注意缺陷多动障碍与抽动障碍患儿自我意识 特征及其与照料者心理健康的关联性分析

Analysis of Self-Concept Characteristics in Children with Attention Deficit Hyperactivity Disorder and Tic Disorder and Their Association with Caregivers’ Mental Health

摘要: 目的：比较注意缺陷多动障碍(ADHD)与抽动障碍(TD)患儿自我意识水平差异，探讨患儿自我意识与主要照料者心理健康的相关性，为儿童神经发育障碍家庭整合干预提供理论与实践依据。方法：选取2023年1月~2024年6月在青岛大学附属医院儿童保健科首次确诊ADHD患儿80例、TD患儿80例，同期选取年龄、性别相匹配健康儿童80例为对照组。采用Piers-Harris儿童自我意识量表(CSCS)评估儿童自我意识，症状自评量表(SCL-90)评估照料者心理健康，比较组间差异，并行Pearson相关及多元线性回归分析。结果：CSCS总分由高到低依次为对照组 > ADHD组 > TD组[(57.66 ± 9.12)分、(49.96 ± 8.86)分、(43.99 ± 8.41)分，F = 42.73，P < 0.001]；TD组低自我意识检出率(62.5%)显著高于ADHD组(42.5%)及对照组(7.5%)，差异有统计学意义(χ² = 89.23, P < 0.001)。照料者SCL-90总分由高到低依次为TD组 > ADHD组 > 对照组[(145.73 ± 41.56)分、(130.92 ± 37.64)分、(95.86 ± 24.85)分，F = 41.26，P < 0.001]，除恐怖因子外，其余各因子得分组间差异均有统计学意义(均P < 0.001)。三组儿童自我意识总分与照料者SCL-90总分均呈显著负相关(ADHD组：r = −0.49，95%CI：−0.64~−0.30，P < 0.001；TD组：r = −0.48，95%CI：−0.63~−0.29，P < 0.001；对照组：r = −0.36，95%CI：−0.54~−0.15，P < 0.001)。控制年龄、性别后，照料者心理症状评分是儿童自我意识水平的独立负向预测因子(ADHD组：β = −0.26，95%CI：−0.42~−0.10，P = 0.002，R² = 0.28；TD组：β = −0.25，95%CI：−0.41~−0.09，P = 0.003，R² = 0.26；对照组：β = −0.19，95%CI：−0.34~−0.04，P = 0.015，R² = 0.17)。结论：ADHD与TD患儿均存在自我意识受损，TD患儿受损更显著；两类患儿照料者心理负担更重；儿童自我意识水平与照料者心理健康呈显著负相关。临床应建立儿童–家庭一体化心理支持模式。

Abstract: Objective: To compare the self-concept characteristics of children with attention deficit hyperactivity disorder (ADHD) and tic disorder (TD), and to explore the correlation between children’s self-concept and mental health of their primary caregivers, so as to provide a basis for family integrated intervention of neurodevelopmental disorders in children. Methods: A total of 80 children with ADHD, 80 children with TD and 80 healthy controls matched for age and gender were enrolled. The Piers-Harris Children’s Self-Concept Scale (CSCS) and Symptom Checklist-90 (SCL-90) were used to evaluate children’s self-concept and caregivers’ mental health. Intergroup differences, Pearson correlation and multiple linear regression were analyzed. Results: The total score of CSCS was significantly different among the three groups (F = 42.73, P < 0.001), with the order of control group [(57.66 ± 9.12) points] > ADHD group [(49.96 ± 8.86) points] > TD group [(43.99 ± 8.41) points]. The detection rate of low self-concept in TD group (62.5%) was significantly higher than that in ADHD group (42.5%) and control group (7.5%) (χ² = 89.23, P < 0.001). The total score of SCL-90 in caregivers was significantly different among the three groups (F = 41.26, P < 0.001), with the order of TD group [(145.73 ± 41.56) points] > ADHD group [(130.92 ± 37.64) points] > control group [(95.86 ± 24.85) points]. Except for the phobia factor, all other factor scores showed significant differences among groups (all P < 0.001). The total score of CSCS was negatively correlated with total score of SCL-90 in all three groups (ADHD group: r = −0.49, 95%CI: −0.64 to −0.30, P < 0.001; TD group: r = −0.48, 95%CI: −0.63 to −0.29, P < 0.001; control group: r = −0.36, 95%CI: −0.54 to −0.15, P < 0.001). After adjusting for age and gender, caregivers’ psychological symptoms were independent negative predictors of children’s self-concept (ADHD group: β = −0.26, 95%CI: −0.42 to −0.10, P = 0.002, R² = 0.28; TD group: β = −0.25, 95%CI: −0.41 to −0.09, P = 0.003, R² = 0.26; control group: β = −0.19, 95%CI: −0.34 to −0.04, P = 0.015, R² = 0.17). Conclusions: Children with ADHD and TD both have impaired self-concept, especially in TD children. Caregivers of affected children suffer from more serious psychological burden. Children’s self-concept is significantly negatively correlated with caregivers’ mental health. A child-family integrated psychological intervention model should be established in clinical practice.