ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups
ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups
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DOI：
10.1097/00004583-200102000-00009
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发表时间：
2001-02-01
影响因子：
13.3
通讯作者：
Vitiello, B
中科院分区：
文献类型：
--
作者：
Jensen, PS;Hinshaw, SP;Vitiello, B
目的：先前的研究尚未确定注意力缺陷多动障碍（ADHD）与破坏性障碍（对立违抗性障碍[ODD]或行为障碍[CD]）共病时，与内化障碍（焦虑和/或抑郁）或两者同时存在时，是否应构成单独的临床实体。确定潜在的ADHD +内化障碍或ADHD + ODD/CD综合征的临床意义可以产生更好的诊断决策，治疗计划和治疗结果。方法：根据参与NIMH儿童注意力缺陷/多动障碍（MTA）协作多点多模式治疗研究的579名ADHD儿童（7-9.9岁）的横截面和纵向信息，研究人员采用验证标准比较ADHD受试者是否有共病内化障碍和ODD/CD。结果如下：大量的证据表明，主要影响的内在和外在的共病disorders. Moderate证据的父母报告的焦虑和ODD/CD状态的相互作用，注意到对治疗的反应，这表明儿童多动症和焦虑症（但没有ODD/CD）可能同样好地响应MTA的行为和药物治疗。只有ADHD或ADHD伴ODD/CD（但没有焦虑症）的儿童对MTA药物治疗（有或没有行为治疗）的反应最好，而患有多种共病障碍（焦虑和ODD/CD）的儿童对联合（药物和行为）治疗的反应最佳。结论：研究结果表明，三个临床概况，多动症共同发生的内化障碍，（主要是父母报告的焦虑症）无任何并发的破坏性障碍（ADHD + ANX），ADHD合并ODD/CD，但无焦虑（ADHD + ODD/CD），ADHD伴焦虑和ODD/CD（ADHD + ANX + ODD/CD）可能有足够的区别，以保证分类为ADHD亚型，不同于既没有合并症的“纯”ADHD。未来的临床、病因学和遗传学研究应该探讨这三种ADHD分类方案的优点。
Objectives: Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method: Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results: Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments. Conclusions: Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.