Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico.
Instituto de Neurociencias Traslacionales, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico.
Int J Environ Res Public Health. 2022 Oct 8;19(19):12880. doi: 10.3390/ijerph191912880.
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder with three presentations: inattentive, hyperactive/impulsive and combined. These may represent an independent disease entity. Therefore, the therapeutic approach must be focused on their neurobiological, psychological and social characteristics. To date, there is no comprehensive analysis of the efficacy of different treatments for each presentation of ADHD and each stage of development. This is as narrative overview of scientific papers that summarize the most recent findings and identify the most effective pharmacological and psychosocial treatments by ADHD presentation and age range. Evidence suggests that methylphenidate is the safest and most effective drug for the clinical management of children, adolescents and adults. Atomoxetine is effective in preschoolers and maintains similar efficacy to methylphenidate in adults, whereas guanfacine has proven to be an effective monotherapy for adults and is a worthy adjuvant for the management of cognitive symptoms. The psychosocial treatments with the best results in preschoolers are behavioral interventions that include training of primary caregivers. In adolescents, the combination of cognitive and cognitive-behavioral therapies has shown the best results, whereas cognitive-behavioral interventions are the most effective in adults. Pharmacological and psychosocial treatments must be adjusted to the ADHD presentation and its neurocognitive characteristics through the patient's development.
注意缺陷多动障碍是一种神经发育障碍，有三种表现形式：注意力不集中、多动/冲动和混合型。这些可能代表一个独立的疾病实体。因此，治疗方法必须针对其神经生物学、心理和社会特征。迄今为止，尚无针对 ADHD 每种表现形式和每个发育阶段的不同治疗方法的综合分析。这是对科学论文的叙述性综述，总结了 ADHD 表现形式和年龄范围的最有效药物和心理社会治疗方法。有证据表明，哌甲酯是儿童、青少年和成人临床管理中最安全、最有效的药物。阿托西汀对学龄前儿童有效，且在成人中的疗效与哌甲酯相似，而胍法辛已被证明是成人有效单药治疗方法，也是管理认知症状的一种值得选择的辅助药物。对学龄前儿童最有效的心理社会治疗方法是包括对主要照顾者进行培训的行为干预。在青少年中，认知和认知行为疗法的结合显示出最好的效果，而认知行为干预在成人中最有效。药物和心理社会治疗必须根据患者的发展情况，根据 ADHD 的表现及其神经认知特征进行调整。
