Vance A L, Luk E S, Costin J, Tonge B J, Pantelis C
Maroondah Child and Adolescent Psychiatry Service, Victoria, Australia.
Aust N Z J Psychiatry. 1999 Jun;33(3):399-406. doi: 10.1046/j.1440-1614.1999.00575.x.
The intermediate- to long-term use of psychostimulant medication has unclear benefits on the core symptoms of attention deficit hyperactivity disorder (ADHD) and delayed onset affective symptom side effects which can mimic these core ADHD symptoms. 'ADHD and anxiety' has also been associated with a poor response to short-term psychostimulant medication treatment. In addition, it is unclear whether 'ADHD and anxiety' should be defined from the child's and/or the parent's perspective. We propose that anxiety will be increased in children with ADHD who are treated with psychostimulant medication in the intermediate- to long-term who are identified by clinicians as poor responders.
Twenty children with ADHD who were medicated for 6 months or more and who had ongoing core symptoms of ADHD were compared to 20 age- and IQ-matched children with ADHD who were medication-naïve. Chi-squared tests were performed on the categorical dependent variables and independent t-tests on the dependent continuous variables.
Anxiety is significantly increased in children with ADHD treated with psychostimulant medication in the intermediate- to long-term who are noted by clinicians to have ongoing core symptoms of ADHD. This statistically significant finding is evident with both categorical and dimensional measures of anxiety from the child's perspective.
The recognition of anxiety and its management in children with ADHD is generally poorly understood. In this particular group of children with ADHD, anxiety may be a side effect of intermediate- to long-term psychostimulant medication and/or a potential marker for a poor response to intermediate- to long-term psychostimulant medication treatment.
精神兴奋药物的中长期使用对注意力缺陷多动障碍（ADHD）的核心症状的益处尚不明确，且会出现延迟性情感症状副作用，这些副作用可能会模仿ADHD的这些核心症状。“ADHD与焦虑”也与短期精神兴奋药物治疗反应不佳有关。此外，尚不清楚“ADHD与焦虑”是否应从儿童和/或家长的角度来定义。我们提出，对于临床医生认定为反应不佳的中长期接受精神兴奋药物治疗的ADHD儿童，其焦虑水平将会升高。
将20名接受药物治疗6个月或更长时间且仍存在ADHD核心症状的ADHD儿童与20名年龄和智商匹配的未接受药物治疗的ADHD儿童进行比较。对分类因变量进行卡方检验，对连续因变量进行独立t检验。
临床医生指出仍存在ADHD核心症状的中长期接受精神兴奋药物治疗的ADHD儿童，其焦虑水平显著升高。从儿童角度来看，无论是焦虑的分类测量还是维度测量，这一具有统计学意义的发现都是明显的。
对于ADHD儿童中焦虑的认识及其管理，人们普遍了解不足。在这一特定的ADHD儿童群体中，焦虑可能是中长期精神兴奋药物治疗的副作用和/或对中长期精神兴奋药物治疗反应不佳的潜在标志。
