ADHD患儿的家庭功能及适应行为失调模型及干预策略研究详细信息

报告作者：

[1]赵宏伊(天水市第一人民医院)
[2]陈江鱼(天水市第一人民医院)
[3]曹庆久(北京大学第六医院)
[4]魏雪峰(天水市第一人民医院)
[5]焦金(天水市第三人民医院)
[6]李成程(广西医科大学)
[7]胡惠桃(天水市第一人民医院)
[8]谭霞(天水市第一人民医院)

中文摘要：

目的本项目通过对ADHD患儿的家庭功能和适应行为进行系统性研究，基于McMaster家庭功能模型理论, 从儿童的问题解决、交流、角色、情感反应、情感介入、行为控制6个维度来评定其家庭功能，明确ADHD症状与家庭功能和适应行为的相互影响机制，探讨对ADHD 患儿的干预策略。方法对入组的93例ADHD 病例组和人口学变量匹配的100例正常健康对照组进行Conners 简明症状问卷、儿童适应行为评定量表和家庭功能评定量表评估，通过对两组被试各量表基线评分进行统计检验，探明病例组在家庭功能及适应行为各维度相较对照组存在的异常，并计算各异常维度与症状评分的相关性。将入组的93例 ADHD患儿随机分为6组，每组由2~3名治疗师主持，对每组多家庭团体开展治疗师指导示范、家属协助、患儿自助实施执行技能训练计划的干预策略。每周1次，每次2小时，共持续12周后进行儿童适应行为评定量表和家庭功能评定量表评估。结果统计结果显示，多动症组与对照组相比，多动症组在生活自理方面、语言能力方面的得分明显降低（31.76±9.42 VS 36.39±5.43分；19.90±6.29 VS 25.47±7.93 p＜0.05）。两组经干预后多动症组在生活自理方面明显改善，与对照组相比无统计学差异（37.64±0.05 VS 37.58±0.10 P＞0.05）；多动症儿童在家庭功能七个维度上的得分均高于阈值，与对照组相比，多动症组儿童在解决问题、通讯、角色、情绪反应均明显升高（2.23±0.42 VS 2.01±0.37；2.23±0.27 VS 2.05±0.25；2.45±0.31 VS 2.25±0.33；2.47±0.28 VS 1.95±0.36 P＜0.005），但经干预后，儿童家庭功能量表显示，多动症组儿童在情绪干预、行为控制方面得到了明显改善，与对照组相比无统计学意义2.47±0.31 VS 2.48±0.12；2.05±0.56 VS 2.02±0.14 P＞0.05）。结论结果表明，有效的交流对促进多动症儿童的适应能力和认知功能具有积极作用，父母对待人和物的方式为他们的孩子提供了模仿的模型。本次研究发现先前的研究与我们的研究之间存在很大差距，中国西部欠发达地区多动症儿童的控制维度超出阈值最大，这与中国东部多动症儿童的控制维度不同。

英文摘要：

Objective:Based on McMaster's Family Functioning Model Theory, by systematically researching into the family functioning and the adaptive behavior of the children with ADHD, this project evaluates their family functioning from six dimensions: children’s problem solving, communication, role,emotional response, emotional intervention and behavior control, clarifies the interaction mechanism between ADHD（(Attention-deficit hyperactivity disorder）symptoms, family functioning and adaptive behavior, and further discusses intervention strategies for children with ADHD. Methods:Evaluting 93 cases in ADHD group and 100 cases in healthynormal controls group matched with demographic variables with Conners Concise Symptom Questionnaire, Children's Adaptive Behavior Rating Scale and Family Function Rating Scale. The baseline scores of each scale of the two groups were statistically tested to find out the abnormalities in family functioning and adaptive behavior between the two groups, and calculate the correlation between each abnormal dimension and symptom score. 93 cases in ADHD group were randomly divided into 6 groups, each group was presided over by 2~3 therapists, and intervention strategies such as tutor guidance demonstration, family assistance and children's self-help implementation of skills training plan were carried out in each group. Children's adaptive behavior rating scale and family functioning rating scale were evaluated once a week for 2 hours, lasting for 12 weeks. Results:Compared with the control group, the statistical results shows that the scores of self-care and language ability in ADHD group were significantly lower (31.76±9.42 VS 36.39±5.43; 19.90±6.29 VS 25.47±7.93 p ＜ 0.05 ）. After intervention, the self-care of ADHD group improved obviously, and there was no statistical difference compared with the control group (37.64 0.05 vs 37.58 0.10 P >0.05). Compared with the control group, the scores in the problem solving,communication, role and emotional response of children in ADHD group went up obviously (2.23±0.42 VS 2.01±0.37； 2.23±0.27 VS 2.05±0.25； 2.45±0.31 VS 2.25±0.33； 2.47 0.28 vs 1.95 0.36 p < 0.005), but after intervention, the children's family functioning scale showed that children in ADHD group improved obviously in emotional intervention and behavior control, and there shows no significant difference compared with the control group (2.47±0.31 VS 2.48±0.12 ; 2.05±0.56 VS2.02±0.14 P＞0.05）. Conclusion:The results show that effective communication plays a positive role in promoting the adaptability and cognitive functioning of ADHD children, and the way parents treat people and things provides their children with models for imitation. This study found that there has a big gap between the previous study and ours.The control dimension of ADHD children in underdeveloped areas in western China exceeds the threshold the most, which is different from the control dimension of ADHD children in eastern China.

中文关键词：

注意缺陷多动障碍; 适应行为; 家庭功能; 认知行为治疗; 团体心理治疗; 系统式家庭治疗

英文关键词：

attention deficit hyperactivity disorder; adaptive behavior; family function; cognitive behavioral; therapy group psychotherapy; systematic family therapy

全文页数：

27 ,图4,表7

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