团体认知训练叠加重复经颅磁刺激对高功能孤独症谱系障碍共病注意缺陷多动障碍的增效作用及脑电机制

doi:10.3969/j.issn.1006-9771.2025.08.015

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (8): 979-986.doi: 10.3969/j.issn.1006-9771.2025.08.015

团体认知训练叠加重复经颅磁刺激对高功能孤独症谱系障碍共病注意缺陷多动障碍的增效作用及脑电机制

仇爱珍¹, 王敏¹, 王秋爽², 吴野¹, 鲍克秀¹()

1.徐州医科大学附属徐州儿童医院康复科，江苏徐州市 221000
2.徐州医科大学公共卫生学院流行病与卫生统计学专业，江苏徐州市 221004

收稿日期:2025-04-14 修回日期:2025-07-28 出版日期:2025-08-25 发布日期:2025-09-01
通讯作者: 鲍克秀(1984-)，女，汉族，硕士，副主任医师，主要研究方向：儿童康复，E-mail：13615136925@163.com。
作者简介:仇爱珍(1981-)，女，汉族，江苏徐州市人，硕士，主任医师，主要研究方向：儿童康复。
基金资助:
徐州市重点研发计划(社会发展)项目-医药卫生面上(KC22197);江苏省卫生健康委科研项目(Z2023002)

Effect of repetitive transcranial magnetic stimulation augmentation on group cognitive training for high-functioning autism spectrum disorder comorbided with attention-deficit/hyperactivity disorder, and electrophysiological mechanisms

QIU Aizhen¹, WANG Min¹, WANG Qiushuang², WU Ye¹, BAO Kexiu¹()

1. Department of Rehabilitation, the Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
2. Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China

Received:2025-04-14 Revised:2025-07-28 Published:2025-08-25 Online:2025-09-01
Supported by:
Xuzhou City Key Research and Development Program (Social Development) General Medicine and Health Project(KC22197);Research Project of the Health Commission of Jiangsu Province(Z2023002)

摘要/Abstract

摘要：

目的探讨重复经颅磁刺激(rTMS)在团体认知训练(GCT)基础上对高功能孤独症谱系障碍(ASD)共病注意缺陷多动障碍(ADHD)患儿的增效作用和脑电机制。

方法 2023年3月至12月，徐州医科大学附属儿童医院及合作特殊教育机构ASD与ADHD共病患儿70例，随机分为对照组(n = 35)和试验组(n = 35)，两组均接受标准化GCT，每周2次，持续10周。GCT训练期间，对照组叠加伪刺激，试验组叠加1 Hz rTMS刺激右侧颞顶联合区，强度80%静息阈值，每周5次，持续10周。治疗前后采用社交反应量表(SRS-2)、重复行为量表-修订版(RBS-R)、Conners父母量表(CPRS-3)注意力缺陷维度和多动/冲动维度评估核心症状，同步记录静息态脑电(EEG)Fz、Cz、Pz的θ、β功率谱密度(PSD)值和θ/β波功率比。

结果对照组脱落2例，试验组脱落1例。治疗后，两组SRS评分(|Z| > 4.876, P < 0.001)、RSB-R评分(|Z| > 4.329, P < 0.001)均显著下降。两组CPRS-3注意力缺陷维度评分均下降(|Z| > 4.940, P < 0.001)，试验组显著低于对照组(Z = 4.732, P < 0.001)；两组CPRS-3多动/冲动维度评分均显著下降(|t| > 16.273, P < 0.001)，试验组明显低于对照组(t = -3.169, P < 0.01)。试验组治疗后Fz位点θ波PSD降低(Z = -4.830, P < 0.001)，明显低于对照组(Z = -2.609, P = 0.009)，θ/β比值降低(t = 4.754, P < 0.001)，低于对照组(t = -2.256, P = 0.027)。

结论在GCT基础上叠加rTMS干预，可减轻ASD与ADHD共病患者的注意缺陷与多动冲动症状，可能与前额叶θ波抑制有关。

关键词: 重复经颅磁刺激, 团体认知训练, 孤独症谱系障碍, 注意缺陷多动障碍

Abstract:

Objective To examine the effect and electrophysiological mechanism of repetitive transcranial magnetic stimulation (rTMS) augmentated to group cognitive training (GCT) on children with high-functioning autism spectrum disorder (ASD) comorbided with attention-deficit/hyperactivity disorder (ADHD).

