Chronic Care for Attention-Deficit/Hyperactivity Disorder: Clinical Management from Childhood Through Adolescence.
Chronic Care for Attention-Deficit/Hyperactivity Disorder: Clinical Management from Childhood Through Adolescence.
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DOI：
10.1097/dbp.0000000000000772
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发表时间：
2020
影响因子：
2.4
通讯作者：
Power, Thomas J.
中科院分区：
文献类型：
--
作者：
Moss, Cierra M.;Metzger, Kristina B.;Carey, Meghan E.;Blum, Nathan J.;Curry, Allison E.;Power, Thomas J.
当被诊断为注意力缺陷/多动障碍（ADHD）的儿童进入青春期后，损伤通常会持续存在。为了检查从儿童期到青春期过渡期间ADHD护理的变化，我们对10岁前诊断为ADHD的患者进行了回顾性、纵向队列研究，以评估从青春期前到青春期在以下方面的变化：(1)初级保健提供者向患者提供ADHD护理的频率，(2)患者就诊时评估的关注范围，(3)实施或推荐的治疗方法。我们从一个大型初级保健网络中的三个实践中确定了患者：(1)出生于1996年至1997年之间，(2)在10岁之前被诊断患有ADHD，(3)从9岁到青春期晚期连续接受初级保健。比较青春期前（9-11岁）、青春期早期（12-14岁）和青春期晚期（15-18岁）患者的临床护理。与青春期前（63%,p < 0.001）相比，10岁前被诊断为ADHD的儿童在青春期晚期（41%）就诊的可能性更低。监测抑郁、自杀和药物滥用的证据从青春期前到青春期增加（p < 0.001），发生在大约90%的青春期患者中。然而，只有大约50%的青少年对危险性活动进行了监测。关于药物转移和驾驶员准备的讨论基本上没有记录。这一发现引起了人们对初级保健提供者如何管理有ADHD病史的青少年的关注。需要加强对危险性行为和驾驶员准备情况的监测，并向患者提供有关药物转移的教育。
Impairments generally persist when children diagnosed with attention-deficit/hyperactivity disorder (ADHD) mature into adolescence. To examine changes in ADHD care during the transition from childhood to adolescence, we conducted a retrospective, longitudinal cohort study of patients diagnosed with ADHD before the age of 10 years to assess changes from preadolescence through adolescence in (1) frequency by which primary care providers offer ADHD care to patients, (2) range of concerns assessed during patient encounters, and (3) treatments implemented or recommended. We identified patients from 3 practices included in a large primary care network who (1) were born between 1996 and 1997, (2) were diagnosed with ADHD before the age of 10 years, and (3) received primary care continuously from age 9 through late adolescence. Clinical care was compared among patients in preadolescence (age 9–11), early adolescence (age 12–14), and late adolescence (age 15–18). Children diagnosed with ADHD before the age of 10 years were less likely to have a documented visit for ADHD during late adolescence (41% of patients) compared with preadolescence (63%, p < 0.001). Evidence of monitoring for depression, suicide, and substance abuse increased from preadolescence to adolescence (p < 0.001) and occurred in about 90% of adolescent patients. However, monitoring for risky sexual activity occurred in only about 50% of adolescents. Discussions of medication diversion and driver readiness were essentially not documented. The findings raise concerns about how primary care providers manage adolescents with a history of ADHD. Improving monitoring of risky sexual behavior and driver readiness and providing patient education about medication diversion are needed.