【作者】 李韵；

【导师】 张红静；

【作者基本信息】 山东大学 ， 应用心理学， 2007， 硕士

【摘要】 目的：1．探讨注意缺陷多动障碍(ADHO)的认知-神经心理学特征，为临床提供辅助诊断指标；2．分析ADHD儿童社会性的情绪和情感、共情、依恋、同伴关系及自我概念等心理社会性发展特点；3．探讨ADHD儿童认知-神经心理学特征和心理社会性发展特征与临床表现的关系，为临床矫治干预提供理论依据。方法：被试为5所小学2～4年级学生2045名，首先由班主任填写“多动症状问卷”，筛查出疑似ADHD儿童，由临床医师根据DSM-Ⅳ诊断标准询问病史并进行临床诊断，最后确定符合入组标准的注意缺陷多动障碍儿童89例。在各ADHD儿童所在的同一班级按性别、年龄、家庭结构和学习成绩匹配后，按比例随机抽取正常儿童150例为正常对照组。分别对ADHD组和正常对照组用一般情况调查问卷、人脸量表、正性负性情绪量表、分化情绪量表、儿童用共情量表、儿童依恋安全性量表、友谊质量问卷、Song-Hattie自我概念量表进行测试，由同一主试，用同一指导语，在安静的教室内进行。分6组进行，每组40例，共239例。测完后，由研究者逐一对239例儿童进行数字划消和Stroop效应测验。结果：1．认知-神经心理特征：①注意力测验中，ADHD组儿童的漏划数和失误率高于对照组儿童，净分低于对照组儿童；②反应抑制测验中，ADHD组儿童的A、B、C、D反应时多于对照组儿童，B、C、D错误数高于对照组儿童，ADHD组的字义干扰反应时多于对照组儿童。2．社会性发展特征：①ADHD组儿童的主观幸福感低于对照组儿童；正性情绪低于对照组儿童，负性情绪高于对照组儿童；ADHD组儿童的愤怒和悲伤得分高于对照组儿童；ADHD组儿童的快乐得分低于对照组儿童；②ADHD组儿童的积极分享和情绪注意得分低于对照组儿童；③ADHD组儿童的母子依恋、母亲依赖度、母亲亲近度、父子依恋、父亲依赖度和父亲亲近度低于对照组儿童；ADHD组儿童母子依恋高于父子依恋，母亲依赖度和母亲亲近度均显著高于父亲依赖度和父亲亲近度，对照组儿童母亲亲近度高于父亲亲近度；④ADHD组儿童的陪伴与娱乐、冲突解决和友谊质量的积极维度低于对照组儿童，冲突与背叛高于对照组儿童；⑤ADHD组儿童的能力自我、成就自我、自信自我、同伴自我、身体自我、学业自我和非学业自我低于对照组儿童。3．ADHD临床表现和认知特点与其心理社会性发展的相关分析：①主观幸福感与注意力缺陷得分、多动冲动得分、颜色干扰反应时、错误平均数、字义干扰反应时及失误率呈负相关；正性情绪与注意力缺陷得分、多动冲动得分、错误平均数、颜色干扰反应时、字义干扰反应时及失误率呈负相关，与净分呈显著正相关；负性情绪与注意力缺陷得分、多动冲动得分及颜色干扰反应时、错误平均数呈正相关，与净分呈显著负相关；高兴与注意力缺陷得分、多动冲动得分及颜色干扰反应时呈显著负相关；愤怒与注意力缺陷得分、多动冲动得分及颜色干扰反应时呈正相关；恐惧与字义干扰反应时、注意力缺陷得分呈正相关；悲伤与注意力缺陷得分、多动冲动得分及错误平均数呈正相关；②痛苦与失误率、注意力缺陷得分呈正相关；积极分享与注意力缺陷得分、错误平均数呈负相关，与净分呈显著正相关；情绪注意与注意力缺陷得分呈显著负相关；同情与颜色干扰反应时呈负相关；③母子依恋、父子依恋、母亲依赖度与注意力缺陷得分、多动冲动得分、错误平均数、颜色干扰反应时、字义干扰反应时及失误率呈负相关，与净分呈显著正相关；父亲依赖度与注意力缺陷得分、多动冲动得分、错误平均数、颜色干扰反应时及失误率呈负相关；母亲亲近度与注意力缺陷得分、多动冲动得分、错误平均数及失误率呈负相关；父亲亲近度与注意力缺陷得分、错误平均数、颜色干扰反应时、字义干扰反应时和失误率呈负相关，与净分呈显著正相关；④肯定与关心与错误平均数呈负相关；帮助与指导与错误平均数、颜色干扰反应时和字义干扰反应时呈负相关，与净分呈正相关；陪伴与娱乐与注意力缺陷得分、多动冲动得分、错误平均数、颜色干扰反应时和失误率呈显著负相关，与净分呈显著正相关；冲突解决与注意力缺陷得分呈显著负相关，与净分呈正相关；积极友谊与注意力缺陷得分、错误平均数、颜色干扰反应时呈负相关，与净分呈显著正相关；背叛与冲突与注意力缺陷得分呈显著负相关；⑤能力自我概念与注意力缺陷得分、多动冲动得分、错误平均数、颜色干扰反应时、字义干扰反应时和失误率均呈显著负相关，与净分呈显著正相关；班级自我概念与失误率呈显著负相关；成就自我概念和学业自我概念与注意力缺陷得分、多动冲动得分、错误平均数和颜色干扰反应时呈显著负相关；家庭自我概念与失误率呈显著负相关；身体自我概念与注意力缺陷得分、多动冲动得分、颜色干扰反应时和失误率呈负相关，与净分呈正相关；自信自我概念与注意力缺陷得分、多动冲动得分、错误平均数、颜色干扰反应时、字义干扰反应时和失误率呈负相关，与净分呈显著正相关；同伴自我概念和非学业自我概念与注意力缺陷得分、多动冲动得分、错误平均数和颜色干扰反应时呈负相关，与净分呈显著正相关。4．不同ADHD临床表现和认知特点与其心理社会性发展的回归分析：①主观幸福感、正性情绪、负性情绪和愤怒均受注意力缺陷得分和颜色干扰反应时的影响；高兴受多动冲动得分和颜色干扰反应时的影响；恐惧主要受字义干扰反应时的影响；悲伤主要受注意力缺陷得分的影响；②痛苦主要受失误率的影响；积极分享和情绪注意主要受注意力缺陷得分的影响；同情主要受颜色干扰反应时的影响；③母子依恋受注意力缺陷得分和颜色干扰反应时的影响；父子依恋受注意力缺陷得分、失误率和颜色干扰反应时的影响；④积极友谊受注意力缺陷得分和净分的影响；消极友谊主要受注意力缺陷得分的影响；⑤学业自我概念受注意力缺陷得分、错误平均数和颜色干扰反应时的影响；非学业自我概念主要受注意力缺陷得分的影响。结论：1．ADHD儿童的数字划消和Stroop效应测验成绩与正常儿童有显著差异，有助于反映ADHD的认知-神经心理特征，可作为辅助临床诊断的神经心理学指标。2．ADHD儿童情绪状态较正常儿童差，主观幸福感低，正性情绪少，负性情绪多，易愤怒和悲伤。3．ADHD儿童依恋安全性差于正常儿童；ADHD组儿童的父子依恋安全性显著差于其母子依恋安全性，而正常儿童的父子依恋与母子依恋较平衡。4．ADHD儿童共情能力、同伴关系及自我概念等较正常儿童差。5．ADHD不同临床表现和认知特点与ADHD儿童心理社会性发展存在不同程度的相关，但多动冲动症状与共情能力和消极友谊无明显相关。6．ADHD儿童心理社会性发展主要受注意力缺陷的影响，同时还受执行功能损害的影响，多动冲动症状对ADHD儿童的心理社会性发展无明显影响，提示对ADHD儿童进行干预治疗时，需有针对性地制定其社会性发展的矫正干预计划。更多还原

【Abstract】 OBJECTIVE: 1. For clinical provided auxiliary diagnosis, investigating traits of cognitive function in attention deficit hyperactivity disorder (ADHD). 