目的：失抑制行為(behavioral disinhibition)是注意力不足/過動症(attention deficit hyperactivity disorder, ADHD)兒童之重要問題，且可能對其發展歷程與長期適應造成廣泛之負面影響。從神經心理學的角度，常以執行注意力功能(executive attention function, EAF)來探討ADHD之失抑制行為，其中，ADHD之反應抑制和衝突監控是常被探討的主要神經心理功能。過去研究支持ADHD兒童之神經生理與神經心理功能之受損，然仍少探究早期抑制歷程之神經生理指標與神經心理功能之關聯，故本研究進一步探討兩者之關聯，以期能區辨不同ADHD次族群，作為後續協助診斷。
方法：受試者中的ADHD組來自南部教學醫院之兒童青少年精神科所轉介之44名7至16歲確診ADHD兒童，控制組則為44名性別、年齡、社經地位、智力、及家庭教養環境相似之正常發展兒童。兩組兒童均接受廣泛性非語文注意力測驗組(Comprehensive Nonverbal Attention Test battery, CNAT)中之4分鐘簡單反應作業(simple reaction time task, SRT)與同步之EEG/ERP測量，N2及P3為刺激鎖定(stimulus-locked)之ERP，分別代表衝突監控(conflict monitoring)及反應抑制(response inhibition)指標。以ADHD犯衝動錯誤(impulsive error, IE)與否，將ADHD兒童分成衝動錯誤組(ADHD-IE)與無衝動錯誤組(ADHD-Without IE)。另依據衝動錯誤之反應時間，將ADHD-IE組再分成快衝動錯誤組(ADHD-FI)以及慢衝動錯誤組(ADHD-SI)，再以控制組之IE嘗試次之N2/P3作為切點，將ADHD-SI兒童分成N2不足組(ADHD-less N2)與足夠N2組(ADHD-enough N2)。ADHD兒童另接受倫敦塔與威斯康辛卡片分類等神經心理評估，以討論神經心理功能與N2/P3分群之關係。
結果：(1) ADHD-IE兒童（33名，75%）之比率顯著高於控制組犯IE兒童（21名，48%），且在多數執行注意力指標均顯著較ADHD-Without IE以及控制組兒童差。(2) ADHD兒童於成功抑制之嘗試次之N2與P3小於控制組，且在FZ及CZ點位均有此趨勢。(３) N2或P3不足之ADHD兒童與足夠N2或P3之ADHD兒童之父母皆主觀報告EAF困難，然N2或P3不足之ADHD兒童呈現明顯較差之客觀EAF表現。
討論：ADHD兒童在SRT作業之IE數高，以及N2與P3不足，指出在早期抑制歷程之抑制及監控功能均較正常發展兒童差。此外，IE及N2/P3指標均可以協助區辨不同神經心理功能表現之ADHD類型，作為支持其有不同次族群(subgroups)之證據，也可作為後續篩檢或治療之指標。以此為基礎，建議未來之研究方向可建立此內生表現型指標之常模及效度，增進臨床使用性。
關鍵字：注意力不足/過動症、執行注意力功能、衝動錯誤、神經生理指標、N2/P3

SUMMARY
Behavioral disinhibition is a critical problem in ADHD children, and it may cause a wide range of adverse outcomes in developmental processes. From the perspective of neuropsychology, executive attention function(EAF) is often used to investigate the behavioral disinhibition of ADHD. Seldom of researches had examined the relationship of neurophysiological indicators and neuropsychological functions. The aim of this study is to investigate the relationship between neurophysiological indicators and neuropsychological functions in order to screen attention problems in ADHD. Participants were 44 seven to sixteen-year-old ADHD children and 44 children with comparable age, gender, home environment, IQ, and social economic status. The EEG was carried out during a 4-min simple reaction time (SRT) task as standard procedure. The stimulus-locked ERP of N2 and P3 was defined as conflict monitoring and response inhibition, respectively. The study revealed that (1) ADHD-IE had significant poor EAFs than did the ADHD-Without IE and control group. (2) The ADHD group had significant less N2/P3 than did the control group where subjects successfully inhibited a response (3) the ADHD-less N2/P3 group had significant poor objective EAFs on neuropsychological assessment. The result indicated that ADHD children had more IEs and less N2/P3 in SRT task, which revealed the inhibition and monitoring processes deficit in early inhibition process. In addition, ADHD-less N2 children might be confirmed a meaningful subgroup that needs close follow-up, treatments different from standard, or both.
Key words: attention deficit hyperactivity disorder (ADHD), executive attention function(EAF), impulsive error, neurophysiological indicator, N2/P3