Methods From March to December, 2023, 70 children diagnosed with ASD+ADHD were recruited from the Affiliated Xuzhou Children's Hospital of Xuzhou Medical University and partnering special education centers. They were randomly divided into control group (n = 35) and experimental group (n = 35). Both groups received standardized GCT, twice a week, for ten weeks. During the same period, the control group received sham stimulation, while the experimental group additionally received 1 Hz rTMS over the right temporoparietal junction at 80% of resting motor threshold, five times a week, for ten weeks. Core symptoms were assessed before and after treatment with the Social Responsiveness Scale-2 (SRS-2), Repetitive Behavior Scale-Revised (RBS-R) and Conners Parent Rating Scale-3 (CPRS-3) attention-deficit and hyperactivity/impulsivity subscales. Resting-state EEG was simultaneously recorded to obtain θ and β power spectral density (PSD) and the θ/β ratio at Fz, Cz and Pz.

Results Two cases in the control group and one in the experimental group dropped down. After treatment, SRS-2 scores (|Z| > 4.876, P < 0.001) and RBS-R scores (|Z| > 4.329, P< 0.001) decreased in both groups. CPRS-3 attention-deficit scores (|Z| > 4.940, P < 0.001) and hyperactivity/impulsivity scores (|t| > 16.273, P < 0.001) decreased in both groups, and they were lower in the experimental group (Z = 4.732, P < 0.001; t = -3.169, P < 0.01). In the experimental group, Fz θ-PSD decreased significantly (Z = -4.830, P < 0.001), and it was lower than that in the control group (Z = -2.609, P = 0.009); and the θ/β ratio likewise fell (t = 4.754, P < 0.001), and it was lower than that in the control group (t = -2.256, P = 0.027).

Conclusion Adding rTMS to GCT can further alleviate attention deficits and hyperactive-impulsive symptoms in children with ASD comorbided with ADHD, which may associate with the inhibit of power of θ wave in profrontal contex.

Key words: repetitive transcranial magnetic stimulation, group cognitive training, autism spectrum disorder, attention deficit/hyperactivity disorder

中图分类号:

R749.93

仇爱珍, 王敏, 王秋爽, 吴野, 鲍克秀. 团体认知训练叠加重复经颅磁刺激对高功能孤独症谱系障碍共病注意缺陷多动障碍的增效作用及脑电机制[J]. 《中国康复理论与实践》, 2025, 31(8): 979-986.

QIU Aizhen, WANG Min, WANG Qiushuang, WU Ye, BAO Kexiu. Effect of repetitive transcranial magnetic stimulation augmentation on group cognitive training for high-functioning autism spectrum disorder comorbided with attention-deficit/hyperactivity disorder, and electrophysiological mechanisms[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 979-986.

图/表 7

表1

表2

表3

表4

表5

表6

两组治疗前后CPRS-3评分多动/冲动维度原始分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	33	前测	24.79±4.23	16.273	< 0.001
		后测	22.58±3.98
试验组	34	前测	23.65±3.85	22.331	< 0.001
		后测	19.65±3.58
治疗前两组比较				-1.155	0.703
治疗后两组比较				-3.169	0.002

表6

表7

治疗前后两组Fz导联θ-PSD、β-PSD和θ/β比值比较"

