Weinstein D, Staffelbach D, Biaggio M
Pacific University, Portland, OR, USA.
Clin Psychol Rev. 2000 Apr;20(3):359-78. doi: 10.1016/s0272-7358(98)00107-x.
Attention-deficit hyperactivity disorders (ADHD) and posttraumatic stress disorder (PTSD) are the most commonly diagnosed disorders in sexually abused children (SAC). There is a high degree of symptom overlap and comorbidity between these disorders, and differential diagnosis can be confusing. Current diagnostic criteria do not include PTSD as a differential diagnosis for ADHD, nor do existing assessment guidelines address these diagnostic similarities. This may have serious implications for SAC. This literature review describes the psychological impact of child sexual abuse and possible consequences for misdiagnosing ADHD in SAC. A comparison of criteria from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) criteria for ADHD and PTSD is presented, and commonalities are discussed. On the basis of this comparison, recommendations are made for improving clinical decision-making and for facilitating differential diagnosis. Routine inquiry about traumatic experiences in children presenting with ADHD symptoms is suggested to increase accuracy in differential diagnosis.
注意力缺陷多动障碍（ADHD）和创伤后应激障碍（PTSD）是性虐待儿童（SAC）中最常被诊断出的疾病。这些疾病之间存在高度的症状重叠和共病现象，鉴别诊断可能会令人困惑。目前的诊断标准不包括将PTSD作为ADHD的鉴别诊断，现有的评估指南也未涉及这些诊断上的相似之处。这可能会对性虐待儿童产生严重影响。这篇文献综述描述了儿童性虐待的心理影响以及在性虐待儿童中误诊ADHD可能产生的后果。文中呈现了《精神疾病诊断与统计手册》第四版（美国精神病学协会，1994年）中ADHD和PTSD的标准比较，并讨论了两者的共性。基于此比较，提出了改进临床决策和促进鉴别诊断的建议。建议对出现ADHD症状的儿童常规询问创伤经历，以提高鉴别诊断的准确性。
