Arnold L Eugene, Ganocy Stephen J, Mount Katherine, Youngstrom Eric A, Frazier Thomas, Fristad Mary, Horwitz Sarah M, Birmaher Boris, Findling Robert, Kowatch Robert A, Demeter Christine, Axelson David, Gill Mary Kay, Marsh Linda
The Ohio State University, Columbus, OH.
Case Western Reserve University, Cleveland.
J Am Acad Child Adolesc Psychiatry. 2014 Jul;53(7):745-60. doi: 10.1016/j.jaac.2014.03.007. Epub 2014 Apr 30.
OBJECTIVE: This study aims to examine trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample. METHOD: The LAMS study assessed 684 children aged 6 to 12 years with the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Although they were selected for elevated manic symptoms, 526 children had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. The χ(2) and Kruskal-Wallis analysis of variance compared resulting latent classes/trajectories on clinical characteristics and medication. RESULTS: Three latent class trajectories best described inattentive symptoms, and 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). A third trajectory (4.5%) started mild, then escalated; and a fourth (14%) started severe but improved dramatically. The improving trajectory was associated with the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72% of the severest inattentive class were in the severest hyperactive/impulsive class, but the severest inattention class also included 62% of the improving hyperactive-impulsive class. CONCLUSION: An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.
目的：本研究旨在考察躁狂症状纵向评估（LAMS）样本中注意力缺陷多动障碍（ADHD）症状的轨迹。 方法：LAMS研究对684名6至12岁儿童采用儿童情感障碍和精神分裂症评定量表（K-SADS）进行评估，并在3年中每半年使用评定量表进行一次评估。尽管这些儿童因躁狂症状升高而被选中，但其中526名儿童有ADHD的基线诊断。通过生长混合模型（GMM），我们分别分析了注意力不集中和多动/冲动症状，并将基线年龄作为协变量。采用多种标准方法确定最佳拟合。χ²检验和Kruskal-Wallis方差分析比较了不同潜在类别/轨迹在临床特征和用药方面的差异。 结果：三种潜在类别轨迹能最好地描述注意力不集中症状，四种类别能最好地描述多动/冲动症状。注意力不集中轨迹随时间保持其相对位置。多动/冲动症状有两条一致的轨迹（最轻和最严重）。第三条轨迹（4.5%）开始时症状较轻，随后加重；第四条轨迹（14%）开始时症状严重，但显著改善。改善轨迹与ADHD的最高发生率和双相诊断的最低发生率相关。最轻微注意力不集中类别的四分之三也属于最轻微多动/冲动类别；最严重注意力不集中类别的72%属于最严重多动/冲动类别，但最严重注意力不集中类别还包括62%改善型多动-冲动类别。 结论：ADHD而非双相诊断预示着多动/冲动症状（而非注意力不集中症状）有更好的病程。注意力不集中和多动/冲动之间相对严重程度的高度重叠证实了这些症状群之间的联系。多动/冲动症状随时间消退得更多。群体均值不足以理解个体ADHD的预后。一小部分亚组在多动/冲动方面随时间恶化，需要比目前提供的更好的治疗。
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