New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY.
New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY.
J Am Acad Child Adolesc Psychiatry. 2019 Feb;58(2):164-166. doi: 10.1016/j.jaac.2018.08.015. Epub 2018 Dec 4.
Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder encompassing a wide array of clinical presentations, levels of impairment, etiologies, and neurobiological correlates. Despite this well-known heterogeneity, most research into the pathophysiology of ADHD has relied on comparisons between typically developing youth and those with the disorder (or perhaps further stratifying by DSM-defined ADHD subtypes). Although informative, this approach assumes a level of pathophysiologic homogeneity that belies the large and growing body of literature underscoring diverse neurobiological and neuropsychological profiles subsumed under the umbrella of this complex syndrome. For example, deficits in executive functions are characteristic of ADHD, yet meta-analysis suggests that these deficits are neither necessary nor sufficient to define all cases and that substantial overlaps in levels of executive functioning exist between children with ADHD and their typically developing peers. Likewise, neuroimaging research points to distinct neural circuits underlying different clinical presentations of ADHD, suggesting that, within the diagnosis of ADHD, the neural circuits that are most salient to the disorder can differ from one child to the next. Refining our understanding of ADHD subtypes not only on the basis of symptoms, but also by incorporating neurobiology, physiology, and neurocognitive profiles, could help propel the field toward greater specificity in diagnosis and treatment.
注意缺陷多动障碍(ADHD)是一种异质性疾病,包括广泛的临床表现、损害程度、病因和神经生物学相关性。尽管存在这种众所周知的异质性,但 ADHD 病理生理学的大多数研究都依赖于与正常发育的青年人和患有该疾病的人进行比较(或者可能根据 DSM 定义的 ADHD 亚型进一步分层)。尽管这种方法很有启发性,但它假设了一种病理生理学的同质性,而这种同质性与越来越多的文献所强调的涵盖在这个复杂综合征下的不同神经生物学和神经心理学特征背道而驰。例如,执行功能缺陷是 ADHD 的特征,但荟萃分析表明,这些缺陷既不是所有病例的必要条件,也不是充分条件,而且 ADHD 儿童和他们的正常发育同龄人之间的执行功能水平存在显著重叠。同样,神经影像学研究指出了 ADHD 不同临床表现背后的不同神经回路,表明在 ADHD 的诊断中,与该疾病最相关的神经回路可以因孩子而异。不仅基于症状,而且还结合神经生物学、生理学和神经认知特征来细化对 ADHD 亚型的理解,可以帮助该领域在诊断和治疗方面实现更高的特异性。
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