Effect of non-pharmacological treatment on the full recovery of social functioning in patients with attention deficit hyperactivity disorder

BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder(ADHD)is associated with adverse events,such as nausea and vomiting,dizziness,and sleep disturbances,and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients’social functioning.AIM To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD.METHODS A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group(methylphenidate hydrochloride and tomoxetine hydrochloride)or the non-pharmacological group(parental training,behavior modification,sensory integration therapy,and sand tray therapy),with 45 cases in each group.Outcome measures included treatment compliance,Swanson,Nolan,and Pelham,Version IV(SNAP-IV)scores,Conners Parent Symptom Questionnaire(PSQ)scores,and Weiss Functional Impairment Rating Scale(WFIRS)scores.RESULTS The non-pharmacological interventions resulted in significantly higher compliance in patients(95.56%)compared with medication(71.11%)(P<0.05).However,no significant differences in SNAP-IV and PSQ scores,in addition to the learning/school,social activities,and adventure activities of the WFIRS scores were observed between the two groups(P>0.05).Patients with non-pharmacological interventions showed higher WFIRS scores for family,daily life skills,and self-concept than those in the pharmacological group(P<0.05).CONCLUSION Non-pharmacological interventions,in contrast to the potential risks of adverse events after longterm medication,improve patient treatment compliance,alleviate patients’behavioral symptoms of attention,impulsivity,and hyperactivity,and improve their cognitive ability,thereby improving family relationships and patient self-evaluation.

Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care

Attention deficit hyperactivity disorder(ADHD)is a common and impairing behavioral health disorder,impacting over 5%of children worldwide.There are multiple evidence-based pharmacological and psychosocial treatments for ADHD,and greater service utilization is associated with improved acute and long-term outcomes.However,long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely.This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers.Families face a variety of structural and attitudinal barriers,ranging from cost and access to stigma and low self-efficacy to successfully implement change.There are multiple interventions that may enhance engagement with ADHD care including psychoeducation,integration of behavioral services in general medical settings,telehealth as well as specific adaptations to existing ADHD treatments,such as the use of motivational interviewing or shared decision making.Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers.Adding motivational interviewing,shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes.However,little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.

Behavioral and Neural Enhancing Effects of a Summer Treatment Program in Children with Attention Deficit Hyperactivity Disorder

Deficiency in executive functioning is a core symptom of attention deficit hyperactivity disorder (ADHD). The brain part responsible for executive functions is the prefrontal cortex (PFC). Although drug-based interventions can improve PFC activity, reports on PFC activity being improved by behavioral treatment are lacking. We evaluated whether a summer treatment program (STP) administering comprehensive behavioral treatment would increase PFC activity in children with ADHD. We examined behavioral and neural changes in 20 children before and after the STP, conducted over a 2-week period. We asked the parents/guardians to complete the Swanson, Nolan, and Pelham IV scale to assess severity of ADHD. The main task evaluating executive control was the reverse Stroop task. To examine changes in physiological indices, we used near-infrared spectroscopy to measure changes in PFC activity. Subjective assessments by parents/guardians indicated that ADHD symptoms improved significantly. There was also significant improvement in the number of correct responses and interference rates in the reverse Stroop task. Furthermore, post-intervention PFC activity was significantly higher. These results suggest that the STP improved inhibitory control in executive function, which is considered as a key symptom of ADHD. The increase in PFC activity further suggests that the STP improves cognition through neural function.

Association of Serotonin Receptors with Attention Deficit Hyperactivity Disorder： A Systematic Review and Meta-analysis

