研究目的：创编基于动作发展理论的篮球游戏，探讨其对6-8岁注意缺陷多动障碍(attention deficit and hyperactivity disorder, ADHD)男童执行功能的影响，为开拓ADHD儿童的非药物干预手段提供借鉴。

研究方法：采用家长填写的ADHD-SNAP-IV对北京市某小学一到三年级1024名学生进行初筛，再由两位精神科医生通过半结构式访谈，结合韦氏智力测验，筛查、募集了符合美国《精神障碍诊断与统计手册 (第5版)》中诊断标准的男童25名，其中注意缺陷型（predominantly inattentive type，ADHD-PI）14名，混合型（combined type，ADHD-C）11名，将25名ADHD随机分为ADHD干预组13人（年龄6.35-8.11岁，平均7.21±0.53岁）、ADHD等待组12名（年龄6.27-8.32岁，平均7.11±0.61岁）。按照与干预组年龄相差不超过半岁，从同年级同学中募集的正常发育男童13人作为正常对照组（年龄6.45-8.25岁，平均7.31±0.65岁）。采用大肌肉动作发展测试第三版（Test of gross motor development Third Version,TGMD-3）对全体被试的大肌肉动作发展水平进行评估，基于动作发展原理创编篮球游戏，ADHD干预组在指导下进行每周4次、每次40分钟、共8周的篮球游戏，ADHD等待组与正常对照组参加日常的身体活动，所有被试干预期间均不参加校外有组织的体育活动。实验干预前后对所有被试采用Stroop色词测验（Stroop Color Word Test，SCWT）、Rey复杂图形记忆测试（Rey Osterrich Complex Figure Test，ROCFT）以及中文版学龄儿童执行功能行为评定量表-父母版（Behavior Rating Inventory of Executive Function，BRIEF-P）评定被试执行功能的变化。使用SPSS25.0对三组男童干预前后组间数据进行单因素方差分析，ADHD-PI男童与ADHD-C男童干预前后组间比较采用独立样本T检验，各组自身前后对比采用配对样本T检验分析，显著性水平为P＜0.05。

研究结果：

1. 基于动作发展原理通过设计不同的动作环境和不同任务难度，针对执行功能的抑制和工作记忆2个维度创编22个篮球游戏，在为期8周的时间里，前4周为基础阶段，后4周为进阶阶段。每周针对一个维度重点进行4次训练，每次课进行2个游戏。

2.8周篮球游戏前后三组被试执行功能比较结果：

（1）生态性执行功能比较结果：各组自身前后比较可见，三组执行功能行为量表所有方面得分显著降低（P＜0.05)。组间比较显示，ADHD干预组除抑制因子、转换因子与情感控制因子外，其余指数及因子得分显著高于正常对照组（P＜0.05）；ADHD等待组除转换因子外，其余指数及因子得分显著高于正常对照组（P＜0.05）。ADHD组间对比，ADHD干预组的总分以及抑制因子、情感控制因子以及工作记忆因子得分显著低于ADHD等待组(P＜0.05)。

（2）操作性执行功能比较结果：

抑制控制功能的比较结果：各组自身前后比较可见，ADHD干预组在A、D测试时间与字义干扰时用时显著降低（P＜0.05）；ADHD等待组在B、C、D测试时间与颜色干扰时部分显著降低（P均＜0.05），正常对照组在C、D测试时间与D错误数中显著降低（P＜0.05）。组间比较显示，ADHD干预组与正常对照组的所有测试结果相当，差异不具有显著性（P均＞0.05）；ADHD等待组的A、B、C、D测试时间、D错误数、颜色干扰时与字义干扰时显著高于正常对照组（P均＜0.05）；ADHD组间对比中，ADHD干预组在A、C、D测试时间、D错误数以及字义干扰时显著低于ADHD等待组（P均＜0.05)。

工作记忆功能的比较结果：各组自身前后比较可见，ADHD干预组、ADHD等待组与正常对照组所有测试得分均显著提高（P均＜0.05）；组间比较可见，ADHD干预组在即时细节记忆与延时细节记忆得分中显著低于与正常对照组（P均＜0.05），ADHD等待组在即时细节记忆与延时细节记忆中得分显著低于正常对照组（P均＜0.05）；ADHD组间对比中，ADHD干预组即时细节记忆与延时细节记忆得分显著高于ADHD等待组（P均＜0.05）。

3．8周篮球游戏前后不同亚型ADHD男童执行功能的比较结果:

