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Objective:To explore the relationship between serum cortisol and attention deficit hyperactivity disorder (ADHD), and to investigate the application of cortisol in the diagnosis of ADHD, so as to provide clues and theoretical basis for the comprehensive prevention and treatment of ADHD in the future.Methods:Serum cortisol levels were detected in 159 ADHD children [ADHD group, 58 cases of predominately inattentive presentation (ADHD-I), 32 cases of predominately hyperactive/impulsive presentation (ADHD-HI), 69 cases of combined presentation (ADHD-C)], and 58 healthy control children (healthy control group) from July 2018 to June 2019, at Fujian Medical University Union Hospital.The receiver operating characteristic (ROC) was used to evaluate the diagnostic value of serum cortisol levels in ADHD groups.Results:(1) The serum cortisol levels of ADHD-I group[(216.58±70.55) nmol/L], ADHD-HI group[(182.26±51.34) nmol/L]and ADHD-C group[(222.81±75.70) nmol/L]were significantly lower than that of the healthy control group[(344.83±98.17) nmol/L](all P<0.001). The level of cortisol in ADHD-HI group was lower than that in ADHD-I group and ADHD-C group ( P<0.05). (2)According to the ROC analysis of serum cortisol, the area under the ROC curve for the diagnosis of ADHD group was 0.866 (95% CI: 0.814-0.917), the maximum Youden index was 0.583, the corresponding sensitivity was 89.3%, the specificity was 69.0%, and the cut-off was 302.88 nmol/L.When the specificity was 85.0%, 246.13 nmol/L was the diagnostic threshold and its corresponding sensitivity was 71.1%.Under the ROC curve for the diagnosis of ADHD-I group, the area was 0.857 (95% CI: 0.792-0.922), the maximum Youden index was 0.552, the corresponding sensitivity was 69.0%, the specificity was 86.2%, and the cut-off was 243.39 nmol/L.Under the ROC curve for the diagnosis of ADHD-HI group, the area was 0.934 (95% CI: 0.887-0.980), the maximum Youden index was 0.745, the corresponding sensitivity was 96.9%, the specificity was 77.6%, and the cut-off was 261.55 nmol/L.Under the ROC curve for the diagnosis of ADHD-C group, the area was 0.841 (95% CI: 0.774-0.908), the maximum Youden index was 0.559, the corresponding sensitivity was 87.0%, the specificity was 69.0%, and the cut-off was 302.82 nmol/L.In view of parents′ lack of understanding of ADHD behavior, it is suggested that the diagnostic threshold of cortisol level of 246.13 nmol/L should be based on 85.0% specificity principle, combined with behavior verification in clinical practice, so as to improve the diagnostic accuracy. Conclusions:Cortisol levels in ADHD-I, ADHD-HI and ADHD-C groups are lower than that in control group.There is functional impairment of hypothalamic-pituitary-adrenal axis in ADHD children.The level of cortisol has certain accuracy in the diagnosis of simple ADHD and can be used in clinical diagnosis.
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BACKGROUND:Children with learning difficulty often present with cognitive impairments and imbalanced development of intelligence accompanied by emotional and behavioral problems.OBJECTIVE:To evaluate the therapeutic effects of integrated interventions in multiple aspects for children with learning difficulties.DESIGN:A case-control study of children with learning difficulties.SETTING:Department of Pediatric Internal Medicine, Union Hospital Affiliated to Fujian Medical University.PARTICIPANTS:This study involved school-age children of 6 to 12years old with learning difficulties who came to the department specialized in pediatric psychology for consultation from July 1998 to July 2001. The diagnosis of learning difficulties conformed to the diagnostic criteria for special learning disability in ICD-10 with IQ ＞ 70 as an essential condition. Children with emotional disorders, mental deficiency, hyperactivity,visual and auditory dysfunctions and organic cerebral diseases were excluded. The diagnosis was further verified by a professor specialized in neuropsychology. The children voluntarily participated in the cognitive training, behavioral intervention and comprehensive trainings of senses and those who fulfilled the one-year treatment were included in this study. The ratio of therapists to the children was 1:2, and each session of treatment lasted for 90-120 minutes given 2-3 times a week, and a treatment course consisted of 24 sessions. The children were supposed to complete 4 consecutive treatment courses. Totally 31 children completed the treatment courses, including 24 boys and 7 girls with the mean age of(7.7±1.2)years who had an average IQ of 87.5±8.6.grated interventions for one year consisting of cognitive training, behavioral intervention and comprehensive training of the senses. Raven's Deductive Reasoning test and Beery Visual-Motor Integration Test were use to examine