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中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (01) : 39 -46. doi: 10.3877/cma.j.issn.1673-5250.2024.01.006

论著

整合视听连续执行测试结果与注意力缺陷多动障碍患儿认知功能特点关系
刘子奇1, 刘思奇2, 陶梦娇1, 任永颖1, 李冠男1, 孙静1, 王昕1, 张建昭1, 杨健1,†()   
  1. 1. 首都儿科研究所附属儿童医院神经内科，北京　100020
    2. 首都医科大学附属北京友谊医院儿科，北京　100050
  • 收稿日期:2023-11-20 修回日期:2024-01-10 出版日期:2024-02-01
  • 通信作者: 杨健

The relationship between integrated visual and auditory continuous performance test results and cognitive function characteristics of children with attention deficit hyperactivity disorder

Ziqi Liu1, Siqi Liu2, Mengjiao Tao1, Yongying Ren1, Guannan Li1, Jing Sun1, Xin Wang1, Jianzhao Zhang1, Jian Yang1,†()   

  1. 1. Department of Neurology, Children′s Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
    2. Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2023-11-20 Revised:2024-01-10 Published:2024-02-01
  • Corresponding author: Jian Yang
  • Supported by:
    General Program of National Natural Science Foundation of China(82271579); Capital Health Development Research Project(2020-1-4111)
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刘子奇, 刘思奇, 陶梦娇, 任永颖, 李冠男, 孙静, 王昕, 张建昭, 杨健. 整合视听连续执行测试结果与注意力缺陷多动障碍患儿认知功能特点关系[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(01): 39-46.

Ziqi Liu, Siqi Liu, Mengjiao Tao, Yongying Ren, Guannan Li, Jing Sun, Xin Wang, Jianzhao Zhang, Jian Yang. The relationship between integrated visual and auditory continuous performance test results and cognitive function characteristics of children with attention deficit hyperactivity disorder[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(01): 39-46.

目的

探讨整合视听连续执行测试(IVA-CPT)结果正常与异常的注意力缺陷多动障碍(ADHD)患儿认知功能的差异，以及注意力缺陷、多动-冲动症状严重程度不同患儿认知功能的差异。

方法

选择2022年1月至2023年6月于首都儿科研究所附属儿童医院神经内科门诊、保健科门诊及多学科ADHD联合门诊就诊的192例ADHD患儿为研究对象。所有患儿均接受韦氏儿童智力测试(WISC-CR)、IVA-CPT、认知功能测试(长程)和SNAP-Ⅳ评定量表父母版评估。根据ADHD患儿IVA-CPT结果正常与否，将其分别纳入IVA正常组(n＝58，IVA-CPT结果正常)与IVA异常组(n＝134，IVA-CPT结果异常)。根据ADHD患儿SNAP-Ⅳ评定量表父母版测试中注意力缺陷维度评分结果，将其分别纳入注意力正常组(n＝46，≤13分)，轻度异常组(n＝54，>13～18分)，中度异常组(n＝53，≥18～23分)，重度异常组(n＝39，≥18～23分)。根据ADHD患儿SNAP-Ⅳ评定量表父母版测试中多动-冲动维度评分结果，将其分别纳入多动-冲动正常组(n＝61，≤13分)，轻度异常组(n＝51，>13～18分)，中度异常组(n＝48，≥18～23分)与重度异常组(n＝32，≥23分)。采用Mann-Whitney U检验或Kruskal-Wallis H检验，对上述分组患儿认知功能评分进行比较，组间进一步两两比较，采用Bonferroni法校正检验水准(校正后检验水准为0.008)。所有受试儿家长均知情同意，并签署临床研究知情同意书。本研究遵循的程序符合首都儿科研究所伦理委员会制定的伦理学标准，并获得该伦理委员会批准(审批文号：SHERLL2023005)。

