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注意力不足过动症(ADHD)
Attention Deficit Hyperactivity Disorder
又称注意力缺失症(Attention deficit disorder)、过度活跃症=Hyperkinetic disorder (ICD-10)
An image of children
待在图书馆、餐馆、上课、听演讲、开会等需要长时间保持静态的场合,对患者来说可能不太容易。[1][2] 图片为冰岛教室内的学生Stofa i hradbraut
症状容易分心(难以把专注力放对地方)英语attentional shift、过度的活动、 难以控制行为和冲动英语impulsivity[3][4]
起病年龄6 - 12 岁 左右[5][6]
病程多于6个月 [5]
病因尚不明确[7]
诊断方法根据症状并排除其他可能的致病原因。[3]
鉴别诊断品行障碍对立反抗症学习障碍躁郁症[8]
治疗心理治疗(Counseling)、改变生活方式(lifestyle changes)、药物[3]
患病率5,110万(2015年)[9]
分类和外部资源
医学专科精神病学
[编辑此条目的维基数据]
“ADHD”的各地常用译名
中国大陆注意力缺陷多动障碍
台湾注意力不足过动症
香港专注力失调/过度活跃症
澳门专注力失调/过度活跃症
日本注意欠陥・多动性障害
大韩民国注意力缺乏过多行动障碍
越南𦇒乱增动减注意

注意力不足过动症(ADHD)是一个经过适度治疗可有效管理的慢性疾病。由于注意力不足过动症(ADHD)的症状表现十分多元,容易让人误以为是其他疾病引起的,因此本条目旨在详列ADHD的症状表现形式,协助读者厘清。

ADHD典型症状包括忘东忘西、粗心大意、写作业很久、吃饭很久、常恍神、家长交代的事一下就忘、东西不会收、今天念的书明天就忘掉大半、怎么教都没用。且/或有明显的焦虑症状。[10]

ADHD在脑部发育尚平均比同一年纪的人慢了三年,因此有较慢发展的认知功能(包括注意,记忆,结构,组织,学习,反应及解决事情能力),及自我动作及情绪控制能力表现,表现出来被简要描述的症状就是注意力不足,冲动及过动表现。[10]

2014年时,基思·康纳斯医师(是早期推动美国大众认知注意力不足过动症的人士之一),在《纽约时报》提出他认为注意力不足过动症在美国有过度诊断的情形[11],不过同年有一篇经过同侪审查(peer-reviewed)的医学回顾性文献表明ADHD在美国成人族群中的诊断率低于实际的盛行率。 [a] [12]

台大医院精神部教授高淑芬指出,国际的ADHD盛行率约7%,但根据台湾的健保资料库统计,无论儿少或成人在台的就医率均不到2%。[13]治疗的目的是为了与“注意力不足过动症”做朋友以发扬优点,避免缺点;而不是为了抹掉这一切,父母的观念应该与时俱进。[14][15]

figures [16]

症状表现

ADHD symptoms by age.

儿童(6-12岁)Children (6-12 Years) 青年(13-17岁)Teenagers (13-17 Years) 成人(18岁以上)Adult
容易分心
(Easily distracted)
内在的不安宁
(Displays inner restlessness)
专注力上的问题
(Inattention/concentration problems)
难以井然有序地完成家庭作业,常导致迟交,且作业内夹杂粗心的错误
(Homework poorly organized, contains careless errors, often not completed)
难以在各项学校/学习事务中保持有计画性、秩序性的。常常有始无终。
(Schoolwork disorganized, shows poor follow-through)
生活缺乏秩序与组织且难以在行动前事先做计划
(Disorganized and fails to plan ahead)
在问题尚未结束时抢答
(Blurts out answers in class before the question is completed)
肢体上的过动可能转变为内心的不安宁
(Hyperactivity may become less visible)
错误判断剩馀时间以及完成一件事所需的时间
(Misjudges available time)
难以完成家务事
(Fails to complete chores at home)
健忘(容易忘记目标动机、……)
Forgetful; easily forget the goal, motivation, reason, etc.
难以开始即完成一个计画
(Difficulty initiating and completing projects)
难以在游戏中轮流
(Has difficulty awaiting turn in games)
-
一件事情还没做到一个阶段就转移注意力到另一件事情
(Shifts activities prematurely)
常常离开座位
(Often out of seat)
-
健忘,常常遗失东西
(Forgetful; often loses things)
常在不适当的时机点找人说话、常不自觉闯入他人的空间 (Often interrupts or intrudes on others)
-
做出冲动的决定
(Makes impulsive decisions)

