不同性别注意缺陷多动障碍儿童的差异研究

Study on difference in attention deficit hyperactivity disorder between different genders of children

摘要

目的 探讨不同性别注意缺陷多动障碍(ADHD)患儿在核心症状、智力得分、功能损害及行为问题的差异,为不同性别ADHD患儿的识别和诊疗提供依据。方法 选择2020年10月至2022年10月于四川省妇女儿童医院儿童保健科就诊的568例6~11岁ADHD患儿为研究对象,其中男性468名(82.4%),女性100名(17.6%).使用韦克斯勒儿童智力量表(WISC-R)、SNAP-Ⅳ评定量表、Weiss功能缺陷程度评定量表父母版(WFIRS-P)、Conners父母症状问卷(PSQ)和Achenbach儿童行为量表(CBCL)分别评估并比较不同性别ADHD患儿的智力水平、核心症状、功能损害和行为问题。结果 与男性患儿相比,女性患儿注意缺陷型占比较高、多动型及混合型占比较低,差异有统计学意义(χ²=33.391,P<0.05);女性患儿年龄相比男性较大,差异有统计学意义(χ²=3.998,P<0.05);不同性别ADHD患儿智力得分在语言分量表、操作分量表及全量表得分均无统计学差异(P>0.05),ADHD女性组智力发展不平衡者检出率较ADHD男孩组略低,但差异无统计学意义(P>0.05);核心症状方面,女性ADHD患儿注意缺陷维度得分高于男性患儿,差异有统计学意义(t=-2.782,P<0.05);在功能损害评估方面,女性ADHD患儿在学习/学校维度得分低于男性患儿,在生活技能维度得分高于男性患儿,差异有统计学意义(t值分别为2.53、-4.35,P<0.05);在行为问题方面,女性ADHD患儿在PSQ学习问题、心身问题及焦虑维度得分均高于男性患儿,差异有统计学意义(t值分别为-2.08、-3.33、-3.07,P<0.05);女性ADHD患儿在CBCL抑郁、社交退缩及躯体主诉维度的得分高于男性患儿,在多动、违纪及攻击性维度的得分低于男性患儿,差异均有统计学意义(t值分别为-4.11、-6.63、-4.32、4.31、10.40、10.51,P<0.05)。结论 与男性注意缺陷多动障碍患儿相比,女性患儿注意缺陷型占比较高,年龄较大,在学习/学校方面的功能损害较重,心身问题、焦虑、抑郁、社交退缩等情况较明显.

Abstract

Objective To investigate differences in core symptoms,intelligence score,functional impairments and behavioral problems of children with attention deficit hyperactivity disorder(ADHD)between different genders,so as to provide a basis for identification,diagnosis and treatment of ADHD in children of different genders. Methods 568 ADHD children aged 6 to 11 years old who visited Department of Child Health Care of Sichuan Provincial Women and Children's Hospital from October 2020 to October 2022 were selected as study subjects.Among them,468 children were male,accounting for 82.4%,and 100 children were female,accounting for 17.6%.Wechsler Intelligence Scale for Children-Revised Version(WISC-R),Swanson Nolan and Pelham Rating Scale-Version Ⅳ(SNAP-Ⅳ),Weiss Functional Impairment Rating Scale-Parent Report(WFIRS-P),Conners Parent Symptom Questionnaire(PSQ)and Achenbach Child Behavior Checklist(CBCL)were employed to assess and compare intelligence level,core symptom,functional impairment and behavioral problem of ADHD children of different genders respectively. Results Compared with the male children with ADHD,the female children with ADHD had a higher proportion of predominantly inattentive presentation type,and lower proportions of predominantly hyperactive-impulsive presentation type and combined presentation type,there was a statistically significant difference(χ²=33.391,P<0.05).The female children with ADHD were older than the male children with ADHD,and the difference was also statistically significant(χ²=3.998,P<0.05).In scores in verbal subscale,operational subscale and whole scale(P>0.05)of WISC-R,there were no statistically significant differences between the different genders of children with ADHD,only the detection rate of imbalanced intellectual development in ADHD girls was slightly lower than that in ADHD boys,but the difference was not significant(P>0.05).In terms of core symptoms,the score in inattentive dimension of the female ADHD children was higher than that of the male ADHD children,and the difference was statistically significant(t=-2.782,P<0.05).In terms of functional impairment assessment,the female ADHD children had lower score in learning/school dimension and higher score in life skill dimension compared with the male children with ADHD,the differences were statistically significant(t=2.53 and -4.35 respectively,both P<0.05).Regarding behavioral problems,the female ADHD children had higher scores in learning problems,psychosomatic problems and anxiety dimensions of the PSQ than the male ADHD children,and the differences were statistically significant(t=-2.08,-3.33 and -3.07 respectively,all P<0.05).The female ADHD children had higher scores in depression,social withdrawal and somatic complaint dimensions of CBCL than the male ADHD children,while they had lower scores in hyperactivity,delinquent behavior and aggression dimensions than the male ADHD children,and the differences were statistically significant(t=-4.11,-6.63,4.32,4.31,10.40 and 10.51 respectively,all P<0.05). Conclusion Compared with the male ADHD children,the female ADHD children have a higher proportion of predominantly inattentive presentation type of ADHD,they are older in age and suffer from more severe functional impairments in learning/school-related aspects,and present more pronounced psychosomatic problems,anxiety,depression and social withdrawal.

关键词

儿童 / 注意缺陷多动障碍 / 性别 / 差异

Key words

children / attention deficit hyperactivity disorder / gender / difference

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基金资助

成都市医学科研立项(2022478)