The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG).
The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG).
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DOI：
10.1007/s00787-021-01871-x
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发表时间：
2023-08
影响因子：
6.4
通讯作者：
Simonoff E
中科院分区：
文献类型：
--
作者：
Coghill D;Banaschewski T;Cortese S;Asherson P;Brandeis D;Buitelaar J;Daley D;Danckaerts M;Dittmann RW;Doepfner M;Ferrin M;Hollis C;Holtmann M;Paramala S;Sonuga-Barke E;Soutullo C;Steinhausen HC;Van der Oord S;Wong ICK;Zuddas A;Simonoff E
注意缺陷多动障碍（ADHD）是儿童及青少年心理健康、儿科和初级保健服务中最常见的神经发育障碍。及时有效地干预以解决ADHD的核心症状及并发问题，是医疗保健行业乃至整个社会的重中之重。尽管很多研究都报道了针对ADHD不同干预措施的益处和不良反应，但这些单独的研究报告以及总结其研究结果的综述、荟萃分析和指南有时并不一致，且难以解读。我们总结了当前的证据，并确定了当前证据中存在的一些方法学问题和空白，我们认为临床医生在评估证据和做出治疗决策时考虑这些问题非常重要。这包括了解偏倚（如盲法不充分和选择偏倚）对研究结果的潜在影响；相对缺乏比较不同治疗方法以及评估药物和非药物治疗的长期有效性、不良反应和安全性的高质量数据；以及与观察性研究相关的问题，包括那些基于大型国家登记系统以及相互比较治疗方法的研究。我们强调了当前国际临床指南之间的关键相似之处，并讨论了出现差异的原因。我们讨论了将这些不同观点整合到一个以个人/家庭为中心的循证实践护理框架中，该框架旨在实现优先考虑个人优势和缺陷以及儿童及其家庭个人治疗目标的最佳结果。最后，我们思考了在不同的医疗保健系统中如何改善这种常见且有损害的疾病的就医途径。
ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems.
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