UCLA Center for Healthier Children, Families, and Communities, 10990 Wilshire Blvd, Suite 900, Los Angeles, CA 90024, USA.
Pediatrics. 2011 Mar;127(3):462-70. doi: 10.1542/peds.2010-0165. Epub 2011 Feb 7.
To determine patterns of comorbidity, functioning, and service use for US children with attention-deficit/hyperactivity disorder (ADHD).
Bivariate and multivariable cross-sectional analyses were conducted on data from the 2007 National Survey of Children's Health on 61 779 children ages 6 to 17 years, including 5028 with ADHD.
Parent-reported diagnosed prevalence of ADHD was 8.2%. Children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability versus 5% without ADHD, 27% vs 2% had a conduct disorder, 18% vs 2% anxiety, 14% vs 1% depression, and 12% vs 3% speech problems (all P < .05). Most children with ADHD had at least 1 comorbid disorder: 33% had 1, 16% had 2, and 18% had 3 or more. The risk for having 3 or more comorbidities was 3.8 times higher for poor versus affluent children (30% vs 8%). Children with ADHD had higher odds of activity restriction (odds ratio: 4.14 [95% confidence interval: 3.34-5.15]), school problems (odds ratio: 5.18 [95% confidence interval: 4.47-6.01]), grade repetition, and poor parent-child communication, whereas social competence scores were lower and parent aggravation higher. Functioning declined in a stepwise fashion with increasing numbers of comorbidities, and use of health and educational services and need for care coordination increased.
Clinical management of ADHD must address multiple comorbid conditions and manage a range of adverse functional outcomes. Therapeutic approaches should be responsive to each child's neurodevelopmental profile, tailored to their unique social and family circumstances, and integrated with educational, mental health and social support services.
确定美国患有注意缺陷多动障碍（ADHD）儿童的合并症、功能和服务使用模式。
对 2007 年全国儿童健康调查中 61779 名 6 至 17 岁儿童的数据进行了双变量和多变量横断面分析，其中包括 5028 名患有 ADHD 的儿童。
父母报告的 ADHD 诊断患病率为 8.2%。患有 ADHD 的儿童更有可能患有其他心理健康和神经发育障碍。父母报告说，46%的 ADHD 儿童有学习障碍，而没有 ADHD 的儿童为 5%，27%的 ADHD 儿童有品行障碍，2%的儿童有品行障碍，18%的 ADHD 儿童有焦虑症，14%的 ADHD 儿童有抑郁症，而 12%的 ADHD 儿童有言语问题（均<.05）。大多数患有 ADHD 的儿童至少有一种合并症：33%的儿童有 1 种，16%的儿童有 2 种，18%的儿童有 3 种或更多种。贫困儿童发生 3 种或更多种合并症的风险比富裕儿童高 3.8 倍（30%比 8%）。患有 ADHD 的儿童活动受限的几率更高（优势比：4.14[95%置信区间：3.34-5.15]），学校问题的几率更高（优势比：5.18[95%置信区间：4.47-6.01]），需要留级和较差的亲子沟通，而社会能力评分较低，父母的恼怒程度较高。随着合并症数量的增加，功能下降呈阶梯式，对健康和教育服务的使用以及对护理协调的需求增加。
ADHD 的临床管理必须解决多种合并症，并管理一系列不良功能结果。治疗方法应针对每个儿童的神经发育状况做出反应，针对他们独特的社会和家庭环境进行调整，并与教育、心理健康和社会支持服务相结合。
