Fernández-Perrone Ana Laura, Martín Fernández-Mayoralas Daniel, Fernández-Jaen Alberto
Hospital Universitario Quirón, Diego de Velázquez 1, Pozuelo de Alarcón, Madrid, Spain.
Rev Neurol. 2013 Feb 22;56 Suppl 1:S77-84.
Attention deficit hyperactivity disorder (ADHD) is a very heterogeneous neurobiological condition. It is the most common neurodevelopmental disorder in the childhood population. Its prevalence is estimated to be 3-6% in school-age children. AIM. To review the characteristics of patients with inattentive subtype ADHD, including those who could be grouped in a more homogenous subtype which the DSM-5 proposes for classification as the restrictive subtype.
The characteristic triad of symptoms consists of attention deficit, hyperactivity and impulsivity. The diagnostic criteria are defined in the DSM-IV-TR. For those with deterioration due to ADHD with no significant hyperactivity problems, this manual offers a confusing diagnostic label. Indeed, the neurobiological substrate underlying the diverse subtypes seems to be different in certain aspects, since the frontostriatal circuit appears to be more affected in combined ADHD, while the frontoparietal circuit is more compromised in the inattentive subtype. For these and other reasons, the DSM-5 will reformulate the different subtypes of ADHD and will probably include a new subgroup that will comprise those patients who satisfy at least six inattention criteria and fewer than two criteria for hyperactivity-impulsivity (restrictive ADHD).
The definition of this subgroup could make it easier to detect some patients who have so far received little attention from the point of view of both research and clinical practice.
注意力缺陷多动障碍(ADHD)是一种非常异质性的神经生物学病症。它是儿童群体中最常见的神经发育障碍。据估计,学龄儿童中的患病率为3%至6%。目的:回顾注意力不集中型ADHD患者的特征,包括那些可归为更同质亚型的患者,DSM-5提议将该亚型分类为受限型。
症状的典型三联征包括注意力缺陷、多动和冲动。诊断标准在《精神疾病诊断与统计手册》第四版修订版(DSM-IV-TR)中定义。对于那些因ADHD导致功能恶化但无明显多动问题的患者,该手册提供了一个令人困惑的诊断标签。事实上,不同亚型背后的神经生物学基础在某些方面似乎有所不同,因为前额纹状体回路在混合型ADHD中似乎受影响更大,而前额顶叶回路在注意力不集中型中受损更严重。由于这些及其他原因,DSM-5将重新制定ADHD的不同亚型,可能会纳入一个新的亚组,该亚组将包括那些满足至少六项注意力不集中标准且多动-冲动标准少于两项的患者(受限型ADHD)。
该亚组的定义可能会使目前在研究和临床实践中都很少受到关注的一些患者更容易被发现。