Craig C
Northern Arizona University, College of Health Professions, Department of Nursing, Flagstaff, USA.
Nurse Pract. 1996 Nov;21(11):101-6, 108.
Adults with attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are a new phenomenon to many health care providers. While increasing evidence indicates children with ADD/ADHD can have persistent problems into adulthood, the significance and management of these disorders for adults are poorly understood. Studies of adults are confounded by frequent comorbidity with other conditions and by retrospective diagnosis of childhood ADD/ADHD. Research studies of pharmacologic interventions do not indicate a clear pattern of efficacy and safety for any drug class. Pharmacologic treatment of adults with ADD/ADHD is often guided by clinical experience. Efficacy of treatment with medications may be related to specific subpopulations among adults with ADD/ADHD. No controlled studies of the clinical efficacy of nonpharmacologic treatment have been done, but clinical experience suggests that counseling to assist with organizational skills and interpersonal relationships may be helpful. Adults who present with problems that include impulsivity, distractibility, impaired interpersonal relationships and significant discrepancies between intellectual ability and work performance should have adult ADD/ADHD as part of their differential diagnosis. A cautious approach to pharmacological management and referral to counselors who have experience with adult ADD/ADHD is advised.
对于许多医疗服务提供者而言，患有注意力缺陷障碍（ADD）和注意力缺陷多动障碍（ADHD）的成年人是一种新现象。虽然越来越多的证据表明，患有ADD/ADHD的儿童成年后可能会持续存在问题，但对于成年人而言，这些疾病的重要性和管理方法却知之甚少。针对成年人的研究因常与其他疾病合并存在以及对儿童期ADD/ADHD的回顾性诊断而变得复杂。药物干预的研究并未表明任何一类药物有明确的疗效和安全性模式。对患有ADD/ADHD的成年人进行药物治疗通常基于临床经验。药物治疗的疗效可能与患有ADD/ADHD的成年人中的特定亚群有关。尚未对非药物治疗的临床疗效进行对照研究，但临床经验表明，提供有助于组织能力和人际关系的咨询可能会有帮助。出现包括冲动、注意力分散、人际关系受损以及智力与工作表现之间存在显著差异等问题的成年人，在鉴别诊断时应考虑成人ADD/ADHD。建议在药物管理方面采取谨慎态度，并转介给有成人ADD/ADHD治疗经验的咨询师。
