The Predictive Value of Temperament in Children with Attention Deficit Hyperactivity Disorder
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摘要:
目的 探讨气质在注意缺陷多动障碍儿童中的特点，了解其在儿童注意缺陷多动障碍中的预测价值。 方法 选取注意缺陷多动障碍（attention deficit/hyperactivity disorder，ADHD）儿童183例、规律治疗半年的ADHD儿童45例和正常对照45例，采用儿童气质问卷（BSQ、MCTQ）测查，同时对治疗前后ADHD儿童填写Weiss功能缺陷量表（父母版）。 结果 气质类型构成方面ADHD儿童治疗前、后及对照组，3组差异有统计学意义（P < 0.001）。在进一步分析中，易养型治疗前与治疗后和对照组，差异具有统计学意义（P < 0.05），治疗后与正常组比较，差异无统计学意义（P > 0.05）。难养型治疗前与正常组比较，差异有统计学意义（P < 0.05），治疗半年后难养型比例降低，易养型比例增加，治疗后半年及正常组以易养型为主，差异无统计学意义（P > 0.05）。气质维度方面，治疗前与治疗后在活动水平、节律性、趋避性、适应性、反应强度、情绪本质、坚持性7个维度的差异有统计学意义（P < 0.05）。治疗前与对照组在活动水平、节律性、适应性、情绪本质、坚持性、注意分散度6个维度的差异具有统计学意义（P < 0.05）。气质量表各维度与Weiss功能缺陷评定量表相关系数为 0.156～0.428（P < 0.05），多元线性回归预测模型显示气质量表的适应性、反应强度、坚持性、活动水平、情绪本质对Weiss功能缺陷评定量表各功能具有预测作用（P < 0.05）。 结论 注意缺陷多动障碍儿童气质维度及类型构成明显异于正常同龄儿童，治疗半年后气质维度及类型构成即有明显变化，且气质各维度对ADHD儿童功能损害有预测作用。 Abstract:Objective To explore the temperament characteristics of children with attention deficit hyperactivity disorder （ADHD） and to understand its predictive value in children with ADHD. Methods 183 children with ADHD , 45 children with ADHD and treated regularly for half a year and 45 normal controls were selected. They were measured by BSQ\MCTQ. At the same time, Weiss functional defect assessment scale was filled in for ADHD children before and after the treatment. Results In terms of temperament type composition, there was a statistically significant difference among the three groups of ADHD children before and after the treatment, as well as the control group （P < 0.001）. In further analysis, there was a statistically significant difference between the easy type before and after the treatment, and the normal group （P < 0.05）, but there was no statistically significant difference between the treated and normal groups （P > 0.05）; The difference between the difficult type before the treatment and the normal group was statistically significant （P < 0.05）. After six months of the treatment, the proportion of difficult type decreased, while the proportion of easy type increased. After six months of the treatment, the easy type was the main type compared to the normal group, and the difference was not statistically significant （P > 0.05）. In terms of temperament dimensions, there were statistically significant differences between pre treatment and post treatment in seven dimensions: activity level, rhythm, avoidance, adaptability, reaction intensity, emotional essence, and persistence （P < 0.05）. Before the treatment, there were statistically significant differences between the control group and the control group in six dimensions of activity level, rhythm, adaptability, emotional essence, persistence, and attention Dispersity （P < 0.05）.The correlation coefficient between the dimensions of the Temperament scale and WFIRS-P was 0.156～0.428 （P < 0.05）. The multiple linear regression prediction model showed that the adaptability, reaction intensity, persistence, activity level, and emotional essence of the temperament scale had predictive effects on the functions of the WFIRS-P （P < 0.05）. Conclusion The temperament dimension and type composition of children with attention deficit hyperactivity disorder are significantly different from those of normal children of the same age. After half a year of the treatment, the temperament dimension and type composition change significantly, and each dimension of temperament can predict the functional damage of ADHD children. -
