团体执行功能训练联合药物治疗注意缺陷多动障碍青少年的探索性研究

Exploratory study on group-based executive function training combined with medication for adolescents with attention-deficit/hyperactivity disorder

摘要

目的 探索团体执行功能训练(EFT-A)联合药物治疗对青少年注意缺陷多动障碍(ADHD)患者执行功能缺陷及核心症状的干预效果,为优化ADHD青少年综合干预方案提供依据。方法 采用方便抽样,选取2023年3月—2025年10月在上海新华医院临床心理科就诊的60例12~16岁ADHD青少年作为研究对象,分为联合治疗组与药物治疗组,每组30人。两组均接受盐酸哌甲酯控释片治疗,联合治疗组同时接受每周1次,共12次的团体EFT-A。采用执行功能行为评定量表、SNAP-Ⅳ量表、简易应对方式问卷和中学生学习动机测验于基线和干预12周后进行评估。采用2×2重复测量方差分析比较两组干预后的变化。结果 51名青少年及其家长完成了干预后问卷评估。重复测量分析结果发现,执行功能总分的组别×时间交互效应显著(F=4.22,P=0.045)。其中,联合治疗组在“反应抑制”(F=5.19,P=0.027)与“认知灵活”(F=8.09,P=0.006)维度上改善显著,交互效应具有统计学意义。联合治疗组在干预后注意缺陷得分(F=6.05,P=0.013)对立违抗得分(F=4.67,P=0.036)显著降低,交互效应具有统计学意义。此外,多动冲动症状、应对方式、学习动机交互效应不显著。结论 EFT-A联合药物治疗能针对性地提升ADHD青少年的反应抑制能力和认知灵活性,提高注意力,减少对立违抗行为,从而证明其可作为药物治疗的有效补充,促进执行功能改善。

Abstract

Objective To explore the effects of group-based executive function training for adolescents with attention-deficit/hyperactivity disorder (ADHD) (EFT-A) combined with medication on executive function deficits and related symptoms in adolescents with ADHD, so as to provide evidence for optimizing comprehensive intervention strategies. Methods Using convenience sampling, 60 adolescents aged 12 - 16 years with ADHD who attended the Department of Clinical Psychology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine between March 2023 and October 2025, were enrolled. Participants were assigned to a combined treatment group or a medication-only group. Both groups received osmotic-release oral system methylphenidate, and the combined treatment group additionally received 12 weekly sessions of group-based executive function training. Assessments at baseline and after 12 weeks included the Behavior Rating Inventory of Executive Function (BRIEF), SNAP-Ⅳ, Simplified Coping Style Questionnaire, and Middle School Students Motivation Test.A 2×2 repeated-measures analysis of variance was used to compare changes between groups. Results A total of 51 adolescents and their parents completed the post-intervention assessment. A significant group × time interaction was found for the total executive function score (F=4.22, P=0.045). Specifically, the combined treatment group showed statistically significant improvements in the response inhibition(F=5.19,P=0.027) and cognitive flexibility dimensions (F=8.09, P=0.006). Additionally, the combined treatment group exhibited significant reductions in post-intervention inattention scores (F=6.05, P=0.013) and oppositional defiant scores(F=4.67, P=0.036), with statistically significant interaction effects. However, no significant group × time interactions were observed for hyperactivity-impulsivity symptoms, coping styles, or learning motivation. Conclusions EFT-A combined with medication specifically enhance response inhibition and cognitive flexibility in adolescents with ADHD, improves attention, and reduces oppositional defiant behavior. These findings suggest that EFT-A may serve as a potential adjunctive intervention for adolescents with ADHD to improve executive functioning.

关键词

注意缺陷多动障碍 / 执行功能 / 青少年 / 团体干预

Key words

attention-deficit/hyperactivity disorder / executive function / adolescents / group intervention

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基金资助

上海市公共卫生体系建设三年行动计划(GWV-10.1-XK19)