Jans Thomas, Philipsen Alexandra, Graf Erika, Schwenck Christina, Gerlach Manfred, Warnke Andreas, Aimac Studiengruppe
Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie des Klinikums der Universität Würzburg, Füchsleinstrasse 15, Würzburg.
Z Kinder Jugendpsychiatr Psychother. 2008 Sep;36(5):335-43. doi: 10.1024/1422-4917.36.5.335.
Given its high heritability, ADHD frequently affects both children and their parents. In addition to co-morbid psychiatric disorders, adults with ADHD often complain of psychosocial difficulties, including family conflicts and poor parenting skills. Inconsistent childrearing practices and parent-child conflicts negatively affect the course of ADHD in children. Moreover, in the case of parental ADHD, the efficacy of parent training as part of the treatment for the child's ADHD seems to be reduced. This article presents a review of the impact of ADHD in mothers on the treatment of their ADHD children. Subsequently, the study protocol of a randomized controlled multi-centre trial to resolve the question of the efficacy of combined treatment of mothers and children is outlined. The main objective of the study is to evaluate whether the treatment of maternal ADHD enhances the efficacy of subsequent parent training as part of the treatment of ADHD in their children. 144 mother-child-pairs (both affected by ADHD according to DSM-IV criteria) are allocated to the trial. Mothers are randomized either to the treatment group (cognitive-behavioural group psychotherapy in combination with open methylphenidate treatment (Medikinet retard) titrated upward individually until the maximum dose of 1.3 mg/kg/day) or to the control group (supportive counselling). After 13 weeks of treatment individualised parent training is administered to both groups of mothers. Treatment comparisons of the primary endpoint (externalizing symptoms in the children) will be performed within a linear regression model.
鉴于注意力缺陷多动障碍(ADHD)具有较高的遗传度,它常常会影响儿童及其父母。除了共病的精神障碍外,患有ADHD的成年人还经常抱怨存在心理社会方面的困难,包括家庭冲突和育儿技能不足。不一致的育儿方式和亲子冲突会对儿童ADHD的病程产生负面影响。此外,如果父母患有ADHD,作为儿童ADHD治疗一部分的父母培训效果似乎会降低。本文综述了母亲患ADHD对其ADHD子女治疗的影响。随后,概述了一项随机对照多中心试验的研究方案,以解决母亲和孩子联合治疗效果的问题。该研究的主要目的是评估治疗母亲的ADHD是否能提高后续作为其子女ADHD治疗一部分的父母培训的效果。144对母子(均根据《精神疾病诊断与统计手册》第四版标准被诊断为患有ADHD)被分配到该试验中。母亲们被随机分为治疗组(认知行为团体心理治疗结合开放的哌甲酯治疗(长效美达新),根据个体情况向上滴定剂量,直至最大剂量1.3毫克/千克/天)或对照组(支持性咨询)。治疗13周后,对两组母亲进行个性化的父母培训。主要终点(儿童的外化症状)的治疗比较将在一个线性回归模型中进行。