Table of Content

10 September 2023, Volume 31 Issue 9

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Professional Forum

Evaluation and treatment of complex attention deficit hyperactivity disorder in childhood

CHEN Li

2023, 31(9):  935-938.  DOI: 10.11852/zgetbjzz2023-0845

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Attention deficit hyperactivity disorder(ADHD) is one of the most common neurodevelopmental disorders in childhood. Complex ADHD in children is relatively unique. These cases differ from typical ADHD cases in various ways, such as the atypical age at which symptoms appear or the presence of complex coexisting conditions. Additionally, the symptoms and functional impairment experienced by children with complex ADHD tend to be more severe.Therefore, these children require comprehensive interdisciplinary evaluation and treatment, as well as long-term standardized follow-up and chronic disease management.

Treatment and intervention of autism spectrum disorder in China and suggestions for further practice

JING Jin

2023, 31(9):  939-944.  DOI: 10.11852/zgetbjzz2023-0680

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Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with unknown etiology, high heterogeneity and rapidly increasing prevalence. Early education and training is the main method of rehabilitation. The intervention for ASD in China is still developing. Various medical and rehabilitation education institutions have carried out a variety of interventions, hoping to improve the function of ASD and reduce the family and social burden caused by ASD. Based on this, this article analyzes and expounds the progress in evidence-based practice of ASD, the current situation of ASD intervention in China, the limitations and the future development direction.

Original Articles

Association between genetic variation of ionized glutamate receptors and attention deficit hyperactivity disorder

XIONG Ping, ZHU Hongmin, HUANG Xin, WU Jing, LIN Jing, ZHONG Yanyan

2023, 31(9):  945-950.  DOI: 10.11852/zgetbjzz2022-1372

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Objective To analyze the association between genetic variation of ionized glutamate receptors (iGluRs) and attention deficit hyperactivity disorder (ADHD), so as to provide a theoretical basis for elucidating the pathogenesis of ADHD. Methods A case-control study was conducted for the potential candidate genes of ADHD, including GRIN2A, GRIN2B, GRIK1, GRIK4 and GRID2. A total of 320 ADHD children were recruited as the ADHD group in Wuhan Children's Hospital from August 2018 to December 2019, meanwhile 355 typically developed children were enrolled in the control group. All children were evaluated by Conners Parental Syndrome Questionnaire (PSQ). The associations of a single site with the risk of ADHDand ADHD symptoms were examined. Results There were no significant differences in age, sex ratio and intelligence quotient between the ADHD and control groups (P>0.05). The TT genotype frequency of rs1385405 locus on GRID2 gene showed a significant difference between the two groups (P=0.001). Individuals carrying the TT genotype at this locus were 2.725 times more likely to develop ADHD than those carrying the GG genotype (OR=2.725). In the ADHD-C subtype, there was a significant difference between the genotype frequency of this polymorphic locus (P=0.004). The risk of ADHD-C in individuals carrying TT genotype was 2.343 times as high as that in individuals carrying GG genotype (OR=2.343). In addition, there was an association between this locus and ADHD symptoms, with a significant difference in total PSQ scores among individuals carrying different genotypes (F=6.711, P=0.001). Conclusion GRID2-rs1385405 is associated with the susceptibility of ADHD in Chinese Han children, and TT genotype is a risk factor.

Effect of the program for the education and enrichment of relational skills on school-age children with attention deficit hyperactivity disorder