[17]

ADHD患者往往缺乏自我管理能力(Self-control/self-regulation)、自我动机(/自我激励/self-motivation),进而形成以下的特质,例如:分心拖延、和缺乏规划。ADHD患者常被其他人认为嘈杂且偏好追求高度刺激好让自己比较不会分心且变得比较有效率。 其实ADHD患者的学习潜力及整体资质与常人无异。

Sluggish cognitive tempo英语Sluggish cognitive tempo (SCT) is a cluster of symptoms that potentially comprises another attention disorder. It may occur in 30–50% of ADHD cases, regardless of the subtype.[18]

SCT symptoms (Summary)

儿童时期

Life Period Examples of Observed Symptoms
Children Failing to pay close attention to details or making careless mistakes when doing school-work or other activities
Trouble keeping attention focused during play or tasks
Appearing not to listen when spoken to (often being accused of "daydreaming")
Failing to follow instructions or finish tasks
Avoiding tasks that require a high amount of longer-term mental effort and organization, such as school projects
Frequently losing items required to facilitate tasks or activities, such as school supplies
Excessive distractibility
Forgetfulness
Procrastination, inability to begin an activity, such as completing homework
Life Period Examples of Observed Symptoms
Teens/Adults Procrastination; delaying or avoiding starting projects that require vigilant mental effort
Difficulty sustaining concentration on conversations or briefly losing attention on someone speaking
Hesitation to sustain concentration in planning and organizing for the completion of tasks
Hesitative responses, doubt, and delayed execution due to inattention remembering information
Difficulty finishing projects or completing assignments because many tasks simultaneously on the go
Forgetting to complete tasks and details after temporarily switching to more stimulating tasks
Difficulty finding misplaced tools after task switching due to bypassing adequate memory storage
Sustained information processing is slower than others causing information gaps that inhibit execution
Problems remembering appointments, obligations, or instructions
Difficulty learning new projects when concentration deficits cause desire to multitask英语Human multitasking or daydream
Distracted from persevering during work; difficulty holding onto a job for a significant amount of time
Change plans to the inconvenience of others due to forgetting or not fully aware of the bigger scenario
Maintaining excessive personal items such as storing old items of diminished usefulness
Obsessive英语Intrusive thoughts behavior as compensation英语Compensation (psychology) or coping mechanism for a perseverance deficit
Difficulty transitioning to new task or activity due to obsessive英语Intrusive thoughts behavior
Higher rate of vigilant英语Vigilance (psychology) concentration fatigue英语Directed attention fatigue after inhibiting many distractions英语Cognitive inhibition from greater effort required

情境

“一名妈妈因洗碗时想著擦地,跑去擦地时又想到家里没有卫生纸,想到什么做什么,结果每件事都只做一半、没完成。”[13]

成人时期

成人注意力不足过动症(Adult ADHD, Adult with ADHD, ADHD in Adult)\其实是注意力不足过动症的症状从幼年延续到成年期,并不是成年后才出现的疾病。其症状基本上仍未脱离分心、过动-冲动的核心概念,只是表现方式有很多(比起幼年期更为多样),一般大众不一定能将这些多样的表现型式与ADHD的核心症状相连结。

研究发现,儿童青少年时期的ADHD症状若未经治疗,约有六成进入成年期后仍有明显症状。

有鉴于目前台湾社会对于成人ADHD的认识有限,不少成人ADHD患者在生活中经历了可能比别人更多的困难和挫折且在迷糊和混乱中度过了不少岁月,却不知其问题的根源,于是只能不断的自我批判欲借此改善现况,然而却反而使自己变得更负面以及精神状况每况愈下。因此下表主要乃根据国立台湾大学医学院附设医院精神医学部、基因医学部主任高淑芬医师之著作摘要整理出成人ADHD的特征,帮助疑似患者自我察觉。[19]

