Daley Katie Campbell
Department of Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Curr Opin Pediatr. 2004 Apr;16(2):217-26. doi: 10.1097/00008480-200404000-00020.
Attention-deficit/hyperactivity disorder (ADHD) is present in 3% to 10% of children in the United States. Children with ADHD can have academic impairments, social dysfunction, and poor self-esteem. There is also a higher risk of both cigarette smoking and substance abuse. Given this, the importance of treatment for ADHD needs to be underscored. This article will briefly review the diagnosis, etiology, and treatment of ADHD, with particular focus on nonstimulant medication and alternative treatment modalities.
Recent evidence suggests that the overall rate of medication treatment for ADHD has been increasing, with over 2 million children being treated with stimulants in 1997. With this increase, controversy has arisen over the possible association of stimulants with growth suppression. In addition, estimates indicate that as many as 30% of children with ADHD either do not respond to stimulant treatment or cannot tolerate the treatment secondary to side effects. This has lead to the consideration of treatment with both nonstimulant medications as well as alternative therapies, including diet, iron supplementation, herbal medications, and neurofeedback. Considering the various treatment options now available for ADHD, along with the complexity of the condition, clinical practice guidelines are emerging for the treatment of ADHD and will be discussed.
ADHD continues to be a serious health problem. Adequate treatment is needed to avoid academic impairments, social dysfunction, and poor self-esteem. This treatment includes consideration of stimulant medication, nonstimulant medication, as well as alternative therapies. The child with ADHD is likely better served with a mutimodal treatment plan, including medication, parent/school counseling, and behavioral therapy. Implementing an evidenced based algorithm for the treatment of ADHD may prove to be most effective.
注意缺陷多动障碍（ADHD）在美国3%至10%的儿童中存在。患有ADHD的儿童可能有学业障碍、社交功能障碍和自尊心低下的问题。吸烟和药物滥用的风险也更高。鉴于此，需要强调ADHD治疗的重要性。本文将简要回顾ADHD的诊断、病因和治疗，特别关注非兴奋剂药物和替代治疗方式。
最近的证据表明，ADHD药物治疗的总体比例一直在上升，1997年有超过200万儿童接受兴奋剂治疗。随着这一比例的上升，关于兴奋剂与生长抑制之间可能存在的关联引发了争议。此外，据估计，多达30%的ADHD儿童对兴奋剂治疗无反应或因副作用无法耐受该治疗。这导致了对非兴奋剂药物以及替代疗法的考虑，包括饮食、铁补充剂、草药和神经反馈。考虑到目前可用于ADHD的各种治疗选择以及该病症的复杂性，ADHD治疗的临床实践指南正在形成并将进行讨论。
ADHD仍然是一个严重的健康问题。需要进行充分治疗以避免学业障碍、社交功能障碍和自尊心低下。这种治疗包括考虑使用兴奋剂药物、非兴奋剂药物以及替代疗法。患有ADHD的儿童可能通过多模式治疗计划得到更好的治疗，包括药物治疗、家长/学校咨询和行为治疗。实施基于证据的ADHD治疗算法可能被证明是最有效的。
