Risk Factors For Attention Deficit/hyperactivity Disorde

在北卡罗来纳州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缺陷多动障碍的患病率和危险因素。通过约翰斯顿县学校的合作，该县所有的小学适龄儿童都得到了学习。在家长的许可下，老师们在课堂上为孩子们完成了行为评级评估。所有根据老师的反应被归类为潜在ADHD的儿童或被父母报告正在服药的儿童都有资格继续学习，以及从所有其他儿童中随机抽样。家长访谈获得了有关儿童行为、产前和童年暴露、父母职业暴露和其他可能与ADHD风险相关的因素的信息。这项初步研究结合了家长和教师的信息，以估计小学生中ADHD的患病率。两阶段筛查采用DSM-IV标准。教师完成了所有儿童的行为评定量表，然后对潜在病例的父母进行了结构化的电话采访。在4所学校的424名1-5年级儿童中，有362名(85%)接受了筛查。我们估计了北卡罗来纳州一个县的小学生中注意力缺陷多动障碍(ADHD)药物治疗的流行率。我们询问了在17所公立小学就读的7333名一年级到五年级儿童的父母，他们的孩子是否曾被心理学家或内科医生诊断为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的患病率以及它如何随年龄、种族、性别和社会经济地位的变化而变化，2)检验早产和早产儿患ADHD风险更高的假设，3)评估母亲吸烟、母亲职业、母亲饮酒和怀孕并发症作为ADHD危险因素的作用。在第一年的研究结果中，根据父母的报告，43名儿童(12%)之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。根据教师和家长的综合报告，46名儿童符合ADHD的研究案例标准。在调整了无反应后，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名儿童的父母(83%)提供了药物使用信息。其中，607名儿童(10%)被诊断为ADHD，434名(7%)正在接受ADHD药物治疗(71%的确诊儿童正在接受药物治疗)。治疗率因性别、种族/民族和年级而异。如果这项研究中观察到的治疗模式具有代表性，那么ADHD对公众健康的影响可能被低估了。 该项目的首席研究员离开了NIEHS，前往新墨西哥大学担任一个职位。该项目的工作仍在继续。在过去的一年里，起草了两篇关于这项以人口为基础的努力中使用的诊断量表的心理测量学特性的论文。这些量表识别ADHD儿童的能力正在与基于医生的更个性化的方法的结果进行对比。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确定与怀孕相关的因素以及可能导致ADHD风险的环境暴露(例如铅)。罗兰博士(前NIEHS首席研究员)正在制定一项建议，以跟踪接受研究的儿童，以评估患有不同亚型ADHD儿童的症状和结果的持续性，并将为这一努力寻求拨款支持。

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.