  • 经常天马行空地想东想西,脑海中不断迸发出新的点子,兴致勃勃地告诉别人后却鲜少具体实践,让美丽的梦想成真。即便兴冲冲开始执行,通常也只是三分钟热度。
  • 喜欢热心主动的帮助别人或提供别人各式各样的建议,不过与此同时,对自己的事却显得吊儿啷当,拖拖拉拉,好像没有作完的一天。
  • 喜欢说话,无论是在会议中或是上课的场合中,仍会忍不住一直跟旁边的人聊天。经常吵到人而不自知。
  • 对注意力不足过动症患者来说,跟别人好好聊天可能不是一件容易的事,因为不耐于倾听,经常插嘴或岔(离)题。
  • 对于时间这个东西没什么概念,常常无法准时赴约,不是迟到,就是根本把这件事抛到九云通宵外,把这件事情给忘了。(缺乏时间观念)
  • 粗心、忽略细节、因为不耐烦而便宜行事。只想求快的结果就是做事的品质令人不敢恭维。
  • 因为注意力不足过动症的缘故,患者显得容易冲动又没耐心,例如:开快车,抢黄灯或闯红灯、插嘴、插队、抢话、发生交通事故、收到罚单或与人起冲突。
  • 注意力不足过动症患者常挨批评像长不大的人、迷迷糊糊、懒懒散散、不用心、说说哥、说说姊、不负责任、白目、生活习惯不好、以自己为中心等。
  • 患者每当遭受到类似的批判,往往觉得无奈又委屈并为此而焦虑。因为患者本身也不想这样,但就是心有馀而力不足,无法自我控制。
  • ADHD患者的言行举止往往令周遭的亲友感到纳闷,一来是他们的表现有时候很不错、学习力也不差,但为何就是需要旁人再三提醒专心把事情做好,还需周遭亲友们不时替患者操心。
  • 一心只讲求快速、效率,却未顾及到做事的品质,以至于语焉不详、字迹潦草、漏洞百出。像是刚拿到一样新东西,连看说明书都不耐烦,便直接动手安装或使用,导致事倍功半,或是不小心就把东西给弄坏了。
  • 对于金钱和财务不太有概念、粗心大意,因此在收支上维持平衡对于成人ADHD患者来说,可能不是一件轻松的事情。
  • 对于ADHD-患者来说,时间通常只有‘现在’没有‘未来’,所以常会把很多事情都挤在同一个时间。ADHD患者的空间能力也不太好,家中的桌子、地上、床铺、和柜子经常堆满东西。书桌上的东西堆积成了一座小山坡,没有归类,然而其抽屉可能空空的,只装了点小纸屑。
  • 当ADHD患者想要或需要某些人、事、物时,他们可能会立马插嘴或打断别人,无论别人是不是正在忙、谈话中。ADHD可能就会要对方放下正在做的事,立即回应他们。ADHD患者之所以会急性子,除了是肇因于冲动的核心症状外,他们也担心如果不现在说出来,未来可能就会忘记啦。
  • 为了找东西而浪费很多宝贵的时间,甚至为此进出家门多次而迟到。
  • 分辨事情缓急轻重的能力不好。例如:明明人家急著要一份资料,ADHD患者却因为别人的一句话或一个动作而分心,转而关注其他的人事时地物,于是原本正在进行的事情全抛诸脑后。对于ADHD来说,一旦应该做的事被打断,就很难再回来持续做完。
  • 常常会从ADHD患者身上观察到一些好似不安、不安稳的小动作,例如:摸东摸西、拉扯衣服、碰碰文具、在椅子上旋转、剥指甲、在纸上涂鸦等。
  • 常觉得静不下来。
  • 丢三落四的,不是找不到手机、钱包、钥匙、帐单就是忘了带应该记得带的重要东西。
  • 说话的时候常常更换主题,使得别人不易厘清重点。
  • 因为冲动的特质,ADHD患者经常不假思索就脱口而出不得体的话。(常讲错话)
  • 不耐于倾听他人,往往对方的话还没讲完,他们就插嘴或急著接话:“我知道,我知道,我告诉你⋯⋯”。但别人要说的并不一定与ADHD患者预测的相同。
  • 可能会借由超车、闯红灯来摆脱等待停等红灯、堵车时的不耐烦。因此容易出车祸和吃罚单。
  • 排队、等待火车对于ADHD来说可能是件非常烦人的事情。
  • 可能因为肢体容易碰撞到别人而引起人际冲突。(肢体协调性可能不足)
  • 遇到稍微比较复杂的指令,就容易乱掉。即便是每天的例行公事,也需要不断地叮咛。
  • 倘若没有明确严格的时间限制,ADHD可能会把他应该做的事、应该缴交的作业、......,无限期的延后,没有完成的一天。
  • 经常从一件事情切换至另一件事情的结果可能是每一件事情都没做完或花很长的时间才能做完。
  • 做事欠缺规划、分辨事情缓急轻重的能力有待加强、缺乏时间观念可能带给人不可靠、不守信的感觉。
  • ADHD患者们也不太容易与别人维持长时间的对话和互动、或者看电视(锁定同一个节目)。总之就是很难持续,还没有到一个段落,就中断离开了。
  • 是一个热心的人,点子很多也很好动,但就是常常恍神、糊里糊涂、少根筋似的。
  • 做事情容易拖拖拉拉,拖延到最后一刻。
  • 思考或者做事情上常看起来心不在焉、虎头蛇尾,讲不听。
  • 不耐久坐、才刚坐下看东西、看资料,不到几分钟就想站起来找人聊天。
  • 各种坐姿,有时候会把脚搁在桌上,或者一直扭动,旁若无人似的。
  • 手上的书已经翻开超过半小时,却因为一直无法专心阅读,所以书还停留在刚翻开时的那一页。
  • 不擅于整理东西、打理生活,不论是随身携带的包包里、家里的房间、抑或是桌子上,基本上都塞著或堆著各种东西。随著时间的流转,这些小平原、小丘陵会变成乱乱的大台地和大山坡。
  • 忘东忘西的,经常忘记答应别人的事情、东西放在哪里、安排好的行程规划、证件、约会的时间地点、资料、应该做到的事、......。注意力不足过动症患者脑部的记忆功能并无缺损,但就是太健忘了,让自己和周边的人都感到十分的无奈。
  • 易粗心犯错、工作效率不足、不易与人建立并维持良好的沟通、常常换工作、换老板、虎头蛇尾、有始无终、恍神、处事乱无章法、坦率直接、没有心机、天真、兴趣广泛、少根筋的乐天派、活泼好动、热心助人、讲义气、喜欢打抱不平、爱讲话所以很容易交朋友、创意十足、热情洋溢、活力充沛、开朗活泼、单纯、时间管理能力有待加强、三思而后行的能力不足。

