Thiruchelvam D, Charach A, Schachar R J
Department of Psychiatry, The Hospital for Sick Children and the University of Toronto, Ontario, Canada.
J Am Acad Child Adolesc Psychiatry. 2001 Aug;40(8):922-8. doi: 10.1097/00004583-200108000-00014.
To identify moderators and mediators of long-term adherence to stimulant medication in children with attention-deficit hyperactivity disorder (ADHD).
Seventy-one children with ADHD were prescribed methylphenidate, followed prospectively on an annual basis for 3 years, and evaluated for adherence to stimulant treatment. The study occurred in Toronto between 1993 and 1997. Adherents were those who took methylphenidate, or another psychostimulant, for 5 or more days per week throughout the follow-up period, except for "drug holidays." Children who adhered at consecutive evaluations were compared with those who did not. Severity of ADHD, presence of oppositional defiant disorder/conduct disorder, learning difficulties, anxiety, age, family dysfunction, and socioeconomic adversity at baseline were investigated as moderators of adherence. Response to treatment at school, measured at 12 months, was investigated as a mediator of adherence.
Fifty-two percent of children adhered to stimulant treatment for 3 years. Absence of teacher-rated oppositional defiant disorder, more teacher-rated ADHD symptoms, and younger age at baseline predicted adherence.
Adherence to stimulant medications is a significant factor in the long-term treatment of children with ADHD.
确定注意缺陷多动障碍（ADHD）患儿长期坚持使用兴奋剂药物治疗的调节因素和中介因素。
71名ADHD患儿被处方哌甲酯，随后进行为期3年的年度前瞻性随访，并评估其对兴奋剂治疗的依从性。该研究于1993年至1997年在多伦多进行。依从者是指在整个随访期间每周服用哌甲酯或其他精神兴奋剂5天或以上的患儿，但不包括“药物假期”。将连续评估时坚持服药的患儿与未坚持服药的患儿进行比较。将基线时ADHD的严重程度、对立违抗障碍/品行障碍的存在情况、学习困难、焦虑、年龄、家庭功能障碍和社会经济逆境作为依从性的调节因素进行研究。将12个月时测量的学校治疗反应作为依从性的中介因素进行研究。
52%的患儿坚持使用兴奋剂药物治疗3年。基线时无教师评定的对立违抗障碍、更多教师评定的ADHD症状以及年龄较小可预测依从性。
坚持使用兴奋剂药物是ADHD患儿长期治疗的一个重要因素。
