Comorbidity prevalence and treatment outcome in children and adolescents with ADHD
Comorbidity prevalence and treatment outcome in children and adolescents with ADHD
复制标题
DOI：
10.1007/s00787-017-1005-z
复制
发表时间：
2017-12-01
影响因子：
6.4
通讯作者：
Bonati, Maurizio
中科院分区：
文献类型：
--
作者：
Reale, Laura;Bartoli, Beatrice;Bonati, Maurizio
虽然ADHD合并症已被广泛研究，但仍有一些问题尚未解决。这项多中心观察性研究旨在检查新诊断的、未经治疗的患有和不患有ADHD的儿童和青少年的临床样本中的共病精神障碍，并根据共病类型比较治疗疗效。我们对从区域ADHD登记数据库中识别的患者的医疗记录进行了分析，这些患者在2011-2016年期间在18个ADHD中心登记。2861名受试者中有1919名（67%）符合ADHD的诊断标准：650名（34%）仅患有ADHD，而1269名（66%）至少有一种共病精神障碍（学习障碍，56%;睡眠障碍，23%;对立违抗性障碍，20%;焦虑症，12%）。合并型ADHD和重度损害（CGI-S ae 5）的患者更容易出现合并症。724例随访患者中有382例（53%）在治疗1年后改善。合并症的ADHD在联合干预或哌醋甲酯单独治疗时表现出更大的改善。具体而言，联合治疗对ADHD伴学习障碍（ES 0.66）和ODD（ES 0.98）表现出显著的优势，对ADHD伴睡眠或焦虑障碍的优势较低。单独的训练干预对ADHD和学习障碍仅显示中等疗效（ES 0.50）。这项研究是第一个描述在意大利的ADHD合并症模式，在多中心临床环境中证实，ADHD通常是一种复杂的疾病。研究结果强调了重要的诊断，治疗和服务组织方面，应广泛扩展，以确保适当和同质的ADHD管理。
Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment na < ve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ae5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.