高智商成人注意缺陷多动障碍患者临床及认知功能特点分析

潘美蓉; 黄芳; 赵梦婕; 王延菲; 钱秋谨; 王玉凤

doi:10.3760/cma.j.issn.1006-7884.2017.06.007

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中华精神科杂志

• 儿童精神医学 •

ENGLISH ABSTRACT

高智商成人注意缺陷多动障碍患者临床及认知功能特点分析

作者及单位信息

出版日期： 2017 -12 -05 ·

DOI： 10.3760/cma.j.issn.1006-7884.2017.06.007

Clinical and cognitive functions in high intelligence quotient adults with attention deficit hyperactivity disorder

Authors Info & Affiliations

Pan Meirong

Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), and the Key Laboratory of Ministry of Health (Peking University), Beijing 100191, China

Huang Fang

Zhao Mengjie

Wang Yanfei

Qian Qiujin

Wang Yufeng

Published： 2017 -12 -05 ·

DOI： 10.3760/cma.j.issn.1006-7884.2017.06.007

3107

107

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摘要

目的探讨高智商成人注意缺陷多动障碍(attention deficit hyperactivity disorder，ADHD)患者的临床特征及认知功能特点。

方法采用横断面研究，对符合DSM-Ⅳ诊断标准的成人高智商ADHD患者68例（高智商ADHD组）、一般智商ADHD患者42例（一般智商ADHD组）及与其年龄、智商相匹配的健康对照者（分别为高智商对照组91名和一般智商对照组51名），进行临床访谈、心理测验及执行功能问卷评定，比较各组间ADHD分型、共患病及认知功能方面的差异。

结果高智商ADHD组与一般智商ADHD组ADHD分型差异无统计学意义。高智商ADHD组共病心境障碍与焦虑障碍的比率高于一般智商ADHD组[36.8%(25/68)与19.0%(8/42)，χ ²=3.880， P=0.049]，Barratt冲动量表中非计划得分低于一般智商ADHD组[（29.5±4.2）分与（31.4±4.3）分， t=2.102， P=0.037]。高智商ADHD组与高智商对照组在智商测验中各项因子分差异均无统计学意义。一般智商ADHD组在算术（ t=-2.335， P=0.020）、倒背（ t=-2.021， P=0.045）及数字符号（ t=-3.043， P<0.01）得分低于一般智商对照组，差异具有统计学意义。高智商ADHD组与一般智商ADHD组执行功能评定量表成人版各项得分均高于匹配智商的健康对照组（均 P<0.01），高智商ADHD组的情感控制（ t=-1.976， P=0.049）、工作记忆（ t=-2.363， P=0.019）及行为管理指数得分（ t=-2.322， P=0.021）低于一般智商ADHD组。

结论高智商ADHD患者心境障碍与焦虑障碍共患比率较高；一般智商ADHD患者注意力及工作记忆能力明显受损；ADHD患者普遍存在执行功能损害；在工作记忆、情感控制以及行为管理方面，高智商ADHD患者受损程度较轻；智商可能是ADHD患者认知功能，尤其是工作记忆能力的保护因素。

关键词：注意力缺陷障碍伴多动;成年人;智力;认知

ABSTRACT

ObjectiveTo explore the clinical characters and cognitive functions in high intelligence quotient (IQ) patients with attention deficit hyperactivity disorder (ADHD) in a Chinese population sample.

MethodsSixty-eight outpatients with a high IQ fulfilling the DSM-Ⅳ diagnostic criteria for ADHD, 91 adults without ADHD matched by high IQ ADHD adults, 42 ADHD outpatients with an average IQ and 51 normal adults with an average IQ matched were identified. All the groups were matched by age. All subjects completed the clinical interview, neuropsychological test and the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A).

ResultsNo significant differences in ADHD subtypes between ADHD group with high IQ and with normal IQ were found. ADHD group with high IQ had more comorbidities of mood disorder and anxiety spectrum disorders than ADHD group with normal IQ (36.8%(25/68) vs. 19.0%(8/42), χ ²=3.880, P=0.049). The Barratt Impulsiveness Scale-Ⅱ scores of non planned were significantly lower in high IQ ADHD group than in general intelligence ADHD group (29.5±4.2 vs. 31.4±4.3, t=2.102, P=0.037) . ADHD group with normal IQ performed worse than control group in test of arithmetic ( t=-2.335, P=0.020) , digit span ( t=-2.021, P=0.045) and digit symbol ( t=-3.043, P<0.01) . When compared with ADHD group with normal IQ, the one with high IQ had lower scores in emotion control ( t=-1.976, P=0.049) , working memory ( t=-2.363, P=0.019) and behavior management index ( t=-2.322, P=0.021) when completing BRIEF-A questionnaire.

ConclusionsThe ADHD group with high IQ has a higher rate of comorbidities with mood disorder and anxiety spectrum disorders. ADHD adults with normal IQ have more serious cognitive damage, especially in working memory. Both ADHD groups have executive function damages. High IQ could protect the cognitive capacity of adults with ADHD, especially in working memory aspect.

KEYWORDS： Attention deficit disorder with hyperactivity;Adult;Intelligence;Cognition

Corresponding author: Qian Qiujin, Email: nc.defudabe.umjbnijuiqnaiq

FUNDING:

National Science and Technology Infrastructure Program (2015BAI13B01) ; National Basic Research Program of China (973 Program 2014CB846104) ; Capital Foundation of Medical Developments (2016-2-4113); Beijing Municipal Science and Technology Commission"Capital Characteristic Clinic Project" (Z131107002213068)

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No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

潘美蓉,黄芳,赵梦婕,等. 高智商成人注意缺陷多动障碍患者临床及认知功能特点分析[J]. 中华精神科杂志,2017,50(6)：425-431.

DOI:10.3760/cma.j.issn.1006-7884.2017.06.007

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成人注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）日益引人关注，世界卫生组织对10个国家18~44岁人群进行调查显示，成人ADHD平均患病率为3.5%。有研究显示，成人ADHD的平均智商分数较健康人低 ^{[
1
]}，且存在不同程度的共患病 ^{[
2
]}现象及认知功能 ^{[
3
,

4
]}方面的问题，如注意力、执行功能 ^{[
5
,

6
]}以及记忆力 ^{[
7
]}的受损。目前越来越多的研究者关注高智商ADHD人群，这些患者可能症状隐蔽，就诊延迟，受到更为持久的困扰 ^{[
8
]}。目前关于高智商ADHD患者认知功能评估的结果存在一定的差异，有研究者发现高智商ADHD人群的认知功能受损不显著 ^{[
9
]}，同时也有研究者支持高智商ADHD人群认知功能受损的假设 ^{[
10
]}，并认为该群体同样存在情绪困扰、行为问题、学业及社会功能等方面的损害 ^{[
11
]}，其执行功能较健康人群存在一定程度的损害 ^{[
12
]}。基于目前对高智商ADHD群体的认识有限且存在一定分歧的现状，我们选取不同智商ADHD患者，对其临床表现及认知功能（智商及执行功能）特点进行比较分析，进而探究高智商与一般智商ADHD患者之间以及与健康对照者之间的临床表现及其认知功能特点。

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摘要
参考文献

参考文献

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Bridgett DJ , Walker ME . Intellectual functioning in adults with ADHD: a meta-analytic examination of full scale IQ differences between adults with and without ADHD[J]. Psychol Assess, 2006,18(1):1-14. DOI: 10.1037/1040-3590.18.1.1 .