Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007
Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007
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DOI：
10.1542/peds.2010-0165
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发表时间：
2011-03-01
期刊：
影响因子：
8
通讯作者：
Halfon, Neal
中科院分区：
文献类型：
--
作者：
Larson, Kandyce;Russ, Shirley A.;Halfon, Neal
目的：了解美国注意力缺陷多动障碍(ADHD)儿童的共病、功能和服务利用模式。方法：对2007年《全国儿童健康调查》中的61779名6~17岁儿童(其中ADHD 5028名)的数据进行双变量和多变量横断面分析。结果：家长报告的ADHD患病率为8.2%。患有ADHD的儿童更有可能有其他心理健康和神经发育状况。家长报告说，患有ADHD的儿童中有46%有学习障碍，而没有ADHD的儿童有5%，27%对2%有品行障碍，18%对2%有焦虑，14%对1%有抑郁，12%对3%有言语问题(均P<；.05)。大多数ADHD儿童至少有1个共病障碍：33%有1个，16%有2个，18%有3个或更多。贫困儿童有3个或3个以上合并症的风险是富裕儿童的3.8倍(30%比8%)。ADHD儿童在活动受限(优势比：4.14[95%可信区间：3.34-5.15])、学习问题(优势比：5.18[95%可信区间：4.47-6.01])、年级重复和亲子沟通不良等方面的优势较高，而社交能力得分较低，父母恶化程度较高。随着合并症数量的增加，功能逐步下降，对健康和教育服务的使用以及对护理协调的需求增加。结论：ADHD的临床管理必须解决多种并存情况，并管理一系列不利的功能后果。治疗方法应针对每个儿童的神经发育状况，根据其独特的社会和家庭情况量身定做，并与教育、心理健康和社会支助服务相结合。儿科杂志2011；127：462-470
OBJECTIVE: To determine patterns of comorbidity, functioning, and service use for US children with attention-deficit/hyperactivity disorder (ADHD).METHODS: Bivariate and multivariable cross-sectional analyses were conducted on data from the 2007 National Survey of Children's Health on 61 779 children ages 6 to 17 years, including 5028 with ADHD.RESULTS: Parent-reported diagnosed prevalence of ADHD was 8.2%. Children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability versus 5% without ADHD, 27% vs 2% had a conduct disorder, 18% vs 2% anxiety, 14% vs 1% depression, and 12% vs 3% speech problems (all P < .05). Most children with ADHD had at least 1 comorbid disorder: 33% had 1, 16% had 2, and 18% had 3 or more. The risk for having 3 or more comorbidities was 3.8 times higher for poor versus affluent children (30% vs 8%). Children with ADHD had higher odds of activity restriction (odds ratio: 4.14 [95% confidence interval: 3.34-5.15]), school problems (odds ratio: 5.18 [95% confidence interval: 4.47-6.01]), grade repetition, and poor parent-child communication, whereas social competence scores were lower and parent aggravation higher. Functioning declined in a stepwise fashion with increasing numbers of comorbidities, and use of health and educational services and need for care coordination increased.CONCLUSIONS: Clinical management of ADHD must address multiple comorbid conditions and manage a range of adverse functional outcomes. Therapeutic approaches should be responsive to each child's neurodevelopmental profile, tailored to their unique social and family circumstances, and integrated with educational, mental health and social support services. Pediatrics 2011;127:462-470