Hechtman L
Department of Psychiatry, McGill University Montreal Children's Hospital, Canada.
Child Adolesc Psychiatr Clin N Am. 2000 Jul;9(3):481-98.
ADHD is the most common psychiatric disorder of childhood (3% to 5% of children) with continued morbidity into adolescence (85%) and adulthood (50% to 70%). It is a condition associated with widespread significant impairment in academic, occupational, social, and emotional functioning. It is also a condition with a broad extensive differential diagnosis as well as a high rate of comorbidity. There is no diagnostically definitive test for ADHD. Therefore, assessments for ADHD need to be comprehensive and should involve multiple domains, informants, methods, and settings. The comprehensive assessment needs to determine whether the subject has ADHD or another disorder. Thus, evaluation of various organic conditions, functional disorders, developmental status, situational, environmental, and family problems should all be explored. The clinical interview of the child and family is one of the cornerstones of the assessment process. A comprehensive medical history and examination, psychoeducational tests, and school-related evaluation, as well as a view of the child's social and emotional functioning, are also crucial. A wide array of rating scales, tests, and measures have been developed (see Table 1) to aid in the systematic standardized assessment of the various deficits associated with ADHD. None of these tests is definitive, however. Recent development of tests of executive functioning, neuroimaging, and genetics may provide more exact diagnostic guidelines in the future. Current DSM-IV criteria are phenomenologic rather than etiologic and are much more relevant and appropriate for children with ADHD compared with adolescents and adults. A comprehensive assessment involving various domains of functioning (academic, social, emotional, physical, and familial) provide not only more accurate diagnosis but also directions as to what difficulties exist and what multifaceted treatment plan is needed to produce current improvement and long-term positive outcome.
注意缺陷多动障碍（ADHD）是儿童期最常见的精神障碍（占儿童的3%至5%），延续至青少年期（85%）及成年期（50%至70%）仍有发病。它是一种与学业、职业、社交及情感功能广泛且显著受损相关的病症。它也是一种鉴别诊断范围广泛且共病率高的病症。目前尚无针对ADHD的确诊性检查。因此，ADHD评估需要全面，应涉及多个领域（包括信息提供者、方法及场景）。全面评估需确定受检者是否患有ADHD或其他障碍。因此，应探究各种器质性疾病、功能性障碍、发育状况、情境、环境及家庭问题。对儿童及其家庭的临床访谈是评估过程的基石之一。全面的病史及检查、心理教育测试、与学校相关的评估以及对儿童社交和情感功能的观察也至关重要。已开发出一系列评定量表、测试及测量方法（见表1），以辅助对与ADHD相关的各种缺陷进行系统的标准化评估。然而，这些测试均非确诊性的。执行功能测试、神经影像学及遗传学方面的最新进展未来可能会提供更精确的诊断指南。当前的《精神疾病诊断与统计手册》第四版（DSM-IV）标准是基于现象学而非病因学的，与青少年及成年人相比，对ADHD儿童更为相关和适用。涉及功能各个领域（学业、社交、情感、身体及家庭）的全面评估不仅能提供更准确的诊断，还能指明存在哪些困难以及需要何种多方面治疗方案才能实现当前改善及长期积极预后。
