营养补充剂治疗儿童注意缺陷多动障碍的研究进展

注意缺陷多动障碍(ADHD)是一种常见的儿童和青少年神经行为障碍性疾病,可能会持续到成年。多不饱和脂肪酸(PUFA)和锌、铁、镁等矿物质供应不足被认为在ADHD症状的发展中发挥重要作用。本文综述了PUFA和矿物质营养补充剂治疗ADHD的相关研究进展,鼓励临床医生在回顾患儿饮食历史的基础上,采取适当的筛查和预防性措施,为ADHD患儿提供个性化治疗策略。     

药物治疗对注意缺陷多动障碍儿童生活质量的影响

生活质量(QOL)是指个体的健康状态对其生理功能、心理功能和社会功能方面的影响。在临床工作及研究中,QOL可以作为评估行为、功能和治疗效果的一种手段,促进对疾病更全面的了解。注意缺陷多动障碍(ADHD)是一种神经发育障碍,研究显示ADHD患儿的QOL显著降低,改善ADHD患儿的QOL具有重要治疗意义。本文介绍了ADHD患儿QOL的临床特点,重点介绍了药物对ADHD患儿QOL 的作用,并提出了未来改善ADHD患儿QOL的方向。     

儿童注意缺陷多动障碍流行病学调查及疗效评价

【目的】调查掌握盐城市儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的发生情况及相关因素,对确诊ADHD患儿给予治疗并评价效果。【方法】采用Conners简明症状问卷对3 000名学龄儿童进行ADHD筛查,对阳性疑似患儿进行诊断,对相关因素进行调查。对确诊ADHD患儿运用不同的方法进行治疗,并比较疗效。【结果】ADHD筛查阳性率为6.02%,ADHD发病率为4.77%,男、女发病率差异有统计学意义(P0.005)。父母遗传、轻度脑损伤和脑发育迟缓史、血铅含量高、感觉统合失调、家庭环境等因素与ADHD发生有关系。药物配合行为干预、心理支持等方法治疗ADHD效果明显。【结论】ADHD危害严重,应及早预防,药物是治疗ADHD的首选,ADHD的综合治疗可提高ADHD的疗效。     

注意缺陷多动障碍儿童社会功能改善的动态观察

目的 观察注意缺陷多动障碍(ADHD)儿童经过哌甲酯控释剂治疗后社会功能的动态变化情况,以及治疗后ADHD儿童社会功能与正常儿童社会功能有无差异。方法 ADHD患儿34例,正常儿童35例。ADHD组服用哌甲酯控释剂治疗24周,分别在基线、治疗第8周、治疗第24周进行问卷调查评估。采用Weiss's 功能缺陷程度评分量表作为社会功能的评定指标。结果 1)ADHD患儿的Weiss's 功能缺陷程度评分量表总分及家庭、学习和学校、生活技能、自我管理、社会活动和冒险活动分都随着治疗时间的延长逐步下降(P<0.001):2)经过24周的治疗,ADHD患儿生活技能和冒险活动两项评分与正常儿童差异无统计学意义(P>0.01),家庭、学习和学校、自我管理、社会活动四项评分与正常儿童差异有统计学意义(P<0.01)。结论 哌甲酯控释剂治疗能够明显改善ADHD患儿的社会功能,且其改善趋势随着治疗时间的延长逐步下降。     

盐酸哌甲酯控释剂治疗儿童ADHD临床疗效影响因素分析

目的 观察中枢神经兴奋剂盐酸哌甲酯控释剂治疗注意缺陷多动障碍(ADHD)患儿临床疗效的影响因素.方法采取自身对照研究方法,选取2014年1月至2015年12月在上海市儿童医院儿保门诊就诊被诊断为ADHD并需要进行治疗的患儿711例;经过盐酸哌甲酯控释剂治疗后,分别于6周、6个月后采用斯诺佩评估量表(SNAP-Ⅳ)的家长使用量表、联合型瑞文测验(CRT)等相关测试,进行治疗前后疗效评估.结果盐酸哌甲酯控释剂对注意力缺陷型和混合型的ADHD患儿治疗效果明显优于多动型/冲动型(χ2=73.109,P<0.01);对认知功能好的ADHD患儿疗效优于合并认知障碍者(χ2=100.225,P<0.01).结论盐酸哌甲酯控释剂治疗儿童不同类型ADHD疗效肯定;疗效受到ADHD类型、患儿智力、药物剂量等的影响.     

