Ogundele Michael O, Ayyash Hani F
Department of Community Paediatrics, Bridgewater Community Healthcare NHS Foundation Trust, Halton District, UK.
Department of Integrated Paediatrics, Mid and South Essex University Hospitals Group, University Hospital NHS Foundation Trust, Southend-on-Sea, UK.
AIMS Public Health. 2023 Feb 7;10(1):35-51. doi: 10.3934/publichealth.2023004. eCollection 2023.
Attention deficit Hyperactivity Disorder (ADHD) is the commonest childhood neurodevelopmental disorder, affecting 3 to 9% by school age, and often persists into adulthood. ADHD in children and young people (CYP) has wide ranging multi-modal impacts on the affected CYP, their carers and the society. Co-morbidity with other neurodevelopmental, behavioural and emotional disorders is the rule rather than exception. Pharmacological treatment is not recommended as the sole therapeutic intervention, and several other non-pharmacological interventions have been advocated within a framework of Multi-modal strategy as the norm, to address both the core symptoms as well as the behavioural and other related difficulties. All paediatric professionals need to be familiar with the principles of different modalities of non-pharmacological or behavioural interventions for managing ADHD in CYP. Most published up-to-date evidence for behavioural interventions both for the core ADHD symptoms and other outcome measures are summarized in this article, including the peculiar problems related to their research. The most effective evidence-based strategies for controlling ADHD core symptoms are combination of stimulant medications with Behavioural therapy (BT) or Cognitive behaviour therapy (CBT), as well as group-based parental Psychoeducation. Standalone BT, CBT, Mindfulness, Neurocognitive training and Neurofeedback cannot currently be recommended for controlling core symptoms due to limited evidence. Other Behavioural interventions could lead to improvements in ADHD-related outcomes, including parenting skills, CYP's social skills, academic performance and disruptive behaviours. School-based non-pharmacological interventions have been shown to reduce disruptive behaviours. Executive skills are also significantly improved with use of computer-based Neurocognitive training and regular physical Cardio exercises. It is disappointing that combinations of different types of psychosocial interventions have low efficacy on both the core ADHD symptoms and other related outcomes. The readers are welcome to test their knowledge and learning efficacy through an accompanying quiz.
注意缺陷多动障碍（ADHD）是最常见的儿童神经发育障碍，学龄儿童中患病率为3%至9%，且常持续至成年期。儿童和青少年（CYP）的ADHD对受影响的CYP、其照料者及社会具有广泛的多模式影响。与其他神经发育、行为和情绪障碍共病是常态而非例外。不建议将药物治疗作为唯一的治疗干预措施，在多模式策略框架下，已提倡采用其他几种非药物干预措施作为常规方法，以解决核心症状以及行为和其他相关困难。所有儿科专业人员都需要熟悉用于管理CYP中ADHD的不同非药物或行为干预模式的原则。本文总结了关于ADHD核心症状及其他结局指标的行为干预的最新公开证据，包括与其研究相关的特殊问题。控制ADHD核心症状最有效的循证策略是将兴奋剂药物与行为疗法（BT）或认知行为疗法（CBT）相结合，以及基于小组的家长心理教育。由于证据有限，目前不建议单独使用BT、CBT、正念、神经认知训练和神经反馈来控制核心症状。其他行为干预可改善与ADHD相关的结局，包括育儿技能、CYP的社交技能、学业成绩和破坏性行为。基于学校的非药物干预已被证明可减少破坏性行为。使用基于计算机的神经认知训练和定期体育有氧运动也可显著改善执行技能。令人失望的是，不同类型的心理社会干预组合对ADHD核心症状和其他相关结局的疗效较低。欢迎读者通过随附的测验来测试他们的知识和学习效果。
