屏幕时间与注意缺陷多动障碍共病抽动障碍患儿行为问题的剂量效应

Dose-response relationship between screen time and behavioral problems in children with attention-deficit/hyperactivity disorder comorbid with tic disorder

摘要

目的 分析注意缺陷多动障碍(ADHD)共病抽动障碍(TD)患儿屏幕使用特征及其与行为问题的关联,并初步探索屏幕使用时间与行为问题之间的潜在非线性关联,为临床干预提供参考。方法 采用临床病例对照设计,选取2024年8月—2026年5月在空军军医大学西京医院就诊及体检的172例6～12岁儿童,其中 ADHD 共病 TD 组(CAT 组)48例、单纯ADHD组46例、单纯TD组48例和健康对照组30例。问卷收集患儿每日使用屏幕时间和首次接触屏幕年龄,采用 SNAP-Ⅳ-26、耶鲁综合抽动严重程度量表(YGTSS) 及Achenbach儿童行为量表(CBCL)父母版量表评估患儿症状与行为问题,数据用方差分析、相关性分析和线性回归等处理。结果 CAT组屏幕日均使用时间(2.84±1.12)h,显著高于其他三组(P<0.001),各组首次接触屏幕年龄差异无统计学意义(P>0.05);控制混杂因素后,日均屏幕使用时间仍与CBCL 总分呈独立正相关(β=0.442,P<0.001);全样本分段回归分析提示,屏幕时长对行为问题的影响可能存在 2.5h/d 的临界阈值;按诊断分层,病情越重耐受阈值越低,CAT组阈值为2.5h/d且效应最突出。结论 屏幕使用时间是儿童行为问题的独立影响因素,ADHD 共病抽动障碍患儿对屏幕暴露更为敏感,2.5h/d 可作为该群体屏幕时间管理的探索性参考值,为临床干预提供初步依据。

Abstract

Objective To investigate screen use characteristics in children with attention-deficit/hyperactivity disorder (ADHD) comorbid with tic disorder (TD) and its association with behavioral problems, and to explore a potential nonlinear association between screen time and behavioral problems, in order to provide reference for clinical interventions. Methods A clinical case-control study was conducted involving 172 children aged 6 to 12 years recruited from outpatient clinics and routine physical examinations between August 2024 and May 2026. Participants were divided into four groups: the comorbid ADHD and TD group (CAT group, n=48), ADHD group (n=46), TD group (n=48), and healthy control group (n=30). Daily screen time and age at first screen exposure were collected using caregiver questionnaires. Symptom severity and behavioral problems were assessed using the 26-item Swanson, Nolan, and Pelham Rating Scale (SNAP-IV-26), the Yale Global Tic Severity Scale (YGTSS), and the parent version of Achenbach Child Behavior Checklist (CBCL). Data were analyzed using one-way analysis of variance (ANOVA), correlation analysis, and linear regression models. Results Theaverage daily screen time of the CAT group was (2.84±1.12) hours, significantly longer than that of the other three groups (P<0.001). Age at first screen exposure did not differ significantly among groups(P＞0.05). After adjusting for confounders, daily screen time was positively associated with the CBCL total score (β=0.442, P<0.001). Segmented regression analysis of the whole sample indicated a critical threshold of approximately 2.5h/d regarding the impact of screen time on behavioral problems. When stratified by diagnosis, disease severity inversely correlated with the tolerance threshold for screen exposure; the CAT group exhibited a threshold of 2.5h/d, where the threshold effect was most evident. Conclusion Daily screen time is an independent influencing factor for behavioral problems in children. Children with ADHD comorbid with TD exhibit higher sensitivity to screen exposure. The 2.5 h/d cutoff may serves as a potential reference for screen time management in this population, providing guidance for targeted clinical interventions.

关键词

注意缺陷多动障碍 / 抽动障碍 / 屏幕时间 / 行为问题 / 剂量-效应关系 / 儿童

Key words

attention-deficit/hyperactivity disorder / tic disorder / screen time / behavioral problems / dose-response relationship / child

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基金资助

国家自然科学基金-面上基金(82571761;82371545);空军军医大学临床研究项目(2022LC2210)