Camara Bettina, Padoin Cintia, Bolea Blanca
Faculty of Medicine, Immunology Department, University of Toronto, Toronto, Canada.
Women's College Hospital, Reproductive Life Stages Program and Child and Family Program, Division of Child and Youth Mental Health, University of Toronto, Toronto, Canada.
Arch Womens Ment Health. 2022 Feb;25(1):1-8. doi: 10.1007/s00737-021-01181-w. Epub 2021 Sep 6.
This systematic review aims to summarize current available evidence for the relationship between sex hormones or reproductive life stages (adrenarche in males and females, menarche, pregnancy, postpartum and menopause) and ADHD.
We systematically reviewed studies investigating the relationship between sex hormones and symptoms of inattention and/or hyperactivity in individuals with an ADHD diagnosis or equivalent assessment of symptoms with validated scales. Articles were screened sequentially by two reviewers who were clinically and academically familiar with ADHD. Studies were rated according to Oxford Levels of Evidence (CEBM 2009).
Four studies matched inclusion criteria. One article was a case report of a female with ADHD and premenstrual syndrome experiencing worsening symptoms prior to each period (Quinn, J Clin Psychol 61:579-587, 2005). Another was a review article analysing literature relating to the effect of hormones on ADHD symptoms and supporting that a relationship exists between ADHD symptoms and sex hormone levels, without further characterization (Haimov-Kochman and Berger, Front Hum Neurosci 8, 2014). Giotakos and colleagues found no relationship between Wender Utah scores and sex hormone levels (Giotakos et al., J Forensic Psychiatry Psychol 16:423-433, 2005). An exploratory study by Ostojic and Miller found evidence for an association between early pubertal onset, inattention and risk-taking behaviour (Ostojic and Miller, J Atten Disord 20:782-791, 2016).
The literature on the relationship between sex hormones and ADHD is limited. Available studies present contradicting information. It is not known how this lack of evidence affects the treatment of ADHD during the lifespan. Further research is required to correctly characterize the mechanisms behind ADHD symptoms and its potential association with sex hormones.
本系统评价旨在总结目前关于性激素或生殖生命阶段（男性和女性的肾上腺初现、月经初潮、怀孕、产后和绝经）与注意力缺陷多动障碍（ADHD）之间关系的现有证据。
我们系统回顾了调查性激素与ADHD诊断个体的注意力不集中和/或多动症状之间关系的研究，或使用经过验证的量表对症状进行等效评估的研究。文章由两名临床和学术上熟悉ADHD的审稿人依次筛选。研究根据牛津证据水平（CEBM 2009）进行评级。
四项研究符合纳入标准。一篇文章是关于一名患有ADHD和经前综合征的女性在每个月经周期前症状加重的病例报告（奎因，《临床心理学杂志》61:579 - 587，2005年）。另一篇是综述文章，分析了有关激素对ADHD症状影响的文献，并支持ADHD症状与性激素水平之间存在关系，但未进一步描述（海莫夫 - 科克曼和伯杰，《人类神经科学前沿》8，2014年）。乔塔科斯及其同事发现温德犹他评分与性激素水平之间没有关系（乔塔科斯等人，《法医精神病学与心理学杂志》16:423 - 433，2005年）。奥斯特约伊奇和米勒的一项探索性研究发现了青春期早发、注意力不集中和冒险行为之间存在关联的证据（奥斯特约伊奇和米勒，《注意力障碍杂志》20:782 - 791，2016年）。
关于性激素与ADHD之间关系的文献有限。现有研究提供了相互矛盾的信息。目前尚不清楚这种证据不足如何影响ADHD在整个生命周期中的治疗。需要进一步研究以正确描述ADHD症状背后的机制及其与性激素的潜在关联。