ZHU Peiying, CHU Liting, MA Chenhuan, PAN Lizhu, GUO Naiqi, LU Dingjie, WANG Yu

2023, 31(9):  951-956.  DOI: 10.11852/zgetbjzz2022-1109

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Objective To explore the effect of the program for the education and enrichment of relational skills (PEERS^®) on the social skills of children with attention deficit hyperactivity disorder (ADHD) aged 6 - 8 years, so as to provide evidence for the clinical application of this project in young ADHD children in China. Methods A total of 74 children aged 6 - 8 years who were diagnosed with ADHD in the Department of Child Health Care of Shanghai Children's Hospital from March to November 2021 were enrolled in this study, and were randomly divided into intervention group and control group. The intervention group received PEERS training for 14 weeks, while the control group did not receive any intervention until the intervention in this study was finished. Social Anxiety Scale for Children (SASC), Social Skills Parent Rating Scale for Primary School Students, Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) and Strengths and Difficulties Questionnaire (SDQ) were used for evaluation before and after the intervention. Results After 14 weeks of training, there was a statistically significant decrease in the fear of denial rating (t=2.35), social avoidance distress score (t=2.34) and total SASC score (t=3.35) in the intervention group compared with those before intervention, and the scores were significantly lower than those in the control group(P<0.05). In terms of the Social Skills Parent Rating Scale for Primary School Students, scores of intention to interact (t=3.70), group prestige (t=2.84), social sensitivity (t=6.31), masking (t=2.34), individual sensitivity (t=3.10), emotional sensibility (t=3.33), expression skills (t=5.95), interaction skills (t=2.47), social expression and control (t=7.24), social feelings (t=7.71), emotional feelings and control (t=3.78) and total scale score (t=9.14) after intervention were significantly higher than those before intervention in the intervention group,which were significantly higher than those of the control group after intervention (P<0.05). In terms of WFIRS-P, the intervention group had significantly higher scores for family (t=3.06), learning/school (t=3.65), self-concept (t=2.44), social activity (t=3.50), adventure activity score (t=7.29) and total scale (t=8.25) after intervention,which were significantly higher than those of the control group after intervention (P<0.05).Except for conduct problems (t=1.57, P=0.122) and hyperactive attention inability (t=1.78, P=0.08),the intervention group had significantly lower scores for emotional symptoms (t=3.01), peer interaction problems (t=1.78) and total difficulty score (t=5.72) after intervention,which were significantly higher than those of the control group after intervention (P<0.05). After intervention, the hyperactivity-impulsivity score on the SNAP-Ⅳ scale was significantly lower in the intervention group than that before intervention (t=2.29, P=0.025), and the decrease was more significant compared to the control group (P<0.05). Conclusion PEERS training can significantly improve the social skills of ADHD children aged 6 - 8 years, and improve social function and some core symptoms of ADHD children.

Randomized controlled trial of the evidence-based therapy based on behavioral parent training group in alleviating Chinese children with symptoms of externalized behavior problems

GAO Liru, QIN Yiming, QU Zhiyong

2023, 31(9):  957-962.  DOI: 10.11852/zgetbjzz2022-1039

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Objective To analyze the effect of the evidence-based therapy based on Behavioral Parent Training (BPT) on alleviating the symptoms of common externalizing behavior problems in Chinese children by a randomized controlled trial. Methods From Nov.2019 to Apr.2020,a total of 141 children aged 6-12 and their parents were randomly divided into intervention group (n=72) and control group (n=69). Parents in the intervention group received BPT for 10 times, while the control group was given no intervention procedure. The Eyberg Child Behavior Inventory (ECBI) was used to assess children's behavior at baseline and after the intervention. Results Finally 114 children finished assessment before and after intervention, of whom 62 children were in the intervention group, and 52 children were in the control group. Post-test scores of ECBI, oppositional defiant behavior (ODB), attention deficit hyperactivity disorder behavior and unnamed factor in the intervention group were significantly lower thanthose of the control group(F=6.13, 4.34, 4.17, 7.41, P＜0.05), but there was no significant difference in the score of conduct problem behavior between the two groups (P＞0.05). After intervention, the scores of ECBI and four specific dimensions of children in the intervention group were significantly lower than those before intervention, but there was no significant difference in the ECBI score between pre-test and post-test for the control group (P＞0.05). Except for conduct problem, the pre-test and post-test difference scores of ECBI and other 3 dimensions in the intervention group were significantly higher than those in the control group (t=2.76, 2.05, 2.44, 3.12, P＜0.05). Conclusion BPT can effectively alleviate common externalized behavior problems of children, which may provide useful reference for taking evidence-based intervention, reducing the occurrence and development of children's externalizing behavior problems.

