Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence
Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence
复制标题
DOI：
10.1542/peds.2004-2560
复制
发表时间：
2005-06-01
期刊：
影响因子：
8
通讯作者：
Wolraich, ML
中科院分区：
文献类型：
--
作者：
Brown, RT;Amler, RW;Wolraich, ML
美国儿科学会质量改进委员会注意力缺陷多动障碍小组委员会审查并分析了当前文献，旨在制定一项用于治疗学龄儿童注意力缺陷多动障碍（ADHD）的循证临床实践指南。该审查包括几份关键报告，包括来自麦克马斯特循证实践中心（由医疗保健研究和质量局支持）的证据审查，加拿大卫生技术评估协调办公室的报告，ADHD多模式治疗比较临床试验（由国家精神卫生研究所支持），以及小组委员会进行的补充审查。这些综述提供了有关ADHD不同治疗方法及其在改善ADHD儿童某些特征或结局方面的疗效以及多种治疗模式与单一模式（例如，单独药物治疗或行为治疗）相比的不良反应和益处的大量信息。其他证据证明了儿童多动症的长期性及其作为慢性疾病的分类，值得应用慢性疾病管理的一般概念，包括侧重于持续的父母和儿童教育，管理和监测的个体治疗计划。证据强烈支持使用兴奋剂药物治疗ADHD儿童的核心症状，并在较小程度上改善功能。单独的行为疗法对ADHD儿童的症状或功能影响有限，尽管将行为疗法与药物结合似乎可以改善功能，并可能减少所需的（兴奋剂）药物量。兴奋剂（主要是哌醋甲酯和苯丙胺）之间的比较并未表明哪一类药物优于另一类药物。
The American Academy of Pediatrics' Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder, reviewed and analyzed the current literature for the purpose of developing an evidence-based clinical practice guideline for the treatment of the school-aged child with attention-deficit/hyperactivity disorder (ADHD). This review included several key reports, including an evidence review from the McMaster Evidence-Based Practice Center ( supported by the Agency for Healthcare Research and Quality), a report from the Canadian Coordinating Office for Health Technology Assessment, the Multimodal Treatment for ADHD comparative clinical trial ( supported by the National Institute of Mental Health), and supplemental reviews conducted by the subcommittee. These reviews provided substantial information about different treatments for ADHD and their efficacy in improving certain characteristics or outcomes for children with ADHD as well as adverse effects and benefits of multiple modes of treatment compared with single modes (eg, medication or behavior therapies alone). The reviews also compared the effects of different medications.Other evidence documents the long-term nature of ADHD in children and its classification as a chronic condition, meriting the application of general concepts of chronic-condition management, including an individual treatment plan with a focus on ongoing parent and child education, management, and monitoring. The evidence strongly supports the use of stimulant medications for treating the core symptoms of children with ADHD and, to a lesser degree, for improving functioning. Behavior therapy alone has only limited effect on symptoms or functioning of children with ADHD, although combining behavior therapy with medication seems to improve functioning and may decrease the amount of ( stimulant) medication needed. Comparison among stimulants ( mainly methylphenidate and amphetamines) did not indicate that 1 class outperformed the other.