Breaux Rosanna, Dunn Nicholas C, Swanson Courtney S, Larkin Emma, Waxmonsky James, Baweja Raman
Coping Skills and Learning to Manage Emotions Readily (CALMER) Lab, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States.
Attention and Behavior Clinic, Department of Psychiatry and Behavioral Health, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States.
Front Psychiatry. 2022 Feb 14;13:794044. doi: 10.3389/fpsyt.2022.794044. eCollection 2022.
Approximately a third of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant irritability; despite this, no study has reviewed whether interventions for youth with ADHD can improve irritability. This mini review sought to address this gap in the literature by discussing existing pharmacological and psychosocial interventions for irritability among children and adolescents with ADHD. A literature search was conducted in April 2021, with a total of 12 intervention articles identified (six pharmacological, one psychosocial, five combined). Studies were excluded if they did not involve an intervention, a measure of irritability, or the population was not youth with ADHD. Of these articles, two were with an ADHD only sample; seven included ADHD with comorbid disruptive behavior, disruptive mood dysregulation disorder (DMDD), or severe mood dysregulation (SMD); and three included ADHD with comorbid autism spectrum disorder (ASD). Findings suggest that central nervous system stimulants used alone or in combination with behavior therapy are effective at reducing irritability in youth with ADHD only or comorbid ADHD and DMDD/SMD. Less evidence was found for the efficacy of guanfacine and atomoxetine for youth with ADHD only or comorbid ADHD and ASD. Parent training alone or in combination with atomoxetine was found to be effective at reducing irritability in youth with comorbid ADHD and ASD. Future research assessing the efficacy of other psychosocial interventions, particularly cognitive behavioral therapy is necessary, as are randomized trials assessing intervention sequencing and intensity among youth with ADHD. Researchers are advised to utilize well-validated measures of irritability in future research.
大约三分之一患有注意力缺陷多动障碍（ADHD）的儿童和青少年会出现明显的易怒情绪；尽管如此，尚无研究探讨针对ADHD青少年的干预措施是否能改善易怒情绪。本综述旨在通过讨论针对患有ADHD的儿童和青少年易怒情绪的现有药物和心理社会干预措施，来填补这一文献空白。于2021年4月进行了文献检索，共确定了12篇干预文章（6篇药物治疗、1篇心理社会治疗、5篇联合治疗）。如果研究不涉及干预、易怒情绪测量，或者研究对象不是患有ADHD的青少年，则将其排除。在这些文章中，两篇仅针对ADHD样本；七篇纳入了合并破坏性行为、破坏情绪调节障碍（DMDD）或严重情绪调节障碍（SMD）的ADHD患者；三篇纳入了合并自闭症谱系障碍（ASD）的ADHD患者。研究结果表明，单独使用中枢神经系统兴奋剂或与行为疗法联合使用，对于仅患有ADHD或合并ADHD与DMDD/SMD的青少年减少易怒情绪有效。对于仅患有ADHD或合并ADHD与ASD的青少年，胍法辛和托莫西汀疗效的证据较少。单独的家长培训或与托莫西汀联合使用，对于合并ADHD与ASD的青少年减少易怒情绪有效。未来需要开展评估其他心理社会干预措施疗效的研究，尤其是认知行为疗法，同时也需要开展随机试验，评估ADHD青少年的干预顺序和强度。建议研究人员在未来研究中使用经过充分验证的易怒情绪测量方法。