Preliminary study on the application of mobile terminal in the early screening for autism spectrum disorder in children at home

LI Yicheng, ZHANG Yuanyuan, HUO Yanyan, WU Dan, MA Ling, QIU Xiaoyan, MA Chenhuan, WANG Jian, LUO Jieming, LI Tianshu, XU Jing, ZHOU Jie, SUN Tingting, SHEN Hongying, XU Lei, WANG Yu, CHEN Jinjin

2023, 31(9):  963-968.  DOI: 10.11852/zgetbjzz2022-1484

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Objective To explore the clinical application value of using mobile terminal for early screening of autism spectrum disorder (ASD) in children aged 0 - 36 months in Shanghai, in order to guide early family intervention. Methods A stratified sampling method was used to randomly select 12 secondary and tertiary maternal and child health care institutions in Shanghai. Children aged 0 - 36 months who underwent routine community physical examination were selected. The revised ASD early screening scale was used as the screening tool to conduct ASD early screening online at home. The primary and secondary screening rate, screening positive rate, positivity distribution and related influencing factors were analyzed. Results A total of 2 748 infants and toddlers participated in the early screening of ASD in the community, with a total of 3 472 screenings and 3 317 valid screenings, representing a valid screening rate of 95.54% and a secondary screening rate of 19.10%. There were 308(9.62%) cases with abnormal screening results, among which the positive rate of boys was 12.44%, significantly higher than that of girls (6.51%) (χ²=33.45, P<0.05). Among those who were screened ≥2 times, 68 children had abnormal screening at least for 1 time, 34 children finally had normal follow-up result with home intervention based on the community health promotion guidance, and the effective rate of home intervention was 50%. There were significant differences in the distribution of screening dimension failures among different age groups. Failure in gross motor skills was concentrated before 12 months of age, failure in language and fine motor skills was concentrated between 18 and 24 months of age, and failure in personal social skills was concentrated between 24 and 30 months of age. The majority (65.17%) represented "no speech" behavior among children who failed in the "five no" screening test. Conclusions The mobile terminal has good clinical application value in early screening of ASD in children at home. Promoting early ASD intervention in community-family is helpful to mobilize the subjective initiative of home and community, improve the early identification capabilities of caregivers and primary care professionals, guide caregivers to understand the law of early development of children and provide responsive care, so as to better prevent ASD and reverse ASD outcomes effectively.

Follow-up study on the effects of comprehensive intervention on children with autism spectrum disorder

ZHANG Ting, SHAO Zhi, YANG Guang, TAO Hongmei, PENG Shuai, ZHANG Yaru, WANG Yi, PENG Yuanqin

2023, 31(9):  969-974.  DOI: 10.11852/zgetbjzz2022-1400

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Objective To analyze the changes in clinical symptoms, language ability, social adaptation, social communication, and Theory of Mind (ToM) skills of children with autism spectrum disorder (ASD) for 1 year after intervention cessation, who have already finished comprehensive intervention and had improved clinical symptoms and social adaptation. Methods Thirty-five children with ASD diagnosed in Chongqing Rehabilitation and Treatment Center for Children with ASD from 2015 to 2020 were selected in this study, and 35 typically developed children were enrolled. ASD children were 3 to 7 years old when receiving intervention, with an average age of (4.60±1.14) years old. ASD children were assessed at pre-intervention (T1), post-intervention (T2), and 1 year after the end of the intervention (T3) by the Childhood Autism Rating Scale (CARS), Psycho-Educational Profile, 3rd edition (PEP-3), Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-Ⅳ), Normal Development of Social Skills from Infant to Junior High School Children(S-M), Social Responsiveness Scale (SRS) and ToM task, while the typically developed children received assessment by WPPSI-Ⅳ, SRS and ToM task. Results Comprehensive intervention significantly improved clinical symptoms, social adaptation and language development of ASD children. There was no significant change in CARS scores between T2 and T3. Children with ASD showed significantly lower SRS score and ToM abilities compared to the typically developed children. CARS scores at T2 and T3, as well as WPPSI-Ⅳ intelligence quotient at T3 significantly predicted ToM ability of ASD children at T3. S-M score at T2 significantly predicted SRS score of ASD children at T3. Conclusions The improvements in clinical symptoms and social adaptation that ASD children gained with comprehensive interventions remain stable after the intervention is withdrawn. The development of ToM and social communication abilities in ASD children is influenced by different psychological abilities.

