VALIDITY OF DSM-N SUBTYPES OF ADHD FOR YOUNG CHILDREN

注意缺陷多动障碍(ADHD)的DSM-IV定义 区分了DSM-III或DSM-III中未识别的ADHD的新亚型- R.符合以多动-冲动为主的标准的儿童 类型(Preh)表现出高度的多动症和冲动，但 没有被报道过的注意力缺陷被认为是 多动症的特征。这一亚型是根据发育情况区分的： 因为四分之三的早产儿年龄在7岁以上。 年龄，他们被认为是完全ADHD的较轻的病例。 注意力缺陷尚不明显的幼儿的综合症。 随着患有这一亚型ADHD的儿童逐渐长大，预计他们 将被报告为表现出更高程度的注意力不集中 置身于更具挑战性的教育环境中， 他们轻微的，但仍在损害注意力的缺陷。因此，新的 Preh亚型有助于学龄前儿童ADHD的早期诊断 注意力不集中的年龄不能很好地衡量。这是非常重要的 然而，测试这一发展模型，因为有以下重要原因 担心Preh类型实际上可能导致不正确的 识别没有注意力的正常、活跃的儿童 赤字，没有功能受损，谁很快就会超过他们的 运动过动症。不同于同年龄段患有全面性ADHD的儿童 综合征，Preh型与对照组在任何指标上没有不同 同伴社会关系受损或学龄前适应 DSM-IV现场试验(它们仅被全球成年人评为受损 措施)。因此，学龄前儿童的PREH类型的效度 将在拟议的研究中通过检验以下假设进行检验： 会表现出比对照组明显更少的出席行为 受试者在挑战的情况下会表现出他们的注意力 赤字，并将表现出比控制措施更大的损害 社交能力和母子互动，更敏感和 比DSM-IV现场试验中使用的数据更适合年龄。其有效性 也将通过测试Preh类型的 假设它们将被报告为逐渐表现出更多 四年来的注意力不集中症状和学习障碍 更具挑战性的教育需求。患有这种疾病的儿童 注意力不集中和多动-冲动的完整综合征(DSM-IV 合并类型)预计将表现出与 Preh型，但在相同年龄段的严重程度更高。此外， 拟议的研究将是对诊断稳定性的第一次研究。 学龄前儿童ADHD随时间的变化和第一次前瞻性研究 对青少年早期出现严重品行问题的考察 患有多动症的儿童。

The DSM-IV definition of Attention-deficit Hyperactivity Disorder (ADHD) distinguishes a new subtype of ADHD not identified in DSM-III or DSM-III- R. Children who meet criteria for the Predominantly Hyperactive-impulsive Type (PreH) exhibit high levels of hyperactivity and impulsivity, but are not reported to have the deficits in attention considered to be the hallmark of ADHD. This subtype was distinguished on developmental grounds: Because three-quarters of children with the PreH Type are < 7 years of age, it was assumed that they represent milder cases of the full ADHD syndrome in young children whose attention deficits are not yet evident. As children with this subtype of ADHD grow older, it is expected that they will be reported to exhibit higher levels of inattention as a result of being placed in more challenging educational environments that reveal their mild, but still impairing attention deficits. Therefore, the new PreH subtype may facilitate the early identification of ADHD at preschool ages when inattention cannot be measured well. It is very important to test this developmental model, however, as there are important reasons for concern that the PreH Type may actually lead to the incorrect identification of normal, active children who do not have attention deficits, are not functionally impaired, and who will soon outgrow their motor hyperactivity. Unlike children of the same age with the full ADHD syndrome, the PreH Type did not differ from controls on any measure of impairment in peer social relationships or preschool adjustment in the DSM-IV Field Trials (they were only rated as impaired by adults on global measures). Therefore, the validity of the PreH Type in preschool children will be examined in the proposed study by testing the hypothesis that they will exhibit significantly less attending behavior than matched control subjects in challenge situations that will reveal their attention deficits, and will exhibit greater impairment than controls on measures of social competence and mother-child interaction that are more sensitive and age-appropriate than those used in the DSM-IV Field Trials. The validity of the PreH Type also will be examined developmentally by testing the hypothesis that they will be reported to exhibit progressively more inattention symptoms and academic impairment over four years as a result of increasingly more challenging educational demands. Children with the full syndrome of inattention and hyperactivity-impulsivity (DSM-IV Combined Type) are expected to show the same forms of impairment as the PreH Type, but with greater severity at the same ages. In addition, the proposed study would be the first study of the stability of the diagnosis of ADHD over time in preschool children and the first prospective examination of the early emergence of serious conduct problems in young children with ADHD.