the deductive reasoning ability and visual-motor integration of the children, and visual attention test and auditory attention test, as well as sequential and reverse-sequence memory tests were employed to test their attentions. Achenbach children behavioral scale was applied to evaluate the children's behavioral problems, and Conners' questionnaire for children's behavioral problem was used to measure their attention-deficit/hyperactivity disorder (ADHD) index.MAIN OUTCOME MEASURES:Changes in the deductive reasoning ability, capability of visual-motor integration, attention and psychological behaviors after one year of intervention.RESULTS:All the 31 patients children entered the result analysis with no loss. After one year of integrated intervention, the children had significantly improved scores for Raven's Deductive Reasoning Test (87.51 ±8.64 vs 90.03±8.70, t=-9.610, P ＜ 0.001) and Beery Visual-Motor Integration Test (6.75±1.74 vs 8.27±1.94, t=-9.002, P ＜ 0.001). Obvious improvement was also seen in the visual attention test (15.90±20.11 vs 2.74±3.67), scope of auditory attention and memory (7.70±1.60 vs 11.23±1.23for sequential memory and 3.52±0.93 vs 6.97±0.16 for reversed-sequence memory, P ＜ 0.01). The total scores for ADHD assessment declined to different extents at 3 and 6 months during the treatment and upon the completion of the treatment (22.65±3.53 vs 18.87±4.14 at month 3, 5.65±3.92at month 6 and 12.65±3.36 at one year, t=7.35-15.36, P ＜ 0.01). The scores for 9 psychobehavioral items in Achenbach children behavioral scale obviously declined were also reduced significantly during the therapy,and 87% (26/31) of the children had obviously improved academic performance.CONCLUSION:Interventions integrating cognitive training, behavioral intervention and comprehensive training of the senses may produce good and persistent effect on the cognitive and emotional symptoms of children with learning difficulties, resulting in obviously improved visual, auditory and brain functions.
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Objective:To probe the curative effects and functional mechanism of integrated interference on children with learning disability.Methods:31children with learning disability have been treated for a year with a combination of methods such as cognitive training,behavior interference and training of all thesenses.During the different periods of treatment,results were recorded and measured. Resrlts:After one year’s integrated treatment of interference,the resultsacquired through Raven Standard Reasoning Test and Beery’s integrated-skill test of children’s vision and movements have greatly improved; errors made in thevisional attention test were dropped dramatically; and the scope of hearing and memory were obviously improved. The excessive exponent measured by Coroner’sForm has decreased; the results obtained by means of the nine factors provided by CBCL to examine psychological behavior have dropped respectively during thedifferent periods of treatment; and 87% of the children have made progress in their studies.Conclusion:The integrated interference by means of cognitive training,behavioral interference and the training of all the senses have produced a good and persistent effect on children with learning disability. The methods of integrated interference, having take into consideration the characteristics of children’s cognition, psychology and emotions, have worked together to bring about the results.
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Objective:To explore the situation of human parvovirus B_ 19 (HPV-B_ 19), cytomegalovirus (CMV) , Group A hemolytic streptococcal infections and immune function in children with tic disorders (TD).Methods:Sixty children with TD were involved in the study. HPV-B_ 19-IgM and CMV-IgM were examined using ELISA method. The titers of antistreptolysin O (ASO) was examined by agglutination. We also detected immune function, the ferrohemoglobin level, leucocyte count and platelet count of peripheral smear in the study. There were 20 healthy children as control group.Results:The positive rate of HPV-B_ 19-IgM (23.3%) were significantly higher than that of control (all are negative, ?2=5.67,P
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Objective:To investigate the features of children's visual cognitive function of attention deficit hyperactivity disorder (ADHD).Methods:By Benton Visual Retention Test (BVRT) including three means of C, D, and E, Trail Making Test, and Symbol-Digit Modalities Test (SDMT), 50 cases of ADHD and 50 cases of normal children were examined in their visual consciousness, visual memory, visual space structure, visual motion attention, and visual scanning et al.Results:①By the means of BVRT, the correct score was significantly lower in ADHD group (4.9?2.0)than in control group(7.7?1.4, t=8.00,P