Attention deficit hyperactivity disorder （ADHD） is one of the most common mental disorders in childhood, with a high heritability about 60% to 90%. Serotonin is a monoamine neurotransmitter. Numerous studies have reported the association between the serotonin receptor family （5-HTR） gene polymorphisms and ADHD, but the results are still controversial. In this study, we conducted a meta-analysis of the association between 5-HTRIB, 5-HTR2A, and 5-HTR2C genetic variants and ADHD. The results showed that the 861G allele of 5-HTRIB SNP rs6296 could significantly increase the risk of ADHD （OR= 1.09, 95% CI： 1.01-1.18）; the 5-HTR2C gene rs518147 （OR=1.69, 95% CI： 1.38-2.07） and rs3813929 （OR = 1.57, 95% CI： 1.25-1.97） were all associated with the risk of ADHD. In addition, we also carried on a case- control study to explore the relevance between potential candidate genes 5-HTR1A, 5-HTRIE, 5-HTR3A and ADHD. The results indicated that 5-HTRIA rs6295 genotype （CC＋CG vs. GG OR=Z00, 95% CI： 1.23-3.27） and allele （OR=1.77, 95% CI： 1.16-2.72） models were statistically significantly different between case group and control group. This study is the first comprehensive exploration and summary of the association between serotonin receptor family genetic variations and ADHD, and it also provides more evidence for the etiology of ADHD.

Efficacy of Photobiomodulation for Attention Deficit Hyperactivity Disorder (ADHD): Case Studies

Extensive research has now been conducted and published for the treatment of dementia or Alzheimer’s disease, traumatic brain injury (TBI) and other brain disorders using photobiomodulation (PBM), also known as low-level laser therapy (LLLT). However, minimal information is available regarding the use of LLLT for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). We have been using LLLT in our practice for over 15 years addressing chronic pain and injury issues. However, our work with brain injuries is more recent, and we have published three case studies, one describing a serious traumatic brain injury and two describing our success with dementia/Alzheimer’s disease and PTSD. Currently, there is very little published evidence regarding efficacious therapy for ADHD. The case studies presented here, suggest that LLLT can provide alleviation of these symptoms, with some improvement reported after just a single treatment, without any need for pharmaceutical intervention.

Does mindfulness meditation improve attention in attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.

Serum ferritin levels in children with attention deficit hyperactivity disorder and tic disorder

BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.

基于“肾藏志”理论对补肾法调控儿童注意缺陷多动障碍下丘脑-垂体-肾上腺轴的探究

基于“肾藏志”理论阐释儿童注意缺陷多动障碍(ADHD)的发生发展,认为肾精亏虚,脑失所养为其关键病机,从传统医学、现代医学角度阐述ADHD患儿下丘脑-垂体-肾上腺(HPA)轴功能低下与肾虚为本的关联性,并在结构与功能上探讨“肾-髓-脑-志”通路与HPA轴的共通点,阐述HPA轴功能紊乱作为中医学肾虚本质的科学依据,结合各家经验以期为探索ADHD中医理论补充现代医学内涵。“肾藏志”理论指导下应用补肾法可调整ADHD患儿HPA轴紊乱,减轻疾病严重程度,以期为补肾法贯穿治疗ADHD提供新的思路。

从五脏阴阳失衡及痰瘀互结探讨小儿多动症

[目的]探讨曹建雄教授运用五脏阴阳合痰瘀互结相关理论治疗小儿多动症的临床经验。[方法]通过随师临诊,结合查阅临床治疗小儿多动症的医案及文献,从五脏辨证及痰瘀互结理论入手,总结曹师辨证治疗小儿多动症的经验,并提供医案一则加以佐证。[结果]曹师认为,心肝火旺、肺脾肾亏虚是小儿多动症的主要病因病机,关键在于“阳动有余,阴静不足”,治疗以平肝息风、安神养心为主,佐以健脾滋肾;结合阴阳平衡理论,调治五脏六腑,辅之以行气活血、温化痰饮;同时注重小儿情志调畅和饮食调护,小儿体质娇嫩,故治疗宜中病即止。所举验案,曹师辨为肝旺脾虚、心肾不交之证,治拟平肝补脾、养心滋肾之法,方以天麻钩藤饮、复脉汤加减,临床上颇有疗效。[结论]曹师以平肝清心为主,佐以健脾补肾、活血化痰治疗小儿多动症,注重审证求因,灵活用药及小儿体质与情志调节,其经验值得学习和传承。

