成人注意力不足过动症
成人注意力不足过动症 Adult Attention deficit hyperactivity disorder | |
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fMRI[1] | |
类型 | 注意力不足过动症 |
分类和外部资源 | |
医学专科 | 精神医学 |
OMIM | 143465 |
成人注意力不足过动症(英语:Adult attention deficit hyperactivity disorder、adult ADHD、adult with ADHD、ADHD in adults、或AADD)是持续到成年的注意力不足过动症,属于神经生理病症。有ADHD症状的儿童青少年中,大约有三分之一到三分之二的人的症状会持续到成年乃至终身。[2](p. 44)[3]
成人注意力不足过动症的典型特征是注意力不集中、注意力过度集中、过动(会表现为内在的不安宁)、情绪失调以及过度的心智游移[4]。成人注意力不足过动症的人在遵照指示、记忆资讯、专注、组织工作、在一定时间内完成工作,以及约会准时上不容易做到。这些情形会影响成人注意力不足过动症生活的不同层面,可能会引起情绪、社交、职业、婚姻、法律、财务等方面的问题[5][6][7],因此会有自尊低落的情形。不过配合适当的引导及教练,ADHD的特质也可能会带来职业上的成功[8]。
特征与症状
![](http://images.weserv.nl/?url=//upload.wikimedia.org/wikipedia/commons/thumb/c/c7/Frustrated_man_at_a_desk_%28cropped%29.jpg/220px-Frustrated_man_at_a_desk_%28cropped%29.jpg)
注意力不足过动症是一个长期的症状并严重打击多数成年患者在教育、就业、和人际关系方面上应有的良好发展。[7][10]
注意力缺陷
成人注意力不足过动症患者之注意力缺陷的症状表现为难以长时间把专注力维持在一件事情上。患者有组织、规划、安排事情的困难而且难以分辨事情的缓急轻重以及难以长期追踪任务进度并最终完成任务[11]。患者不仅健忘而且时间管理能力明显有问题[11]。患者总是在截止期限前一刻才完成作业或根本还没动手开始做作业、迟交作业[11]。注意力缺陷也影响患者的驾驶型态,患者常在行驶中粗心大意、收到罚单、超速。[11]
注意力缺陷会让患者难以把事情想清楚、评估清楚,导致患者难以做决定[12]。
过动
从青春期开始直到往后的人生,过动-冲动的症状将渐渐不再频繁以外部的肢体表现出来,转而倾向以“内在的不安宁(inner restlessness)”等内在型式或以多话或插嘴打断他人等外在形式表现。[2](p. 44)[13]
冲动
过度参与具有相当高的机率会让参与者付出代价的活动;过度(过于频繁、用词过重或语气过于直接)说出那些具有相当高可能性会让他最终付出代价的言论[14]。成年时期的冲动后果往往重于童年时期的冲动。除此之外,患者可能会在时机未成熟的情况下贸然中断关系、或是在找到其他工作之前就辞职。[14] 冲动的问题同样会导致患者的驾驶行为出状况[14]。
情绪不稳
成人注意力不足过动症患者通常已衍生出情感障碍(狂躁、轻度狂躁、躁郁症或忧郁症)、焦虑症、物质滥用或间歇性暴怒症等共病[15]。
心情不稳、容易激动、容易暴怒、低挫折容忍度(遭遇挫折时的反应过度[12])以及缺乏动机(摆烂)等都是成人注意力不足过动症患者的常见特征。虽然这些特征也常见于某些心理疾病。[16][17]患者通常难以应场合需要而控制自己的情绪(特别是那些负面的情绪),这让患者常难以维系工作与人际关系[18]。
缺乏动机
有注意力不足过动症的人常会有自我管理及自我激励上的不足,这些又会引起像分心、延宕、无组织等容易造成问题的特质。常会被其他人视为是没有条理的,常常需要维持高度兴兴奋才能比较不分心,维持正常的生活。不过,有注意力不足过动症的成年人,其学习潜力及整体智力和其他人没有太大的差异[来源请求]
执行功能缺损
ADHD的症状在不同ADHD患者间的差异,以及在ADHD病患一生中的变化都相当的大。随著ADHD的在神经生物学上的进展,ADHD的病因已逐渐明朗——ADHD病患所遭遇的困境是由大脑中负责执行指令的部分所导致(参见:过动症的病理生理学),这造成了维持注意力、制定计划、组织能力、排定优先次序、缺乏时间概念、抑制冲动、决策制定上的问题。
这些缺陷造成的困境从普通到严重都有,可能使ADHD患者无法有效地组织他们的生活、规划例行工作,甚至无法有效地根据可能的后果想定办法并采取行动,即便他们在事前就已经察觉该后果。这进而导致了在学校,以及职场中的低落表现,以及无法发挥潜能的状况。在年轻的成年患者之中可以观察到以下情形,如存在交通违规的不良驾驶纪录[19]、酗酒历史,或是药物滥用。这类困境通常是由ADHD患者的客观行为(observed behaviour)所造成(例如冲动型患者,举例来说,可能因侮辱他们的上司而被解雇),即便他们早就知道这么做会让自己惹上麻烦,并且真心地想要避免这些行为。ADHD患者经常会错失一些和他同年龄并且有相同经验的成年人可以察觉,或应该知道的事情。这项差异可能导致他们被旁人贴上“懒”、“笨”或是“不体贴 (inconsiderate)”等标签。