同为注意力不足过动症患者之哈洛威尔医师对于成人注意力不足过动症的观察:[20]

哈洛威尔:“治疗成人ADHD患者与治疗儿童青少年ADHD患者,两者是同等重要的。因为ADHD对于一位成人的冲击相当广泛,例如:生涯英语career婚姻家庭、......等。” [20]


注:为使疑似患者早日察觉症状,因此条列了许多对于ADHD偏负面的描述。事实上,ADHD的核心症状不多,条列的内容大多为核心症状的表现型。ADHD患者litterally(其实)也有很多优点(可参看相关书籍)。

治疗

[21]

家中的行为治疗

用“爱”来沟通

倾听与陪伴

[22]

父母教育训练 (Parent Management Training)

已隐藏部分未翻译内容,欢迎参与翻译

Raising a child with ADHD is not easy. Family life is often dominated by conflicts and sometimes there is additional pressure from other people too. Teachers, friends, family members or other parents often assume that the child’s behavior is a result of the wrong kind of parenting. But many parents of children with ADHD gradually develop strategies to help them cope better in everyday life.

Raising a child with ADHD can be very challenging. It demands a lot of attention from parents. The child’s behavior often leads to tension within the family or trouble at school. Children with ADHD are abnormally impulsive and restless. They don’t follow rules or instructions and are sometimes aggressive. So it is perfectly normal for parents to sometimes feel helpless, annoyed or even furious, as well as worrying about their child. But it is important to remember that the child is not behaving that way on purpose and that their behavior has nothing to do with their character.

