Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-1410, USA.
J Clin Psychiatry. 2012 May;73(5):711-7. doi: 10.4088/JCP.11m07099.
Although current attention-deficit/hyperactivity disorder (ADHD) diagnostic criteria do not include emotional symptoms, externalizing behavior problems, or aggression, the practicing clinician is often faced with the evaluation and management of these symptoms when assessing and treating patients with ADHD. While much research has focused on comorbid disorders in ADHD, less attention has been directed to comorbid symptoms that may or may not meet syndrome criteria but that influence ADHD treatment planning and outcome. The aim of this study is to describe emotional and behavioral symptoms in children and adolescents with ADHD and compare them with non-ADHD control groups.
From 1995 to 2005, clinically referred children and adolescents with the combined subtype of ADHD (n = 175) or the inattentive subtype of ADHD (n = 70) as diagnosed by the primary physician (using DSM-IV criteria) were compared with a non-ADHD psychiatric control group (n = 65) and a non-ADHD community control group (n = 72) on measures that assessed emotional symptoms, externalizing behavior problems, and aggression; comparisons were controlled for age, sex, and family income.
Both ADHD groups had depressive symptom severity equal to a non-ADHD psychiatric control group and greater than community control groups. Externalizing behavior problems and aggression were more severe in the ADHD combined subtype group compared with other groups. As ADHD symptom severity increased, externalizing behavior problems and aggression, but not internalizing symptoms, also increased in severity. Family income had an independent relationship with externalizing disorders.
High rates of internalizing emotional symptoms, externalizing problem behaviors, and aggression were found in a clinical ADHD sample. Externalizing behavior problems and aggression appeared to be related to the hyperactive-impulsive ADHD symptom domain and to overall ADHD symptom severity. It remains an empirical question as to whether effective treatment of the core symptoms of ADHD will also reduce the presence of associated emotional and behavioral symptoms and improve daily functioning in children and adolescents with ADHD.
尽管目前的注意力缺陷/多动障碍（ADHD）诊断标准不包括情绪症状、外化行为问题或攻击行为，但临床医生在评估和治疗 ADHD 患者时，经常需要评估和处理这些症状。虽然许多研究都集中在 ADHD 的共病障碍上，但对可能符合或不符合综合征标准但影响 ADHD 治疗计划和结果的共病症状的关注较少。本研究旨在描述 ADHD 儿童和青少年的情绪和行为症状，并将其与非 ADHD 对照组进行比较。
1995 年至 2005 年，根据主要医生的诊断（使用 DSM-IV 标准），将患有 ADHD 混合亚型（n=175）或 ADHD 注意力不集中亚型（n=70）的临床转诊儿童和青少年与非 ADHD 精神病对照组（n=65）和非 ADHD 社区对照组（n=72）进行比较，评估情绪症状、外化行为问题和攻击行为；比较时控制了年龄、性别和家庭收入。
两组 ADHD 患者的抑郁症状严重程度与非 ADHD 精神病对照组相当，且高于社区对照组。与其他组相比，ADHD 混合亚型组的外化行为问题和攻击行为更为严重。随着 ADHD 症状严重程度的增加，外化行为问题和攻击行为的严重程度也随之增加，而内化症状则没有增加。家庭收入与外化障碍有独立关系。
在一个临床 ADHD 样本中发现了高发生率的内化情绪症状、外化问题行为和攻击行为。外化行为问题和攻击行为似乎与多动冲动 ADHD 症状域和整体 ADHD 症状严重程度有关。有效的 ADHD 核心症状治疗是否也能减轻相关的情绪和行为症状，并改善 ADHD 儿童和青少年的日常功能，这仍然是一个经验性问题。
