Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Division of Autism and Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
J Dev Behav Pediatr. 2020 Feb/Mar;41 Suppl 2S(Suppl 2):S99-S104. doi: 10.1097/DBP.0000000000000772.
Impairments generally persist when children diagnosed with attention-deficit/hyperactivity disorder (ADHD) mature into adolescence. To examine changes in ADHD care during the transition from childhood to adolescence, we conducted a retrospective, longitudinal cohort study of patients diagnosed with ADHD before the age of 10 years to assess changes from preadolescence through adolescence in (1) frequency by which primary care providers offer ADHD care to patients, (2) range of concerns assessed during patient encounters, and (3) treatments implemented or recommended.
We identified patients from 3 practices included in a large primary care network who (1) were born between 1996 and 1997, (2) were diagnosed with ADHD before the age of 10 years, and (3) received primary care continuously from age 9 through late adolescence. Clinical care was compared among patients in preadolescence (age 9-11), early adolescence (age 12-14), and late adolescence (age 15-18).
Children diagnosed with ADHD before the age of 10 years were less likely to have a documented visit for ADHD during late adolescence (41% of patients) compared with preadolescence (63%, p < 0.001). Evidence of monitoring for depression, suicide, and substance abuse increased from preadolescence to adolescence (p < 0.001) and occurred in about 90% of adolescent patients. However, monitoring for risky sexual activity occurred in only about 50% of adolescents. Discussions of medication diversion and driver readiness were essentially not documented.
The findings raise concerns about how primary care providers manage adolescents with a history of ADHD. Improving monitoring of risky sexual behavior and driver readiness and providing patient education about medication diversion are needed.
患有注意缺陷多动障碍（ADHD）的儿童随着年龄的增长进入青春期后，其障碍通常仍然存在。为了研究从儿童期向青春期过渡期间 ADHD 治疗的变化，我们对 10 岁以下被诊断为 ADHD 的患者进行了回顾性、纵向队列研究，以评估从青春期前到青春期期间（1）初级保健提供者为患者提供 ADHD 治疗的频率，（2）患者就诊时评估的关注范围，以及（3）实施或推荐的治疗方法的变化。
我们从一个大型初级保健网络中的 3 个诊所中确定了患者，这些患者（1）出生于 1996 年至 1997 年之间，（2）在 10 岁之前被诊断为 ADHD，（3）在 9 岁至青春期晚期期间连续接受初级保健。比较了青春期前（9-11 岁）、青春期早期（12-14 岁）和青春期晚期（15-18 岁）患者的临床治疗。
与青春期前（63%，p<0.001）相比，10 岁前被诊断为 ADHD 的儿童在青春期晚期（41%的患者）就诊时接受 ADHD 治疗的记录较少。从青春期前到青春期，对抑郁、自杀和药物滥用的监测证据增加（p<0.001），约 90%的青少年患者接受了监测。然而，只有约 50%的青少年接受了对危险性行为的监测。药物滥用和驾驶准备情况的讨论基本上没有记录。
这些发现引起了人们对初级保健提供者如何管理有 ADHD 病史的青少年的关注。需要加强对危险性行为和驾驶准备的监测，并为患者提供有关药物滥用的教育。
