持续性操作测试在学龄前儿童注意缺陷和多动障碍筛查中的应用及研究

Application and research of continuous performance test in screening attention deficit and hyperactivity disorder in preschool children

摘要

目的 探讨持续性操作测试在学龄前儿童注意缺陷和多动障碍(ADHD)筛查中的应用及研究。方法 选取2023年1月至2024年6月于苏州市吴中区妇幼保健所就诊,且以主诉为多动或注意力不集中的176例儿童的资料,依据«儿童青少年注意缺陷多动障碍诊疗指南»和«精神障碍诊断与统计手册(第5版)»中诊断标准,将其分为ADHD组142例,非ADHD组34例.比较两组学龄前儿童持续性注意力测评(K-CPT)、Conners评定量表父母症状问卷(PSQ)、注意力缺陷多动障碍评定量表-Ⅳ(SNAP-Ⅳ)(父母版)的得分,分析三种评估方法的一致性及对ADHD患儿的筛查能力。结果 ADHD组与非ADHD组的K-CPT测试、Conners量表PSQ和SNAP-Ⅳ(父母版)得分比较,差异均有统计学意义(t值分别为38.339、8.418、10.203,P<0.05).K-CPT测试、Conners量表PSQ、SNAP-Ⅳ(父母版)三种评估方法ADHD等级分布比较,差异无统计学意义(Hc=0.060,P>0.05).K-CPT测试、Conners量表PSQ、SNAP-Ⅳ(父母版)的Kappa系数分别为0.532、0.332、0.339,K-CPT测试的结果一致性良好.K-CPT测试、Conners量表PSQ、SNAP-Ⅳ(父母版)的筛选敏感性分别为0.873、0.782、0.754;K-CPT测试筛选的准确性(0.841)高于Conners量表PSQ(0.750)和SNAP-Ⅳ(父母版)(0.739),三种评估方法的阳性预测值均较高。结论 在大规模幼儿园儿童的ADHD初步筛查中,K-CPT测试具有更好的适用性和准确性.

Abstract

Objective To explore the application and research of the continuous performance test (CPT) in the screening of attention deficit and hyperactivity disorder (ADHD) among preschool children. Methods Data from 176 children who visited the Suzhou Wuzhong District Maternal and Child Health Care Center with chief complaints of hyperactivity or inattention from January 2023 to June 2024 were collected. Based on the diagnostic criteria in the Guidelines for the Diagnosis and Treatment of ADHD in Children and Adolescents and the Diagnostic and Statistical Manual of Mental Disorders (5th edition), the children were divided into the ADHD group (142 cases) and the non-ADHD group (34 cases). The scores of the Conners' kiddie continuous performance test (K-CPT), the Conners Parent Symptom Questionnaire (PSQ), and the Swanson Nolan and Pelham-Ⅳ (SNAP-Ⅳ) (parent version) were compared between the two groups. The consistency of the three assessment methods and their screening ability for children with ADHD were analyzed. Results Significant differences were found between the ADHD and non-ADHD groups in the scores of the K-CPT test, the Conners PSQ, and the SNAP-IV (parent version) (t=38.339, 8.418 and 10.203, respectively, P<0.05). However, no significant difference was observed in the ADHD severity distribution among the three assessment methods (Hc=0.060, P>0.05). The Kappa coefficients of the K-CPT test, Conners PSQ, and SNAP-Ⅳ (parent version) were 0.532, 0.332, and 0.339, respectively, indicating good consistency of the K-CPT test. The sensitivities of the K-CPT test, Conners PSQ, and SNAP-Ⅳ (parent version) in screening were 0.873, 0.782, and 0.754, respectively. The accuracy of the K-CPT test (0.841) was higher than that of the Conners PSQ (0.750) and SNAP-Ⅳ (parent version) (0.739). All three assessment methods had high positive predictive values. Conclusion The K-CPT test demonstrates better applicability and accuracy for preliminary ADHD screening in large-scale preschool populations.

