注意缺陷多动障碍儿童注意控制能力与行为社会功能及视频脑电图的相关性研究

Association of attention and response control with behavioral problems, social functioning, and video electroencephalogram in children with attention-deficit/hyperactivity disorder

摘要

目的 探讨注意缺陷多动障碍(ADHD)儿童注意控制能力与行为问题、社会功能及视频脑电图(V-EEG)异常的关联,为临床评估与个体化干预策略制定提供参考。方法 采用回顾性病例分析方法,纳入2022年6月—2025年6月就诊于武汉市第一医院儿童保健中心的130例ADHD儿童,依据美国《精神障碍诊断与统计手册》(第5版)分为注意缺陷型(ADHD-I,49例)、多动/冲动型(ADHD-HI,36例)和混合型(ADHD-C,45例)。所有儿童均完成视听整合连续测试(IVA-CPT)、Conners父母症状问卷(PSQ)、Weiss功能性缺陷量表(WFIRS-P)及V-EEG检查。比较不同亚型在行为问题、社会功能及V-EEG异常率上的差异,并采用偏相关分析(控制年龄和总智商)探讨IVA-CPT注意力和控制力商数与PSQ、WFIRS-P各维度的相关性,并采用偏点二列相关分析评价其与V-EEG异常的相关性。结果 三组儿童的性别、年龄、总智商差异无统计学意义(P>0.05)。PSQ显示,ADHD-C和ADHD-HI组在品行问题、冲动-多动及多动指数得分均高于ADHD-I组(P<0.05),ADHD-C组在学习问题和冲动-多动得分最高(P<0.05)。WFIRS-P显示,ADHD-C组在学习/学校维度得分高于ADHD-HI组,冒险活动维度得分高于其他两组(P<0.05)。三组间V-EEG异常率差异无统计学意义(18.4%、22.2%、28.9%,P=0.476)。偏相关分析(控制年龄和总智商)显示:控制力商数与品行问题、冲动-多动、多动指数及生活技能损害呈负相关(偏r=-0.536~-0.309,P<0.05);注意力商数与学习问题、学习/学校及冒险活动损害呈负相关(偏r=-0.520~-0.233,P<0.05);偏点二列相关分析显示:注意力、控制力商数与V-EEG异常呈负相关(偏点二列r=-0.339~-0.220,P<0.05)。结论 ADHD不同亚型在行为问题和社会功能损害上存在异质性,混合型儿童在部分维度表现出更明显损害。注意控制能力与部分行为社会功能指标及V-EEG异常存在相关性,提示其可能参与ADHD临床表现异质性的形成。但V-EEG异常在不同亚型间缺乏特异性,尚不足以作为分型标志。

Abstract

Objective To investigate the association of attention control ability with behavioral problems, social functioning, and video electroencephalography (V-EEG) abnormalities in children with attention-deficit/hyperactivity disorder (ADHD), so as to provide reference for clinical assessment and individualized intervention. Methods A total of 130 children with ADHD who attended the Child Health Center of Wuhan First Hospital from June 2022 to June 2025 were enrolled, and their clinical data were retrospectively collected. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the children were classified as inattentive type (ADHD-I, n=49), hyperactive/impulsive type (ADHD-HI, n=36), and combined type (ADHD-C, n=45). All participants completed the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Conners Parent Symptom Questionnaire (PSQ), and Weiss Functional Impairment Rating Scale–Parent Report (WFIRS-P) and underwent video electroencephalography (V-EEG). Behavioral problems, social functioning, and V-EEG abnormality rates were compared among the three ADHD types. After adjustment for age and full-scale intelligence quotient (IQ), partial correlation analyses were used to examine the associations of IVA-CPT attention and response-control quotients with PSQ and WFIRS-P scores. Partial point-biserial correlation analyses were used to assess the associations between these quotients and V-EEG abnormalities. Results No significant differences were found in sex, age, or total IQ among the three groups (P>0.05). Compared with the ADHD-I group, the ADHD-C and ADHD-HI groups had higher scores for conduct problems, hyperactivity/impulsivity, and the hyperactivity index (P<0.05), while the ADHD-C group had higher learning-problem and hyperactivity/impulsivity scores than both other groups (P<0.05). In terms of WFIRS-P, the ADHD-C group scored higher than the ADHD-HI group in the learning/school domain and higher than both other groups in the risk-taking domain (P<0.05). The V-EEG abnormality rates were 18.4%, 22.2%, and 28.9% in the ADHD-I, ADHD-HI, and ADHD-C groups, respectively, with no significant difference among the three groups (P=0.476). After adjustment for age and full-scale IQ, response-control quotients were negatively correlated with conduct problems, hyperactivity/impulsivity, hyperactivity index, and impairment in life skills (partial r=-0.536 to -0.309, P<0.05). Attention quotients were negatively correlated with learning problems and impairment in the learning/school and risk-taking domains (partial r=-0.520 to -0.233, P<0.05). Both attention and response-control quotients were negatively correlated with V-EEG abnormalities (partial point-biserial r=-0.339 to -0.220, P<0.05). Conclusions Different ADHD subtypes exhibit heterogeneity in behavioral problems and social functioning impairments, with the combined subtype being the most severely affected in several domains. Attention and response-control quotients are associated with several measures of behavioral problems and social functioning impairment and with V-EEG abnormalities, suggesting that differences in attention and response control may be related to the clinical heterogeneity of ADHD. However, V-EEG abnormality rates do not differ significantly across ADHD subtypes, limiting their utility for distinguishing different subtypes.

关键词

注意缺陷多动障碍 / 异质性 / 注意控制能力 / 行为问题 / 社会功能 / 视频脑电图

Key words

attention-deficit/hyperactivity disorder / heterogeneity / attention and response control / behavioral problems / social functioning / video-electroencephalogram

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基金资助

湖北省自然科学基金(2025AFC101);湖北省儿科联盟医学科研项目(HPAMRP202410)