成人注意缺陷多动障碍患者的时间洞察力

目的:探讨成人注意缺陷多动障碍(ADHD)的时间洞察力特点及其与症状的相关性。方法:纳入符合美国精神障碍诊断与统计手册第5版(DSM-5)的成人ADHD患者85例(18~35岁),和年龄、性别匹配的正常对照85例(19~34岁),采用ADHD评定量表(ADHD-RS)和津巴多时间洞察力量表(ZTPI)评估ADHD症状和时间洞察力。结果:ADHD组过去消极、现在享乐和现在宿命得分高于对照组,过去积极和未来得分低于对照组(均P<0.001)。女性和注意缺陷为主型ADHD的注意缺陷(IA)与未来得分负相关(r=-0.70、-0.65,均P<0.001);男性和混合型ADHD的多动冲动(HI)与现在享乐得分正相关(r=0.41、0.42,均P<0.05);共患病组的过去消极得分较高且与IA和HI得分正相关(均P<0.01)。结论:成人ADHD不平衡的时间洞察力与症状严重程度正相关,且与性别、亚型和共患病有关。

数字疗法在精神科的临床应用与发展

数字疗法(digital therapeutics,DTs)是指利用计算机、智能手机和可穿戴设备等电子设备,通过软件程序和互联网技术,对疾病或症状进行评估、干预的一类非药物治疗方法,目前已证实其对多种精神障碍疾病存在良好的治疗效果。数字疗法能够改善睡眠障碍人群的失眠问题,增强注意力缺陷多动障碍患者的注意力和工作记忆能力,同时还能治疗抑郁症、焦虑症等疾病。数字疗法在未来将向个性化治疗、通俗化治疗、碎片化治疗、娱乐化治疗等方向发展,具有广阔的发展前景。

父母行为训练联合药物对儿童注意缺陷多动障碍长期疗效的随机单盲对照研究

目的探讨父母行为训练联合药物治疗对儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)与单纯使用药物的长期疗效差异,为ADHD的治疗提供依据。方法采用随机单盲对照研究方法,选取2019年9月~2020年7月在温州市人民医院儿童保健科门诊就诊的ADHD患儿60例,按照随机数字表法将其分为联合治疗组和单纯药物组,每组各30例。两组均给予盐酸托莫西汀治疗,联合治疗组在药物治疗的同时进行父母行为训练,采用SNAP-Ⅳ量表及韦氏智力测试评定患儿核心症状及认知功能改善情况,比较两组治疗3个月及治疗1年后的疗效。结果最终55例患儿完成本次研究,其中联合治疗组27例,单纯药物组28例。治疗3个月时,两组患儿SNAP-Ⅳ量表评分及韦氏智力测试得分比较,差异均无统计学意义(P均>0.05);治疗1年后,联合治疗组仍保持稳定疗效,SNAP-Ⅳ量表评分及韦氏智力测试得分与3个月比较,差异均无统计学意义(P均>0.05);单纯药物组1年后SNAP-Ⅳ量表评分比3个月升高,韦氏智力测试得分降低,差异均有统计学意义(P均<0.05);治疗1年后,联合治疗组SNAP-Ⅳ量表评分低于单纯药物组,韦氏智力测试得分高于单纯药物组,差异均有统计学意义(P均<0.05)。结论父母行为训练联合药物治疗能有效改善儿童ADHD的核心症状及认知功能,长期疗效显著,值得临床推广。

儿童注意缺陷多动障碍非药物治疗研究进展

注意缺陷多动障碍(attention deficit and hyperactivity disorder,ADHD)是儿童最常见的神经行为障碍之一,严重影响儿童的生活、学习及社交能力,且可延续至成人阶段。全球儿童ADHD的总体发病率为7.2%,我国儿童ADHD总体发病率为5.6%。随着对疾病认知的进步,ADHD的诊断率还在增加。对于学龄前或学龄期儿童ADHD的治疗,无论是否使用药物,都需要联合非药物治疗进行综合干预。该文对目前临床常用的非药物治疗进行综述。

