Dittmann Ralf W, Banaschewski Tobias, Schacht Alexander, Wehmeier Peter M
Department for Child and Adolescent Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany,
Atten Defic Hyperact Disord. 2014 Dec;6(4):291-302. doi: 10.1007/s12402-014-0136-z. Epub 2014 Apr 6.
The aim of this study was to explore the course of attention-deficit/hyperactivity disorder (ADHD) core symptoms, ADHD-related difficulties, and emotional expression during ADHD pharmacotherapy and associations between them. This prospective, observational study examines pediatric patients with ADHD who newly initiated stimulant, atomoxetine or a combination of both treatments. Data were collected at baseline; weeks 1, 2, and 4; and months 3, 6, 9, and 12. Physicians rated ADHD core symptoms using the ADHD Rating Scale (ADHD-RS); patients, parents, and physicians rated ADHD-related difficulties using the Global Impression of Perceived Difficulties (GIPD) Scale; and patients and parents rated emotional expression using the Expression of Emotion Scale for Children (EESC). Results were analyzed using mixed model repeated measures. Associations are presented by Spearman's correlations. Overall, 504 patients, mean age 9.6 years, 72.6% males, were analyzed. Fifty percent of patients started atomoxetine, 49.0% stimulant and 1% a combination of both. ADHD-RS, GIPD, and EESC scores decreased significantly in both monotherapy groups. Correlations between ADHD-RS and parent- or physician-rated GIPD scores were at-best moderate and increased over time but remained low to moderate for patient-rated GIPD [patient, r=0.43 (95% CI 0.34, 0.51); parent, r=0.58 (0.50, 0.64); physician, r=0.55 (0.48, 0.62)]. Correlations between ADHD-RS and patient- or parent-rated EESC scores were low at baseline (r<0.2) and increased over time mostly for parent ratings [patient, r=0.35 (0.26, 0.44); parent, r=0.41 (0.32, 0.50)]. These data support the effectiveness of ADHD pharmacotherapy. The at-best moderate correlations between ADHD core symptoms and ADHD-related difficulties or emotional expression assessed by different raters indicate potentially important patient outcomes beyond core symptoms.
本研究的目的是探讨注意力缺陷多动障碍（ADHD）核心症状、ADHD相关困难以及ADHD药物治疗期间的情绪表达过程，以及它们之间的关联。这项前瞻性观察性研究考察了新开始使用兴奋剂、托莫西汀或两者联合治疗的ADHD儿科患者。在基线、第1、2和4周以及第3、6、9和12个月收集数据。医生使用ADHD评定量表（ADHD-RS）对ADHD核心症状进行评分；患者、家长和医生使用总体感知困难量表（GIPD）对ADHD相关困难进行评分；患者和家长使用儿童情绪表达量表（EESC）对情绪表达进行评分。使用混合模型重复测量分析结果。关联通过斯皮尔曼相关性表示。总体而言，分析了504例患者，平均年龄9.6岁，72.6%为男性。50%的患者开始使用托莫西汀，49.0%使用兴奋剂，1%使用两者联合治疗。两个单一疗法组的ADHD-RS、GIPD和EESC评分均显著下降。ADHD-RS与家长或医生评定的GIPD评分之间的相关性充其量为中等，并随时间增加，但患者评定的GIPD仍为低至中等水平[患者，r = 0.43（95%CI 0.34，0.51）；家长，r = 0.58（0.50，0.64）；医生，r = 0.55（0.48，0.62）]。ADHD-RS与患者或家长评定的EESC评分之间的相关性在基线时较低（r<0.2），且大多随时间增加，主要是家长评定方面[患者，r = 0.35（0.26，0.44）；家长，r = 0.41（0.32，0.50）]。这些数据支持ADHD药物治疗的有效性。不同评分者评估的ADHD核心症状与ADHD相关困难或情绪表达之间充其量为中等相关性，表明除核心症状外可能还有重要的患者结局。
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