Chinese Medical E-ournals Database
Adv Search
中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2024, Vol. 20 ›› Issue (01): 39 -46. doi: 10.3877/cma.j.issn.1673-5250.2024.01.006

Original Article

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)
HTML ( ) PDF ( )
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
[1]
Li F, Cui Y, Li Y, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17，524 individuals [J]. J Child Psychol Psychiatry, 2022, 63(1): 34-46. DOI: 10.1111/jcpp.13445.
[2]
Zhao X, Hayes T, Timmons A, et al. Unpacking inequities in ADHD diagnosis: examining individual-level race/ethnicity and state-level online information-seeking patterns [J]. Adm Policy Ment Health, 2023, 50(4): 576-590. DOI: 10.1007/s10488-023-01259-w.
[3]
潘学霞，麻宏伟，戴晓梅. 整合视听连续测试诊断注意缺陷多动障碍的临床应用探讨[J]. 中国当代儿科杂志，2007, 9(3): 210-212. DOI: 10.3969/j.issn.1008-8830.2007.03.008.
[4]
Scimeca LM, Holbrook L, Rhoads T, et al. Examining Conners Continuous Performance Test-3 (CPT-3) embedded performance validity indicators in an adult clinical sample referred for ADHD evaluation [J]. Dev Neuropsychol, 2021, 46(5): 347-359. DOI: 10.1080/87565641.2021.1951270.
[5]
Barkley R. Attention-deficit/hyperactivity disorder, self-regulation, and time: toward a more comprehensive theory [J]. J Dev Behav Pediatr, 1997, 18(4): 271-279.
[6]
Kofler MJ, Groves NB, Singh LJ, et al. Rethinking hyperactivity in pediatric ADHD: preliminary evidence for a reconceptualization of hyperactivity/impulsivity from the perspective of informant perceptual processes [J]. Psychol Assess, 2020, 32(8): 752-767. DOI: 10.1037/pas0000856.
[7]
Chang SH, Shie JJ, Yu NY. Enhancing executive functions and handwriting with a concentrative coordination exercise in children with ADHD: a randomized clinical trial [J]. Percept Mot Skills, 2022, 129(4): 1014-1035. DOI: 10.1177/00315125221098324.
[8]
刘思奇，朱一可，张樊，等. 不同亚型注意缺陷多动障碍儿童认知功能特点的比较 [J]. 中华行为医学与脑科学杂志，2021, 30(10): 910-915. DOI: 10.3760/cma.j.cn371468-20210720-00416.
[9]
American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M]. 5th ed. Arlington: American Psychiatric Association, 2013. DOI: 10.1176/appi.books.9780890425596.
[10]
唐丽君，张海涛，陈蕾，等. 韦氏儿童智力量表全式和简式在智力评残中的应用效果 [J]. 中国当代医药，2022, 29(6): 66-68, 72. DOI: 10.3969/j.issn.1674-4721.2022.06.019.
[11]
及春兰，马扬，张峰，等. 313例ADHD儿童注意力测评结果分析 [J]. 中国妇幼保健，2008, 23(27): 3834-3836. DOI: 10.3969/j.issn.1001-4411.2008.27.022.
[12]
Wei W, Lu H, Zhao H, et al. Gender differences in children′s arithmetic performance are accounted for by gender differences in language abilities [J]. Psychol Sci, 2012, 23(3): 320-330. DOI: 10.1177/0956797611427168.
[13]
Nobel E, Brunnekreef JA, Schachar RJ, et al. Parent-clinician agreement in rating the presence and severity of attention-deficit/hyperactivity disorder symptoms [J]. Atten Defic Hyperact Disord, 2019, 11(1): 21-29. DOI: 10.1007/s12402-018-0267-8.
[14]
Chen Y, Spagna A, Wu T, et al. Testing a cognitive control model of human intelligence [J]. Sci Rep, 2019, 9(1): 2898. DOI: 10.1038/s41598-019-39685-2.
[15]
Bertelli MO, Cooper SA, Salvador-Carulla L. Intelligence and specific cognitive functions in intellectual disability: implications for assessment and classification [J]. Curr Opin Psychiatry, 2018, 31(2): 88-95. DOI: 10.1097/YCO.0000000000000387.
[16]
Mu S, Wu H, Zhang J, et al. Structural brain changes and associated symptoms of ADHD subtypes in children [J]. Cereb Cortex, 2022, 32(6): 1152-1158. DOI: 10.1093/cercor/bhab276.
[17]
Krieger V, Amador-Campos JA. Clinical presentations of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents: comparison of neurocognitive performance [J]. Child Neuropsychol, 2021, 27(8): 1024-1053. DOI: 10.1080/09297049.2021.1917530.
[18]
Wu T, Shen H, Sheng Y, et al. Use of cognitive correction training improves learning for children with mathematics learning disability [J]. Appl Neuropsychol Child, 2020, 9(2): 172-178. DOI: 10.1080/21622965.2018.1552866.
[19]
Kofler MJ, Soto EF, Fosco WD, et al. Working memory and information processing in ADHD: evidence for directionality of effects [J]. Neuropsychology, 2020, 34(2): 127-143. DOI: 10.1037/neu0000598.
[20]
Teixeira-Santos AC, Moreira CS, Magalhães R, et al. Reviewing working memory training gains in healthy older adults: a Meta-analytic review of transfer for cognitive outcomes [J]. Neurosci Biobehav Rev, 2019, 103: 163-177. DOI: 10.1016/j.neubiorev.2019.05.009.
[21]
Kollins SH, DeLoss DJ, Ca？adas E, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial [J]. Lancet Digit Health, 2020, 2(4): e168-e178. DOI: 10.1016/S2589-7500(20)30017-0.
[22]
Dymowski AR, Ponsford JL, Willmott C. Cognitive training approaches to remediate attention and executive dysfunction after traumatic brain injury: a single-case series [J]. Neuropsychol Rehabil, 2016, 26(5-6): 866-894. DOI: 10.1080/09602011.2015.1102746.
[23]
Schmitz F, Krämer RJ. Task switching: on the relation of cognitive flexibility with cognitive capacity [J]. J Intell, 2023, 11(4): 68. DOI: 10.3390/jintelligence11040068.
