Kessler Ronald C, Green Jennifer Greif, Adler Lenard A, Barkley Russell A, Chatterji Somnath, Faraone Stephen V, Finkelman Matthew, Greenhill Laurence L, Gruber Michael J, Jewell Mark, Russo Leo J, Sampson Nancy A, Van Brunt David L
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA.
Arch Gen Psychiatry. 2010 Nov;67(11):1168-78. doi: 10.1001/archgenpsychiatry.2010.146.
Controversy exists about the appropriate criteria for a diagnosis of adult attention-deficit/hyperactivity disorder (ADHD).
To examine the structure and symptoms most predictive of DSM-IV adult ADHD.
The data are from clinical interviews in enriched subsamples of the National Comorbidity Survey Replication (n = 131) and a survey of a large managed health care plan (n = 214). The physician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current adult ADHD. Analyses examined the stability of symptoms from childhood to adulthood, the structure of adult ADHD, and the adult symptoms most predictive of current clinical diagnoses.
The ACDS was administered telephonically by clinical research interviewers with extensive experience in the diagnosis and treatment of adult ADHD.
An enriched sample of community respondents.
Diagnoses of DSM-IV /ACDS adult ADHD.
Almost half of the respondents (45.7%) who had childhood ADHD continued to meet the full DSM-IV criteria for current adult ADHD, with 94.9% of these patients having current attention-deficit disorder and 34.6% having current hyperactivity disorder. Adult persistence was much greater for inattention than for hyperactivity/impulsivity. Additional respondents met the full criteria for current adult ADHD despite not having met the full childhood criteria. A 3-factor structure of adult symptoms included executive functioning (EF), inattention/hyperactivity, and impulsivity. Stepwise logistic regression found EF problems to be the most consistent and discriminating predictors of adult DSM-IV /ACDS ADHD.
These findings document the greater persistence of inattentive than of hyperactive/impulsive childhood symptoms of ADHD in adulthood but also show that inattention is not specific to ADHD because it is strongly associated with other adult mental disorders. In comparison, EF problems are more specific and consistently important predictors of DSM-IV adult ADHD despite not being in the DSM-IV, suggesting that the number of EF symptoms should be increased in the DSM-V/ICD-11.
关于成人注意力缺陷多动障碍（ADHD）诊断的适当标准存在争议。
研究对《精神疾病诊断与统计手册》第四版（DSM-IV）成人ADHD最具预测性的结构和症状。
数据来自全国共病调查复制研究（n = 131）丰富子样本中的临床访谈以及一项对大型管理式医疗保健计划的调查（n = 214）。使用医生管理的成人ADHD临床诊断量表（ACDS）来评估儿童期ADHD和当前成人ADHD的扩展症状。分析考察了从儿童期到成年期症状的稳定性、成人ADHD的结构以及对当前临床诊断最具预测性的成人症状。
由在成人ADHD诊断和治疗方面有丰富经验的临床研究访谈员通过电话方式实施ACDS。
社区受访者的丰富样本。
DSM-IV/ACDS成人ADHD的诊断。
童年期患有ADHD的受访者中，近一半（45.7%）仍符合当前成人ADHD的完整DSM-IV标准，其中94.9%的患者目前患有注意力缺陷障碍，34.6%的患者目前患有多动障碍。成人期注意力不集中的持续情况比多动/冲动更为常见。尽管未达到完整的儿童期标准，但其他受访者符合当前成人ADHD的完整标准。成人症状的三因素结构包括执行功能（EF）、注意力不集中/多动和冲动。逐步逻辑回归发现，EF问题是成人DSM-IV/ACDS ADHD最一致且最具区分性的预测因素。
这些发现表明，ADHD儿童期注意力不集中的症状在成年期比多动/冲动症状持续时间更长，但也表明注意力不集中并非ADHD所特有，因为它与其他成人精神障碍密切相关。相比之下，EF问题是DSM-IV成人ADHD更具特异性且始终重要的预测因素，尽管它未被纳入DSM-IV，这表明在DSM-V/ICD-11中应增加EF症状的数量。
