注意缺陷多动障碍的治疗

注意缺陷多动障碍 (ADHD)的治疗近来有不少进展 ,现综述如下 :1　药物治疗1 1　中枢兴奋剂　包括哌醋甲酯 (MPH)、右旋苯丙胺 (DEX)和苯异妥因。兴奋剂可防止儿茶酚胺的重吸收 ,并促使其释放 ,故对ADHD患者的儿茶酚胺不足有补偿作用 ,有资料显示中枢兴奋剂可改善额叶的功能不良。中枢兴奋剂中MPH和DEX是治疗ADHD的首选 ,二者改善ADHD的核心症状的作用是相同的 ,而且MPH可改善短期记忆。最近的研究肯定了中枢兴奋剂对治疗儿童ADHD的作用。成人ADHD ,尤其是在童年期发病的 ,中枢兴奋剂仍是首选。无论对学龄或学前儿童还是青少…     

注意缺陷多动障碍儿童的智力水平分析

目的　测试ADHD儿童的智力水平及分测验结构。方法　采用韦氏儿童智力量表 (C WISC)对 12 9名ADHD患儿和 87名正常儿童进行智力评估。结果　ADHD患儿的智商多在正常范围或边缘水平 ,但VIQ与PIQ之间的平衡性较差。结论　ADHD患儿的智商较正常儿童平均水平为低 ,且智力发展不平衡者较多 ,二组差异有显著性意义。     

双相障碍与注意缺陷多动障碍

本文从流行病学、症状学、遗传学、药理学、影像学方面对双相障碍(BPD)和注意缺陷多动障碍(ADHD)的关系作一综述。     

注意缺陷多动障碍的氨基酸代谢研究进展

本文综述了近几年注意缺陷多动障碍的多种氨基酸代谢的研究进展     

成人注意缺陷多动障碍

本文就成人ADHD的诊断、相关问题以及治疗作一综述。     

注意缺陷多动障碍药物治疗进展

介绍治疗注意缺陷多动障碍(attention-deficit-hyperactivity disorder,ADHD)的药物临床应用。     

对成人注意缺陷与多动障碍的认识

对成人注意缺陷与多动障碍的流行病学、评定量表、症状、诊断、治疗等进行论述。     

执行功能与注意缺陷多动障碍

执行功能是指个体在实现某一特定目标时 ,以灵活、优化的方式控制多种认知加工过程协同操作的认知神经机制[1 ] 。对执行功能的研究是当前认知神经科学研究的前沿问题之一。近年来 ,不断有来自临床观察和试验研究的证据 ,支持注意缺陷多动障碍 (ａｔｔｅｎｔｉｏｎ ｄｅｆｉｃｉｔｈｙｐｅｒａｃｔｉｖｉｔｙｄｉｓｏｒｄｅｒ,ＡＤＨＤ)患者在执行功能方面存在某些障碍。 1 997年美国学者Ｂａｒｋｌｅｙ提出了解释ＡＤＨＤ执行功能的神经心理模型 ,使研究者们进一步关注执行功能与ＡＤＨＤ之间的关系。现就执行功能的类型、相应的行为研究范…     

注意缺陷多动障碍的药物治疗进展

介绍注意缺陷多动障碍的药物治疗进展,以及各类药物的疗效及不良反应。     

注意缺陷多动障碍儿童气质特征的研究

目的探讨注意缺陷多动障碍(ADHD)儿童的气质特征.方法采用中国学龄儿童气质量表对50例8～12岁ADHD患儿进行测查,并与中国常模(n=4350)进行比较.结果ADHD组与常模组的气质类型分布有高度显著性差异(P＜0.01),患儿中麻烦型及中间近麻烦型的比例明显高.ADHD组的活动水平、节律性、适应性、反应强度、心境、持久性、注意转移、反应阈等气质维度的得分与常模组比较有显著性差异.结论ADHD儿童的气质可能有其独特性,应根据其气质特征制定相应的干预方案.     

注意缺陷多动障碍执行功能的研究进展

注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)是儿童时期常见的中枢神经系统疾病,其主要表现为注意力不集中、多动及冲动.西方国家患病率为3%～5%之间,国内患病率为3%～10%.ADHD的症状可以造成儿童的学习、人际关系、社交等多个领域的功能明显缺损,部分儿童的症状还可以持续至成年而不愈,成为成人ADHD.     