Association between adolescent interpersonal distress and parent-child communication

LI Mingyu, XIANG Yanqi, ZHANG Aidi, TAN Simin, SHAN Li, ZHU Li, ZHANG Yayi

2023, 31(9):  975-979.  DOI: 10.11852/zgetbjzz2023-0186

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Objective To identify the relationship between adolescent interpersonal distress and parent-child communication, in order to provide reference for improving teenagers' interpersonal communication ability. Methods From May to July 2022, totally 720 middle school students were selected into this study. Interpersonal Relationship Assessment Scale (IRAS) and Adolescent Parent-child Communication Psychological Questionnaire (PACT) were used to evaluate interpersonal distress and parent-child communication, respectively, then the association between the two in students at different grades was analyzed. Results The total score of interpersonal distress of middle school students was [8.00 (4.00,13.00)], and the detection rate of interpersonal distress was 46.53%(335/720). Logistic regression analysis showed that authoritarian paternal parenting style (OR=8.750, 95%CI:2.041 - 7.511, P＜0.05) was an independent risk factor for interpersonal distress in junior middle school students, while higher scores of mother-child communication motivation (OR=0.363), mother-child communication ability (OR=0.327) and parent-child communication motivation (OR=0.203) were associated with lower risk of interpersonal distress of junior middle school students (P＜0.05). Neglectful maternal parenting style (OR=6.575, 95%CI:1.792 - 24.126, P＜0.05) was an independent risk factor for interpersonal distress among senior high school students, while higher scores of mother-child communication ability (OR=0.286) and father-child communication motivation (OR=0.439) were related to lower risk of interpersonal distress among senior high school students (P＜0.05). Conclusions It is worth paying attention to the problem of adolescent interpersonal disturbance. Changing parenting style and strengthening parent-child communication can help improve the interpersonal problems of adolescents.

Reliability and validity test of Chinese version of the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for Adolescence

LI Zhanquan, ZHU Lin, CHEN Zekai

2023, 31(9):  980-985.  DOI: 10.11852/zgetbjzz2023-0163

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Objective To revise the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), and to evaluate its validity and reliability in Chinese adolescents. Methods Standard forward-backward translation procedure, cross-cultural adaptation and pilot test were used in the translation of the SPSRQ.From Jan.17th to Sept.30th in 2022,totally 1 350 adolescents were tested by random sampling and grade stratified sampling. The data were classified into two groups, data of one group were used to conduct exploratory factor analysis and item analysis, and data of the other group were used to conduct confirmatory factor analysis, criterion validity test and reliability test. Results The Chinese version of SPSRQ-A contained two dimensions of reward sensitivity and punishment sensitivity, with 16 items in reward sensitivity and 21 items in punishment sensitivity, whose cumulative contribution of variance accounted for 54.321% of total variance. Confirmatory factor analysis showed that the fitting indexes met the statistical standard (χ²/df=3.156, RMSEA=0.059, SRMR=0.0617, CFI=0.906, NNFI=0.900). Item-content validity index(I-CVI) was 0.800 - 1.000, and scale-content validity index/average(S-CVI/Ave) was 0.970. There was significant correlation between the scores of two dimensions and the scores of two criterion scales (r=-0.453 - 0.604, P<0.001). The Cronbach's α coefficient of the scale and each dimension ranged from 0.883 to 0.953, the split-half reliability coefficient of the scale was 0.887. Conclusion The Chinese version of SPSRQ-A shows good reliability and validity, which can be used as an effective tool to evaluate the reinforcement sensitivity of Chinese adolescents.

Review

Research advance in the role of gut microbiota in attention deficit hyperactivity disorder

ZHENG Jie, CHEN Yanhui

2023, 31(9):  986-989.  DOI: 10.11852/zgetbjzz2022-1269

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The microbial-gut-brain axis (MGB), which is composed of gut microbiota and its metabolites together with the central nervous system, neuroendocrine system, neuroimmune system and autonomic nervous system, is considered to be a bridge between environmental risk factors and pathological mechanisms of ADHD. Monoamine neurotransmitter levels and hypothalamic-pituitary-adrenal (HPA) axis disturbances, which have received much attention in ADHD research, are closely related to MGB imbalance. Given that the differences in geographical environment and dietary habits may cause regional differences in the intestinal microbial composition, exploring the influence of living habits on the specific characteristics and metabolites of intestinal microbes in different regions and their role in the pathological process of ADHD is helpful to understand the mechanism of MGB involving in ADHD and to provide a basis for accurate ADHD prevention and treatment strategies as well as life guidance.

