Spencer T, Biederman J, Wilens T
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, USA.
Child Adolesc Psychiatr Clin N Am. 2000 Jan;9(1):77-97.
Despite a large body of literature documenting the effectiveness of medication in the treatment of ADHD, there has been public and professional concern regarding the possible inappropriate diagnosis and prescription of ADHD medications. Recently the Council of Scientific Affairs of the American Medical Association addressed these concerns in a scholarly review. Several factors were identified that contributed to existing controversies: (1) Like most psychiatric disorders, diagnostic criteria for ADHD are based on history and behavioral assessment. There are no pathognomonic laboratory or radiologic tests to confirm the diagnosis. (2) Attention deficit hyperactivity disorder is a chronic disorder and requires extended treatment. (3) Treatment includes potentially abusable medications. After a review of the voluminous literature, this distinguished panel concluded that ADHD is one of the best researched disorders in medicine; in fact, the overall data on its validity are far more compelling than for many other medical conditions. They also concluded that there was little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of stimulants by physicians. Consistent with the current emphasis on cognitive dysregulation in ADHD, treatment concerns have expanded from a primarily behavioral focus to include enhancement of executive functions in scholastic as well as other settings. Although stimulants have been the most studied compounds, there is a considerable body of literature indicating an important role for other psychopharmacologic agents. Noradrenergic and dopaminergic modulation appears to be necessary for effective anti-ADHD treatment. In addition, promising evidence of newer cholinergic agents may provide other useful alternatives. As with all psychiatric disorders, comorbid conditions are prominent and may lead to high morbidity and disability if not addressed. As with other areas of medicine, it is sometimes necessary to use multiple agents to treat comorbidity or to achieve an effective response.
尽管有大量文献记录了药物治疗注意力缺陷多动障碍（ADHD）的有效性，但公众和专业人士一直担心ADHD药物可能存在不恰当的诊断和处方情况。最近，美国医学协会科学事务委员会在一项学术综述中探讨了这些问题。确定了几个导致现有争议的因素：（1）与大多数精神疾病一样，ADHD的诊断标准基于病史和行为评估。没有确诊的实验室或影像学检查来证实诊断。（2）注意力缺陷多动障碍是一种慢性疾病，需要长期治疗。（3）治疗包括可能被滥用的药物。在对大量文献进行综述后，这个杰出的小组得出结论，ADHD是医学上研究最充分的疾病之一；事实上，关于其有效性的总体数据比许多其他医疗状况更有说服力。他们还得出结论，几乎没有证据表明ADHD存在广泛的过度诊断或误诊，也没有证据表明医生普遍过度开具兴奋剂处方。与目前对ADHD认知失调的重视一致，治疗关注点已从主要的行为焦点扩展到包括在学业以及其他环境中增强执行功能。尽管兴奋剂是研究最多的化合物，但有大量文献表明其他精神药物也起着重要作用。去甲肾上腺素能和多巴胺能调节似乎是有效的ADHD治疗所必需的。此外，新型胆碱能药物的有前景证据可能提供其他有用的选择。与所有精神疾病一样，共病情况很突出，如果不加以解决，可能导致高发病率和残疾。与医学的其他领域一样，有时需要使用多种药物来治疗共病或实现有效反应。