Transferrin in korean children with attention deficit hyperactivity disorder

Objective

The aim of the present study was to investigate the relationship between iron, ferritin, transferrin, total iron binding capacity (TIBC), hemoglobin, mean corpuscular volume (MCV) mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in children with ADHD.

Methods

MethodsaaThe sample consisted of 48 ADHD children and sex and age matched control children (a couple of 28 boys, 22 girls; age 6-8 years; mean±SD, 6.98±0.39). We diagnosed ADHD according to DSM-IV. ADHD symptoms were evaluated subjectively with Conners'' Parent Rating Scales, Dupaul Parent ADHD Rating Scales. Subjects with ADHD and control were evaluated the hematology test including the iron, transferrin, MCV etc. Paired t test were used to evaluate the relation of a lot of hematology findings between ADHD and control group.

Results

The serum iron, ferritin, transferrin, TIBC, hemoglobin, MCV, MCH, and MCHC of ADHD group were respectively 80.92±33.33 ug/dL, 35.81±16.59 ng/mL, 248.42±44.15 mg/dL, 351.69±102.13 ug/dL, 12.78±0.71 g/dL, 82.94±2.58 fL, 27.18±1.12 uug, 32.79±1.12%. Otherwise the serum iron, ferritin, transferrin, TIBC, hemoglobin, MCV, MCH, and MCHC of control group were respectively 82.04±28.14 ug/dL, 37.05±18.28 ng/mL, 266.27±25.40 mg/dL, 352.77±89.54 ug/dL, 12.77±0.70 g/dL, 81.81±2.96 fL, 26.69±0.99 uug, 32.66±0.96%. A significant difference were found in the transferrin(t=2.63, p=0.011), MCV (t=2.19, p=0.034), and MCH (t=2.18, p=0.034).

Conclusion

These results suggested that lower transferrin levels might be related with ADHD symptoms.     

Executive dysfunctions in children with attention deficit hyperactivity disorder

One hundred and twenty-four male children ranging in age from seven to 12 years-old were selected. The sample was divided into two groups: (1) sixty-two with attention deficit hyperactivity disorder (ADHD) children; and (2) sixty-two normal matched controls (N-ADHD). Three tests were individually administered: (1) Wisconsin Card Sorting Test (WCST); (2) Verbal fluency and semantics (animals and fruits); and, (3) Picture Arrangement subtest of the WISC-R. For all the test scores, statistically significant differences were found between both ADHD and N-ADHD groups. Two separate factor analyses were performed, using the normal and ADHD groups. Four factors were found for the N-ADHD group, which accounted for 85.7% of the variance. The factor structure presented some similarities in both groups: Factor 2, 3 and 4 in the control group corresponded to factors 1, 2 and 3 in the ADHD group. Nonetheless, in the ADHD group Factor 1 (Abstraction and Flexibility Factor) was absent. Results are interpreted as supporting the hypothesis of executive dysfunction in children with ADHD.     

Somatosensory functioning in children with attention deficit hyperactivity disorder

In older to test the hypothesis that attention deficit hyperactivity disorder (ADHD) is related to deficits in somatosensory processing, 49 ADHD male children and 49 matched controls were tested on a wide range of tactile tasks, and somatosensory evoked potentials (SEP) were also recorded. In addition, parents' and teachers' ratings on the children's typical responses to tactile stimuli were obtained. The results show that the ADHD children were less skilled on suprathreshold, but not on threshold tasks than were the controls. Further, a larger percentage of ADHD children were 'tactile defensive'. Finally, the ADHD children showed Iarger-than-normal amplitudes of late, but not early components of the SEP. These data suggest that some aspects of somatosensory processing by ADHD children are deficient.     

