目的分析破坏性行为障碍(DBD)对注意缺陷多动障碍(ADHD)患儿成人期预后的影响。方法采用Conners成人ADHD诊断会谈量表(CAADID)、美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查(SCID-Ⅰ)和SCID-Ⅱ工具、功能大体评定量表(GAF),对1999年9月-2006年7月就诊于本院儿科门诊的ADHD患儿的成人期心理状况进行评估,比较基线期伴与不伴DBD者的成人期预后。其中基线期共患DBD的ADHD者(ADHD伴DBD组)58例,基线期不共患DBD的ADHD者(ADHD不伴DBD组)58例。结果ADHD伴DBD组GAF分低于ADHD不伴DBD组,差异有统计学意义[(71.6±10.6)分vs(77.1±11.3)分,t=2.725P=0.007];GAF>70分在二组所占比率的差异亦有统计学意义(37.9%vs56.9%,χ2=4.184P=0.041)。ADHD伴DBD组请家教辅导及休学的比率均高于ADHD不伴DBD组(85.7%vs68.8%,26.8%vs10.4%),差异有统计学意义(P=0.038,0.035)。ADHD伴DBD组成人期满足成人ADHD、ADHD边缘状态和缓解者的比率分别为58.6%、24.1%和17.2%;ADHD不伴DBD组分别为43.1%、15.5%和41.4%,二组差异有统计学意义(χ2=8.225P=0.016),ADHD伴DBD组成人期ADHD持续存在者较多。ADHD伴DBD组15例(25.9%)有情感障碍,ADHD不伴DBD组6例(10.3%),二组差异有统计学意义(χ2=4.710P=0.030),ADHD伴DBD组共患情感障碍的OR值为3.023(95%CI1.080～8.463)。ADHD伴DBD组8例(13.8%)患未特定焦虑障碍,ADHD不伴DBD组2例(3.4%),二组差异有统计学意义(χ2=3.940P=0.047)。ADHD伴DBD组22例(37.9%)至少共患1种轴Ⅰ精神障碍,ADHD不伴DBD组11例(19.0%),二组差异有统计学意义(χ2=5.124P=0.024),ADHD伴DBD组共患精神障碍的OR值为2.611(95%CI1.123～6.072)。ADHD伴DBD组罹患B组人格障碍19例(32.8%),ADHD不伴DBD组4例(6.9%),二组差异有统计学意义(χ2=12.202P<0.001),ADHD伴DBD组共患B组人格障碍的OR值为6.577(95%CI2.074～20.859);其中反社会型人格障碍在二组间的比率分别为29.3%和5.2%,二组差异有统计学意义(χ2=11.842P=0.001)。ADHD伴DBD组罹患C组人格障碍5例(8.6%),ADHD不伴DBD组13例(22.8%),二组差异有统计学意义(χ2=4.382P=0.036),ADHD伴DBD组共患C组人格障碍的OR值为0.319(95%CI0.106～0.965)。ADHD伴DBD组罹患至少1种DSM-Ⅳ轴Ⅰ或轴Ⅱ障碍者33例(56.9%),ADHD不伴DBD组22例(37.9%),二组差异有统计学意义(χ2=4.184P=0.041),ADHD伴DBD组罹患轴Ⅰ或轴Ⅱ障碍的OR值为2.160(95%CI1.028～4.539)。结论儿童期DBD影响ADHD患儿成人期的预后,共患DBD的ADHD患儿在成人期总体社会功能相对较差,罹患成人ADHD、情感障碍、焦虑障碍及B组人格障碍(尤其是反社会型人格障碍)者较多。 Objective To analyze the effect of disruptive behavior disorder (DBD) on the prognosis of children with attention deficit hyperactivity disorder (ADHD). Methods Con ADHD Diagnostic Conversation Scale (CAADID), Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSID) and SCID-Ⅱ (Definitive Clinical Examination of Axis Ⅰ) and General Function Scale (GAF) to evaluate the adult psychiatric status of ADHD pediatric patients treated in our pediatric clinic from September 1999 to July 2006, and to compare the prognosis of adults with and without DBD at baseline. There were 58 ADHD patients (ADHD with DBD group) with baseline DBD co-occurrence, 58 ADHD patients without DBD co-baseline disease (DBD group). Results The GAF score of ADHD with DBD was lower than that of ADHD without DBD ([(71.6 ± 10.6) vs 77.1 ± 11.3, t = 2.725 P = 0.007] The differences were also statistically significant (37.9% vs56.9%, χ2 = 4.184P = 0.041). The rates of tutoring counseling and drop-off in ADHD with DBD group were higher than that in ADHD without DBD group (85.7% vs68.8%, 26.8% vs10.4%, respectively), the difference was statistically significant (P = 0.038,0.035). ADHD with DBD group adult adulthood meet the ADHD, ADHD marginal state and the ratio of remission were 58.6%, 24.1% and 17.2%; ADHD without DBD were 43.1%, 15.5% and 41.4%, respectively, the two groups were statistically significant Significance of learning (χ2 = 8.225P = 0.016), ADHD with DBD group ADHD persistent persistence of more. ADHD with DBD group, 15 cases (25.9%) had affective disorder, ADHD without DBD group, 6 cases (10.3%), the difference was statistically significant (χ2 = 4.710P = 0.030), ADHD with DBD group comorbid affective disorder OR of 3.023 (95% CI 1.080 ~ 8.463). There were 8 cases (13.8%) with no specific anxiety disorder in ADHD with DBD group and 2 cases (3.4%) in ADHD without DBD group. The difference between the two groups was statistically significant (χ2 = 3.940P = 0.047). ADHD with DBD group, 22 cases (37.9%) had at least 1 axis Ⅰ mental disorder, ADHD without DBD group, 11 cases (19.0%), the difference between the two groups was statistically significant (χ2 = 5.124P = 0.024) The odds ratio for comorbid psychiatric disorders in the DBD group was 2.611 (95% CI 1.123 to 6.072). There were 19 cases (32.8%) of ADHD with DBD group and 4 cases (6.9%) of ADHD without DBD group. There was significant difference between the two groups (χ2 = 12.202P <0.001) The OR of personality disorder in group B was 6.577 (95% CI 2.074 ~ 20.859). The rates of antisocial personality disorder in the two groups were 29.3% and 5.2% respectively, with significant difference between the two groups (χ2 = 11.842 P = 0.001). There were 5 cases (8.6%) of ADHD with DBD group and 8 cases of ADHD without DBD group (22.8%). There were significant differences between the two groups (χ2 = 4.382P = 0.036), ADHD with DBD group The OR of group C personality disorder was 0.319 (95% CI0.106 ~ 0.965). There were 33 cases (56.9%) with at least one DSM-Ⅳ axis or axis Ⅱ disorder in ADHD with DBD group and 22 cases (37.9%) with ADHD without DBD group, the difference was statistically significant (χ2 = 4.184P = 0.041), OR of 2.160 (95% CI 1.028-4.539) in patients with ADHD with DBD who had axial I or II disability. Conclusion Childhood DBD affects the prognosis of adult children with ADHD. Children with ADHD who suffer from DBD generally have poor overall social function in adulthood, ADHD, affective disorder, anxiety disorder and personality disorder in group B (especially antisocensive Personality disorder) are more.