Key words:
- Attention deficit/hyperactivity disorder /
- Temperament /
- Children /
- Scale
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表 1 性别、入组年龄及ADHD分型一般描述[
$\bar x \pm s $ /n（%）]Table 1. Gender，age and ADHD classification description [
$\bar x \pm s $ /n（%）]特征 治疗前（n = 183） 治疗后（n = 45） 对照组（n = 45） χ2/F P 性别 男 170（92.9） 38（84.4） 38（84.4） 5.092 0.071 女 13（7.1） 7（15.6） 7（15.6） 年龄 8.10 ± 1.36 9.19 ± 1.64 8.43 ± 1.518* 10.556 0.000 类型
混合型
注意力缺陷型
多动/冲动型
部分缓解
67（36.6）
100（54.6）
16（8.7）
0（0.0）
3（6.7）
9（20.0）
2（4.4）
31（68.9）
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表 2 不同组儿童气质构成比较 [n（%）]
Table 2. Comparison of temperament composition of children in different groups [n（%）]
气质分型 治疗前（n = 183） 治疗后（n = 45） 对照组（n = 45） χ2 P 易养型 14（7.7） 15（33.3）* 19（42.2）* 难养型 71（38.8） 11（24.4） 6（13.3）* 启动缓慢型 8（4.4） 2（4.4） 3（6.7） 43.407 0.000* 中间偏易养型 86（47.0） 15（33.3） 15（33.3） 中间偏难养型 4（2.2） 2（4.4） 2（4.4） 与治疗前比较，*P < 0.05。
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表 3 ADHD儿童治疗前、后和正常儿童的气质维度比较（
$\bar x \pm s $ ）Table 3. Comparison of temperament dimensions between ADHD children before and after treatment and normal children （
$\bar x \pm s $ ）量表 治疗前
（n = 183）治疗后
（n = 45）对照组
（n = 45）F P 活动水平 4.17 ± 0.69 3.49 ± 0.72# 3.37 ± 0.68# 34.499 0.000* 节律性 3.53 ± 0.70 3.28 ± 0.54# 3.00 ± 0.61#& 12.492 0.000* 趋避性 2.92 ± 0.72 2.53 ± 0.71# 2.87 ± 0.72& 5.147 0.006* 适应性 3.36 ± 0.70 2.89 ± 0.65# 2.78 ± 0.63# 18.535 0.000* 反应强度 4.04 ± 0.83 3.49 ± 0.91# 3.86 ± 0.94& 7.418 0.001* 情绪本质 3.33 ± 0.66 2.95 ± 0.54# 3.02 ± 0.60# 9.344 0.000* 坚持性 3.88 ± 0.71 3.07 ± 0.68 # 2.76 ± 0.75#& 57.496 0.000* 注意分散度 4.31 ± 0.75 4.26 ± 0.85 3.96 ± 0.63# 3.901 0.021* 反应阈值 3.64 ± 0.68 3.68 ± 0.87 3.69 ± 0.71 0.104 0.901 与治疗前比较，#P < 0.05；与治疗后比较，&P < 0.05；*P < 0.05。
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表 4 气质量表各维度与Weiss功能缺陷评定量表各因子相关分析（r）
Table 4. Correlation analysis between dimensions of gas quality scale and factors of Weiss functional defect assessment scale （r）
量表 家庭 学习学校 生活技能 自我管理 社会活动 冒险活动 总分 活动水平 .250** .156* .270** .110 .132 .277** .309** 节律性 .016 .056 .206** .064 .033 .077 .112 趋避性 −.053 −.123 −.059 .181* .115 −.079 −.062 适应性 .326** .205** .327** .292** .365** .241** .428** 反应强度 .412** .124 .254** .195** .244** .264** .373** 情绪本质 .206** .170* .329** .268** .294** .275** .357** 坚持性 .201** .171* .246** .050 .205** .184* .283** 注意分散度 .023 .064 .083 .144 .050 .051 .094 反应阈值 .099 −.027 .071 .012 .031 .000 .074 *P < 0.05，**P < 0.01。
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表 5 气质与weiss量表多元线性回归分析
Table 5. Multiple linear regression analysis of temperament and Weiss scale
WEISS功能 变量 β（回归系数） SE值 标准β值 t P 家庭 适应性 1.792 0.510 0.241 3.515 0.001* 反应强度 2.013 0.431 0.321 4.676 0.000* 学习学校 适应性 1.963 0.526 0.275 3.732 0.000* 生活技能 适应性 1.317 0.423 0.234 3.116 0.002* 反应强度 0.918 0.329 0.193 2.786 0.006* 坚持性 1.050 0.407 0.189 2.580 0.011* 自我管理 适应性 0.849 0.209 0.288 4.052 0.000* 社会活动 适应性 1.791 0.377 0.334 4.750 0.000* 反应强度 0.691 0.319 0.153 2.168 0.031* 冒险活动 活动水平 0.971 0.277 0.252 3.511 0.001* 情绪本质 0.768 0.290 0.191 2.652 0.009* 总分 适应性 6.960 1.611 0.306 4.320 0.000* 反应强度 5.195 1.256 0.271 4.135 0.000* 坚持性 3.510 1.552 .156 2.261 0.025* *P < 0.05。
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