注意缺陷/多动障碍儿童临床特征与单胺类神经递质研究

目的：探讨注意缺陷/多动障碍（ADHD）儿童的临床特征及血清单胺类神经递质水平的变化。方法：对32例ADHD儿童（研究组）和46名正常儿童（对照组）测评Piers-Harris儿童自我意识量表（PHCSS）、儿童焦虑性情绪障碍筛查表（SCRED）、儿童冲动量表（BIS）等,对其中30例ADHD儿童及36名正常儿童测量血清5-羟色胺（5-HT）、多巴胺（DA）、肾上腺素等的含量。结果：研究组PHCSS评分低于对照组（P〈0.01）;研究组SCRED和BIS评分均高于对照组（P〈0.001）。研究组血清5-HT低于对照组（P=0.002）。血清5-HT水平与冲动总分（r=-0.273）呈负相关;血清DA水平与运动分呈正相关（r=0.541）。结论：ADHD儿童具有多动、冲动、自我意识低等临床特征。而血清5-HT水平降低可能与ADHD的冲动控制困难特征有关。     

Sleep disturbances and serum ferritin levels in children with attention-deficit/hyperactivity disorder

Background  A subset of children with attention-deficit/hyperactivity disorder (ADHD) may present with impairing sleep disturbances. While preliminary evidence suggests that iron deficiency might be involved into the pathophysiology of daytime ADHD symptoms, no research has been conducted to explore the relationship between iron deficiency and sleep disturbances in patients with ADHD. The aim of this study was to assess the association between serum ferritin levels and parent reports of sleep disturbances in a sample of children with ADHD. Methods  Subjects: Sixty-eight consecutively referred children (6–14 years) with ADHD diagnosed according to DSM-IV criteria using the semi-structured interview Kiddie-SADS-PL. Measures: parents filled out the Sleep Disturbance Scale for Children (SDSC) and the Conners Parent Rating Scale (CPRS). Serum ferritin levels were determined using the Tinaquant method. Results  Compared to children with serum ferritin levels ≥45 μg/l, those with serum ferritin levels <45 μg/l had significantly higher scores on the SDSC subscale “Sleep wake transition disorders” (SWTD) (P = 0.042), which includes items on abnormal movements in sleep, as well as significantly higher scores on the CPRS–ADHD index (P = 0.034). The mean scores on the other SDSC subscales did not significantly differ between children with serum ferritin ≥45 and <45 μg/l. Serum ferritin levels were inversely correlated to SWTD scores (P = 0.043). Conclusion  Serum ferritin levels <45 μg/l might indicate a risk for sleep wake transition disorders, including abnormal sleep movements, in children with ADHD. Our results based on questionnaires set the basis for further actigraphic and polysomnographic studies on nighttime activity and iron deficiency in ADHD. Research in this field may suggest future trials of iron supplementation (possibly in association with ADHD medications) for abnormal sleep motor activity in children with ADHD.     

Treatment of attention deficit hyperactivity disorder in children

Objective The present study investigated the predictive power of anxiety, IQ, severity of ADHD and parental depression on the outcome of treatment in children with ADHD. Method Fifty children with ADHD (ages 8–12) were randomized to a 10-week treatment of methylphenidate or to a treatment of methylphenidate combined with multimodal behavior therapy. Prior to treatment predictors were assessed. Outcome was assessed separately for parents and teachers on a composite measure of inattentive, hyperactive, oppositional- and conduct disorder symptoms. Results There was neither a significant difference between the two treatments at baseline nor did treatment condition predict outcome. Therefore the data were collapsed across the two treatments. A combination of anxiety and IQ predicted teacher-rated outcome, explaining 18% of the variance. Higher anxiety and higher IQ’s indicated better treatment outcome. There were no significant predictors of the parent-rated outcome. Conclusion This study showed a small but significant predictive effect of IQ and anxiety on treatment outcome in children with ADHD. Clinical implications This study supports the idea that for the treatment of ADHD children with comorbid anxiety and higher IQ respond better to the two most used treatments for ADHD.     

