Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Int J Psychiatry Med. 2010;40(4):383-9. doi: 10.2190/PM.40.4.b.
The regional study by Baumgardner and colleagues converges with existing literature to clearly show that the distribution of ADHD diagnosis falls along socioeconomic lines, according to the relative wealth of neighborhoods. This adds additional evidence that trends in the diagnosis and treatment for ADHD in children move in the exact opposite direction from those who are at highest risk for meeting criteria, for experiencing impairment, for and downstream socioeconomic sequelae. Contributing factors, such as marginal diagnoses (such as when parent and teacher symptom reports diverge), inadequate insurance coverage, limited time, and lack of familiarity and comfort with diagnostic and prescribing guidelines, may leave the door open to misdiagnosis and treatment. In some cases, this may take the form of over-diagnosis and over-treatment, in the form of false-positive diagnoses with ADHD, and treatments for it, or may alternatively take the form of false-negative diagnoses. If the social and epidemiological data are any indication, it is furthermore likely that such false-positive or false-negative outcomes may break along socioeconomic lines. Increased use of formal screening tools, increased curricular time for mental health in primary care residencies, support for physicians in the field in the form of referral options and remote consultation and support, may all serve to improve quality of care for individual patients, and may also serve to regularize treatment across socioeconomic and sociodemographic lines, hence reducing disparities. Further research is needed to study the root causes and dynamics that create such disparities, but the steps outlined above may help in the near term.
Baumgardner 及其同事的区域研究与现有文献相吻合，清楚地表明 ADHD 诊断的分布沿着社会经济线，根据社区的相对富裕程度而定。这进一步证明，儿童 ADHD 的诊断和治疗趋势与那些最符合标准、最容易出现损伤、社会经济后果最严重的趋势完全相反。促成因素，如边缘性诊断（例如当家长和教师的症状报告不一致时）、保险覆盖不足、时间有限以及对诊断和处方指南不熟悉和不适应，可能会导致误诊和治疗不当。在某些情况下，这可能表现为过度诊断和过度治疗，即 ADHD 的假阳性诊断和治疗，或者可能表现为假阴性诊断。如果社会和流行病学数据有任何指示，那么这种假阳性或假阴性结果很可能沿着社会经济线出现。增加使用正式的筛查工具、在初级保健住院医师培训中增加心理健康课程时间、为该领域的医生提供转诊选择和远程咨询与支持等，都可能有助于提高个别患者的护理质量，也可能有助于在社会经济和社会人口统计学方面规范治疗，从而减少差异。需要进一步研究造成这种差异的根本原因和动态，但上述步骤可能有助于在短期内实现这一目标。
