认知训练对注意缺陷多动障碍伴认知迟缓特质的有效性及脑影像机制

Attention deficit hyperactivity disorder (ADHD) is a common seeing neuro-develop disorder. Cognitive sluggish trait (SCT) is a kind of trait that has been gradually paid more attention in recent years. ADHD and SCT had a co-prevalent rate close to 1/2. Compared to ADHD children without SCT, ADHD/SCT need to be further investigated with high incidence, high functional impairment and poor prognosis. Current studies suggest children with ADHD/SCT are charactered by biological defects related to slower reaction time and processing speed, with insufficient activation of the right superior parietal lobe, besides its executive function defect. Cognitive training is particularly effective for ADHD, which has the extension effect brain activation. However, researches are not enough on the intervention of ADHD/SCT children, especially by using cognitive training. Biological research on ADHD/SCT is not enough either. In our previous study, we have explored the biological mechanism of ADHD, without the observation on SCT. And we confirm the efficacy of cognitive training on ADHD. This study will revise the SCT scale and apply it to the outpatient ADHD children. We will collect clinical and neuropsychological characteristics of the clinically enrolled children to confirm the neuropsychological defects of ADHD/SCT. ADHD/SCT children will be randomly assigned to receive cognitive training treatment and control treatment respectively. The clinical, neuropsychological and brain image data of cognitive training groups will be compared before and after the intervention to evaluate the effect of cognitive training. Based on this study, we try to provide more clues for the biological basis of ADHD/SCT.

注意缺陷多动障碍（ADHD）是一类常见神经发育性障碍，伴有认知迟缓特质（SCT）的ADHD患儿（ADHD/SCT）具有患病率高、功能影响大、预后差的特点。研究发现，ADHD/SCT患儿除了执行功能的损害之外，兼具反应时间、加工速度的缺陷与右侧上顶叶激活不足的表现，后者可能是SCT对应的生物性特征；认知训练能改善ADHD儿童的流体智力，与加工速度的改善非常相关，对ADHD/SCT儿童具有较大的治疗潜力。我国对ADHD/SCT的研究有限。研究组已对ADHD的生物学特征进行了探索，确认了认知训练的有效性，但未针对ADHD/SCT进行研究和干预。本研究拟修订SCT量表；对ADHD儿童进行临床、神经心理、脑影像学数据的采集，寻找与ADHD/SCT相关的生物性标志；随机分组ADHD/SCT儿童，进行认知训练，通过自身前后和组间比较，评估认知训练的有效性，最终为ADHD/SCT的生物学机制提供线索。

注意缺陷多动障碍（ADHD）是一类常见神经发育性障碍，伴有认知迟缓特质（SCT）的ADHD患儿（ADHD/SCT）具有患病率高、功能影响大、预后差的特点。研究发现，ADHD/SCT患儿除了执行功能的损害之外，兼具反应时间、加工速度的缺陷与右侧上顶叶激活不足的表现，后者可能是SCT对应的生物性特征；认知训练能改善ADHD儿童的流体智力，与加工速度的改善非常相关，对ADHD/SCT儿童具有较大的治疗潜力。我国对ADHD/SCT的研究有限。本研究组（1）修订了SCT量表，信效度可靠，可用于对此类特质的测量。（2）对ADHD/SCT患儿进行了临床、神经心理、脑影像学数据的采集，发现该类患儿与母孕期异常更有关，存在更多行为和功能学损害，内化问题更严重；存在更明显的“知觉推理”和“工作记忆”损害；存在“颞叶”功能的明显异常；而“颞叶”功能的异常可能是ADHD/SCT患儿的特征性生物性损害。（3）研究组对ADHD/SCT儿童进行了认知训练，通过自身前后比较，发现认知训练的方式对此类患儿有效，能明显改善患儿的行为、神经心理表现。本研究的成果可用于临床筛选和有效干预ADHD/SCT特质的患儿，为ADHD/SCT患儿特征提供依据，并奠定进一步探索SCT特质脑生物特征的基础。