Venlafaxine in children and adolescents with attention deficit hyperactivity disorder

The primary purpose of this study was to describe tolerability and efficacy of venlafaxine in the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD). A 6-week open trial of venlafaxine was conducted in 13 children and adolescents (mean age 9.9 +/- 2.5 years) with ADHD, and without comorbid depression. Venlafaxine was initiated at a dose of 18.75 mg/day and flexibly titrated to 56.25 mg/day. The Conners parent scale and Clinical Global Improvement (CGI) severity item were performed at baseline and at the end of the 6-week trial. All subjects completed the trial. Mean final dose of venlafaxine was 40.3 +/- 7.0. Venlafaxine was significantly effective in reducing the total score of the Conners parent scale from baseline to endpoint (P < 0.002, Z =-3.113) and the CGI severity item (P < 0.05). Transient side-effects such as somnolence (n = 2), stomachache (n = 2), and headache (n = 1) disappeared after second week of treatment. Also three subjects complained of sedation after raising the dose to 56.5 mg/day, therefore the dose was reduced to the previous level. These preliminary data suggest that venlafaxine may be an effective medication in the treatment of some children and adolescents with ADHD. Future double-blind controlled trials should be undertaken.     

Increased levels of plasma glial-derived neurotrophic factor in children with attention deficit hyperactivity disorder

Abstract

Background: Recent evidence suggests that neurotrophic growth factor systems, including brain-derived neurotrophic factor, might be involved in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Glial cell line-derived neurotrophic factor (GDNF) is from the transforming growth factor-β family and is abundantly expressed in the central nervous system, where it plays a role in the development and function of hippocampal cells. To date, no association studies have been done between ADHD and GDNF. Thus, here we investigate the hypothesis that there are differences in plasma GDNF levels between children with ADHD and healthy controls. Methods: Plasma GDNF levels were measured in 86 drug-naïve children with ADHD and 128 healthy children. The severity of ADHD symptoms was determined by scores on the Korean ADHD Rating Scale (K-ARS) in patients and healthy controls. Results: The median plasma GDNF levels in ADHD patients was 74.0 (IQR: 23.4–280.1) pg/ml versus 24.6 (IQR: 14.5–87.3) pg/ml in healthy controls; thus the median plasma GDNF levels in ADHD patients were significantly higher than in healthy controls (Mann–Whitney U-test, P < 0.01). Plasma GDNF levels were correlated positively with K-ARS subscale scores (inattention, hyperactivity–impulsivity and total), determined by Spearman's correlation test in ADHD patients and healthy controls (r = 0.371, P < 0.01; r = 0.331, P < 0.01; and r = 0.379, P < 0.01, respectively). Conclusions: These findings suggest increased plasma GDNF levels in untreated ADHD patients. In addition, plasma GDNF levels had a significant positive correlation with inattention, hyperactivity–impulsivity and K-ARS total scores in ADHD patients and healthy controls. Further studies are required to determine the source and role of circulating GDNF in ADHD.     

Interaction of attention and graphomotor functions in children with attention deficit hyperactivity disorder

The present article provides a review of a series of studies in children with attention deficit hyperactivity disorder (ADHD) concerning (1) the effects of methylphenidate on various attentional functions, (2) the stimulant-induced changes of both qualitative and quantitative (i.e. kinematic) aspects of handwriting, (3) the interaction between conscious control of handwriting and fluency of handwriting movements, and (4) possible therapeutic approaches to graphomotor disturbances. Children with ADHD showed impairments in various aspects of attentional functioning. Pharmacological treatment of ADHD children with methylphenidate resulted in marked improvements of various components of attentional functioning. In comparison to the performance following the withdrawal of methylphenidate, children with ADHD on methylphenidate displayed a significant improvement in task accuracy in the areas of vigilance, divided attention, selective attention (inhibition, focused attention and integration of sensory information) and flexibility. However, the comparison with healthy children revealed considerable deficits regarding vigilance, divided attention, flexibility and selective attention (focused attention and integration of sensory information) in children with ADHD on methylphenidate. The comparison of writing movements of children on and off methylphenidate revealed that medication resulted in a better handwriting, but a deterioration in handwriting fluency as assessed by kinematic analysis. Children with ADHD may use their increased attentional capacities to focus on skills (e.g. handwriting) that are independent of conscious control or may even be disturbed by attention. The findings summarized in this paper indicate, therefore, that administration of methylphenidate alone is insufficient in the treatment of children with ADHD. Children with ADHD may benefit from instructions on how to best use their improved attentional capacities.