Attention deficit hyperactivity disorder and school bullying

JIN Zhenkun, ZHANG Gong

2023, 31(9):  990-995.  DOI: 10.11852/zgetbjzz2023-0017

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Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood, with the main symptoms of inattention, hyperactivity and impulsivity. ADHD children usually have difficulties with academic performance, peer relationships and emotional regulation. School bullying is an act of bullying and humiliation that occurs deliberately or maliciously between students through physical, verbal and online means, causing harm and having a negative psychological impact on both the bully and the person being bullied. Children with ADHD are more likely to engage in school bullying than normal children, and the impact of school bullying on ADHD children is more severe. Individual characteristic factors such as age and ADHD symptoms, as well as risk factors such as peer relationships and parenting styles may all be potential factors influencing the involvement of ADHD children in school bullying, and the experience of school bullying may lead to a variety of mental health problems in ADHD children. Intervention strategies for school bullying need to take into account the unique nature of ADHD children. Multi-level school bullying intervention for ADHD children from family, school and society may be a more effective measure.

Research advance in virtual/augmented reality in the diagnosis and treatment of autism spectrum disorder

ZHAI Tianyu, YAN Wenjie, DU Yasong

2023, 31(9):  996-999.  DOI: 10.11852/zgetbjzz2022-1414

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This review introduces the research progress in virtual/augmented reality technology in the diagnosis and treatment of autism spectrum disorder (ASD), discusses related problems in the use of related technologies and the research process, in order to improve further researches on ASD and provide a new method for the early diagnosis and treatment of ASD children.

Research progress on sensory characteristics of autism spectrum disorder

LI Xiang, FAN Lili

2023, 31(9):  1000-1004.  DOI: 10.11852/zgetbjzz2022-1518

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Autism spectrum disorder(ASD) is a complex neurodevelopmental disorder that begins in early development. Sensory abnormalities are common among ASD children and were included in the diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Sensation is an important cornerstone for the development of advanced functions such as cognition and social interaction. Accurately grasping the sensory characteristics of ASD is the key to better understanding its advanced dysfunction such as social interaction. In this review, current related researches on ASD sensory characteristics are sorted out and integrated, aiming to provide reference for early screening, individualized intervention and basic research of ASD.

Research advance in the application of music therapy in pediatric medicine overseas

ZHANG Dandan, YANG Yanyi, LIN Qian, XIA Ying, WANG Guyi, LU Wenjing, ZHANG Yongjun

2023, 31(9):  1005-1009.  DOI: 10.11852/zgetbjzz2022-0578

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In recent years, because of wide audience, good safety, good efficacy and other characteristics, music therapy has been more and more recognized by clinical practice of pediatric medicine. Scholars have conducted extensive studies on the theory and practice of music therapy, and believed that music therapy is an effective auxiliary means in pediatric medical diagnosis and treatment, which can play a positive role in relieving symptoms, releasing pressure and regulating emotions. This paper reviews the application of music therapy in pediatric clinical practice in recent years, summarizes the impact of music therapy on the diagnosis and treatment of pediatric diseases, in order to provide reference for the application of music therapy in related fields.

Meta-analysis

Meta-analysis of the effect of exercise interventions on executive function among children and adolescents with attention deficit hyperactivity disorder

