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儿童和父母特征与注意缺陷多动障碍药物使用。

Child and Parental Characteristics of Medication Use for Attention-Deficit/Hyperactivity Disorder.

机构信息

Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

Department of Chronic Diseases & Ageing, Centre of Fertility & Health, Norwegian Institute of Public Health, Oslo, Norway.

出版信息

J Child Adolesc Psychopharmacol. 2020 Sep;30(7):456-464. doi: 10.1089/cap.2019.0019. Epub 2020 Jul 14.

Abstract

To investigate child and parental characteristics of medication use for attention-deficit/hyperactivity disorder (ADHD). Participants were part of the prospective population-based Norwegian Mother, Father and Child Cohort study (MoBa) ( = 114,500 children, 95,000 mothers, and 75,000 fathers). This cohort was linked to the Norwegian Prescription Database (NorPD) and the Norwegian Patient Registry (NPR) to compare child and parental characteristics in children medicated and not medicated for ADHD during years 2008-2013. One thousand seven hundred and sixty-four children (74% boys) with ADHD (International Classification of Diseases [ICD-10]: F90 and F98.8) were identified. One thousand three hundred and sixty-two (77%) used medication. Boys and girls did not differ in the use of ADHD medication (both 77%). Mean age at first prescription was 9 years in both boys and girls, and age at ADHD diagnosis was 8 years in medicated and unmedicated children. Significantly more hyperkinetic conduct disorders (F90.1), and significantly fewer with attention-deficit disorder (F98.8) were found among the medicated children compared to the unmedicated children. The medicated children also had a significantly lower global functioning (Child Global Assessment Scale). Child disruptive symptoms reported in the MoBa child age 3 year questionnaire were significantly higher in children who used medication compared to the nonusers ( = 2.2,  = 0.03), and group differences in ADHD symptoms at age 3 years were close to significant ( = 1.8,  = 0.07). Other preschool child and parental characteristics were not significantly different in the two groups. In this large birth cohort study, where a great majority of children with ADHD used medication, only child characteristics were significantly associated with the use of medication. We could not replicate previous findings suggesting that "environmental factors," such as parental education and psychopathology, drive medication use. The small differences between medicated and unmedicated children in this cohort study, where a majority used medication, might be due to strong established clinical practices where medication is offered as a treatment option, particularly for hyperkinetic conduct disorder in an egalitarian high-income society.

摘要

为了研究儿童和父母在注意力缺陷多动障碍(ADHD)药物治疗方面的特点。参与者是前瞻性的基于人群的挪威母婴儿童队列研究(MoBa)的一部分(= 114500 名儿童,95000 名母亲和 75000 名父亲)。该队列与挪威处方数据库(NorPD)和挪威患者登记处(NPR)相关联,以比较 2008-2013 年期间患有和未患有 ADHD 的儿童的儿童和父母特征。确定了 1764 名患有 ADHD(国际疾病分类[ICD-10]:F90 和 F98.8)的儿童。1362 名(77%)使用了药物。男孩和女孩在 ADHD 药物使用方面没有差异(均为 77%)。男孩和女孩首次处方的平均年龄均为 9 岁,诊断 ADHD 的年龄在用药和未用药儿童中均为 8 岁。与未用药儿童相比,用药儿童中多动性品行障碍(F90.1)明显更多,注意力缺陷障碍(F98.8)明显更少。用药儿童的总体功能(儿童总体评估量表)明显较低。MoBa 儿童 3 岁问卷中报告的儿童破坏性行为症状在用药儿童中明显高于非用药儿童(= 2.2,= 0.03),并且 3 岁时 ADHD 症状的组间差异接近显著(= 1.8,= 0.07)。两组之间其他学龄前儿童和父母特征没有显著差异。在这项大型出生队列研究中,绝大多数 ADHD 儿童使用药物治疗,只有儿童特征与药物使用显著相关。我们无法复制先前的研究结果,即“环境因素”,如父母教育和精神病理学,推动药物使用。在大多数人使用药物的这个队列研究中,用药儿童和未用药儿童之间的微小差异可能是由于在平等的高收入社会中,提供药物治疗作为一种治疗选择的既定临床实践。

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