结果

①IVA正常组ADHD患儿的基本反应能力、序列关系、比较大小、短时记忆容量(倒背)及威斯康星卡片分类测试评分，均高于IVA异常组，并且差异均有统计学意义(Z＝－2.17、P＝0.030，Z＝－2.69、P＝0.007，Z＝－3.30、P＝0.001，Z＝－2.32、P＝0.020，Z＝－2.58、P＝0.010)。②注意力正常组与轻度、中度及重度异常组ADHD患儿的注意分配测验评分比较，差异有统计学意义(χ2＝8.66，P＝0.034)，进一步两两比较结果显示，差异无统计学意义(P>0.008)，其中注意力重度异常组患儿注意分配测验评分低于注意力正常组(P＝0.009)。③多动-冲动正常组与轻度、中度及重度异常组ADHD患儿的短时记忆容量(正背)和短时记忆容量(倒背)评分比较，差异均有统计学意义(χ2＝8.14、7.98，P＝0.043、0.046)，进一步两两比较结果显示，差异均无统计学意义(P>0.008)。

结论

IVA-CPT结果正常的ADHD患儿认知功能水平较IVA-CPT结果异常者更好；注意力受损的ADHD患儿认知功能损害可能更为明显。

关键词: 注意力缺陷障碍伴多动, 认知功能, 认知功能障碍, 记忆，短时, 任务切换, 儿童
Objective

To investigate the difference of cognitive function between normal and abnormal results of integrated visual and auditory continuous performance test (IVA-CPT) in children with attention deficit hyperactivity disorder (ADHD), and the difference of cognitive function in children with different severity of attention deficit and hyperactive-impulsive symptoms.

Methods

A total of 192 children with ADHD who visited the Department of Neurology, Department of Health Care and multidisciplinary ADHD joint clinic of the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2022 to June 2023 were selected as the study subjects. All children were assessed by Wechsler intelligence test for children (WISC-CR), IVA-CPT, cognitive function test (long range) and parent version of Swanson Nolan and Pelham, version Ⅳ scale (SNAP-Ⅳ). According to the results of IVA-CPT, the children with ADHD were divided into normal IVA group (n=58, normal result of IVA-CPT) and abnormal IVA group (n=134, abnormal result of IVA-CPT). According to the attention deficit dimension score of the parent version of SNAP-Ⅳ for children with ADHD, they were divided into the normal attention group (n=46, ≤13 points), mild abnormal attention group (n=54, >13-18 points), moderate abnormal attention group (n=53, ≥18-23 points), and severe abnormal attention group (n=39, ≥23 points). According to the score of hyperactive-impulsive dimension of the parent version of SNAP-Ⅳ for ADHD children, they were divided into normal hyperaction-impulsion group (n=61, ≤13 points), mild abnormal hyperaction-impulsion group (n=51, >13-18 points), moderate abnormal hyperaction-impulsion group (n=48, ≥18-23 points), and severe abnormal hyperaction-impulsion group (n=32, ≥23 points). Score of cognitive function of the above groups were compared by Mann-Whitney U test or Kruskal-Wallis H test, and further pairwise comparison between groups was conducted by Bonferroni method for adjusting the test level (the adjusted test level was 0.008). Informed consent was obtained from the parents of all children. The study protocol was approved by the Ethics Committee of the Capital Institute of Pediatrics (Approval No. SHERLL2023005).

Results

①The basic reaction ability, sequence relation, comparison size, short-term memory capacity (backward memory) and Wisconsin Card Sorting Test score of ADHD children in normal IVA group were higher than those in abnormal IVA group, and the differences were statistically significant (Z=-2.17, P=0.030; Z=-2.69, P=0.007; Z=-3.30, P=0.001; Z=-2.32, P=0.020, Z=-2.58, P=0.010). ②There were significant differences in the scores of attention allocation test among the normal attention group, and mild, moderate and severe abnormal attention groups (χ2=8.66, P=0.034), but there was no significant difference in further pairwise comparison between each two groups (P>0.008), and score of attention allocation test of severe abnormal attention group was lower than that of normal attention group (P=0.009). ③There were significant differences in the scores of short-term memory capacity (forward memory) and short-term memory capacity (backward memory) among ADHD children in normal hyperactive-impulsive group, and mild, moderate and severe hyperactive-impulsive groups (χ2=8.14, 7.98; P=0.043, 0.046), but there was no significant difference in further pairwise comparison between each two groups (P>0.008).

