Faraone Stephen V, Wilens Timothy E, Petty Carter, Antshel Kevin, Spencer Thomas, Biederman Joseph
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
Am J Addict. 2007;16 Suppl 1:24-32; quiz 33-4. doi: 10.1080/10550490601082767.
Diagnosing ADHD in adults is difficult when the diagnostician cannot establish an onset prior to the DSM-IV criterion of age seven or if the number of symptoms does not achieve the DSM threshold for diagnosis. These diagnostic issues are an even larger concern for clinicians faced with adults with substance use disorders (SUD). The present study compared four groups of adults: full ADHD subjects who met all DSM-IV criteria for childhood onset ADHD, late onset ADHD subjects who met all criteria except the age at onset criterion, subthreshold ADHD subjects who did not meet full symptom criteria, and non-ADHD subjects who did not meet any of the above criteria. Diagnoses were by the Structured Clinical Interview for DSM-IV, and the Drug Use Severity Index (DUSI) was used for self-report of substance use. Cigarette and marijuana use was significantly greater in all ADHD groups relative to non-ADHD controls. Although usage rates of other drugs failed to reach significance, the ADHD groups were more likely to have used each drug (except alcohol) compared with the non-ADHD group. The late onset and full ADHD groups were more likely to have endorsed ever having a problem due to use of cigarettes, alcohol, or marijuana and reported more trouble resisting use of drugs or alcohol. The full ADHD group was more likely than the other groups to have reported "getting high" as their reason for using their preferred drug. Adults with ADHD have elevated rates of substance use and related impairment. Data about late onset ADHD provides further support for the idea that the DSM-IV age at onset criterion is too stringent. In contrast, subthreshold ADHD seems to be a milder form of the disorder, or perhaps a heterogeneous group of true ADHD cases and false positives.
当诊断医生无法确定发病时间早于《精神疾病诊断与统计手册》第四版（DSM-IV）规定的7岁标准，或者症状数量未达到DSM诊断阈值时，对成年人多动症（ADHD）进行诊断就会很困难。对于面对患有物质使用障碍（SUD）的成年人的临床医生来说，这些诊断问题更是令人担忧。本研究比较了四组成年人：符合儿童期起病ADHD所有DSM-IV标准的完全ADHD受试者、除起病年龄标准外符合所有标准的迟发性ADHD受试者、未达到全部症状标准的亚阈值ADHD受试者以及不符合上述任何标准的非ADHD受试者。诊断采用DSM-IV结构化临床访谈，药物使用严重程度指数（DUSI）用于自我报告物质使用情况。与非ADHD对照组相比，所有ADHD组的香烟和大麻使用量显著更高。虽然其他药物的使用率未达到显著水平，但与非ADHD组相比，ADHD组使用每种药物（酒精除外）的可能性更高。迟发性和完全ADHD组更有可能认可曾因使用香烟、酒精或大麻而出现问题，并报告在抵制使用药物或酒精方面有更多困难。完全ADHD组比其他组更有可能报告“兴奋”是其使用首选药物的原因。患有ADHD的成年人物质使用及相关损害发生率较高。关于迟发性ADHD的数据进一步支持了DSM-IV起病年龄标准过于严格这一观点。相比之下，亚阈值ADHD似乎是该障碍的一种较轻形式，或者可能是一组由真正的ADHD病例和假阳性组成的异质性群体。