SONG Yiling, FAN Biyao, BAI Xiaotian, YU Hongjun

2023, 31(9):  1010-1016.  DOI: 10.11852/zgetbjzz2022-1568

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Objective To systematically evaluate the effects of exercise interventions on executive function among children and adolescents with attention deficit hyperactivity disorder (ADHD), in order to provide a basis for developing non-pharmacological treatments for children with ADHD. Methods Literature related to the effects of exercise interventions on executive function in children and adolescents with ADHD published to November 8th, 2022 was captured through searching PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases. Reviewer Manager 5.4 was used for Meta-analysis, combined effect sizes were calculated. Heterogeneity test, sensitivity analysis and subgroup analysis were performed. Egger's test in Stata 15.0 was used to test for publication bias in the literature. Results Fifteen studies with a total number of 592 participants with ADHD were included. Meta-analysis showed that exercise interventions improved inhibitory control (SMD=0.54, 95%CI: 0.23 - 0.86,P<0.001), working memory (SMD=0.61, 95%CI: 0.29 - 0.93,P<0.001), and cognitive flexibility (SMD=0.66, 95%CI: 0.23 - 1.09,P＝0.003) of ADHD children and adolescents. Subgroup analysis showed the following results: 1) Moderate-intensity exercise had a moderate effect on inhibitory control and working memory, and moderate-to-vigorous-intensity exercise had a moderate effect on cognitive flexibility(P＜0.05). 2) Open-skilled sports had a moderate effect on inhibitory control, working memory and cognitive flexibility(P＜0.05),while closed-skilled sports did not significantly improve executive functions (P＞0.05). 3) Exercising regularly two times/week produced a large effect on inhibitory control (P＜0.05), and a more frequent (≥3 times/week) had a moderate-to-large effect on cognitive flexibility. 4) Interventions ranging from 6 to 8 weeks had a positive effect on inhibitory control and cognitive flexibility, and interventions with 12 weeks had a moderate-to-large effect on working memory (P＜0.05). Conclusions Exercise interventions are effective in improving executive function in children and adolescents with ADHD. Moderate-intensity exercise is most effective in improving inhibitory control and working memory, and moderate- to high-intensity exercise interventions are required in order to improve cognitive flexibility. Open-motor skills improve executive function of ADHD children. Exercise 2 times/week for 6-8 weeks can improve inhibitory control, while improving working memory requires more frequent and longer periods of exercise intervention.

Clinical Research

Association between executive function and behavioral problems in school-age children with attention deficit hyperactivity disorder

ZHANG Yu, YANG Yuankui, GUO Jing, XIE Fan, YUAN Xiaofang, FENG Jingwen, ZHANG Yi

2023, 31(9):  1017-1023.  DOI: 10.11852/zgetbjzz2022-0260

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Objective To explore the characteristics of executive function in school-age children with attention deficit hyperactivity disorder (ADHD) and its correlation with behavioral problems, so as to provide a theoretical basis for clinical intervention. Methods Thirty-two children with ADHD admitted to the Outpatient Clinic of Child Psychology Department, The First People's Hospital of Changzhou from May 2020 to December 2020 were selected into this study. Meanwhile 37 healthy children matched by age and sex were recruited. The Stroop test, Digit Distance Test (DST) and Wisconsin Card Test (WCST) were used for assessment, and parents completed the Parent Symptom Questionnaire (PSQ).The differences in executive function tests and questionnaire results between the two groups were compared, and the correlation was analyzed. Results 1) The scores of learning problems, impulse-hyperactivity and hyperactivity index in ADHD group were significantly higher than those of healthy children (t=4.44, 2.63, 2.51, P<0.05). 2) There was no statistically significant difference in the results of DST test between ADHD children and healthy children (t=1.84, 0.26, P>0.05), while the rate of persistent error in WCST in ADHD children was significantly higher than that in healthy children (t=2.46, P=0.02). In the Stroop test, the positive numbers of card B, card C and interference of ADHD children were significantly lower than those in healthy children (t=2.81, 4.67, 3.86, P<0.05).The rate of executive function disorder in ADHD group and healthy group was 81.25% and 43.24%, respectively, and the difference was significantly different (χ²=10.40, P<0.05), of which the rate of abnormal Stroop test result was significantly higher (68.75%).3) There was no significant correlation of DST and WCST test results with PSQ score; however, card A and card C test time of Stroop test, and interference amount time of the Stroop test were mildly correlated with the psychosomatic disorder index, learning problems index, impulsivity-hyperactivity index, and hyperactivity index (r=0.35-0.47, P<0.05). 4) Logistic regression analysis showed that the persistent error rateand the number of correct cards C were independent predictive factors for ADHD (P<0.05). The area under the curve (AUC) of the working characteristic curve for the persistent error rate and correct card C was 0.743 and 0.783, respectively (Z=0.491, P=0.624). The maximum Jorden index was 0.459 (sensitivity 1.000, specificity 0.459) when the persistent error rate was 4.23 and the maximum Jorden index was 0.498 when the number of correct cards C was 44.5 (sensitivity 0.811, specificity 0.688). Conclusions Executive dysfunction is highly prevalent in school-age children with ADHD and is associated with behavioral problems. Executive function tests can be used as an auxiliary indicator to the diagnosis of ADHD.