Over time, many families come up with strategies to help them cope with everyday situations. There are various strategies to help plan the day and avoid surprises, or to at least be ready for them. Some parents are reluctant to lay down clear rules because they don’t want to be too authoritarian or strict. But the aim of these strategies is to help create an environment in which the child can cope better.

Routines, clear instructions and rules

Many parents say it is helpful to plan and structure the day carefully. Clear routines can help children to know what to expect and be better prepared for things. A lot of parents say that telling their child about any changes to the routine as soon as possible helps too.

It is also a good idea to give your child very specific instructions. Then they will know what exactly needs to be done and you will also have the opportunity to offer praise or a reward when the task has been completed. For instance, instead of saying “Please clean up your room,” it would be better to say something like “Please put your toys in the box and make your bed.” Whenever your child does what you ask them to do, it is important to praise them for that specific task. For example: “Thank you for washing the dishes so nicely.”

Parents often say that it helps to establish clear rules for behavior and to reward their child when those rules are followed. One example of a reward is a certain amount of TV time. If the child breaks the rule, this privilege is taken away again. For this system to work, everyone needs to be aware of what kind of behavior is expected from the child and what the reward will be. It is also important to follow through on these agreements as much as possible.

Setting realistic goals

Children and teenagers with ADHD may have problems that touch many different areas of their lives. As a result, some parents might want to try to change everything all at once – for instance, improve their child’s relationships with siblings, classmates and teachers and also improve their performance at school.

It is very important to make realistic goals so the child doesn’t feel overwhelmed or frustrated. Goals should be approached in small steps that the child is capable of completing. An example of a specific goal might be playing with other children at recess without getting into a fight. The goals and achievements can be noted on a list or somewhere else, and then checked later on.

Watching for signs of overstimulation

If you notice early on that a given situation is too much for your child to handle, and that they are overstimulated or agitated and about to lose control, you can respond right away and, for instance, have them take a time-out in another room.

Watching for these signs in everyday life can also help you recognize what kinds of situations or other things may trigger the problematic behavior. It is important to talk with your child. For instance, you could wait for a quiet moment and then ask how they are feeling and why they think they “exploded.”

Children may find it easier to focus on a task or fall asleep if they are in a room that is calm and free of distractions. So it might help to keep things like televisions or computers out of the room where your child does their homework or sleeps. It might also be a good idea for their desk to face the wall instead of a window, so that they have fewer distractions.

Sports and hobbies

Many parents and children find that sports and exercise help to blow off some steam and get rid of excess energy. But it is also important to make sure that physical activities are guided by an adult because some children tend to become overexcited when they get too much exercise. Injuries resulting from inattentiveness are more common amongst children and teenagers with ADHD, so not all types of sports are equally suitable.

Sports and exercise are best scheduled for the afternoon: Things need to quiet down towards the evening to avoid problems falling asleep.

Having other hobbies can also make things a little easier. It is important for a child to find an activity that is captivating and enjoyable, and which offers opportunities to experience success. Feeling appreciated and knowing that they have done something well often helps children to focus better when doing other activities they are less enthusiastic about.

Praise is key

It is important to give children honest praise when they have succeeded at something and to encourage a healthy self-esteem despite all of the problems. Children who have ADHD often don’t get enough positive feedback because they cause trouble at home and in school, and have difficulties finding friends.

It’s not always easy to show affection and understanding when your daily life together is often so difficult. But taking some time to give your child caring attention, do things together, have fun and enjoy shared experiences can make it easier to take the stressful moments more in your stride.

Pay attention to your own needs and accept help

It is important for parents to pay attention to their own needs in order to balance out the stresses of daily life and help them stay calm when dealing with their child. This means getting help – for instance from friends or family who can give them a break, or in the form of professional support to assist them in parenting.

It is worth involving close friends or relatives who get along well with the child and can occasionally spend an afternoon or evening with them – without being caught up in the everyday problems. That way both parents could have regular breaks to recharge their batteries.

Participating in education programs for parents, seeking advice and establishing good relationships with specialists who treat ADHD in children is a great help for many parents. It can help you be more patient, calm and tolerant when dealing with the problems in everyday life. But it also helps not to ask too much of yourself.

