Risk Factors For Attention Deficit/hyperactivity Disorde

在北卡罗来纳州的约翰斯顿县进行的一项以人群为基础的研究正在调查注意力缺陷多动障碍的患病率和危险因素。通过与约翰斯顿县学校的合作，对该县所有小学适龄儿童进行了研究。在家长的许可下，教师完成了对孩子们在课堂上的行为评级评估。所有根据老师的回答或父母报告服用药物的儿童被归类为可能患有多动症的儿童都有资格进行进一步的研究，沿着的还有随机抽取的所有其他儿童。家长访谈获得的信息，儿童行为，产前和儿童期暴露，父母的职业暴露和其他因素可能与多动症的风险。这项试点研究结合了家长和教师的信息，以估计小学儿童多动症的患病率。两阶段筛选采用DSM-IV标准。教师完成所有儿童的行为评级量表，然后对潜在病例的家长进行结构化电话采访。在4所学校的424名1-5年级儿童中，有362人（85%）接受了筛查。我们估计了北卡罗来纳州一个县的小学儿童中注意力缺陷多动障碍（ADHD）药物治疗的患病率。我们询问了7333名就读于17所公立小学的1至5年级儿童的父母，他们的孩子是否曾被心理学家或医生诊断为ADHD，以及他们的孩子目前是否正在服用药物治疗ADHD。该项目的主要目的是：1）描述ADHD的患病率及其随年龄、种族、性别和社会经济地位的变化; 2）检验早产和足月分娩ADHD风险较高的假设; 3）评估母亲吸烟、母亲职业、母亲饮酒和妊娠并发症作为ADHD风险因素的作用。在第一年的研究结果中，根据父母的报告，43名儿童（12%）以前曾被健康专业人员诊断为ADHD。34名儿童（9%）正在服用ADHD药物。根据教师和家长的报告，46名儿童符合ADHD的研究案例标准。在调整无应答后，治疗或未治疗的ADHD合并的估计患病率为16%。基于全样本的患病率估计值较低，但仍高于基于DSMIV标准的已发表报告。在整个研究中，6099名儿童（83%）的父母提供了药物使用信息。其中，607名儿童（10%）被诊断为ADHD，434名（7%）接受ADHD药物治疗（71%的诊断儿童接受药物治疗）。治疗率因性别、人种/种族和等级而异。如果本研究中观察到的治疗模式具有代表性，则ADHD对公共卫生的影响可能被低估。 该项目的首席研究员离开了NIEHS，在新墨西哥州大学任职。这一项目的工作仍在继续。在过去的一年里，两篇论文的心理测量学特性的诊断量表中使用的人口为基础的努力已经起草。这些量表识别ADHD儿童的能力与更个性化的基于医生的方法的结果进行了对比。此外，正在使用所有研究参与者的信息确定总体患病率估计，现在注意力将转移到识别可能导致ADHD风险的妊娠相关因素以及环境暴露（例如铅）。Rowland博士（前NIEHS首席研究员）正在制定一项建议，以跟踪研究的儿童，以评估患有各种亚型ADHD的儿童的症状和结果的持续性，并将寻求对这种努力的资助。

The prevalence of and risk factors for Atention Deficit Hyperactivity Disorder are being investigated in a population-based study carried out in Johnston County, North Carolina. Through the cooperation of the Johnston County schools, all elementary school age children in the county were studied. With parental permission, teachers completed behavior rating evaluations for children in their classroom. All children classified as potentially having ADHD according to teacher responses or reported by parents to be taking medications were eligible for further study, along with a random sample of all other children. Parent interviews obtained information on child behavior, prenatal and childhood exposures, parental occupational exposures and other factors potentially related to risk for ADHD. The pilot study combined parent and teacher information to estimate the prevalence of ADHD among elementary school children. Two-stage screening used DSM-IV criteria. Teachers completed behavior-rating scales on all children and then parents of potential cases were administered a structured telephone interview. 362 of 424 (85%) children in grades 1-5 in four schools were screened. We estimated the prevalence of medication treatment for attention deficit-hyperactivity disorder (ADHD) among elementary school children in a North Carolina county. We asked parents of 7333 children in grades 1 through 5 attending 17 public elementary schools whether their child had ever been given a diagnosis of ADHD by a psychologist or physician and whether their child was currently taking medication to treat ADHD. The primary aims of the project are 1) to describe the prevalence of ADHD and how it varies by age, race, gender, and SES, 2) to test the hypothesis that preterm and post-term births are at higher risk for ADHD and 3) to evaluate the role of maternal smoking, maternal occupation, maternal alcohol consumption and pregnancy complications as risk factors for ADHD. In the results for the first year of the study, according to parental reports, 43 children (12%) previously had been diagnosed with ADHD by a health professional. Thirty-four children (9%) were taking ADHD medication. Forty-six children met study case criteria for ADHD based on combined teacher and parent reports. After adjusting for non-response, the estimated prevalence of treated or untreated ADHD combined was 16% The prevalence estimate based on the full sample is lower, but still greater than published reports based on DSMIV criteria. In the overall study, parents of 6099 children (83%) provided information on medication use. Of these, 607 children (10%) had been given an ADHD diagnosis, and 434 (7%) were receiving ADHD medication treatment (71% of the diagnosed children were receiving medication). Treatment rates varied by sex, race/ethnicity, and grade. If treatment patterns observed in this study are representative, the public health impact of ADHD may be underestimated. The lead investigator for this project left NIEHS for a position at the University of New Mexico. Work on this project is continuing. In the past year, Two papers on the psychometric properties of the diagnostic scales used in this population-based effort has been drafted. The ability of these scales to identify children with ADHD is being contrasted with results from a more individualized physician-based approach. In addition, an overall prevalence estimate is being determined using information from all study participants, and attention will now shift to identifying prgnancy-related factors as well as environmental exposures (e.g. lead) that may contribute to risk of ADHD. Dr. Rowland (former NIEHS lead investigator) is developing a proposal to follow the children who were studied to evaluate persistence of symptoms and outcomes among children with various subtypes of ADHD, and will be seeking grant support for such an effort.