Association between sensory integration function and developmental dyslexia in children with attention deficit hyperactivity disorder

HUANG Wenxian, TAN Weiting, ZHANG Shanhong, YANG Binrang

2023, 31(9):  1024-1027.  DOI: 10.11852/zgetbjzz2023-0203

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Objective To analyze the association between sensory integration function and developmental dyslexia in children with attention deficit hyperactivity disorder, in order to privide new clues for improving reading ability and sensory integration function. Methods Totally 345 children diagnosed with ADHD in Shenzhen Children's Hospital from June 2019 to June 2021 were randomly selected, including 274 ADHD children comorbid DD, 71 children with ADHD only. Meanwhile, 103healthy children were selected into control group. One-way ANOVA was used to compare the score of the sensory integration function among the three groups. Pearson correlation analysis was used to evaluate the correlation between sensory integration scores and rapid automatized naming (RAN). Results 1) The scores of vestibular balance(37.2±1.5,39.0±1.7), developmental dyskinesia (41.6±1.4, 44.4±1.6), spatial orientation(45.9±1.5, 48.5±1.7), proprioception(40.0±1.3, 42.1±1.5)and emotional response(42.3±1.3, 42.7±1.6) in ADHD children with or without dyslexia were not significantly different(P>0.05), which both were lower than those in control group(P<0.05). The scores of neurophysiological inhibition of the brain(44.9±1.3), tactile defense(48.9±1.3) in the comorbid group were lower than those in children with ADHD (49.6±1.5, 53.2±1.5), which were significantly lower in ADHD group than that in control group (P<0.05). 2) The score of rapid automatized naming was negatively related to vestibular balance, spatial orientation and tactile defense in the comorbid group (r=-0.201、 -0.121、-0.126, P<0.05). Conclusion Children with ADHD often have sensory integration dysfunction, most significantly in the children with ADHD comorbid DD, and some sensory integration indexes are negatively correlated with RAN.

Refractive screening status of 1 390 children aged 2 - 6 years in Huaibei, Anhui province

CUI Mingming, SUI Guanghui, ZHANG Hao, LYU Yanyu, YANG Suhong, WANG Lin

2023, 31(9):  1028-1032.  DOI: 10.11852/zgetbjzz2023-0014

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Objective To investigate the refractive changes of young children in Huaibei area, Anhui province, in order to provide evidence for eye care, prevention and control of myopia and amblyopia. Methods A total of 1 390 2- to 6-year-old children in Huaibei District, who took physical examination in 18 kindergartens, were randomly selected into this study. Refractive screening with Suresight automatic optometry, along with the risk of amblyopia, was analyzed. The rate of refractive abnormality was determined and the composition of refractive abnormality factors was analyzed according to the standards provided by the instrument and the national specifications for eye care and vision examination services for children aged 0 - 6 years (trial). Results The rate of abnormal binocular refraction in preschool children was 22.99% based on the instrument standards, the rate ofhyperopia was 26.47%, and the rate of refractive abnormalities was 14.39% based on the national specifications. There was no statistically significant difference in refractive abnormalities in different age and sex groups (χ²=3.36,0.90,P>0.05). In terms of the refractive status, the proportion rates of suspected hyperopia, astigmatism, anisometropia and hypermetropia were 74.7%, 25.8%, 22.3% and 1.8%, respectively. Conclusion It is highly recommended that the national standard of refractive errors should be used in refractive screening for early identification of refractive abnormality, which helps to facilitate the graded health management of refractive screening, and is one key component for children's eye care.