注意缺陷多动障碍儿童执行功能特征

目的:探讨注意缺陷多动障碍(ADHD)儿童执行功能的特征。方法:采用Stroop效应、视觉和听觉Go/No-Go反应、倒背数字、延缓期的空间位置记忆广度、伦敦塔任务和连线测验分别测试40例ADHD儿童和25例正常对照组儿童的反应抑制、语音工作记忆、视空间工作记忆、计划能力和定势转移能力。结果:1.ADHD儿童完成字义与字色相矛盾的字色命名时间较正常对照组儿童明显延长(P﹤0.05)。2.ADHD儿童完成视觉和听觉的Go/No-Go反应所犯错误数均较正常对照组儿童明显增多(P﹤0.01)。3.ADHD儿童倒背数字分数和延缓期的空间位置记忆广度均较正常对照组儿童明显低(P﹤0.01)。4.ADHD儿童完成两步、四步和五步伦敦塔任务的时间均较正常对照组儿童明显延长、犯错误数明显增多(P﹤0.05);而完成四步、五步伦敦塔任务的最初计划时间则较正常对照组儿童明显缩短(P﹤0.01)。5.ADHD儿童完成连线测验甲式的时间和犯错误数与正常对照组儿童无显著性差异(P﹥0.05),而完成乙式所需时间则较正常对照组儿童明显延长、犯错误数较正常对照组儿童明显增多(P﹤0.05)。结论:ADHD儿童存在反应抑制、语音工作记忆、视空间工作记忆、计划能力和定势转移能力等多项执行功能的缺陷。

感觉统合训练改善注意缺陷多动障碍儿童行为、智力及执行功能的对照研究

目的:研究感觉统合训练对注意缺陷多动障碍(Attention Deficit Hyperactivity Disorder,ADHD)儿童行为与认知的改善作用。方法:将确诊为ADHD的儿童52名设为实验组,52名健康儿童志愿者为对照组。对实验组进行感觉统合训练,于训练前和训练60次后用Conners父母用量表(Conners Parents Symptom Questionnaire,PSQ)、瑞文联合型测验(Combined Raven's Test,CRT)、威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)进行测试,比较实验组训练前后的测试结果,并将训练后的结果与对照组比较。结果:①实验组PSQ的品行障碍、冲动-多动和多动指数得分训练后均低于训练前[(0.60±0.34)vs.(0.68±0.35),(0.92±0.57)vs.(1.25±0.70),(0.82±0.29)vs.(1.08±0.44);均P<0.05];②实验组训练后的瑞文IQ值和WCST完成分类数、概念化水平得分均高于训练前[如,IQ值(105.37±22.76)vs.(97.37±24.15),P<0.001],而WCST错误应答数、选择错误率、第一分类数、持续错误百分数得分均低于训练前[如,错误应答数(39.40±22.22)vs.(46.60±23.44),P<0.001];③实验组训练后完成第一个分类应答数及持续性错误百分数得分均高于对照组[(12.03±5.08)vs.(10.65±0.84),(50.75±18.35)vs.(39.95±15.34);均P<0.05]。结论:感觉统合训练能改善注意缺陷多动障碍儿童的异常行为,提高其认知水平,但临床症状缓解后部分执行功能仍未恢复到正常水平。

注意缺陷多动障碍儿童的工作记忆损害特征

目的:探讨注意缺陷多动障碍(ADHD)儿童工作记忆功能特征。方法:本研究为横断面研究。根据美国精神疾病诊断和统计手册第4版(DSM-IV),对符合ADHD诊断标准的未经治疗的100名门诊患儿及年龄、性别相匹配的100名正常儿童分别采用韦氏儿童智力测验量表中国修订本(C-WISC)及其中的顺背数字(反映言语存贮、加工)、倒背数字(反映言语存贮、加工、中央执行)、Corsi木块和空间n-Back任务(反映视空间存贮和中央执行)进行言语及空间工作记忆测试。结果:ADHD组儿童在顺背数字最高位数及总得分、倒背数字最高位数及总得分、Corsi木块最多木块数及总得分均低于对照组儿童,空间2-Back任务反应时短于对照组儿童(均P<0.05)。结论:ADHD儿童存在工作记忆功能缺陷,此缺陷涉及言语环路、视空间存贮系统及中央执行。

