADHD about careers are adapted, with caution, from literature on counseling adults with learning disabilities (LD), and specific guidelines for the employment counselor are presented.