随著问题的累积,患者会建立起消极的自我认知,并成就一种失败的恶性循环。高达80%的成人患者可能有某种形式的精神病学合并症[20],例如忧郁症和焦虑[7]。许多ADHD患者有学习障碍,例如阅读障碍,这也让患者面临的困境更加严峻[21]。
健康与社会领域的障碍
成人注意力不足过动症患者与非 成人注意力不足过动症患者相比,成人ADHD患者在工作或求职上遭遇困难(occupational difficulties)、发生交通事故、犯罪、染上物质滥用的比例较高[22][23][24]。研究显示,成人注意力不足过动症患者在童年时期几乎都曾经自我羞辱过并且历经郁郁寡欢和低自尊,这主要是因为他们在童年时期频繁觉得或发现自己被误解、歧视(差别待遇)、放生、放弃、忽略、当成空气、跟同侪的差异过多、遭遇学习障碍、与同侪在学业成就上的巨大落差、惨不忍睹的成绩单(包含学期成绩单上教师所留之如同对患者道德审判的评语)、身处功能不全的家庭或高风险家庭、走过过于破碎坎坷的家庭关系和人际关系等。[25]这些挫折和遭遇到的问题极为可能是成人注意力不足过动症患者后来罹患严重忧郁、物质滥用和出现人格障碍等行为问题的重要根源之一。[26][22][24]
职场
照顾儿童的老师以及照顾者会适应儿童注意力不足过动症的症状。不过针对患有注意力不足过动症的成人,其雇主以及其他与其互动的人,比较不容易将这些特质视为是注意力不足过动症的症状。某方面这是因为症状随著人的成长而改变,注意力不足过动症的成人比较不会有明显过动的症状,不过其过动会内化为持续的心智活动以及内在的不安宁感[13],或是根本不承认世界上有注意力不足过动症这个疾病的存在[27]。
行为障碍
成人注意力不足过动症(尤其是“过动-冲动”、“混合型”)可能增加其做出令众人感到无法接受的犯罪行为(包含对亲密伴侣的暴力、家庭暴力、酒精成瘾)的风险。若成人注意力不足过动症合并行为障碍,则上述风险将显著提升。然而许多成人注意力不足过动症患者也遭受亲密暴力(IPV)。[28][29][30][31]
置身于存在紧密关系暴力的环境将增加孩子罹患ADHD的机会。具有忧虑倾向的父母,其养育小孩的能力与经济能力通常有限,将导致孩子的健康较差且发育不良并增加罹患注意力不足过动症的机率[32][33][34]。成长于婚后暴力的家庭中的孩子,其未来将有较高机率出现行为问题[35]。
物质滥用
成人注意力不足过动症患者中约有五分之一到四分之一的人带有物质滥用的情况。[36]
治疗
![](http://images.weserv.nl/?url=//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Methylfenidaat_NL.jpg/261px-Methylfenidaat_NL.jpg)
成人注意力不足过动症的治疗包含药物并结合行为治疗、认知治疗、或职能医学介入。[37]治疗往往从以药物治疗ADHD的症状及可能存在的共病开始。
单独使用药物治疗虽然能有效的改善ADHD的生理症状,但药物并不会返还成人患者在ADHD的抑制之下,没有习得的一些能力。举例而言:一个成人ADHD患者可能在服药后重新获得专注的能力,然而像是做计画、分辨事情的缓急轻重、和有效的与人沟通等后天习得的能力则需要花时间学习、培养。[38]
流行病学
![](http://images.weserv.nl/?url=//upload.wikimedia.org/wikipedia/commons/thumb/2/25/Approximate_Prevalence_Distribution_of_the_Subtypes_of_ADHD_in_adulthood.svg/220px-Approximate_Prevalence_Distribution_of_the_Subtypes_of_ADHD_in_adulthood.svg.png)
成人注意力不足过动症的流行率约落在3%-5%之间[40][15]。
美国的成人注意力不足过动症的流行率为4.4%左右。[15]
社会与文化
患者的升学求职与婚姻
在美国,患有注意力不足过动症的成人,若其症状明显的限制一项或多项主要生活活动,依照美国联邦的残疾人非歧视法律(例如1973年残疾人正常活动法及2008年美国身心障碍法案),这就符合残疾的条件。针对ADHD确实构成残疾的患者,工作场所有责任提供合理的调适,教育机构有责任提供适当的学术调整,使此个体可以更有效,更有生产力的工作[41][42]。
经济
在2004年的研究中,针对ADHD的成年人和相同教育程度的人比较收入差异。若都是高中毕业,ADHD的成年人每年会比同为高中毕业的人少10,791美元的收入,若都是大学毕业,ADHD的成年人每年会比同为高中毕业的人少4,334元的收入。此研究认为美国因为ADHD少了770亿美元的生产力[43]。相对的,因为药物滥用的生产力损失是580亿美元,酒精滥用的生产力损失是850亿美元,而忧郁症的生产力损失是430亿美元[44]。
公众意识
![](http://images.weserv.nl/?url=//upload.wikimedia.org/wikipedia/commons/thumb/d/db/RickandPatrick001.jpg/220px-RickandPatrick001.jpg)
