破坏性行为障碍发病机制的执行功能缺陷假说与脑影像学研究

Disruptive behavior disorder is featured by violation of social rules, compulsive and disruptive behavior. The stage of children and adolescent is important in the development of disruptive behavior disorder, which may impact the growth of children as well as bring potential harm to society. Studys from neuropsychology found that children with disruptive behavior disorder suffer from different kinds of executive function defects. They presented neuropsychological defects not only in pure operational executive function task, but also in scenarios related performance of executive function, which was related to emotional regulation. At the same time, studys from brain imaging showed stucture and functional abnormal in disruptive behavior disorder patient in prefrontal cortex, which was consistent with the defects in executive function. Up to now, a systematic and in-depth study for disruptive behavior disorder in neuropsychology and brain imaging is still absent. In this study, the profile of executive function defect and brain imaging characteristics in disruptive behavior disorder will be explored with the comparison to normal developed children. Pure operational neuropsychological task as well as scenarios related neuropsychological task will be used. Intervention based on executive function training will be practiced, the effect of which will be assessed. Through this study, we want to provide a preliminary and systematic profile of executive function defect in disruptive behavior disorder. We also want to find some rules in understanding the etiology of disruptive behavior disorders from the view of neuropsychology and brain imaging. Executive function training brings a new way in treating disruptive behavior disorder. This study also provides theoretical basis and practical experience for executive function training, which may prevent disruptive behavior disorder from getting worse.

破坏性行为障碍（DBD）是以违反社会规则、冲动和破坏行为为特征的心理障碍，儿童青少年阶段是该障碍发生发展的重要阶段，对儿童成长造成影响，给社会带来潜在危害。神经心理研究发现患儿存在执行功能缺陷，不仅涉及操作性神经心理测试表现缺陷，也涉及与情景相关的执行功能表现缺陷。脑影像学的研究证实患儿确实存在前额叶结构和功能的异常，与执行功能表现相关联。目前国内的执行功能研究多以注意缺陷多动患儿为对象,缺乏对DBD的特征研究。本研究拟以破坏性行为障碍患儿为研究对象，对其操作性神经心理测试和与情景相关的执行功能以及脑影像学特点进行研究，并与健康儿童做比较；通过执行功能训练，对患儿的神经心理和脑影像学改变作比较。通过本研究，能初步、系统地了解破坏性行为障碍患儿的执行功能特点及脑影像学特征，为进一步探讨破坏性行为障碍发病机制提供线索；为早期的有效干预，阻止其进一步发展，提供理论依据和实践经验。

破坏性行为障碍（DBD）是以违反社会规则、冲动和破坏行为为特征的心理障碍，儿童青少年阶段是该障碍发生发展的重要阶段，对儿童成长造成影响，给社会带来潜在危害。本研究以破坏性行为障碍患儿为研究对象，对其操作性神经心理测试与情景相关的执行功能以及脑影像学特点进行研究；编制了执行功能的训练软件，对DBD患儿进行训练。本研究发现：DBD患儿与健康发育儿童相比存在明显的情绪、行为问题（t=4.685-8.067，P＜0.001）；存在“工作记忆”、“反应抑制能力”等多个“冷”执行维度的损害（t=2.327-16.596，P＜0.05）；存在与“情绪调节”相关的负性情绪调节问题（t=2.236-2.874，P＜0.05））；“冷”、“热”执行功能之间存在一定的相关性（r=0.250-0.335，P＜0.05）。DBD患儿在大脑结构和功能上存在缺陷，包括：左楔叶、左颞中极、左颞上中回、左颞中回、右颞上回、左顶上小叶、左小脑前后叶、左小脑脚；左侧杏仁核与左额叶中央前回的功能连接弱，右杏仁核与右扣带回前部、右额内侧回的功能连接减弱；脑结构异常程度与执行功能缺陷存在相关性（r=0.488-0.672，P＜0.05）。通过执行功能的训练，破坏性行为障碍患儿在行为（t=2.813-2.933，P＜0.05）、执行功能的多个得分上（t=2.563-6.234，P＜0.05）均得到了好转。本研究结果将加深对破坏性行为障碍发病机制的理解。

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