Conclusions

ADHD children with normal IVA-CPT results have better cognitive functions than those with abnormal IVA-CPT results. Cognitive impairment may be more obvious in ADHD children with attention impairment.

Key words: Attention deficit disorder with hyperactivity, Cognitive functions, Cognitive dysfunction, Memory, short-term, Task switching, Child
表1 2组ADHD患儿WISC-CR评分与认知功能评分比较(分)
组别 例数 WISC-CR评分(±s) 基本反应能力[M(Q1，Q3)] 空间认知能力[M(Q1，Q3)] 数学认知能力[M(Q1，Q3)] 语言理解能力[M(Q1，Q3)] 数字推理能力[M(Q1，Q3)] 序列关系[M(Q1，Q3)]
IVA正常组 58 100.3±9.7 5.0(4.0，6.0) 5.5(4.0，7.0) 5.0(4.0，6.0) 5.0(4.0，6.0) 6.0(4.0，7.0) 6.0(5.0，6.5)
IVA异常组 134 98.3±12.1 5.0(4.0，5.0) 5.0(4.0，7.0) 4.0(3.0，5.0) 5.0(4.0，6.0) 5.0(4.0，6.0) 5.0(4.0，6.0)
统计量   t＝1.02 Z＝－2.17 Z＝－0.80 Z＝－1.76 Z＝－0.56 Z＝－1.10 Z＝－2.69
P值   0.311 0.030 0.423 0.079 0.577 0.273 0.007
组别 例数 比较大小[M(Q1，Q3)] 物体数量认知[M(Q1，Q3)] 瑞文推理测验[M(Q1，Q3)] 注意分配测验[M(Q1，Q3)] 短时记忆容量(正背)[M(Q1，Q3)] 短时记忆容量(倒背)[M(Q1，Q3)] 威斯康星卡片分类测验[M(Q1，Q3)]
IVA正常组 58 5.0(4.0，6.0) 5.0(4.0，6.0) 6.0(5.0，7.0) 6.0(5.0，6.0) 5.0(4.0，6.0) 6.0(5.0，7.0) 6.0(5.0，7.0)
IVA异常组 134 4.5(4.0，5.0) 5.0(4.0，6.0) 5.0(4.0，7.0) 6.0(5.0，6.0) 5.0(4.0，6.0) 5.0(4.0，6.0) 6.0(4.5，6.0)
统计量   Z＝－3.30 Z＝－0.84 Z＝－1.83 Z＝－1.90 Z＝－0.86 Z＝－2.32 Z＝－2.58
P值   0.001 0.402 0.067 0.058 0.398 0.020 0.010
表2 注意力正常组、轻度异常组、中度异常组及重度异常组ADHD患儿认知功能评分比较[分，±s/M(Q1，Q3)]
组别 例数 基本反应能力 空间认知能力 数学认知能力 语言理解能力 数字推理能力 序列关系 比较大小
①注意力正常组 46 5.0(4.5，6.0) 7.0(5.0，8.0) 4.6±2.2 5.2±2.0 6.0(5.0，7.0) 5.6±1.1 5.0±1.4
②注意力轻度异常组 54 5.0(4.0，5.0) 6.0(4.0，7.0) 4.0(3.8，5.0) 4.7±1.7 6.0(4.0，6.0) 5.0(4.0，6.0) 5.0(4.0，5.0)
③注意力中度异常组 53 5.0(4.3，5.0) 5.0(4.0，7.0) 4.0(3.0，5.0) 4.5(4.0，7.0) 5.0(4.0，6.8) 5.0(5.0，6.0) 4.0(4.0，5.0)
④注意力重度异常组 39 5.0(4.0，6.0) 4.9±2.0 4.8±2.1 5.0±1.8 4.7±2.2 5.0(4.0，6.0) 5.0(4.0，5.0)