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Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is one of the predictive and treatable risk factors for delinquency, including intimate partner violence (IPV). Effective treatment of IPV needs to address personal dynamic risk factors, offender typology, and dynamics of the domestic violence. It is unknown whether treatment of ADHD symptoms contributes to a decrease in IPV. The ITAP study aims to investigate the relationship between treatment of ADHD symptoms and IPV in patients in forensic mental health care. Moreover, this study examines the role of comorbid psychopathology, subtype of the offender, and dynamics of the domestic violence.
- ^ Wymbs, Brian T.; Dawson, Anne E.; Suhr, Julie A.; Bunford, Nora; Gidycz, Christine A. ADHD Symptoms as Risk Factors for Intimate Partner Violence Perpetration and Victimization. Journal of Interpersonal Violence (SAGE Publications). 2016-07-10, 32 (5): 659–681. ISSN 0886-2605. doi:10.1177/0886260515586371.
Preliminary evidence underscores links between attention-deficit hyperactivity disorder (ADHD) symptoms and intimate partner violence (IPV) perpetration and ...
- ^ Childhood ADHD, Conduct Disorder Linked to Intimate Partner Violence. MedScape. 2010-11-11 [2019-01-20]. 原始内容存档于2019-01-01.
Adolescents with conduct disorder (CD), alone or with attention-deficit/hyperactivity disorder (ADHD), may be at increased risk for perpetrating intimate partner violence (IPV) with and without injury as young adults, new research suggests. In addition, childhood ADHD without CD was found to be a significant predictor of later IPV resulting in injury.
- ^ Childhood ADHD, Conduct Disorder Linked to Intimate Partner Violence Page 2. MedScape. 2019-01-20 [2019-01-20]. 原始内容存档于2019-01-01.
A new study suggests that childhood conduct disorder, ADHD, and ... all strong predictors for perpetrating future intimate partner violence with ...
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外部链接
- 廖晓菁药师/杨智超医师. 成人之注意力不足及過動症. 国立台湾大学医学院. [2018-07-23]. (原始内容存档于2018-01-29).
- 杨碧桃 (国立屏东师范学院特殊教育学系副教授). 成人 ADHD 患者之治療 (PDF). 国立屏东教育大学特殊教育学系(旧称:屏师特殊教育). 2004-05, 8: 1-9 [2018-07-23]. (原始内容存档 (PDF)于2018-07-23).
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