（1）注意缺陷型男童干预前后组内与组间比较结果：各组生态性执行功能测试自身前后比较可见，ADHD干预组与正常对照组所有生态性执行功能得分均显著降低（P＜0.05），ADHD等待组除总分外，所有部分得分显著降低（P＜0.05）；组间比较显示，ADHD干预组除总分、抑制因子、转换因子与组织因子外，其余得分显著高于正常对照组（P＜0.05），ADHD等待组除转换因子外，其余部分得分显著高于正常对照组（P＜0.05）。ADHD组间对比，ADHD干预组总分与抑制因子得分显著低于ADHD等待组（P＜0.05）。各组操作性执行功能中的抑制控制功能自身前后比较可见，ADHD干预组A、B、D测试时间显著减少（P＜0.05），ADHD等待组B、C测试时间显著减少（P＜0.05），正常对照组C、D测试时间与D错误数显著降低（P＜0.05）；组间比较显示，ADHD干预组与正常对照组在所有测试结果中，差异不具有显著性（P均＞0.05）；ADHD等待组B、C、D时间、D错误数、颜色干扰时以及字义干扰时显著高于正常对照组（P＜0.05）。ADHD组间对比，ADHD干预组C、D时间、D错误数、颜色干扰时以及字义干扰时显著低于ADHD等待组（P＜0.05）。各组操作性执行功能中的工作记忆功能自身前后比较可见，三组所有部分得分显著提高（P＜0.05）；组间比较显示，ADHD干预组与ADHD等待组即时细节记忆与延时细节记忆得分显著低于正常对照组（P＜0.05），ADHD组间对比，ADHD干预组即时细节记忆与延时细节记忆得分显著高于ADHD等待组（P＜0.05）。

（2）混合型男童干预前后组内与组间比较结果：各组生态性执行功能测试自身前后比较可见，ADHD干预组与正常对照组所有得分显著降低（P＜0.05），ADHD等待组除组织因子与总分外，其余得分显著降低（P＜0.05）。组间比较显示，ADHD干预组除转换、情感控制因子与任务启动因子外，其余得分显著高于正常对照组（P＜0.05），ADHD等待组除转换因子与任务启动因子外，其余得分显著高于正常对照组（P＜0.05）。ADHD组间对比，ADHD干预组总分、工作记忆因子与情感控制因子得分显著低于ADHD等待组（P＜0.05）。各组操作性执行功能中的抑制控制功能自身前后比较可见，ADHD干预组D测试时间用时显著降低（P＜0.05），ADHD等待组不具有显著性变化（P均＞0.05）。正常对照组C、D测试时间与D错误数显著降低（P＜0.05）。组间比较显示，ADHD干预组在D错误数与颜色干扰时高于正常对照组（P＜0.05），ADHD等待组A、B、C、D测试时间、D错误数以及颜色干扰时高于正常对照组（P＜0.05）；ADHD组间对比，ADHD干预组A、D测试时间与D错误数显著低于ADHD等待组（P＜0.05）。各组操作性执行功能中的工作记忆功能自身前后比较可见，ADHD干预组、ADHD等待组与正常对照组所有得分显著提高（P＜0.05）；组间比较显示，ADHD干预组即时细节记忆、延时细节记忆与即时结构记忆得分显著低于正常对照组（P＜0.05），ADHD等待组即时细节记忆、延时细节记忆得分显著低于正常对照组（P＜0.05）；ADHD组间对比，ADHD干预组即时细节记忆与延时细节记忆显著高于ADHD等待组（P＜0.05）。

（3）注意缺陷型与混合型男童干预比较结果：干预后，ADHD-PI男童生态执行功能的抑制因子显著低于ADHD-C男童，操作性执行功能测试中，Stroop测验的C测试时间与颜色干扰时显著低于ADHD-C男童，工作记忆的即时细节记忆得分均显著高于ADHD-C男童（P均＜0.05）。

研究结论：

基于动作发展理论创编的篮球游戏可有效改善6-8岁ADHD男童的执行功能，尤其可提升其抑制和记忆功能；注意缺陷型男童从篮球游戏中获得的执行功能收益比混合型更显著。

Purpose: to explore the creation of basketball game based on motor development theory and its influence on the executive function of ADHD boys aged 6-8, so as to develop non-drug interventions for ADHD children.

