Heriot S A, Evans I M, Foster T M
MH-Kids, John Hunter Hospital, NSW, Australia.
Child Care Health Dev. 2008 Jan;34(1):121-33. doi: 10.1111/j.1365-2214.2007.00745.x.
While the use of stimulant medication as a treatment for children with attention deficit hyperactivity disorder (ADHD) has been the most studied therapy in child psychiatry, there is debate about its use with young children. This study describes a series of cases seen in a normal clinical context, treated with one of four different treatment programmes.
Sixteen pre-school children diagnosed with ADHD and their parents were randomly assigned to receive one of four treatments: (1) 0.3 mg/kg methylphenidate, parent training programme; (2) 0.3 mg/kg methylphenidate, parent support programme; (3) placebo medication, parent training; and (4) placebo medication, parent support. Changes were assessed at the individual level, using clinical observations, parent and teacher rating scales and measures of parenting and family factors.
Children were more likely to improve when the treatment involved at least one active component (medication or parent training). However, there was notable variability in individual parental and child participants' responses to all treatment conditions, indicating the importance of interactions between treatment variables and other factors.
Findings are discussed within the framework of a transactional model, and inferences are drawn about the limitations of the idea that there is a 'best treatment' that is universally applicable.
虽然使用刺激性药物治疗注意力缺陷多动障碍（ADHD）儿童是儿童精神病学中研究最多的疗法，但对于其在幼儿中的使用仍存在争议。本研究描述了在正常临床环境中看到的一系列病例，采用四种不同治疗方案之一进行治疗。
16名被诊断患有ADHD的学龄前儿童及其父母被随机分配接受四种治疗之一：（1）0.3mg/kg哌甲酯，家长培训方案；（2）0.3mg/kg哌甲酯，家长支持方案；（3）安慰剂药物，家长培训；（4）安慰剂药物，家长支持。使用临床观察、家长和教师评定量表以及育儿和家庭因素测量在个体水平上评估变化。
当治疗至少涉及一种活性成分（药物或家长培训）时，儿童更有可能改善。然而，个体家长和儿童参与者对所有治疗条件的反应存在显著差异，表明治疗变量与其他因素之间相互作用的重要性。
在交易模型的框架内讨论了研究结果，并对存在普遍适用的“最佳治疗”这一观点的局限性进行了推断。