共患和不共患ADHD的抽动障碍患儿临床特征调查分析

目的 分析共患和不共患注意力缺陷多动障碍(ADHD)的抽动障碍(TD)患儿临床特征,为临床治疗提供思路。方法 病例随机选自2018年6月-2019年11月就诊于中国中医科学院广安门医院儿科6～12岁符合研究标准的单纯TD患儿及TD共患ADHD(TD+ADHD)患儿共计408例(单纯TD患儿296例,TD+ADHD患儿112例),调查两组患儿抽动障碍病程、亚型分布、抽动障碍始发年龄等发病情况以及疾病严重程度方面的差异;分析TD+ADHD组患儿注意缺陷多动障碍病情分布情况。结果 在耶鲁综合抽动严重程度量表(YGTSS)总分及损害率方面,TD+ADHD组明显高于单纯TD患儿(t=-23.24、-19.17,P＜0.001),但其分值高低却不受ADHD亚型的影响;在TD+ADHD患儿组中,注意缺陷子量表分值高于多动/冲动子量表(t=2.96,P＜0.05);与TD共患注意缺陷为主型ADHD(TD+ADHD-I)患儿相比,TD共患多动/冲动为主型ADHD(TD+ADHD-HI)与TD共患混合型ADHD(TD+ADHD-C)的就诊年龄较偏小(F=7.93,P=0.019)。结论 TD+ADHD的患儿抽动障碍病情更为严重,但其严重程度却不受ADHD亚型的影响;TD+ADHD-HI与TD+ADHD-C患儿的早期行为问题更加突出且易被发现,因此更早地选择去医院就诊,但TD+ADHD-I患儿在就诊时其注意缺陷问题已经非常严重。     

注意缺陷多动障碍患儿家长心理状况调查及干预

目的了解注意缺陷多动障碍(ADHD)患儿家长心理健康状况并提供有效的干预。方法采用焦虑自评量表(SAS)对104例ADHD患儿主要照顾者的焦虑状况进行评定,并随机分成干预组和对照组。根据SAS评定结果干预组家长给予相应的家庭心理干预和ADHD相关知识讲座,对照组行常规指导不提供干预,追踪观察6个月并进行对照分析。结果承担着主要照顾责任的直系亲属焦虑明显高于国内常模。接受家庭心理干预的患儿家长焦虑程度明显减轻,ADHD患儿的治疗效果干预组和对照组有效率分别为96.15%和75%,干预组疗效明显优于对照组(P0.01)。结论ADHD患儿家长接受家庭心理干预能减轻其焦虑,同时能提高ADHD患儿的独立生活、学习能力,提高治疗效果。     

盐酸哌甲酯控释片联合小儿智力糖浆治疗儿童多动症的临床效果及安全性

目的观察盐酸哌甲酯控释片联合小儿智力糖浆治疗儿童多动症(ADHD)临床疗效及药物不良反应,为ADHD治疗方案的选择提供参考依据。方法选择2010年1月-2016年10月天津市第五中心医院诊治的ADHD患儿108例作为研究对象,将其按照就诊顺序编号,采用数字随机表法将患儿分为A、B、C 3组,每组36例,A组采用盐酸哌甲酯控释片治疗,B组采用小儿智力糖浆治疗,C组采用盐酸哌甲酯控释片联合小儿智力糖浆治疗,3组患儿均连续治疗3个疗程,比较3组患儿治疗前后的多动症评分变化及治疗后临床疗效,治疗过程中出现的药物不良反应。结果两组患儿性别、年龄、体质量、体质量指数、ADHD病程、ADHD病情严重程度分级、入组时ADHD行为量表评分比较,差异无统计学意义(P0.05)。3组患儿完成3个治疗疗程后,多动症评分均较治疗前有明显降低(P0.05),但C组患儿降低幅度明显高于A组和B组,B组降低幅度低于A组(P0.05)。C组患儿临床总有效率明显高于A、B组患儿,A组患儿临床总有效率明显高于B组患儿(P0.05)。A、C组患儿治疗过程中出现药物不良反应率高于B组患儿(P0.05),A、C两组患儿药物不良反应比较差异无统计学意义(P0.05)。结论盐酸甲酯控释片联合小儿智力糖浆治疗小儿多动症临床疗效较满意,但在临床治疗方案制定时应充分考虑患儿身体条件,充分考虑药物不良反应对患儿生长发育可能造成的影响,提高患儿治疗时的安全性。     

