Vance Alasdair, Winther Jo, Rennie Kelly
Academic Child Psychiatry Unit and Developmental Neuropsychiatry Program, Royal Children's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2012 Feb;48(2):E33-7. doi: 10.1111/j.1440-1754.2010.01941.x. Epub 2011 Jan 18.
Attention-deficit/hyperactivity disorder (ADHD) assessment and treatment in children and adolescents is complex. Key biological and psychosocial risk factors need to be identified and treated because of their potential mediating interaction that affect the onset, progression, and psychosocial and medication treatment response of core ADHD symptoms and common associated co-morbid conditions. Both psychosocial and medication treatments, alone and in combination, have been shown to reduce the core ADHD symptoms and those of its key co-morbid disorders. Yet, to date, the potential synergism between targeted and specific medication and psychosocial treatments remains poorly understood and under-researched. Interestingly, recent positron emission tomography findings emphasise the importance of contextual salience and positive reinforcement strategies for stimulant medication, the primary medication treatment for ADHD, to have its effect. This is not surprising, given recent epigenetic models of gene-environment interaction that are revolutionising our understanding of developmental disorders like ADHD. This annotation briefly outlines the emerging evidence that supports the role of psychosocial treatment alongside medication treatment in the management of ADHD. Future significant clinical directions are noted.
儿童和青少年注意力缺陷多动障碍（ADHD）的评估与治疗较为复杂。由于关键的生物学和社会心理风险因素存在潜在的中介相互作用，会影响ADHD核心症状以及常见相关共病情况的发病、进展、社会心理和药物治疗反应，因此需要对其进行识别和治疗。社会心理治疗和药物治疗单独使用或联合使用，均已被证明可减轻ADHD核心症状及其关键共病的症状。然而，迄今为止，针对性的特定药物与社会心理治疗之间的潜在协同作用仍知之甚少，且研究不足。有趣的是，最近的正电子发射断层扫描结果强调了情境显著性和积极强化策略对于治疗ADHD的主要药物——兴奋剂药物发挥作用的重要性。鉴于最近的基因 - 环境相互作用表观遗传模型正在彻底改变我们对ADHD等发育障碍的理解，这并不奇怪。本注释简要概述了支持社会心理治疗与药物治疗相结合在ADHD管理中作用的新证据，并指出了未来重要的临床方向。