270例儿童多动症中医证型分布及演变规律探讨

目的:探索儿童多动症的中医证型分布特点及治疗过程中的证型变化,为辨证治疗儿童多动症提供依据。方法:观察全国9家单位收集的270例多动症患儿的证型变化,运用SPSS 22.0进行分析,总结儿童多动症中医证型的分布及变化特点。结果:270例患儿中,初诊时以心肝火旺证居多,占40.4%,治疗后期以肝肾阴虚证多见,占47.8%。《精神障碍诊断与统计手册》第5版(DSM-Ⅴ)西医分型与中医证候分布之间存在一定的联系,中医证型在不同病程患儿中的分布无显著差异(P>0.05)。结论:儿童多动症中医证型分布与DSM-Ⅴ分型有一定的相关性,而与病程长短无明显关联;在治疗过程中,初期以心肝火旺证居多,后期以肝肾阴虚证多见,说明儿童多动症疾病初期实多虚少,后期虚多实少,存在由心肝火旺证向肝肾阴虚证转变的趋势。

儿童家长对注意缺陷多动障碍的知晓率与治疗态度

目的:了解儿童家长对注意缺陷多动障碍(ADHD)的知晓率和治疗态度,为制定ADHD的健康教育和社区干预策略提供依据。方法:抽取6～13岁小学生的家长867名,采用自编儿童注意缺陷多动障碍知晓率调查问卷完成调查,问卷内容围绕一个ADHD典型案例的描述设置15个问题,了解家长对ADHD案例的识别能力、发展趋势与影响程度估计及治疗态度。结果:家长对ADHD的识别率为36.9%;全体家长中,有60.7%的家长认为ADHD对儿童健康造成明显影响,有53.6%的家长认为不需要看医生,61.0%的家长不赞同药物治疗。男性儿童的家长对ADHD的识别率(46.6%vs.58.2%)和认为需要看医生的比例(40.3%vs.50.6%)均低于女性儿童的家长(均P<0.05);父亲对ADHD的识别率(44.7%vs.56.2%,61.4%)和影响估计(55.2%vs.65.9%,61.9%)低于母亲或其他长辈(均P<0.05),而母亲对药物治疗的接受性低于父亲或其他长辈(33.0%vs.42.3%,50.0%;P<0.05)。受教育程度为高中的家长对ADHD的识别率高于初中及以下或大学及以上程度的家长(60.4%vs.48.1%,49.6%;P<0.05)。结论:小学生家长对ADHD有关问题的认识还有很多误解或不足,不同家长对ADHD的知晓率和治疗态度也存在差异,有必要开展针对性的ADHD相关知识的健康教育。

不同诊断标准的多动症患者临床特点比较

目的:比较美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)和国际疾病分类第10版(ICD-10)诊断为多动症患儿的临床特征,以期为临床上选用何种诊断标准提供参考。方法:对516例门诊就诊的多动症患儿进行研究,以儿童临床诊断性会谈量表与父母进行定式访谈,仅符合DSM-Ⅳ的317例组成ADHD组(注意缺陷多动障碍,attention deficit-hyperactivity disorder,ADHD),同时符合两种诊断标准的199例组成HKD-ADHD组(多动性障碍,hyperkinetic disorder,HKD)。结果:HKD-ADHD组以混合型为主(75.4%),ADHD组患者以注意缺陷型为主(67.2%);前者较后者起病和就诊年龄早,共患品行问题、对立违抗障碍和感觉统合失调多(P均<0.05);后者在低年龄段共患学习困难多(P<0.05)。结论:HKD较ADHD患者临床症状更严重,但仅符合DSM-Ⅳ标准的患者较一般儿童在学习、行为方面已出现一些功能损害,因此在临床中推荐采用DSM-Ⅳ标准,以使患者能得到早期诊治。