Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France.
Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France.
Eur Child Adolesc Psychiatry. 2018 Mar;27(3):367-376. doi: 10.1007/s00787-017-1061-4. Epub 2017 Oct 5.
European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician's decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student's t test or Wilcoxon Mann-Whitney test and Chi-square or Fisher's test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23-16.55), p = 0.023], age [OR 1.46 (1.14-1.88), p = 0.003], ODD/CD [OR 5.53 (2.19-14.01), p < 0.001], DCD [OR 4.22 (1.70-10.48), p = 0.002], PRI [OR 0.97 (0.94-0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians' treatment decision-making complies with European guidelines and is furthermore associated with the type and severity of ADHD symptoms but also with co-occurring disorders.
欧洲指南就注意力缺陷多动障碍（ADHD）的诊断以及非药物和药物治疗提供了最佳实践建议。本研究旨在：(1) 评估临床医生在诊断为 ADHD 的儿童中启动哌醋甲酯治疗的决定是否符合欧洲指南；(2) 确定与推荐哌醋甲酯处方相关的临床因素。在法国的一家儿童和青少年精神病学门诊，连续评估了 5 至 13 岁的 ADHD 诊断患者。患者接受了多学科评估，包括诊断访谈、父母问卷评估症状严重程度以及智商测试。我们比较了有（n=105）和没有（n=55）推荐哌醋甲酯治疗的儿童，使用学生 t 检验或 Wilcoxon 曼-惠特尼检验和卡方或 Fisher 检验。实施多变量逻辑回归以确定每个变量对治疗建议的各自影响。推荐启动哌醋甲酯治疗与以下因素相关：(1) ADHD 混合表现；(2) 共患对立违抗性障碍/品行障碍（ODD/CD）、发育协调障碍（DCD）和学习障碍（LD）；(3) 父母问卷上显示的临床严重程度和损害；以及 (4) 感知推理能力下降。使用多变量回归模型，ADHD 混合表现[混合与主要多动/冲动和未指定的 OR 4.52（1.23-16.55），p=0.023]、年龄[OR 1.46（1.14-1.88），p=0.003]、ODD/CD[OR 5.53（2.19-14.01），p<0.001]、DCD[OR 4.22（1.70-10.48），p=0.002]、PRI[OR 0.97（0.94-0.99），p=0.01]与推荐哌醋甲酯治疗显著相关。我们的结果表明，临床医生的治疗决策符合欧洲指南，并且与 ADHD 症状的类型和严重程度相关，还与共患障碍相关。
