不同焦虑水平注意缺陷多动障碍患儿执行功能损害特征研究

Executive function impairments in children with attention-deficit/ hyperactivity disorder at different anxiety levels

摘要

目的 探讨伴不同焦虑水平的注意缺陷多动障碍(ADHD)儿童及健康对照儿童在多维度执行功能上的差异,为ADHD针对性干预提供依据。方法 采用横断面设计,纳入2017—2024年就诊的7~14岁ADHD患儿394例(根据Conners父母评定量表焦虑因子分,分为伴高焦虑组ADHD+ANX 100例、伴低焦虑组ADHD-ANX 294例)及健康对照儿童90例。所有对象均接受韦氏智力测验第四版(WISC-Ⅳ)、连线测验、Stroop色词测验和剑桥自动化神经心理测验(CANTAB)评估。采用协方差分析或Kruskal-Wallis检验比较组间差异,控制年龄和性别,并进行Bonferroni校正。结果 三组在WISC-Ⅳ总分(F=27.981,P<0.001)、连线测验转换时间(H=23.536,P<0.001)、Stroop色词干扰时(H=8.461,P=0.001)、CANTAB中视觉快速处理指标敏感度(RVPA,F=7.473,P=0.001)、非停止信号试次错误数(SSTDEG,F=9.458,P＜0.001)及五选择模式反应时间(如RTIFMDRT,F=14.843,P＜0.001)等多个指标上差异均有统计学意义,ADHD两组均低于健康对照组(P<0.05)。此外,在CANTAB的视觉快速处理的平均延迟(RVPMDL,P＜0.001),空间工作记忆组间错误数(SWMBE,P=0.003)和停止信号反应时间(SSTSSRT,P=0.011)等指标中,仅ADHD-ANX组与对照组相比差异有统计学意义(P<0.05),但在停止信号试次错误数(SSTDES)上,仅ADHD+ANX组表现差于对照组(P=0.001)。结论 ADHD儿童与健康对照组相比存在多维度执行功能损害。伴有高焦虑水平未提示更广泛的执行功能受损。

Abstract

Objective To investigate differences in multidimensional executive functions among children with attention-deficit/hyperactivity disorder (ADHD) at high or low anxiety levels compared to typically developing (TD) children, so as to provide evidence for targeted interventions in ADHD. Methods A cross-sectional study was conducted on 394 children (aged 7 - 14 years) diagnosed with ADHD between 2017 and 2024.Participants were categorized into a high-anxiety group (ADHD+ANX, n=100) and a low-anxiety group (ADHD-ANX, n=294) based on the anxiety factor scores from the Conners′ Parent Rating Scale.Additionally, 90 TD children were recruited as healthy controls.All participants were assessed using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-Ⅳ), Trail Making Test (TMT), Stroop Color-Word Test, and the Cambridge Neuropsychological Test Automated Battery (CANTAB).Group comparisons were conducted using analysis of covariance (ANCOVA) or the Kruskal-Wallis test, with age and sex controlled as covariates, and the Bonferroni correction was applied for multiple comparisons. Results There were significant group differences across multiple measures, including total scores on the WISC-Ⅳ (F=27.981, P<0.001), Trail Making Test switching time (H=23.536, P<0.001), Stroop color-word interference time (H=8.461, P=0.001), Rapid Visual Information Processing A-prime task of CANTAB (RVPA, F=7.473, P=0.001), number of errors in go-signal trials (SSTDEG, F=9.458, P<0.001), and five-choice reaction time measures (e.g., RTIFMDRT, F=14.843, P<0.001). Both ADHD groups performed worse than the healthy control group across these indices (all P<0.05). Additionally, for mean latency in the Rapid Visual Information Processing task (RVPMDL, P<0.001), Spatial Working Memory Between Errors (SWMBE, P=0.003), and stop-signal reaction time (SSTSSRT, P=0.011), statistically significant differences were observed only between the ADHD-ANX group and the control group (all P<0.05). In contrast, for errors in stop-signal trials (SSTDES), only the ADHD+ANX group showed significantly poorer performance compared with the control group (P=0.001). Conclusion Children with ADHD exhibit multidimensional executive function impairments compared with TD children, and a high anxiety level was not associated with more extensive executive dysfunction.

关键词

注意缺陷多动障碍 / 焦虑 / 执行功能 / 神经心理学测验

Key words

attention-deficit/hyperactivity disorder / anxiety / executive function / neuropsychological tests

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基金资助

深圳市科技计划(RCYX20221008092849069);深圳市医疗卫生三名工程项目(SZSM201612036);广东省高水平医院建设专项经费(2022)