INTRODUCTION
Endophenotypes for psychopathology have been conceived as unobserved, but measurable manifestations of phenomena that connect genetic liability to clinical disorders (Miller & Rockstroh, 2013). Kropotov(2009) also suggested more accurate psychiatric diagnosis can be made using knowledge about brain systems and brain operations. Franke, Neale, & Faraone (2009) reviewed genome-wide association studies suggested 3 level of concepts of endophenotype in ADHD. Functions of brain unit are involved in disease related endophenotypes as level1, which are seen as neuropsychological functions. Level 2 are brain structure or functional neuroimages. From the perspective of neuropsychology, several studies which used executive attention function(EAF) as endophenotype often investigate the behavioral disinhibition of ADHD. Among them, response inhibition and conflict monitoring are the major neuropsychological functions that are often explored in ADHD. Several researches claimed ADHD children have both neuropsychological/neurobehavioral and neuroimagical function impairments. But seldom of them had examined the relationship of neurophysiological indicators and neuropsychological functions. The aim of this study is to investigate the relationship between neurophysiological indicators and neuropsychological functions in order to screen attention problems in ADHD.

MATERIALS AND METHODS
Participants were 44 seven to sixteen-year-old ADHD children and 44 children with comparable age, gender, home environment, IQ, and social economic status. The EEG was carried out during a 4-min simple reaction time (SRT) task as standard procedure. The stimulus-locked ERP of N2 and P3 was defined as conflict monitoring and response inhibition, respectively. EAFs were assessed by Comprehensive Nonverbal Attention Test Battery (CNAT) as objective indices, and behavioral questionnaires were used as subjective indices. ADHD children are regrouped into ADHD-IE and ADHD-Without IE. In addition, the ADHD-IE group is also regrouped into ADHD-FI and ADHD-SI according to the reaction time of the impulsive error. The amplitude of N2/P3 in the control group with IEs was used as the proper criterion for regrouping the ADHD children into two groups: ADHD children with enough N2(ADHD-enough N2) and those with less N2(ADHD-less-N2). Tower of London (ToL) and Wisconsin Card Sorting Test (WCST)were also administered in ADHD groups in order to examine the relationship of neurophysiological indicators and neuropsychological functions within ADHD groups.

RESULTS AND DISCUSSION
(1) Seventy-five percent of ADHD children made IEs in SRT was significantly more than in the control group (48%). ADHD-IE had significant poor EAFs than did the ADHD-Without IE and control group. (2) The ADHD group had significant less N2/P3 than did the control group where subjects successfully inhibited a response, at frontal and central sites. (3) Both ADHD-less N2/P3 and ADHD-enough N2/P3 groups had poorer subjective EAFs on questionnaires, however, the ADHD-less N2/P3 group had significant poor objective EAFs on neuropsychological assessment.

CONCLUSION
ADHD children had more IEs and less N2/P3 in SRT task, which revealed the inhibition and monitoring processes deficit in early inhibition process. In addition, IE and N2/P3 indicators of early inhibition process in ADHD children might help to differentiate subtypes of ADHD with different neuropsychological abilities, and the possibility that ADHD-less N2 children might be confirmed a meaningful subgroup that needs close follow-up, treatments different from standard, or both. We have developed neurophysiological and neuropsychological indicators only using a 4-minutes SRT during simultaneously EEG recording, which can be used to screen EAF deficits. N2/P3 of IE in SRT at pre-test and post-test point or during intervention also could be feedback signals as traing effects or targets. Future studies should construct norms and validity of these indicators, which can enhance clinical efficacy.

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