摘要目的:探讨共病抽动障碍(TD)对于注意缺陷多动障碍(ADHD)儿童奖赏功能的影响，为ADHD患儿的认知功能研究提供新的参考。方法:选取2021年7月至2022年12月于苏州大学附属第三医院就诊的62例ADHD儿童(ADHD组)和47例ADHD共病TD儿童(ADHD＋TD组)，同期在某小学招募47名健康对照(HC组)儿童。采用Conners父母症状问卷(PSQ)、Achenbach儿童行为量表(CBCL)和执行功能行为评定量表(BRIEF)评估其行为特征。所有受试者在E-Prime 3.0系统下完成爱荷华赌博任务(IGT)。采用SPSS 25.0统计软件对3组量表得分及IGT结果进行分析。结果:3组被试交往不良和强迫性因子得分均差异有统计学意义( H＝26.36，38.43，均 P<0.01)；ADHD＋TD组的交往不良及强迫性因子得分[3(1，5)分，5(3，9)分]均高于ADHD组[2(1，4)分，4(1，7)分，均 P<0.05]。在IGT中，三组被试高奖励、低奖励、高惩罚与低惩罚的平均反应时( H＝9.99，13.25，10.00，14.92，均 P<0.01)及低奖励、低惩罚反应变异率( H＝13.14，18.84，均 P<0.05)均差异有统计学意义；两两比较发现，高奖励时，ADHD＋TD组平均反应时大于HC组，低奖励时，ADHD＋TD组的反应变异率大于ADHD和HC组(均 P<0.05)，ADHD＋TD组在低奖赏时决策稳定性波动更明显。 结论:共病TD会加重ADHD儿童在社交与强迫行为方面的损害，且其低奖赏决策稳定性降低。

abstractsObjective:To explore the effects of comorbid tic disorder (TD) on reward function in children with attention deficit hyperactivity disorder (ADHD), and to provide a new reference for the study of cognitive function in children with ADHD.Methods:From July 2021 to December 2022, a total of 62 children with ADHD (ADHD group) and 47 ADHD children with TD (ADHD+ TD group) were recruited from the Third Affiliated Hospital of Soochow University, and 47 typically developing children (HC group) were recruited from a primary school in Changzhou. Behavioral characteristics were assessed using the Conners parent symptom questionnaire (PSQ), Achenbach child behavior checklist (CBCL) and behavior rating inventory of executive function (BRIEF). All participants completed the Iowa gambling task (IGT) under the E-Prime 3.0 platform. SPSS 25.0 software was used to analyze the scores of the three scales and the IGT results.Results:There were significant differences in the scores of adverse interaction and compulsive factors among the three groups ( H=26.36, 38.43, both P<0.01). Children in ADHD+ TD group exhibited higher scores in the adverse interaction and compulsive factors (3(1, 5), 5(3, 9)) compared to ADHD group (2(1, 4), 4(1, 7), both P<0.05). In IGT, the mean reaction times of three groups were significantly different under the conditions of high reward, low reward, high punishment, and low punishment ( H=9.99, 13.25, 10.00, 14.92, all P<0.01), while their reaction variabilities were significantly different under low reward and low punishment conditions ( H=13.14, 18.84, both P<0.05). Pairwise comparisons revealed that the average reaction time of the ADHD+ TD group was longer than that of the HC group under the condition of high reward, while the reaction variability of the ADHD+ TD group was longer than that of the HC and ADHD group under low reward condition (all P<0.05). The decision stability of the ADHD+ TD group fluctuated more significantly under low reward condition. Conclusion:Comorbid TD may lead to the impairment of social and compulsive behaviors in children with ADHD, and their reward decision stability is reduced.