注意缺陷多动障碍共患对立违抗障碍儿童的家庭环境因素
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摘要
目的:探讨注意缺陷多动障碍(ADHD)共患对立违抗障碍(ODD)的儿童家庭环境特点及家庭危险因素。方法:选取符合DSM-5诊断的140例ADHD儿童(伴ODD亚组34例、不伴ODD亚组106例),正常对照儿童45例,由父母填写一般情况问卷和家庭环境量表中文版(FES-CV)。采取多重回归分析探讨ADHD、ADHD共患ODD的家庭相关因素。结果:多重回归分析显示,儿童月龄越低(β=-0.03,P<0.01)、家庭亲密度(β=-0.50,P<0.05)和组织性(β=-0.49,P<0.01)越低、矛盾性(β=0.30,P<0.05)越高,患ADHD的风险越大;儿童家庭矛盾性(β=0.21,P<0.05)和控制性(β=0.20,P<0.05)越高,ADHD儿童共患ODD的风险越大。结论:儿童月龄低、家庭亲密度和组织性低、矛盾性高是ADHD的危险因素。家庭矛盾性和控制性高是ADHD共患ODD的危险因素。
Objective: To investigate the characteristics of family environment of children with attention-deficit/hyperactivity disorder(ADHD) and comorbid oppositional defiant disorder( ODD),and to analyze the risk factors for ADHD and ODD. Methods: Totally 140 children with ADHD(34 cases in ADHD with ODD group, 106 in ADHD without ODD group) meeting the diagnostic criteria of DSM-5 and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version( K-SADS-PL), and 45 normal children were selected. The general information questionnaire and Family Environment Scale-Chinese Version(FES-CV) were reported by parents. Results: Multiple regression analysis showed that children age(β=-0. 03, P < 0. 01), family cohesion(β=-0. 50,P<0. 05),and organization(β=-0. 49,P <0. 01) had negative association with ADHD diagnosis,while family conflict had positive association(β=0.30,P <0. 01). Family conflict(β=0. 21,P <0. 05) and control(β=0. 20,P < 0. 05) had positive association with comorbidity of ADHD and ODD. Conclusion: It suggests that younger age,lower family cohesion and organization may be risk factors for ADHD,and higher family conflict and control may be risk factors for comorbidity of ADHD and ODD.
Objective: To investigate the characteristics of family environment of children with attention-deficit/hyperactivity disorder(ADHD) and comorbid oppositional defiant disorder( ODD),and to analyze the risk factors for ADHD and ODD. Methods: Totally 140 children with ADHD(34 cases in ADHD with ODD group, 106 in ADHD without ODD group) meeting the diagnostic criteria of DSM-5 and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version( K-SADS-PL), and 45 normal children were selected. The general information questionnaire and Family Environment Scale-Chinese Version(FES-CV) were reported by parents. Results: Multiple regression analysis showed that children age(β=-0. 03, P < 0. 01), family cohesion(β=-0. 50,P<0. 05),and organization(β=-0. 49,P <0. 01) had negative association with ADHD diagnosis,while family conflict had positive association(β=0.30,P <0. 01). Family conflict(β=0. 21,P <0. 05) and control(β=0. 20,P < 0. 05) had positive association with comorbidity of ADHD and ODD. Conclusion: It suggests that younger age,lower family cohesion and organization may be risk factors for ADHD,and higher family conflict and control may be risk factors for comorbidity of ADHD and ODD.
引文
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[7]Pressman LJ,Loo SK,Carpenter EM,et al.Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD[J].J Am Acad Child Adolesc Psychiatry,2006,45(3):346-354.
[8]任桂英,钱铭怡,王玉凤,等.家庭环境与ADHD儿童某些心理特征相关性的研究[J].中国心理卫生杂志,2002,16(4):268-272.
[9]王峰,杜亚松,周国权,等.注意缺陷多动障碍家庭环境影响因素分析[J].中国儿童保健杂志,2016,24(6):579-582.
[10]熊伟,张恩,任忠林,等.注意缺陷多动障碍患儿家庭环境因素分析[J].临床精神医学杂志,2015,25(4):269-270.
[11]郭全芳,张云红,张增.家庭干预对ADHD患儿家庭环境及父母教养方式的影响[J].中国心理卫生杂志,2008,22(6):423-428.
[12]黄丽.ADHD共病ODD儿童认知行为特点与心理社会因素的相关性研究-以ADHD儿童为对照[D].青岛:青岛大学,2015.
[13]张跃兵,罗学荣,管冰清,等.伴对立违抗障碍的ADHD患儿相关家庭环境因素对照研究[J].中国临床心理学杂志,2008,16(6):659-661.
