Department of Psychiatry, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21211, USA.
Pediatrics. 2012 Nov;130 Suppl 2:S125-38. doi: 10.1542/peds.2012-0900J.
Hyperactivity, impulsivity, and inattention (referred to as "ADHD [attention-deficit/hyperactivity disorder] symptoms") occur in 41% to 78% of children with autism spectrum disorders (ASDs). These symptoms often affect quality of life, interfering with learning or interventions that target primary ASD symptoms. This practice pathway describes the guidelines for evaluation and treatment of children and adolescents with ASD and comorbid ADHD symptoms.
Current research in this area is limited, and, therefore, these recommendations are based on a systematic literature review and expert consensus in the Autism Speaks Autism Treatment Network Psychopharmacology Committee.
The recommended practice pathway includes the Symptom Evaluation Pathway for systematic assessment of ADHD symptoms across settings; examination for comorbid sleep, medical, or psychiatric comorbidities that may contribute to symptoms; and evaluation of behavioral interventions that may ameliorate these symptoms. For children for whom medication is being considered to target the ADHD symptoms, the medication choice pathway provides guidance on the selection of the appropriate agent based on a review of available research, assessment of specific advantages and disadvantages of each agent, and dosing considerations.
These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. Our systematic review of the current evidence indicates the need for more randomized controlled trials of the medications for ADHD symptoms in ASD. There will also be a need for studies of the effectiveness of these practice pathways in the future.
在自闭症谱系障碍（ASD）儿童中，有 41%至 78%会出现多动、冲动和注意力不集中（简称“ADHD [注意缺陷/多动障碍]症状”）。这些症状常影响生活质量，干扰学习或针对 ASD 主要症状的干预措施。本实践路径描述了评估和治疗 ASD 合并 ADHD 症状儿童和青少年的指南。
该领域目前的研究有限，因此这些建议基于自闭症代言者自闭症治疗网络精神药理学委员会的系统文献回顾和专家共识。
推荐的实践路径包括症状评估路径，用于在各种环境中系统评估 ADHD 症状；检查是否存在共病睡眠、医疗或精神共病，这些共病可能导致症状；并评估可能改善这些症状的行为干预措施。对于那些正在考虑用药物治疗 ADHD 症状的儿童，药物选择路径提供了根据现有研究进行药物选择的指导，评估每种药物的具体优缺点，并考虑剂量问题。
这些建议为治疗 ASD 合并 ADHD 症状的初级保健提供者提供了一个框架。我们对现有证据的系统回顾表明，需要进行更多关于 ASD 中 ADHD 症状药物的随机对照试验。未来也需要研究这些实践路径的有效性。