2. Analyzing psychological social development traits of ADHD children, such as emotion and feeling, empathy, attachment, peer relationship and self-concept, and so on. 3. For clinical correction intervention provided theoretical basis, investigating relationship about ADHD children’s traits of cognitive function and psychological social development and clinical manifestations.METHODS: Study had been hold among 2-4 grade 2045 students in five primary schools. First, the teacher in charge of the class filled out "the Hyperkinetic Symptoms Questionnaire". It could screen the suspected ADHD children. Then clinicians asked the suspected ADHD children’s illness history and gave clinical diagnosis according to DSM-IV. Last, we assured that the ADHD children who agreed with our criteria had 89 persons. We randomly chose 150 normal children in ratio compare to the ADHD children’s sex, age, family and learning score match in the same class. The ADHD group and control group were measured by the common questionnaire, Face Scale, Positive and Negative Affect Scale Table, Emotional Divide Scale, Empathy Scale for Children, Attachment Safety Scale for Children, Friendship Quality Questionnaire, Song-Hattie Self-concept Scale separately. They used same subject and same test guidance in the silence classroom. The children had been divided into 6 groups, 40 of each, total of 239 people. After testing, the investigator tested the 239 children one by one, using Number Cancel and Stroop Test.RESULTS: 1.Traits of cognitive function: ?In attention test, the total of opps(Op) and lapsus(La) in ADHD were higher than those in control, pure scores(Pu) were lower than those in control. (2)In response inhibition test, the time of part A, B, C, D in ADHD were more than those of the control, the error of part B, C, D in ADHD were higher than those in control, MIT in ADHD were more than those in control.2.Traits of psychological social development: (1)Well-being in ADHD was lower than that in control, Positive Emotion in ADHD was lower than that of the control, Negative Emotion was higher than that in control, Angry and Sadness in ADHD were higher than those in control, Happiness in ADHD was lower than that in control. (2) Positive Sharing and Emotion Attention in ADHD were lower than those in control.(3) Mother-dependence, Father-dependence, Mother-intimacy, Father-intimacy, Mother-child Attachment, Father-child Attachment of the ADHD children were all lower than those controls, Father-dependence, Father-intimacy, Father-child Attachment in ADHD children were higher than Mother-dependence, Mother-intimacy, Mother-child Attachment; Father-intimacy was lower than Mother-intimacy in control. (4)Companion and Recreation, Conflict Solve, Positive Friendship Quality in ADHD were lower than those in control, Conflict and Betray was higher than that in control. (5)Ability-concept, Achievement-concept, Self-confident-concept, body-concept, Companion-concept, Schoolwork-concept and Non-schoolwork-concept in ADHD were lower than those in control.3.The correlation analysis of clinical manifestations of ADHD and cognitive function and psychological social development: (1)There was negative correlation between Well-being and DSMAT, DSMHT, Average Error, CIT, MIT, La; there was negative correlation between PA and DSMAT, DSMHT, AE, CIT, MIT, La, and positive correlation in Pu; there was positive correlation between NA and DSMAT, DSMHT, AE, CIT, negative correlation in Pu; there was negative correlation between Happiness and DSMAT, DSMHT, CIT; there was positive correlation between Angry and DSMAT, DSMHT, CIT; there was positive correlation between Afraid and DSMAT, MIT; there was positive correlation between Sad and DSMAT, DSMHT, AE; (2)There was positive correlation between Su and DSMAT and La; there was negative correlation between PS and DSMAT and AE, and significantly