Methods: 25 boys who meet diagnostic criteria for attention deficit and hyperactivity disorder (ADHD) in "Diagnostic and Statistical Manual of Mental Disorders (5th edition)" were selected and recruited from the grade 1-3 1024 students of a primary school in Beijing through the ADHD-SNAP-IV (filled in by parents) and semi-structured interviews by two psychiatrists based on Wechsler Intelligence Scale. 14 of them belong to ADHD-PI, and the remaining 11 are ADHD-C. They were randomly divided into the ADHD intervention group (n=13; aged 6-8, average: 7.21±0.53), the ADHD waiting group (n=12; aged 6-8, average: 7.11±0.61). According to the age difference of no more than half a year with intervention group, 13 boys with normal development were recruited and matched from the same grades to be the normal control group (aged 6-8, average: 7.31±0.65). The test of gross motor development third version (tgmd-3) was used to evaluate the level of gross motor development of all subjects. Basketball games were created based on the principle of motor development. Under the guidance of the ADHD intervention group, basketball games were played 4 times a week for 40 minutes each time for a total of 8 weeks , and the ADHD waiting group and the normal control group participated in normal physical activities in the school, and all subjects did not participate in extracurricular organized sports during the intervention period. Before and after the experimental intervention, the changes of the subjects' executive function were evaluated by the Stroop color word test (SCWT), the Rey Osterrich Complex Figure Test (ROCFT) and the Behavior Rating Inventory of Executive Function (BRIEF-P). SPSS25.0 was used to conduct One-way ANOVA on the data before and after intervention of the three groups, independent sample T test was performed on the data between ADHD-PI boys and ADHD-C boys before and after the intervention, and paired sample T test was performed on the data before and after intervention of various groups; P < 0.05 means the difference was significant.

Results:

1. 22 basketball games for targeted training were created by designing different action environments and different task difficulties based on the principle of motor development and combining the dimensions of executive function inhibition and working memory. During the 8-week training period, the first 4 weeks were the basic stage, and the last 4 weeks were the difficulty increasing stage. 4 times of training were emphatically conducted for one dimension in one week, and 2 games in each class.

2. The comparison results of the executive function of the three groups of subjects before and after the 8-week basketball game intervention:

(1) Comparative results of ecological executive function: Each group can be seen before and after comparison, the scores of BRIEF in all aspects of the three groups were significantly decreased (P < 0.05). Inter group comparison display, except for the inhibitory factor, conversion factor and affective control factor, the scores of other indexes and factors in ADHD intervention group were significantly higher than those in normal control group (P<0.05); except for conversion factor , the remaining index and factor scores of ADHD waiting group were significantly higher than those of normal control group (P<0.05). The comparison between ADHD groups showed that the scores of total score, inhibitory factor, affective control factor and working memory factor of ADHD intervention group were significantly lower than those of ADHD waiting group (P<0.05).

(2) Comparative results of operational executive function:

Comparative results of inhibitory control function: Each group can be seen before and after comparison, the ADHD intervention group was significantly decreased in the test time of A,  D and the word interference time (P<0.05); the ADHD waiting group was significantly decreased in the test time of B,C,D and the color interference time(P<0.05); the normal control group was significantly decreases in the test time of C,D and the number of errors of D (P < 0.05). Inter group comparison display, all the test results of the ADHD intervention group and the normal control group were similar, and the difference was not significant (all P>0.05); the ADHD waiting group was significantly higher than the normal control group in the time of A,B,C,D, the number of errors of D, the color interference and the word interference (all P < 0.05); the comparison between ADHD groups showed that the ADHD intervention group was significantly lower than the ADHD waiting group in the test time of A,C,D, the number of errors of D and word interference (all P<0.05).

Comparison results of working memory function: Each group can be seen before and after comparison, all test scores of the ADHD intervention group，the ADHD waiting group and the normal control group were significantly increased (P<0.05); Inter group comparison display, the scores of immediate detail memory, delayed detail memory in the ADHD intervention group and the ADHD waiting group were significantly lower than those in the normal control group, and the difference was significant (all P < 0.05); the comparison between ADHD groups showed that the scores of immediate detail memory and delayed detail memory in the ADHD intervention group were significantly higher than those in the ADHD waiting group (all P＜0.05).