Chain mediating role of psychological resilience and emotional balance between daily stress and depression in adolescents

WANG Yao, YU Zengyan

2023, 31(9):  1033-1037.  DOI: 10.11852/zgetbjzz2023-0098

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Objective To explore the chain mediating effect of psychological resilience and emotional balance in the association between daily stress and adolescent depression, in order to provide a theoretical basis for improving adolescent depression and other emotional problems. Methods The Adolescent Stressful Life Events Scale, the Positive and Negative Affect Scale for Children (PANAS-C), the Connor-Davidson Resilience Scale and Center for Epidemiologic Studies Depression Scale (CES-D) were used to investigate 1 153 middle school students from a middle school in Heilongjiang Province in September 2022 by a cluater sampling method. The characteristics of depressive symptoms were first analyzed by chi-square test and binary Logistic regression model, and then structural equation modeling was used to test the chain mediating role of psychological resilience and positive/negative emotions in the association between daily stress and adolescent depression. Results Among 1 153 junior high school students, 474 (41.1%) had depressive symptoms, and the detection rates of depreesion were significantly different among students with different gender, grade and left-behind experience (χ²=6.12, 9.71, 13.89, P<0.05). Higher scores of daily stress and negative emotions were risk factors for adolescent depression in the post-epidemic era (OR = 1.03, 95%CI: 1.02 - 1.04; OR = 1.12, 95%CI: 1.10 - 1.14), while positive emotions were protective factors for adolescent depression (OR = 0.94, 95%CI:0.92 - 0.96). Independent mediating effects of psychological resilience, positive and negative emotions in the association between daily stress and adolescent depressive symptoms levels were significant, and the mediating effects were 4.09%, 5.22% and 39.90%, respectively, as were the chain mediating effects (mediating effects were 3.88%, 4.13%). Conclusion Daily stress predicts adolescent depression directly and also indirectly through the chain mediating effects of psychological resilience and emotional balance.

Health Education

Investigation on demand for sexual health education among middle school students in Shanghai and Zhejiang

CAO Li, WANG Yanhuan, WANG Yingying, ZHAO Qi, XU Biao, FU Chaowei

2023, 31(9):  1038-1044.  DOI: 10.11852/zgetbjzz2023-0164

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Objective To investiagte the demand and influencing factors of sexual health education, and to explore appropriate education strategies among middle school students in Shanghai and Zhejiang. Methods A self-designed questionnaire was used to conduct a self-administered anonymous survey in selected six middle schools of Shanghai and Zhejiang Province, China in October 2021. Totally 2 042 students were cluster-sampled. Univariate analysis was performed using t test, χ² test and Wilcoxon test, and multivariate analysis was performed using Logistic regression analysis. Results Among 1 733 valid subjects, 69.4% had received sexual health education before, and it was significantly lower among boys (χ² =24.897) and students in Taizhou (χ² =7.949) compared with girls and students in Shanghai (P<0.05). More than half (51.7%) were very satisfied with their received education, and it was significantly lower among girls (χ²＝7.910) and senior high school students (χ²＝13.615) compared with boys and junior high school students (P<0.05). Near 67.8% of the students believed that they had easy access to sexual health knowledge, and the proportion was significantly higher among students in Shanghai(Z=2.700,P=0.007).Nearly 63.9% were willing to learn more about sexual health, and Taizhou students had a larger demand than Shanghai students (χ²=36.044, P<0.001). Sexual psychology (52.8%), sexual health care (48.1%) and sexual moral law (46.7%) ranked top 3 in what students wanted. Schools (60.2%) and teachers (51.0%) were the most welcome facility and provider of sexual health, respectively. Multiple Logistic regression analysis showed that students who were boys (OR=0.54, 95%CI: 0.39 - 0.75), studied in Taizhou (OR=0.64, 95%CI: 0.46 - 0.87), had good relationship with only mother/father (OR=0.64, 95%CI: 0.45 - 0.92), and students with below-average household finances (OR=0.42, 95%CI:0.25 - 0.69) were less likely to have received sexual health education before. Demands of sexual health education were statistically higher among those studied in Taizhou (OR=1.64, 95%CI: 1.10 - 2.48) and already had spermatogenesis or menstruation (OR=2.03, 95%CI:1.24 - 3.33), while it was statistically lower among those whose parents were in poor relationship (OR=0.49, 95%CI:0.26 - 0.96). Conclusions There are great demands for sexual health education among middle school students, and it is significantly related to gender, region of schooling, spermatogenesis/menstruation status, family relationships and economic level. The role of schools and teachers should be enhanced to promote their sexual health in China.