Departments of Psychiatry and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
CNS Drugs. 1997 Apr;7(4):264-72. doi: 10.2165/00023210-199707040-00002.
The use of CNS stimulants for the treatment of attention deficit hyperactivity disorder (ADHD) in children has steadily increased in most areas of the world over the last 30 years. In mid-1995, at least 1.5 million US children were receiving methylphenidate or dexamphetamine (dextroamphetamine). However, in other countries these agents are not used as widely.Specific stimulant-induced benefits for children with ADHD include: improved school grades, more completed classroom work, fewer reprimands for disruptive behaviour, improved handwriting, and improved behaviour at home and in social situtions. Stimulants benefit at least 75% of children with ADHD and are remarkably well tolerated, having few (for the most part minor and temporary) adverse effects.However, the benefits of stimulants that are obvious in most patients with ADHD during a brief clinical trial are primarily symptomatic. Although the behavioural benefits of stimulants are generally present during each period of treatment for as long as the ADHD condition exists (and children with ADHD are now often staying on stimulant medication into their mid-teens), the treatment has not been shown to change the long term outcome of the disorder.Before prescribing stimulants, paediatric physicians need to perform a careful diagnostic assessment for ADHD using multiple sources of information, including detailed ratings of the child's behaviour from his/her teachers and from a parent. If at baseline, the child's academic and behavioural adjustment in the classroom is good, stimulant medication would be inappropriate. However, if the child's pattern of ADHD has consistently and seriously interfered with his/her classroom and home adjustment, stimulant treatment should be actively considered. Should stimulant therapy be initiated, knowledgeable medical follow-up is required.
在过去的 30 年中，全球大多数地区都在稳步增加中枢神经系统兴奋剂（CNS 兴奋剂）用于治疗儿童注意缺陷多动障碍（ADHD）。1995 年年中，至少有 150 万美国儿童正在接受哌醋甲酯或右旋苯丙胺（右旋苯丙胺）。然而，在其他国家，这些药物并没有被广泛使用。CNS 兴奋剂对 ADHD 儿童的具体益处包括：提高学习成绩、完成更多课堂作业、减少因破坏性行为而受到的训斥、提高书写水平以及改善家庭和社会环境中的行为。兴奋剂对至少 75%的 ADHD 儿童有效，且耐受性良好，仅有少数（大多数为轻微且暂时的）不良反应。
然而，在短期临床试验中，大多数 ADHD 患者明显受益于兴奋剂，这些益处主要是症状改善。虽然兴奋剂的行为益处通常在治疗期间存在，只要 ADHD 持续存在（现在 ADHD 儿童经常在十几岁时继续服用兴奋剂药物），但治疗并未显示能改变该疾病的长期预后。
在开兴奋剂处方之前，儿科医生需要使用多种信息来源（包括来自孩子老师和家长的详细行为评估）对 ADHD 进行仔细的诊断评估。如果在基线时，孩子在课堂上的学业和行为适应良好，则不适合使用兴奋剂药物。但是，如果 ADHD 模式一直严重干扰孩子的课堂和家庭适应，那么应该积极考虑使用兴奋剂治疗。如果开始进行兴奋剂治疗，则需要进行有知识的医疗随访。