注意缺陷多动障碍患儿嗅觉改变特征及相关机制分析

目的分析注意缺陷多动障碍(ADHD)患儿嗅觉改变特征及相关机制。方法选取2018年6月-2019年3月在温州市第七人民住院及门诊的100例ADHD患儿为研究对象,温州市100例健康儿童为对照组。随机将观察组患儿分为观察Ⅰ组(50例)和观察Ⅱ组(50例)。比较观察组与对照组儿童的嗅觉能力总评分、嗅觉阈值得分、嗅球容积。观察Ⅰ组患儿采取药物治疗,观察Ⅱ组患儿不采取药物治疗。比较观察Ⅰ组和观察Ⅱ组儿童不同时间点嗅觉能力总评分、嗅觉阈值得分。结果观察组儿童嗅觉阈值得分和嗅觉能力总评分均显著低于对照组(P0.05)。观察组儿童嗅球容积实测值和嗅球校正容积值均显著小于对照组(P0.05)。观察Ⅰ组和观察Ⅱ组儿童不同时间嗅觉能力总评分、嗅觉阈值评分比较差异无统计学意义(P0.05)。结论 ADHD患儿的嗅觉功能明显下降,且抗ADHD治疗对于患儿嗅觉功能效果不佳,在治疗ADHD的基础上选择有效的治疗嗅觉异常药物尤为重要。     

药物治疗对注意缺陷多动障碍患儿体格生长影响的研究进展

注意缺陷多动障碍(ADHD)是儿童时期最常见的神经发育障碍性疾病,对儿童的学业水平、人际交往、社会功能以及整个家庭、社会都有不可忽视的影响。ADHD的发病率在过去几十年里一直呈上升趋势。兴奋剂哌甲酯(MPH)与选择性去甲肾上腺素再摄取抑制剂托莫西汀(ATX)均为治疗ADHD公认的一线药物。药物对ADHD儿童体格生长可能带来的消极影响令家长担忧。本文就药物治疗对ADHD患儿体格生长的影响、相关机制及管理进行综述,以期提高患儿临床药物治疗的依从性。     

Current Evidence on the Role of the Gut Microbiome in ADHD Pathophysiology and Therapeutic Implications

Studies suggest that the bidirectional relationship existent between the gut microbiome (GM) and the central nervous system (CNS), or so-called the microbiome–gut–brain axis (MGBA), is involved in diverse neuropsychiatric diseases in children and adults. In pediatric age, most studies have focused on patients with autism. However, evidence of the role played by the MGBA in attention deficit/hyperactivity disorder (ADHD), the most common neurodevelopmental disorder in childhood, is still scanty and heterogeneous. This review aims to provide the current evidence on the functioning of the MGBA in pediatric patients with ADHD and the specific role of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in this interaction, as well as the potential of the GM as a therapeutic target for ADHD. We will explore: (1) the diverse communication pathways between the GM and the CNS; (2) changes in the GM composition in children and adolescents with ADHD and association with ADHD pathophysiology; (3) influence of the GM on the ω-3 PUFA imbalance characteristically found in ADHD; (4) interaction between the GM and circadian rhythm regulation, as sleep disorders are frequently comorbid with ADHD; (5) finally, we will evaluate the most recent studies on the use of probiotics in pediatric patients with ADHD.     

Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder--United States, 2003

Attention-deficit/hyperactivity disorder (ADHD), previously known as attention deficit disorder, is a neurobehavioral disorder characterized by pervasive inattention and hyperactivity-impulsivity that often results in substantial functional impairment. Prevalence estimates of ADHD in school-aged children have ranged from 2% to 18% in community samples. Although stimulant medications are an effective first-line treatment for ADHD , concern persists regarding the possible side effects and long-term health outcomes associated with stimulant consumption. Estimating the number of children who have had ADHD diagnosed and are currently taking medication for the disorder is an important step toward understanding the overall burden of ADHD in the United States. Previously, population-based estimates of medication treatment for ADHD were not available or were limited by their lack of generalizability. To estimate rates of parent-reported ADHD diagnosis and medication treatment for ADHD, CDC analyzed data from the 2003 National Survey of Children's Health (NSCH). This report describes the results of that analysis, which indicated that, in 2003, approximately 4.4 million children aged 4-17 years were reported to have a history of ADHD diagnosis; of these, 2.5 million (56%) were reported to be taking medication for the disorder. Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.     

盐酸托莫西汀治疗儿童多动症合并短暂性抽动障碍的疗效观察

目的观察盐酸托莫西汀治疗儿童多动症合并短暂性抽动障碍的临床疗效。方法 76例多动症合并短暂性抽动障碍患儿,按用药方案的不同分为两组各38例。对照组采用盐酸哌甲酯治疗,观察组采用盐酸托莫西汀治疗,比较两组的治疗效果。结果观察组治疗后的注意缺陷评分、多动障碍评分、PSQ评分、TRS评分均显著低于对照组(P<0.05)。两组的不良反应发生率比较无显著差异(P>0.05)。结论盐酸托莫西汀治疗儿童多动症合并短暂性抽动障碍的效果确切,安全性高。     

儿童注意缺陷多动障碍药物依从性及影响因素

注意缺陷多动障碍(ADHD)是儿童和青少年期最常见的神经发育障碍,约影响全世界5%～11%的儿童。药物治疗是6岁以上ADHD儿童首选方案,约70%患者药物治疗有效。多种药物已被应用于ADHD临床治疗,如盐酸哌甲酯和苯丙胺、盐酸托莫西汀及可乐定和胍法辛等。药物副作用、药物剂型、患儿生长速度、家庭因素、患儿用药体验、睡眠问题或障碍等多种因素均会影响药物依从性。医生、父母和患儿共享信息、商讨治疗方案、监测疗效和副作用,并积极开展医教结合、家校结合,实施行为管理和干预,有助于提高依从性、改善治疗效果,促进患儿学业成绩及社会功能、生活质量全面提升。     

The Development of Play for Children in Hospitals: British and European Perspectives

We investigated the perceptions about the behaviors that are characteristic of children with attention deficit hyperactivity disorder (ADHD), and the stimulant medication used to manage the symptoms of ADHD, in 40 Mexican American and non-Hispanic White mothers and their children (mean age 9.63 years). Mothers also reported the disorder-related information they had received from the professionals who worked with their children and the disorder-related information they had communicated to their children. Results revealed that mothers and children viewed oppositional defiant disorder (ODD) and ADHD symptoms as equally salient, and they viewed stimulant medication as similarly important in treating both clusters of behavior. However, mothers reported receiving and communicating less information about ODD than about ADHD. There were differences related to ethnicity in the responses. The results suggest that professionals who work with children with ADHD and their families should consider providing information to them about ODD and its treatment.     

儿童、青少年注意缺陷多动障碍的评估及管理

注意缺陷多动障碍(ADHD)是一种慢性神经发育障碍,可能持续终生。对怀疑可能患有ADHD的儿童、青少年应启动诊断评估。临床诊断应建立在综合评估的基础上。应按照慢性病管理模式来管理ADHD,制定完善的治疗计划。父母培训/行为干预、药物治疗是得到证据支持的最有效治疗方法。影响治疗选择的主要因素有患者年龄、疾病严重程度及共患病。行为干预是学龄前儿童首选的治疗方法,对于学龄期儿童、青少年首选药物治疗,联合或不联合行为。