家庭功能与父母教养方式对注意缺陷多动障碍儿童症状严重程度的影响：一项病例对照研究

Impact of Family Functioning and Parenting Styles on Symptom Severity in Children with Attention-Deficit/Hyperactivity Disorder: A Case-Control Study

摘要: 目的：探讨家庭功能、父母教养方式与注意缺陷多动障碍(Attention-Deficit/Hyperactivity Disorder, ADHD)儿童症状严重程度之间的多维关联，并分析心理社会因素对ADHD症状严重程度的独立及交互预测作用。方法：采用病例对照研究设计，纳入2024年1月至2025年12月在东南某省会城市三甲医院儿童精神科门诊确诊的ADHD儿童128例，以及同期从两所普通公立小学招募的健康对照儿童120例。使用一般情况调查表、家庭功能评定量表(Family Assessment Device, FAD)、父母教养方式问卷(Egna Minnen Beträffande Uppfostran, EMBU)及SNAP-IV评定量表进行数据收集。采用独立样本t检验、Pearson相关分析、多元线性回归及探索性中介效应分析进行数据处理。结果：(1) ADHD组在FAD所有七个维度上的得分均显著高于对照组(P < 0.01)，其中总功能(t = 9.15, P < 0.001, Cohen’s d = 1.17)、问题解决(t = 8.34, P < 0.001, d = 1.06)和沟通(t = 7.96, P < 0.001, d = 1.01)的组间差异最大。(2) ADHD组父母在情感温暖因子上的得分显著低于对照组(父亲：t = −9.88, P < 0.001；母亲：t = −10.23, P < 0.001)，在惩罚严厉(父亲：t = 7.82, P < 0.001；母亲：t = 8.47, P < 0.001)、拒绝否认(父亲：t = 7.34, P < 0.001；母亲：t = 7.89, P < 0.001)及过度保护(父亲：t = 6.12, P < 0.001；母亲：t = 6.35, P < 0.001)因子上的得分显著高于对照组。(3) SNAP-IV总均分与FAD总功能(r = 0.62, P < 0.01)、母亲惩罚严厉(r = 0.58, P < 0.01)呈中度正相关，与母亲情感温暖(r = −0.55, P < 0.01)呈中度负相关。(4) 多元回归分析显示，FAD总功能(β = 0.41, P < 0.001)、母亲情感温暖(β = −0.28, P = 0.003)及母亲拒绝否认(β = 0.23, P = 0.008)是ADHD症状严重程度的独立预测因素，共解释总变异的47.3%。(5) 探索性中介分析提示，母亲情感温暖部分中介了家庭功能与ADHD症状之间的关系(间接效应比例 = 22.6%)。结论：家庭功能失调和不良的父母教养方式与ADHD儿童症状严重程度呈显著关联，且家庭功能主要通过影响母亲情感温暖进而影响ADHD症状表现。这一发现支持将家庭系统评估和以母亲情感支持为核心的父母培训纳入ADHD的综合干预框架。

Abstract: Objective: To investigate the multidimensional associations between family functioning, parenting styles, and symptom severity in children with Attention-Deficit/Hyperactivity Disorder (ADHD), and to analyze the independent and interactive predictive effects of psychosocial factors on ADHD symptom severity. Methods: A case-control study design was employed. A total of 128 children diagnosed with ADHD at the pediatric psychiatric clinic of a tertiary hospital in a southeastern provincial capital city between January 2024 and December 2025 were enrolled, along with 120 typically developing control children recruited from two ordinary public elementary schools during the same period. Data were collected using a general demographic questionnaire, the Family Assessment Device (FAD), the Egna Minnen Beträffande Uppfostran (EMBU) questionnaire, and the Swanson, Nolan, and Pelham-IV Rating Scale (SNAP-IV). Independent-sample t-tests, Pearson correlation analyses, multiple linear regression, and exploratory mediation analysis were conducted for data processing. Results: (1) The ADHD group scored significantly higher than the control group across all seven dimensions of the FAD (P < 0.01), with the largest between-group differences observed in general functioning (t = 9.15, P < 0.001, Cohen’s d = 1.17), problem solving (t = 8.34, P < 0.001, d = 1.06), and communication (t = 7.96, P < 0.001, d = 1.01). (2) The ADHD group had significantly lower scores on the emotional warmth factor for both fathers (t = −9.88, P < 0.001) and mothers (t = −10.23, P < 0.001), and significantly higher scores on punishment and harshness (fathers: t = 7.82, P < 0.001; mothers: t = 8.47, P < 0.001), rejection and denial (fathers: t = 7.34, P < 0.001; mothers: t = 7.89, P < 0.001), and overprotection (fathers: t = 6.12, P < 0.001; mothers: t = 6.35, P < 0.001) compared to the control group. (3) The mean SNAP-IV score was moderately positively correlated with FAD general functioning (r = 0.62, P < 0.01) and maternal punishment and harshness (r = 0.58, P < 0.01), and moderately negatively correlated with maternal emotional warmth (r = −0.55, P < 0.01). (4) Multiple regression analysis revealed that FAD general functioning (β = 0.41, P < 0.001), maternal emotional warmth (β = −0.28, P = 0.003), and maternal rejection and denial (β = 0.23, P = 0.008) were independent predictors of ADHD symptom severity, together explaining 47.3% of the total variance. (5) Exploratory mediation analysis suggested that maternal emotional warmth partially mediated the relationship between family functioning and ADHD symptoms (proportion of indirect effect = 22.6%). Conclusion: Family dysfunction and maladaptive parenting styles are significantly associated with symptom severity in children with ADHD, and family functioning may influence ADHD symptom presentation primarily through its effect on maternal emotional warmth. These findings support the integration of family system assessment and maternal emotional support-focused parenting training into comprehensive intervention frameworks for ADHD.