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目的分析注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)共患对立违抗障碍(oppositional defiant disorder,ODD)患儿行为与父母间冲突的关系。方法选择符合美国《精神障碍诊断与统计手册(第Ⅳ版)》(DSM-Ⅳ)中ADHD和诊断标准的门诊儿童,ADHD伴ODD者33例(占总数的55%)为共患组,单纯ADHD者27例(占总数的45%)为ADHD组。由儿童填写儿童对婚姻冲突的感知量表(Children’s Perception of Interparental Conflict Scale,CPIC),其父母填写Achenbach儿童行为量表(Achenbach’s Child Behavior Checklist,CBCL)。对数据结果进行t检验、相关分析及Logistic回归分析。结果 1)共患组在CPIC各因子及总分得分均显著高于ADHD组(P<0.05),焦虑/抑郁问题、违纪行为、攻击行为、外化性行为问题的得分及行为问题总分显著高于ADHD组(P<0.05);2)相关分析发现,共患组儿童社交问题、注意问题、违纪行为、攻击行为、外化性行为问题与感知到的婚姻冲突存在相关性;3)Logistic回归分析显示,保留在模型中的变量有自我归因(P=0.005,OR=1.489),应对效能(P=0.026,OR=1.329),冲突频率(P=0.019,OR=1.254)。结论共患组儿童有更多的行为问题,可能与父母婚姻间冲突有关,儿童对婚姻冲突的感知中的自我归因、应对效能、冲突频率增加了ADHD共发ODD的危险,提示对共患有ODD、ADHD的儿童进行治疗时,不仅要注意调节其父母关系,更要引导儿童正确看待婚姻冲突。
Objective To analyze the relationship between behavior and parental conflict in children with attention deficit hyperactivity disorder (ADHD) with oppositional defiant disorder (ODD). Methods Thirty-three outpatients (55% of the total) with ADHD and ODD were selected as outpatients with ADHD and diagnostic criteria in DSM-IV (DSM-IV) 27 cases of ADHD (45% of the total) ADHD group. The Children’s Perception of Inter-Parental Conflict Scale (CPIC) was completed by children, and their parents completed Achenbach’s Child Behavior Checklist (CBCL). T test data analysis, correlation analysis and Logistic regression analysis. Results 1) The scores of CPIC factor and total score in comorbidity group were significantly higher than those in ADHD group (P <0.05). The total score of scores of anxiety / depression, discipline, aggression, aggressive behavior and behavior problems were significant (P <0.05); 2) Correlation analysis showed that social problems, attention problems, disciplinary behaviors, aggressive behaviors and externalized behavior problems in children with comorbidities were correlated with perceived marital conflicts; 3) Logistic Regression analysis showed that the variables retained in the model had self-attribution (P = 0.005, OR = 1.489), coping effectiveness (P = 0.026, OR = 1.329) and frequency of conflict (P = 0.019, OR = 1.254). Conclusions Children in the comorbid group have more behavioral problems, which may be related to the conflict between parents and matrimonies. The children’s self-attribution and coping skills in perceiving marital conflicts increase the frequency of ADHD co-incident ODD, suggesting that co-occurrence When children with ODD and ADHD are treated, they should not only pay attention to regulating their parents’ relationship, but also guide children to correctly view marital conflicts.