重复经颅磁刺激联合社交康复训练治疗注意缺陷多动障碍儿童临床研究OA北大核心CSTPCD

Objective To observe the effect of repetitive transcranial magnetic stimulation(rTMS)combined with social reha-bilitation training on children with attention deficit hyperactivity disorder(ADHD).Methods A total of 60 children diagnosed with ADHD in the Children's Hospital of Nanjing Medical University from March 2019 to June 2022 were randomly divided into control group and observation group,with 30 cases in each group.The control group received routine medication,once a day for 12 weeks.The observation group received rTMS combined with the program for the education and enrichment of relational skills(PEERS)social rehabilitation training in addition to the routine medication,including 15 minutes rTMS treatment a time,twice a week for 12 weeks.The PEERS social rehabilitation training course consisted of 6 parts:communication,information interaction,game initia-tion,self-initiative,disagreement resolution and social pragmatics,which had 12 classes,50 minutes per session,once a week,for 12 weeks.Before and after treatment,Swanson,Nolan and Pelham-Ⅳ rating scale(SNAP-Ⅳ)was used to evaluate attention deficit and hyperactivity/impulsivity.Weiss functional impairment rating scale-parent form(WFIRS-P)was used to evaluate social func-tional behavior.Social anxiety scale for children(SASC)was used to evaluate anxiety.Depression self-rating scale for children(DSRSC)was used to evaluate depression.The correlations of WFIRS-P family score and social activity score with SNAP-Ⅳ score,SASC score and DSRSC score were analyzed.Results(1)SNAP-Ⅳ scores:compared with that before treatment,attention deficit,hyperactivity/impulsivity,opposition and defiance scores in SNAP-Ⅳ of both groups decreased significantly after treatment(P<0.05).Compared with the control group,attention deficit,hyperactivity/impulsivity and opposition defiance scores in SNAP-Ⅳ of the observation group were lower after treatment(P<0.05).(2)WFIRS-P scores:compared with that before treatment,the family,learn-ing/school,life skill,self-concept,social activity and adventure activity scores in WFIRS-P of both groups decreased significantly after treatment(P<0.05).Compared with the control group,the family and social activity scores in WFIRS-P of the observation group were lower after treatment(P<0.05).(3)SASC and DSRSC scores:compared with that before treatment,the SASC and DSRSC scores of both groups decreased significantly after treatment(P<0.05).Compared with the control group,SASC and DSRSC scores of the observation group were lower after treatment(P<0.05).(4)Correlation analysis:the family score in WFIRS-P was posi-tively correlated with hyperactivity/impulsivity,opposition and defiance scores in SNAP-Ⅳ(r=0.357,P=0.005;r=0.284,P=0.028),the SASC score(r=0.352,P=0.006)and the DSRSC score(r=0.353,P=0.006).The social activity score in WFIRS-P was positively correlated with opposition and defiance score in SNAP-Ⅳ(r=0.293,P=0.023),as well as the DSRSC score(r=0.347,P=0.007).Conclusion rTMS combined with social rehabilitation training can effectively improve attention deficit hyperactivity disorder,anxiety and depression of children with ADHD,and enhance their family and social activity functions.