关键词

学龄前儿童 / 持续性注意力测评 / 注意缺陷多动障碍 / 大规模筛查 / Conners评定量表父母症状问卷 / 注意力缺陷多动障碍评定量表-Ⅳ(父母版)

Key words

preschool children / continuous performance test / attention deficit hyperactivity disorder / large-scale screening / Conners Parent Symptom Questionnaire / Swanson Nolan and Pelham-Ⅳ(parent version)

参考文献

[1] Basu S, Phogat R, Jartarkar M, et al. Role of visual brain wave entrainment on the resting state brainwaves of children with and without attention-deficit/hyperactivity disorder[J]. Appl Neuropsychol Child, 2024, 1-19.

[2] Lv Y, Cheng W, Wang M, et al. Multimodal integrated intervention for children with attention-deficit/hyperactivity disorder[J]. World J Clin Cases, 2023, 11(18): 4267-4276.

[3] 孙钰英, 祝慧琴, 刘潘婷, 等. 学龄前儿童听处理评估量表在注意缺陷多动障碍儿童中的应用研究[J]. 中国当代儿科杂志, 2023, 25(8): 824-830.

[4] Varela L J, Magnante T A, Miskey M H, et al. A systematic review of the utility of continuous performance tests among adults with ADHD[J]. Clin Neuropsychol, 2024, 38(7): 1524-1585.

[5] Wang T S, Wang S S, Wang C L, et al. Theta/beta ratio in EEG correlated with attentional capacity assessed by conners continuous performance test in children with ADHD[J]. Front Psychiatry, 2024, 14: 1305397.

[6] 刘寰忠, 钟怡. 2018版加拿大儿科学会«儿童青少年注意缺陷多动障碍诊疗指南»解读[J]. 中国全科医学, 2019, 22(14): 1641-1647.

[7] Perera B, Courtenay K, Solomou S, et al. Diagnosis of attention deficit hyperactivity disorder in intellectual disability: diagnostic and statistical manual of mental disorder V versus clinical impression[J]. J Intellect Disabil Res, 2020, 64(3): 251-257.

[8] Barnard H, Rao R, Xu Y, et al. Association of the Conners' kiddie continuous performance test (K-CPT) performance and parent-report measures of behavior and executive functioning[J]. J Atten Disord, 2018, 22(11): 1056-1065.

[9] 朱琳, 李斐, 陈立. 4种常见评定量表在儿童注意缺陷多动障碍诊断与随访管理中的应用[J]. 重庆医科大学学报, 2020, 45(1): 32-35.

[10] Hall C L, Guo B, Valentine A Z, et al. The validity of the SNAP-Ⅳ in children displaying ADHD symptoms[J]. Assessment, 2020, 27(6): 1258-1271.

[11] 黄媛媛, 朱启东, 王凤晨, 等. 儿童注意缺陷多动障碍认知功能损害特征及其影响因素[J]. 安徽医科大学学报, 2023, 58(8): 1387-1392.

[12] Yanmei L, Xiaofang Y, Qishan L, et al. Prevalence and trends in diagnosed ADHD among US children and adolescents, 2017-2022[J]. JAMA Netw Open, 2023, 6(10): e2336872.

[13] 黄琦, 黄欣欣, 钱沁芳, 等. 注意缺陷多动障碍共患发育性协调障碍的学龄前儿童智力结构特征[J]. 中国儿童保健杂志, 2023, 31(2): 136-140.

[14] 许明慧, 韩梦蝶, 赵雪, 等. 注意力缺陷多动障碍评估工具的研究进展[J]. 护理研究, 2023, 37(2): 289-292.

[15] Osborne J L, Shields A S, Paltell K C, et al. 27 differentiating attention-deficit/hyperactivity disorder (ADHD) subtype using continuous performance tests among children with comorbid ADHD and anxiety[J]. J Int Neuropsychol Soc, 2023, 29(s1): 635-636.

[16] 王亚, 李婷, 朱若平, 等. 注意缺陷多动障碍伴孤独症特征患儿行为和家庭环境研究[J]. 安徽医学, 2023, 44(5): 515-518.

[17] 岳鑫鑫, 刘若楠, 刘倩溶, 等. 注意缺陷多动障碍儿童父母情绪调节困难和儿童情绪调节的关系[J]. 中国心理卫生杂志, 2024, 38(7): 553-558.

基金资助

2022年吴中区科技计划项目(医疗卫生领域)(WZYW2022005)