项目	组别	n	测试	M(Q_L, Q_U)/( $x - ± s$ )	Z/t值	P值
Fz-θ/μV²	对照组	33	前测	17.24(15.34, 22.65)	-0.241	0.809
	对照组	33	后测	16.69(11.23, 22.76)	-0.241	0.809
	试验组	34	前测	16.97(14.24, 18.68)	-4.830	< 0.001
	试验组	34	后测	13.89(8.89, 15.94)	-4.830	< 0.001
	治疗前两组比较				-0.608	0.543
	治疗后两组比较				-2.609	0.009
Fz-β/μV²	对照组	33	前测	3.06(2.38, 5.11)	-0.785	0.432
	对照组	33	后测	3.08(2.38, 5.11)	-0.785	0.432
	试验组	34	前测	3.29(2.22, 4.16)	-0.812	0.417
	试验组	34	后测	3.29(2.23, 4.24)	-0.812	0.417
	治疗前两组比较				-0.314	0.754
	治疗后两组比较				-0.326	0.744
Fz-θ/β	对照组	33	前测	5.25±1.43	1.682	0.102
	对照组	33	后测	5.10±1.32	1.682	0.102
	试验组	34	前测	5.45±1.46	4.754	< 0.001
	试验组	34	后测	4.37±1.32	4.754	< 0.001
	治疗前两组比较				0.548	0.586
	治疗后两组比较				-2.256	0.027

表7

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组别	n	性别(男/女)/n	年龄/岁	ADOS-2	WISC-IV	ADHD-RS
对照组	33	20/13	8.96±1.56	6.00(6.00, 7.00)	92.91±10.09	41.67±6.65
试验组	34	21/13	9.04±1.33	6.50(6.00, 8.00)	92.00±8.44	41.65±6.01
χ²/t/Z值		0.013	-0.228	-1.247	-0.401	-0.013
P值		0.910	0.821	0.213	0.690	0.990

模块	内容
社交思维	用眼睛“倾听”(解析肢体语言；捕捉微表情；追踪目光落点；与环境互动)
	以耳“观”心(解析语音韵律：语气/重音/语调/语速；辨识隐喻暗示；捕捉潜在情感)
	破译无声信号(解析肢体语言；识别情绪变化；追踪环境互动)
	站在他人视角(模拟对方立场；预判互动反应；化解沟通冲突)
	解构复杂场景(拆解逻辑链条；预判潜在信息；构建因果模型)
执行功能	三思而后行(暂停-评估-执行三步骤；情绪冲动管理；多场景预演)
	走神应对方案(注意力召回信号；抗干扰策略；任务锚定技术)
	时间管理框架(任务切片化；时间计划表；记忆清单)
	逆境响应机制(合理提要求，找原因继续沟通，合理接受拒绝)
	灵活且有规则(“交通信号灯”系统、坚守核心原则、思维灵活性)

团体认知训练叠加重复经颅磁刺激对高功能孤独症谱系障碍共病注意缺陷多动障碍的增效作用及脑电机制

Effect of repetitive transcranial magnetic stimulation augmentation on group cognitive training for high-functioning autism spectrum disorder comorbided with attention-deficit/hyperactivity disorder, and electrophysiological mechanisms

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组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	33	前测	85.00(75.00, 109.50)	-4.876	< 0.001
		后测	82.00(72.00, 104.50)
试验组	34	前测	94.00(83.50, 116.25)	-5.019	< 0.001
		后测	84.50(77.50, 113.00)
治疗前两组比较				-1.556	0.120
治疗后两组比较				-1.205	0.228

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	33	前测	71.00(62.00,78.00)	-4.329	< 0.001
		后测	60.00(49.00, 72.50)
试验组	34	前测	71.00(61.50, 78.00)	-4.516	< 0.001
		后测	65.50(56.00, 74.00)
治疗前两组比较				1.157^a	0.165
治疗后两组比较				-1.783^b	0.075

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	33	前测	20.00(18.50, 21.00)	-5.143	< 0.001
		后测	18.00(16.00, 19.00)
试验组	34	前测	19.00(18.00, 20.00)	-4.940	< 0.001
		后测	12.00(10.00, 15.25)
治疗前两组比较				1.501	0.133
治疗后两组比较				4.732	< 0.001

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