Objective: To explore the characteristics of executive function in children with attention-deficit/hyperactivity disorder comorbid with high functioning autism. Methods: A total of 165 children with attention-deficit/hyperactivity disorder (ADHD group), 65 children with attention-deficit/Hyperactivity disorder comorbid with high functioning autism (ADHD-HFA group), and 84 healthy controls (control group) (based on the criteria of DSM-5) were recruited from the Outpatient Clinic of Child Healthcare Department of Shen Zhen Children's Hospital. The Rey complex figure test (RCFT), trail making test (TMT), Stroop color-word test were used to assess working memory, shifting and inhibition. Results: ADHD group (2.1±1.9, 7±5, 2.1±2.0 and 7±5) and ADHD-HFA group (2.0±2.0, 7±6, 2.0±2.1 and 6±5) performed worse than control group (3.4±2.0, 10±5, 3.4±2.0 and 10±6) in Rey complex figure test (all P<0.05). ADHD group ((171±8) s, (27.40±0.82) s and (52.29±1.62) s) and ADHD-HFA group ((197±11) s, (29.7±1.1) s and (58.6±2.1) s) group took longer time on the TMT-2, Stroop2 and Stroop4 test than control group ((135±18) s, (22.4±1.9) s and (38.7±3.8) s) (all P<0.05). In children with low intelligence quotient (IQ), ADHD group ((30±8) s) and ADHD-HFA group ((34±9) s) performed worse on Stroop3 test than control group ((20±4) s) (all P<0.05). In children with average IQ, ADHD group ((19±5) s and (24±8) s) took longer time on the Stroop1 and Stroop3 test than control group ((16±3) s and (19±4) s) (all P<0.05). In children with high IQ, ADHD-HFA group ((20±8) s) spent more time on Stroop1 than control group ((15±4) s) (P<0.05). Inattention symptoms were associated with the time on TMT-2 of ADHD-HFA group (r=0.275 and 0.329, all P<0.05). The score of item 1 in autism spectrum screening questionnaire (ASSQ) was negatively correlated with immediate recall structure and detail scores as well as delay structure scores of Rey complex figure test (r=-0.358, -0.326 and -0.306, all P<0.05). The score of item 4 was positively correlated with errors of Stroop4 (r=0.296, P<0.05). The score of item 22 was positively correlated with time of color interference (r=0.279, P<0.05). Conclusions: Children with ADHD-HFA are likely to demonstrate the spatial working memory, shifting and inhibition deficits associated with ADHD alone. Some domains of executive function impairment in ADHD-HFA group are related with symptoms of inattention/hyperactivity and autism.
目的： 探讨共患高功能孤独症的注意缺陷多动障碍（ADHD）儿童的执行功能特征。 方法： 选取2017年6月至2019年6月就诊于深圳市儿童医院儿童保健科门诊的符合美国精神障碍诊断与统计手册第5版（DSM-5）诊断标准的ADHD共患高功能孤独症（ADHD-HFA组）患儿65例，单纯ADHD儿童（ADHD组）165例，健康儿童（健康对照组）84名。采用Rey复杂图形测试、连线测试、Stroop色词命名任务测试空间工作记忆、转换能力和抑制功能。 结果： （1）Rey复杂图形的即时结构、即时细节、延时结构、延时细节得分ADHD组[（2.1±1.9）分和（7±5）分和（2.1±2.0）分和（7±5）分]、ADHD-HFA组[（2.0±2.0）分和（7±6）分和（2.0±2.1）分和（6±5）分]显著低于健康对照组[（3.4±2.0）分和（10±5）分和（3.4±2.0）分和（10±6）分]（均P<0.05）；ADHD组[（171±8） s和（27.40±0.82） s和（52.29±1.62） s]和ADHD-HFA组[（197±11） s和（29.7±1.1） s和（58.6±2.1） s]的数字-字母连线时间、Stroop2试、Stroop4试时间显著高于健康对照组[（135±18） s和（22.4±1.9） s和（38.7±3.8） s]（均P<0.05）。（2）在中下智商群体，ADHD组[（30±8） s]和ADHD-HFA组[（34±9） s]的Stroop3试时间比健康对照组[（20±4）s]多（均P<0.05）；中等智商群体，ADHD组[（19±5） s和（24±8） s]在Stroop1和Stroop3用时多于健康对照组[（16±3） s和（19±4） s]（均P<0.05）；中上智商群体，ADHD-HFA组[（20±8） s]的Stroop1耗时显著高于健康对照组[（15±4） s]（P<0.05）。（3）ADHD-HFA组的注意不集中得分与数字-字母连线错误数显著正相关（r=0.275、0.329，均P<0.05），ASSQ条目1得分与Rey复杂图形即时结构、即时细节、延时结构得分显著负相关（r=-0.358、-0.326、-0.306，均P<0.05），条目4与Stroop4错误数显著正相关（r=0.296，P<0.05），条目22得分与颜色干扰用时显著正相关（r=0.279，P<0.05）。 结论： ADHD-HFA展示了与ADHD相似的空间工作记忆、转换和抑制功能缺陷，ADHD-HFA组在执行功能一些领域受损可能与ADHD症状和孤独症谱系障碍（ASD）症状有关。.
Keywords: Attention deficit disorder with hyperactivity; Executive function; High functioning autism; Inhibition function.