positive correlation in Pu; there was significantly negative correlation between EA and DSMAT; there was negative correlation between FO and CIT;(3)There was negative correlation between MA, FA, MD and DSMAT, DSMHT, AE, CIT, MIT, La, and significantly positive correlation in Pu; there was negative correlation between FD and DSMAT, DSMHT, AE, CIT, La, there was negative correlation between MI and DSMAT, DSMHT, AE, La, and significantly positive correlation in Pu; (4)There was negative correlation between AC and AE; there was negative correlation between HI and AE, CIT, MIT, and positive correlation in Pu; there was significantly negative correlation between CR and DSMAT, DSMHT, AE, CIT, La, and significantly positive correlation in Pu; there was negative correlation between SC and DSMAT, and positive correlation in Pu; there was negative correlation between PF and DSMAT, AE, CIT, Pu; there was negative correlation between CB(NF) and DSMAT; (5)There was significantly negative correlation between ABC and DSMAT, DSMHT, AE, CIT, MIT, La, significantly positive correlation in Pu; there was negative correlation between CLC and La; there was negative correlation between ACC, SWC and DSMAT, DSMHT, AE, CIT; there was negative correlation between FAC and La; there was negative correlation between BOC and DSMAT, DSMHT, CIT, and positive correlation in Pu; there was negative correlation between SCC and DSMAT, DSMHT, AE, CIT, MIT, La, significantly positive correlation in Pu; there was negative correlation between COC, NSC and DSMAT, DSMHT, AE, CIT, significantly positive correlation in Pu.4.The regression analysis of clinical manifestations of ADHD and cognitive function and psychological social development: (1) DSMAT and CIT affected on Well-being, PA, NA and Angry, DSMHT and CIT affected on Happiness, MIT affected on Afraid; DSMAT affected on Sadness;(2)Su was affected by La; DSMAT affected on PS and EA; FO was affected by CIT;(3)DSMAT and CIT affected on MA, DSMAT, CIT and La affected on FA;(4)DSMAT and Pu affected on PF, DSMAT affected on NF; (5) DSMAT, AE and CIT affected on SWC, DSMAT affected on NSC.CONCLUSIONS: 1.The results of Number Cancel Test and Stroop Test were been different notably between the ADHD group and the control, so these two tests reflected the traits of neuropsychlology and can provide the evidence for clinical auxiliary diagnosis.2.The emotion state of ADHD child was worse than normal child, Well-being lower, Positive Emotion less, Negative Emotion more, and ADHD child were father angry, sadness and pessimistic.3.The Attachment Security of ADHD was worse than in control, there was difference in ADHD child of Mother-attachment and Father-attachment, but there was balance in normal child.4.The social development, such as Empathy Ability, Friendship and Self-concept, in ADHD were all worse than normal.5.There was the different correlation in clinical manifestations of ADHD and cognitive function and psychological social development, but there was no correlation in hyperactivity disorder and Empathy and Negative Friendship.6.Children’s psychological social development affected mainly by attentional disorder, meanwhile it affected by impairment of executive function, but hyperactivity disorder didn’t affect on children’s psychological social development. It was suggested that to treat ADHD, we would establish corrective intervention plan to social development specifically.更多还原