Obioha Obianuju, Adesman Andrew
aPsychology Department, Princeton University, Princeton, New Jersey bDevelopmental & Behavioral Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York, USA.
Curr Opin Pediatr. 2014 Feb;26(1):119-29. doi: 10.1097/MOP.0000000000000053.
To provide clinicians with an updated overview of key considerations related to the clinical assessment and management of attention-deficit/hyperactivity disorder (ADHD) in adolescents.
The American Psychiatric Association's recently revised Diagnostic and Statistical Manual of Mental Disorders-5 included significant changes regarding diagnostic criteria for ADHD in adolescents. The American Academy of Pediatrics (AAP) also recently revised their Clinical Practice Guidelines for ADHD; whereas prior guidelines were focused on children aged 6-12, the new guidelines extend up to age 17. An understanding of these revised diagnostic criteria and clinical guidelines is essential for pediatricians and others who care for adolescents. In addition to providing an updated review of the clinical approach to assessment and treatment of ADHD in adolescents, recent findings are briefly described relating to common comorbidities, psychosocial risks, and long-term outcome.
Diagnosis and treatment of adolescents with ADHD present unique challenges and obstacles. Clinicians need to be careful and deliberate in their evaluation of a teenager with recent-onset symptoms suggestive of ADHD, giving consideration to other conditions that could mimic ADHD and screening for common comorbid conditions. In terms of treatment of adolescents, the AAP recommends medication as the first-line intervention, noting that stimulants have a much broader evidence base and larger effect size than nonstimulants. Although clinicians now have a multitude of medication formulations to choose among, they must also be vigilant to the potential for stimulant misuse and diversion.
为临床医生提供有关青少年注意力缺陷多动障碍（ADHD）临床评估与管理的关键考量因素的最新概述。
美国精神病学协会最近修订的《精神疾病诊断与统计手册》第5版对青少年ADHD的诊断标准有重大改变。美国儿科学会（AAP）最近也修订了其ADHD临床实践指南；先前的指南侧重于6至12岁的儿童，新指南将范围扩大至17岁。对于儿科医生及其他照顾青少年的人员而言，理解这些修订后的诊断标准和临床指南至关重要。除了对青少年ADHD评估与治疗的临床方法进行最新综述外，还简要描述了有关常见共病、心理社会风险和长期预后的最新发现。
ADHD青少年的诊断和治疗存在独特的挑战与障碍。临床医生在评估近期出现提示ADHD症状的青少年时需谨慎且深思熟虑，要考虑到可能模仿ADHD的其他病症，并筛查常见的共病情况。在青少年治疗方面，AAP推荐药物治疗作为一线干预措施，指出兴奋剂比非兴奋剂有更广泛的证据基础和更大的效应量。尽管临床医生现在有多种药物制剂可供选择，但他们也必须警惕兴奋剂滥用和转移的可能性。
