Facts, values, and attention-deficit hyperactivity disorder (ADHD): an update on the controversies.
Facts, values, and attention-deficit hyperactivity disorder (ADHD): an update on the controversies.
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DOI：
10.1186/1753-2000-3-1
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发表时间：
2009-01-19
影响因子：
5.6
通讯作者：
Johnston, Josephine
中科院分区：
文献类型：
--
作者：
Parens, Erik;Johnston, Josephine
黑斯廷斯中心，一个生物伦理学研究机构，正在举办一系列的5个研讨会，以研究围绕使用药物治疗儿童情绪和行为障碍的争议。这些研讨会汇集了临床医生，研究人员，学者和倡导者与不同的观点和来自不同领域。我们在CAPMH上的第一篇评论来自我们的第一个研讨会，它解释了我们的方法，并探讨了一般的争议。这篇评论来自我们的第二次研讨会，解释了为什么知情人士对ADHD的诊断和治疗意见不一。根据研讨会参与者的发言和我们对文献的理解，我们提出8点。(1)ADHD的标签是基于对导致损害的一组异质症状的解释。(2)因为症状和损伤是多维的，所以不可避免地存在一个“模糊区”，理性的人会有不同的解释。(3)许多其他变量，从不同的诊断系统和工具到不同的养育方式和期望，也有助于解释为什么与ADHD相关的行为可以被不同地解释。(4)由于人们对精神病学和养育子女的正确目标持有不同的观点，有些人会更关心对待处于模糊地带的儿童，而另一些人则不那么关心。(5)认识到自然界在受损儿童和未受损儿童之间没有明确的界限，并且人类有责任选择谁应该接受诊断，这并没有削弱多动症的重要性。(6)一旦ADHD被诊断出来，围绕最有效治疗的事实是复杂和不完整的;与一些流行的智慧相反，行为治疗，单独或与低剂量药物联合使用，可以有效地长期减少核心ADHD症状，并改善整体功能的许多方面。(7)特别是当一个孩子占据了模糊地带，不同的人会强调不同的价值观嵌入在药理学和行为的方法。(8)真正明智的决策需要父母（在他们能够的范围内，孩子）对ADHD诊断和治疗的复杂和不完整的事实有一定的了解。
The Hastings Center, a bioethics research institute, is holding a series of 5 workshops to examine the controversies surrounding the use of medication to treat emotional and behavioral disturbances in children. These workshops bring together clinicians, researchers, scholars, and advocates with diverse perspectives and from diverse fields. Our first commentary in CAPMH, which grew out of our first workshop, explained our method and explored the controversies in general. This commentary, which grows out of our second workshop, explains why informed people can disagree about ADHD diagnosis and treatment. Based on what workshop participants said and our understanding of the literature, we make 8 points. (1) The ADHD label is based on the interpretation of a heterogeneous set of symptoms that cause impairment. (2) Because symptoms and impairments are dimensional, there is an inevitable "zone of ambiguity," which reasonable people will interpret differently. (3) Many other variables, from different systems and tools of diagnosis to different parenting styles and expectations, also help explain why behaviors associated with ADHD can be interpreted differently. (4) Because people hold competing views about the proper goals of psychiatry and parenting, some people will be more, and others less, concerned about treating children in the zone of ambiguity. (5) To recognize that nature has written no bright line between impaired and unimpaired children, and that it is the responsibility of humans to choose who should receive a diagnosis, does not diminish the significance of ADHD. (6) Once ADHD is diagnosed, the facts surrounding the most effective treatment are complicated and incomplete; contrary to some popular wisdom, behavioral treatments, alone or in combination with low doses of medication, can be effective in the long-term reduction of core ADHD symptoms and at improving many aspects of overall functioning. (7) Especially when a child occupies the zone of ambiguity, different people will emphasize different values embedded in the pharmacological and behavioral approaches. (8) Truly informed decision-making requires that parents (and to the extent they are able, children) have some sense of the complicated and incomplete facts regarding the diagnosis and treatment of ADHD.