Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents
Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents
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DOI：
10.1001/jama.279.14.1100
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发表时间：
1998-04-08
影响因子：
120.7
通讯作者：
Slanetz, PJ
中科院分区：
文献类型：
--
作者：
Goldman, LS;Genel, M;Slanetz, PJ
目的.-通过审查与 ADHD 患者的诊断、最佳治疗和实际护理相关的问题以及患者滥用 ADHD 药物的证据，处理公众和专业人士对注意力缺陷/多动症 (ADHD) 药物可能过量处方的担忧，特别是哌醋甲酯。数据来源.-使用美国国家医学图书馆数据库检索 1975 年至 1997 年 3 月有关术语“注意缺陷多动障碍”的文献综述 哌醋甲酯、兴奋剂以及兴奋剂滥用和依赖性，还审查了缉毒局的相关文件。研究选择。-包括所有涉及小学至高中年龄儿童的英语研究。数据提取。-选择所有搜索到的文章并提供给共同作者审查，共同作者已知的其他文章被添加到初始列表中，共同作者之间就以下方面达成共识： 与要求本报告的决议中所要求的问题最相关的文章，这些文章的相关信息已包含在报告中。数据综合。-ADHD 的诊断标准基于广泛的实证研究，如果应用得当，可以诊断出一种具有高人际可靠性、良好的表面有效性、病程和药物反应性高可预测性的综合征，ADHD 的标准 儿童的范围扩大了，人们越来越认识到 ADHD 会持续到青春期和成年期，因此，更多的儿童（特别是女孩）、青少年和成人接受兴奋剂药物的诊断和治疗，儿童接受的治疗时间也更长。使用标准化诊断标准的流行病学研究表明，3% 至 6% 的学龄人口（小学到高中）可能患有 ADHD 尽管美国青少年接受 ADHD 治疗的比例几乎处于这一患病率范围的下限，但药物治疗，特别是兴奋剂的使用，已得到广泛研究，通常可以提供显着的短期症状和学业改善。几乎没有证据表明兴奋剂滥用或转移是目前的一个主要问题，特别是在 ADHD 患者中，尽管最近的趋势表明，随着兴奋剂生产和使用的扩大，这一问题可能会增加。 结论：尽管一些儿童在评估不足的情况下被诊断为患有多动症，并且在某些情况下，当存在替代治疗方案时，会开出兴奋剂药物，但几乎没有证据表明多动症普遍存在过度诊断或误诊，或者医生普遍过度开哌甲酯。
Objective.-To deal with public and professional concern regarding possible overprescription of attention-deficit/hyperactivity disorder (ADHD) medications, particularly methylphenidate, by reviewing issues related to the diagnosis, optimal treatment, and actual care of ADHD patients and of evidence of patient misuse of ADHD medications.Data Sources.-Literature review using a National Library of Medicine database search far 1975 through March 1997 on the terms attention deficit disorder with hyperactivity methylphenidate, stimulants, and stimulant abuse and dependence, Relevant documents from the Drug Enforcement Administration were also reviewed.Study Selection.-All English-language studies dealing with children of elementary school through high school age were included.Data Extraction.-All searched articles were selected and were made available to coauthors for review, Additional articles known to coauthors were added to the initial list, and a consensus was developed among the coauthors regarding the articles most pertinent to the issues requested in the resolution calling for this report, Relevant information from these articles was included in the report.Data Synthesis.-Diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness, The criteria of what constitutes ADHD in children have broadened, and there is a growing appreciation of the persistence of ADHD into adolescence and adulthood, As a result, more children (especially girls), adolescents, and adults are being diagnosed and treated with stimulant medication, and children are being treated for longer periods of time, Epidemiologic studies using standardized diagnostic criteria suggest that 3% to 6% of the school-aged population (elementary through high school) may suffer from ADHD, although the percentage of US youth being treated for ADHD is al most at the lower end of this prevalence range, Pharmacotherapy, particularly use of stimulants, has been extensively studied and generally provides significant short-term symptomatic and academic improvement, There is little evidence that stimulant abuse or diversion is currently a major problem, particularly among those with ADHD, although recent trends suggest that this could increase with the expanding production and use of stimulants.Conclusions.-Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate by physicians.