[24]
Kattner F, Samaan L, Schubert T. Cross-modal transfer after auditory task-switching training [J]. Mem Cognit, 2019, 47(5): 1044-1061. DOI: 10.3758/s13421-019-00911-x.
[25]
Murphy DH, Castel AD. Responsible attention: the effect of divided attention on metacognition and responsible remembering [J]. Psychol Res, 2023, 87(4): 1085-1100. DOI: 10.1007/s00426-022-01711-w.
[26]
Song JH. The role of attention in motor control and learning [J]. Curr Opin Psychol, 2019, 29: 261-265. DOI: 10.1016/j.copsyc.2019.08.002.
[27]
García-Baos A, D′Amelio T, Oliveira I, et al. Novel interactive eye-tracking game for training attention in children with attention-deficit/hyperactivity disorder [J]. Prim Care Companion CNS Disord, 2019, 21(4): 19m02428. DOI: 10.4088/PCC.19m02428.
[28]
赵夏薇，毛萌，杨速飞，等. 视听整合持续作业测试在注意缺陷多动障碍诊断中的作用[J/OL]. 中华妇幼临床医学杂志(电子版), 2008, 4(3): 176-180. DOI: 10.3877/cma.j.issn.1673-5250.2008.03.103.
[1] Hongyu Tao, Jingjing Ye, Jin Yu, Xiuzhen Yang, Jingjing Qian, Bin Xu, Weize Xu, Qiang Shu. Value of contrast transthoracic echocardiography in assessing right-to-left shunt-related diseases in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(10): 959-965.
[2] Xiaofei Li, Hongli Liu, Qiuling Shi, Jing Tian, Li Li, Hongbo Qi, Xin Luo. A prospective randomized controlled study of low intensity focused ultrasound uterine involution treatment for prevention and treatment of postpartum hemorrhage in natural childbirth women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 534-539.
[3] Qin Liu, Hanmin Liu, Liang Xie. Current status of research on the role of matrix metalloproteinases in the pathogenesis of childhood asthma[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 564-568.
[4] Yun Xiang, You Lu, Fan Yang. Current research status of correlation between per-and polyfluoroalkyl substances exposure and childhood obesity[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 569-574.
[5] Yanan Wang, Dan Liu, Zhengnong Cao, Huimin Jia. Clinical diagnosis and treatment of children with late-onset congenital diaphragmatic hernia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 410-419.
[6] Mengsi Zhang, Yiqun Ma, Lijuan Meng, Hui Zhu, Jinfeng Fu. Observation on the effect of the combined use of pressure gloves, webbed finger compression straps and foam silicone gel sheeting after surgery in children with cicatricial syndactyly[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(04): 329-334.
[7] Xiaoli Yang, Wanfu Li, Zhu Ma, Lan Ma, Yi Zheng, Xiaoli Fu, Jing Wang. Application effect of one-step forceps needle method in laparoscopic high ligation of hernia sac in children[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 535-538.
[8] Hebei Ding, Xun Wang, Weiguo Chen. Comparison of application of sevoflurane inhalation anesthesia and propofol intravenous anesthesia in pediatric indirect inguinal hernia surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 570-574.
[9] Jixiao Zeng, Xiaogang Xu, Xinxing Wang, Fei Liu, Menglong Lan, Boyuan Tao, Zijian Liang, Zhihua Ye, Yuanyuan Luo. Da Vinci robotic-assisted Swenson-like pull through for Hirschsprung disease[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 239-243.
[10] Chinese Society of Organ Transplantation of Chinese Medical Association, Surgery Group of Chinese Society of Surgery of Chinese Medical Association, Transplantation Group of Chinese Society of Surgery of Chinese Medical Association, South China Alliance of Split Liver Transplantation. Chinese Clinical Practice Guidelines on Split Liver Transplantation in Children[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 593-601.
[11] Jun Liu, Wenjing Qiu, Fanghao Sun, Songying Li, Shuhong Yi, Binsheng Fu, Yang Yang, Hui Luo. Comparison of in vivo and in vitro split liver transplantation in pediatric liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 688-693.
[12] Jiachen Zhang, Hongxin Song. The correlation between the changes of spherical equivalent and myopia progression in children with refractive error[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(04): 217-222.
[13] Chen Zhang, Ming Qin, Juan Dong, Yulong Chen. Diagnostic value of ultrasound in ischemic changes of intestinal volvulus in children[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 565-568.
[14] Xiaosheng Chen, Jia He, Fang Liu, Rui Wu, Haitao Yang, Xiaohan Fan. Pacemaker implantation in a child with a 31-second cardiac arrest induced by tilt table test: a case report and literature review[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(05): 488-494.
[15] Yali Cao, Yumeng Gao, Yingqian Zhang, Bo Li, Junbao Du, Hongfang Jin. Clinical progress of sitting intolerance in children[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(05): 510-515.
Viewed
Full text


Abstract

Copyright © Chinese Medical Association, Chinese Medical Multimedia Press  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号