【指南】ADHD最新指南的解读
1、Expanded Age Range
The previous guideline provided recommendations for children aged 6-12, but the update addresses ADHD in those aged 4-18.
诊断年龄从之前的6-12岁扩大到4-18岁。这是一个重大改变。
It is recommended that primary care clinicians evaluate any child presenting with behavioral or academic problems as well as hyperactivity, inattention, or impulsivity. This update is important because it includes children traditionally considered "preschoolers," for which there are fewer data than for older children. This group can be more difficult to diagnose and may respond less well to stimulant therapy. The inclusion of adolescents acknowledges that many children with ADHD do not "grow out of it" during adolescence. It also highlights that teenagers with ADHD might not be diagnosed until the second decade of life.
2、Meeting the DSM-IV Criteria
As with the previous guideline, to make a diagnosis of ADHD, clinicians should ensure that DSM-IV criteria have been met. Diagnosis should be primarily informed by information from parents, teachers, and others involved in the child's care. Other causes of symptoms also should be ruled out (eg, restlessness and difficulty concentrating can be manifestations of mood or anxiety disorders, and, in older youths, psychotic disorders). Stressful life events in the absence of a psychiatric diagnosis and medications (such as antihistamines) can also mimic certain ADHD symptoms. In short, the differential diagnosis of ADHD includes developmentally expected behaviors, general medical conditions, and treatments and other psychiatric diagnoses.
3、Assess for Coexisting Conditions
When evaluating a child for ADHD, clinicians should also assess for potential coexisting conditions, such as oppositional defiant disorder and conduct disorder. These conditions are commonly comorbid with ADHD. Fortunately, symptoms of these comorbidities may be indeed reduced with treatments often given to children with ADHD.
关于ADHD共症(如对立违抗性障碍和行为障碍)的评估与治疗,在国内也开展得很好。
4、Chronic Care
The new guidelines recommend that clinicians recognize and approach ADHD as a chronic condition in which patients generally require special long-term mental health care. It is recommended that care follows the principles of the chronic care model and the medical home. ADHD is a condition that generally persists for years and its effect on young patients can extend well into adulthood. For that reason, an approach that keeps a long-term perspective in mind is appropriate.
美国的医疗保险体系应该很快会跟上;国内嘛,还得自己掏腰包!