Monastra Vincent J
Clinical Director, FPI Attention Disorders Clinic, 2102 E. Main St. Endicott, NY 13760, USA.
Int J Psychophysiol. 2005 Oct;58(1):71-80. doi: 10.1016/j.ijpsycho.2005.03.010.
Despite specific diagnostic criteria, published practice guidelines for assessing patients, and the availability of effective pharmacological treatments for children diagnosed with attention-deficit/hyperactivity disorder (AD/HD), a review of prescription practices in the United States indicates that as few as 25-50% of these patients receive even minimal medical treatment for this condition. Because untreated children with AD/HD are at increased risk for psychoactive substance abuse, criminal behavior, and other social problems as adults, the provision of effective care during childhood is essential. In order to clarify the factors impeding treatment during childhood and develop a targeted intervention to overcome these barriers, two studies involving 1514 families were conducted. Each family included one child diagnosed with AD/HD. Factors associated with treatment failure or non-compliance with medical advice included: dissatisfaction with a diagnostic process limited to brief observation, interview, and review of behavior rating scales; fear of stimulant medication; lack of medication response within the first month; development of side-effects during the first month; lack of understanding of the reasons stimulants were being prescribed for a child, and insufficient clinical response. Based on these findings, an intervention program consisting of a comprehensive evaluation process (that included neuropsychological and neurophysiological tests of attention, and medical screening for other health problems associated with inattention and hyperactivity) and parent education about the medical causes of AD/HD, the biochemical action of medications, the relationship between dietary habits and attention, and the educational rights of children with AD/HD was conducted. Following completion of this three session intervention, 95% of patients complied with medical recommendations, initiated pharmacological treatment, and continued medication for a 2-year follow-up period. Three percent of the patients were diagnosed and treated for other medical conditions.
尽管有特定的诊断标准、已发布的评估患者的实践指南，以及针对被诊断患有注意力缺陷/多动障碍（AD/HD）的儿童有有效的药物治疗方法，但一项对美国处方实践的审查表明，这些患者中只有25% - 50%的人接受了针对该病症的哪怕是最基本的药物治疗。由于未接受治疗的AD/HD儿童成年后滥用精神活性物质、犯罪行为及出现其他社会问题的风险会增加，因此在儿童期提供有效的护理至关重要。为了阐明阻碍儿童期治疗的因素并制定有针对性的干预措施以克服这些障碍，开展了两项涉及1514个家庭的研究。每个家庭都有一个被诊断患有AD/HD的孩子。与治疗失败或不遵守医嘱相关的因素包括：对仅限于简短观察、访谈和行为评定量表审查的诊断过程不满意；对兴奋剂药物的恐惧；第一个月内没有药物反应；第一个月内出现副作用；不理解给孩子开兴奋剂的原因，以及临床反应不足。基于这些发现，实施了一个干预项目，该项目包括一个全面的评估过程（包括对注意力的神经心理学和神经生理学测试，以及对与注意力不集中和多动相关的其他健康问题进行医学筛查），并对家长进行关于AD/HD的医学病因、药物的生化作用、饮食习惯与注意力之间的关系以及AD/HD儿童的教育权利等方面的教育。在完成这个为期三阶段的干预后，95%的患者遵守了医疗建议，开始了药物治疗，并在为期两年的随访期内持续用药。3%的患者被诊断并治疗了其他疾病。