χ2值   2.33 5.34 3.43 1.11 4.19 5.56 3.94
P值   0.507 0.115 0.330 0.774 0.241 0.135 0.268
组别 例数 物体数量认知 瑞文推理测验 注意分配测验 短时记忆容量(正背) 短时记忆容量(倒背) 威斯康星卡片分类测验
①注意力正常组 46 5.0(4.3，7.0) 6.2±1.5 6.0(6.0，6.0) 5.5(4.0，7.0) 5.5(5.0，6.0) 6.0(5.5，7.0)
②注意力轻度异常组 54 5.0(4.0，5.5) 6.0(4.0，7.0) 6.0(5.0，6.0) 5.0(4.0，6.0) 5.0(4.5，6.0) 5.5(4.0，6.5)
③注意力中度异常组 53 5.0(4.0，6.0) 6.0(4.0，7.0) 6.0(6.0，6.0) 5.0(4.0，6.0) 5.0(5.0，6.0) 5.5(4.5，7.0)
④注意力重度异常组 39 5.0(4.0，5.0) 6.0(4.3，7.0) 5.0(4.0，6.0) 5.0±1.5 5.0(4.0，6.0) 5.0(5.0，7.0)
χ2值   5.61 2.17 8.66 2.35 4.48 2.74
P值   0.132 0.538 0.034 0.503 0.214 0.434
表3 多动-冲动正常组、轻度异常组、中度异常组及重度异常组ADHD患儿认知功能评分比较[分，±s/M(Q1，Q3))]
组别 例数 基本反应能力 空间认知能力 数学认知能力 语言理解能力 数字推理能力 序列关系 比较大小
①多动-冲动正常组 61 5.0(4.0，5.0) 6.0(4.0，7.0) 5.0(4.0，5.0) 5.0(4.0，7.0) 6.0(5.0，6.0) 5.0(4.0，6.0) 5.0(4.0，6.0)
②多动-冲动轻度异常组 51 5.0(5.0，6.0) 6.0(5.0，7.0) 4.0(3.0，5.0) 5.0(3.5，7.0) 6.0(4.0，7.0) 5.3±1.4 4.0(4.0，5.0)
③多动-冲动中度异常组 48 5.0(4.0，6.0) 5.2±1.9 4.5±1.7 4.5(4.0，6.0) 4.9±1.9 5.0(4.0，6.0) 4.0(4.0，5.0)
④多动-冲动重度异常组 32 4.3±1.0 4.7±1.7 6.0(4.0，6.0) 4.9±1.9 4.9±1.9 5.0±1.0 4.2±1.5
χ2值   6.18 4.04 5.78 0.31 1.66 2.98 7.30
P值   0.103 0.257 0.123 0.958 0.645 0.394 0.057
组别 例数 物体数量认知 瑞文推理测验 注意分配测验 短时记忆容量(正背) 短时记忆容量(倒背) 威斯康星卡片分类测验
①多动-冲动正常组 61 5.0(4.0，6.0) 7.0(5.0，7.0) 6.0(5.0，6.0) 5.00(4.0，6.0) 6.0(5.0，6.0) 6.0(5.0，6.50)
②多动-冲动轻度异常组 51 5.0(4.0，5.0) 6.0(4.0，7.0) 6.0(5.0，6.0) 5.0(4.0，7.0) 5.0(4.0，6.0) 6.0(5.0，7.0)
③多动-冲动中度异常组 48 5.0(4.0，6.0) 6.0(3.5，7.0) 6.0(5.0，6.0) 5.0(4.0，5.5) 5.0(4.0，6.0) 6.0(5.0，7.0)
④多动-冲动重度异常组 32 5.0±1.4 6.0(4.0，6.0) 5.5(5.0，6.0) 4.0(4.0，5.0) 6.0(5.0，6.0) 5.1±1.5
χ2值   1.45 2.82 1.71 8.14 7.98 1.22
P值   0.693 0.421 0.636 0.043 0.046 0.749
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