3. Comparative results of executive function of different subtypes of ADHD boys before and after 8-week basketball game intervention:  

(2) Intra group and inter group comparison results of ADHD-PI boys before and after intervention: The ecological executive function test of each group can be seen before and after comparison, the scores of all ecological executive functions in the ADHD intervention group and normal control group were significantly decreased (P < 0.05); except for the total score, the scores of all parts of the ADHD waiting group were significantly decreased(P<0.05). Inter group comparison display, except for the total score, inhibitory factor, conversion factor and tissue factor, the rest scores of ADHD intervention group were significantly higher than those of the normal control group (P<0.05); except for conversion factors, the rest scores of ADHD waiting group were significantly higher than those of the normal control group (P<0.05); the comparison between ADHD groups showed that the total score and inhibitory factor score of ADHD intervention group were significantly lower than those of ADHD waiting group (P<0.05). The inhibition control function in the operational executive function of each group can be seen before and after comparison, the ADHD intervention group was significantly reduced in the time of A, B, D (P<0.05); the ADHD waiting group was significantly reduced in the test time of B and C (P<0.05); the normal control group was significantly decreases in the test time of C, D and the number of errors of D (P<0.05). Inter group comparison display, there was no significant difference between ADHD intervention group and normal control group in all test results (all P>0.05); the ADHD waiting group was significantly higher than the normal control group in the time of B,C,D, the number of errors of D, the color interference and the word interference (P<0.05); the comparison between ADHD groups showed that the ADHD interference group was significantly lower than the ADHD waiting group in the time of C and D, the number of errors of D, the color interference and the word interference(P<0.05). The working memory function in the operational executive function of each group can be seen before and after comparison, all test scores of the ADHD intervention group，the ADHD waiting group and the normal control group were significantly increased (P<0.05). Inter group comparison display, the scores of immediate detail memory，delayed detail memory in the ADHD intervention group and the ADHD waiting group were significantly lower than those in the normal control group (P＜0.05); the comparison between ADHD groups showed that the scores of immediate detail memory and delayed detail memory in the ADHD intervention group were significantly higher than those in the ADHD waiting group (P<0.05).

(2) Intra group and inter group comparison results of ADHD-C boys before and after intervention: The ecological executive function test of each group can be seen before and after comparison, the scores of all ecological executive functions in the ADHD intervention group and normal control group were significantly decreased (P < 0.05),except for tissue factor and total score, other scores in ADHD waiting group were significantly decreased (P < 0.05). Inter group comparison display, except for conversion factor, affective control factor and task initiation factor, the rest scores of ADHD intervention group were significantly higher than those of normal control group (P<0.05); except for conversion factor and task initiation factor, the rest scores of ADHD waiting group were significantly higher than those of normal control group (P<0.05); the comparison between ADHD groups showed that the total score, working memory factor and affective control factor score of ADHD intervention group were significantly lower than those of ADHD waiting group (P<0.05). The inhibition control function in the operational executive function of each group can be seen before and after comparison, the ADHD intervention group was significantly decreased in the test time of D (P<0.05), the ADHD waiting group had no significant changes before and after intervention (P>0.05), and the normal control group was significantly decreases in the test time of C and D, and the number of errors of D (P<0.05). Inter group comparison display, the ADHD intervention group was higher than the normal control group in number of errors of D and color interference (P < 0.05), and the ADHD waiting group was higher than the normal control group in the test time of A,B,C,D, the number of errors of D and the color interference (P < 0.05); the comparison between ADHD groups showed that the ADHD intervention group was significantly lower than the ADHD waiting group in the test time of A and D and the number of errors of D (P<0.05). The working memory function in the operational executive function of each group can be seen before and after comparison, all scores before and after the ADHD intervention group, ADHD waiting group and normal control group were significantly increased (P<0.05).Inter group comparison display, the scores of immediate detail memory, delayed detail memory and Immediate structural memory in the ADHD intervention group were significantly lower than those in the normal control group (P<0.05), and the scores of immediate detail memory and delayed detail memory in the ADHD waiting group were significantly lower than those in the normal control group (P < 0.05); the comparison between ADHD groups showed that the scores of immediate detail memory, delayed detail memory in the ADHD intervention group were significantly higher than those in the ADHD waiting group (P<0.05).

③ Comparing results of ADHD-PI boys and ADHD-C boys: after the intervention, the inhibitive factors of ecological executive function of ADHD-PI boys were significantly lower than those of ADHD-C boys. In the operational executive function test, in the C test time and color interference of Stroop test, ADHD-PI boys were significantly lower than those of ADHD-C boys. The scores of immediate detail memory of working memory, ADHD-PI boys were significantly higher than those of ADHD-C boys (all P < 0.05).

Conclusions and suggestions:

The self-created basketball game based on motor development theory can effectively improve the executive function of ADHD boys aged 6-8, especially the control and memory function；the improvement of executive function of ADHD-PI boys is more significant than ADHD-C boys;