[14]黄广文,苏林雁,王伯兰,等.伴ADHD的对立违抗性障碍儿童行为特征分析[J].中国心理卫生杂志,2005,19(4):259-261.
[15]费立鹏,沈其杰,郑延平,等.家庭亲密度和适应性量表和家庭环境量表的初步评价---正常家庭与精神分裂症家庭成员对照研究[J].中国心理卫生杂志,1991,5(5):198-202.
[16]Association AP.Diagnostic and Statistical M anual of M ental Disorders(DSM-IV)[M].Arlington VA:American Psychiatric Association,2013.
[17]Kaufman J,Birmaher B,Brent D,et al.Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version(K-SADS-PL):initial reliability and validity data[J].J Am Acad Child Adolesc Psychiatry,1997,36(7):980-988.
[18]Simon V,Czobor P,Bálint S,et al.Prevalence and correlates of adult attention-deficit hyperactivity disorder:meta-analysis[J].Br JPsychiatry,2009,194(3):204-211.
[19]Harvey EA,M etcalfe LA,Herbert SD,et al.The role of family experiences and ADHD in the early development of oppositional defiant disorder[J].J Consult Clin Psychol,2011,79(6):784-795.
[2]Barkley RA,Fischer M,Smallish L,et al.Young adult outcome of hyperactive children:adaptive functioning in major life activities[J].J Am Acad Child Adolesc Psychiatry,2006,45(2):192-202.
[3]常卫利,李岳玲,钱秋谨,等.持续到成人早期的注意缺陷多动障碍的相关因素[J].中国心理卫生杂志,2011,25(12):942-946.
[4]Larsson JO,Larsson H,Lichtenstein P.Genetic and environmental contributions to stability and change of ADHD symptoms betw een8 and 13 years of age:a longitudinal tw in study[J].J Am Acad Child Adolesc Psychiatry,2004,43(10):1267-1275.
[5]Azeredo A,M oreira D,Barbosa F.ADHD,CD,and ODD:systematic review of genetic and environmental risk factors[J].Res Dev Disabil,2018,82:10-19.doi:10.1016/j.ridd.2017.12.010.
[6]刘津.共患对立违抗性障碍的注意缺陷多动障碍研究-临床特点、危险因素与临床干预[D].北京大学,2004.
[7]Pressman LJ,Loo SK,Carpenter EM,et al.Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD[J].J Am Acad Child Adolesc Psychiatry,2006,45(3):346-354.
[8]任桂英,钱铭怡,王玉凤,等.家庭环境与ADHD儿童某些心理特征相关性的研究[J].中国心理卫生杂志,2002,16(4):268-272.
[9]王峰,杜亚松,周国权,等.注意缺陷多动障碍家庭环境影响因素分析[J].中国儿童保健杂志,2016,24(6):579-582.
[10]熊伟,张恩,任忠林,等.注意缺陷多动障碍患儿家庭环境因素分析[J].临床精神医学杂志,2015,25(4):269-270.
[11]郭全芳,张云红,张增.家庭干预对ADHD患儿家庭环境及父母教养方式的影响[J].中国心理卫生杂志,2008,22(6):423-428.
[12]黄丽.ADHD共病ODD儿童认知行为特点与心理社会因素的相关性研究-以ADHD儿童为对照[D].青岛:青岛大学,2015.
[13]张跃兵,罗学荣,管冰清,等.伴对立违抗障碍的ADHD患儿相关家庭环境因素对照研究[J].中国临床心理学杂志,2008,16(6):659-661.
[14]黄广文,苏林雁,王伯兰,等.伴ADHD的对立违抗性障碍儿童行为特征分析[J].中国心理卫生杂志,2005,19(4):259-261.
[15]费立鹏,沈其杰,郑延平,等.家庭亲密度和适应性量表和家庭环境量表的初步评价---正常家庭与精神分裂症家庭成员对照研究[J].中国心理卫生杂志,1991,5(5):198-202.
[16]Association AP.Diagnostic and Statistical M anual of M ental Disorders(DSM-IV)[M].Arlington VA:American Psychiatric Association,2013.
[17]Kaufman J,Birmaher B,Brent D,et al.Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version(K-SADS-PL):initial reliability and validity data[J].J Am Acad Child Adolesc Psychiatry,1997,36(7):980-988.
[18]Simon V,Czobor P,Bálint S,et al.Prevalence and correlates of adult attention-deficit hyperactivity disorder:meta-analysis[J].Br JPsychiatry,2009,194(3):204-211.
[19]Harvey EA,M etcalfe LA,Herbert SD,et al.The role of family experiences and ADHD in the early development of oppositional defiant disorder[J].J Consult Clin Psychol,2011,79(6):784-795.