Sharing experiences in a self-help group with other parents who have children with ADHD is sometimes helpful. Regardless of the kind of support you choose, letting others help you out and actively addressing problems can make everyday family life much easier. It allows you to take a step back and clear your head so you can support your child as best you can.[23]

Psychological treatments

已隐藏部分未翻译内容,欢迎参与翻译

Children with ADHD who have psychological treatment will usually have a type of therapy known as cognitive behavioral therapy. “Cognitive” approaches focus on things related to your memory, thoughts and mental abilities. Parents can learn behavioral therapy techniques in parent education programs. They will first use them under the supervision of their child’s therapist. Behavioral therapy typically combines several interventions that focus on changing different aspects of the child’s behavior.

One approach aims to encourage good behavior in children using reward systems or negative consequences. Here it is important to clearly describe the desired behavior, and it should also be possible to check whether the child behaves in the desired way. In order to give the “behavior plan” a chance to work, you have to stick to it consistently for several weeks. You should therefore make sure it isn’t too much for your child to handle, and avoid trying to change too many types of behavior at the same time.

Another approach involves the use of “time-outs” when children misbehave. In time-outs, children spend a short amount of time in a different room.
Cognitive approaches help children and teenagers to plan and complete tasks more effectively. One example is the use of “When-then sentences.” These are instructions that children come up with themselves in order to practice completing certain tasks. For instance, “When I finish my homework I will look at my timetable and pack my backpack for the next day.” This is an example of a kind of technique known as self-instructional training.

A different technique is known as self-management training. Here children learn how to be better organized. For instance, they may learn to break tasks down into smaller steps, and check how successful they have been by asking themselves questions such as:

What do I have to do?
What do I need in order to do it?
How can I do it?
Did I succeed?

Research on the effectiveness of cognitive and behavioral therapy approaches in children and teenagers with ADHD has produced conflicting results. This does not mean that these approaches do not help. But more research is necessary.

Psychological treatments have long been tested and proven to be effective in the treatment of many other kinds of mental disorders. Children and teenagers with ADHD who also have other mental health problems, such as anxiety disorders and depression, may benefit from other psychological treatments too.

Families who would like to have psychological treatment often have to be patient. It can take several weeks or months to get an appointment in a psychotherapy practice.[24]

Neurofeedback

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Another treatment option for ADHD is known as neurofeedback. This is a special kind of biofeedback. It involves measuring electrical activity in the brain (brain waves) using electrodes placed on your scalp, and then displaying the readings on a screen. By observing their own brain waves, children can learn to consciously control their thoughts and concentrate better as a result. Nowadays there are also devices with which you can learn to complete certain tasks, such as moving an object on the screen, using your brain waves.

Whereas some studies have suggested that neurofeedback could be helpful, others have not found any effect. So more research is needed in this area too.[24]

Support at school

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ADHD affects many areas of life, usually at school too. For treatment to be successful, parents and therapists should therefore also involve the child’s school or kindergarten. If a child has learned self-management skills, for instance, it would be helpful if their teachers were aware of this.

It is also possible for teachers to adjust the learning environment so that it is easier for children with ADHD to follow in class. This could include rearranging the classroom. For example, the child could sit at a desk that allows the teacher to keep an eye on them and react if they stop paying attention. They should also sit somewhere where they are exposed to as few distractions as possible. It can therefore be better to put desks in rows rather than group them. Objects that are not needed can be hidden from view in cupboards. When the class writes a test, the child with ADHD could take their test in a separate room, away from distractions.

There are various other things that teachers can do at school, such as

introduce short “physical exercise breaks” during lessons, or attend a training course to find out more about ADHD and how to better deal with children who have ADHD, as well as learn education techniques that aim to encourage children to behave well.

There is very little research on interventions at school, so it is not possible to say much about how effective they may be. They are often only carried out as part of small projects, or by individual teachers who are interested in helping children with ADHD.[24]

对于治疗方式的不同论点(灰框内容无医学实证支持)

請注意:以下有部份內容(灰色框線內)並非出自Wikipedia:可靠來源 (醫學)
中华民国(台湾)有社会学学者从新闻媒体资料库-联合知识库搜集2001年起有关注意力不足过动症的新闻报导,并从记者的报导中,利用内容分析方法分析出“儿童的过动问题一开始就以生物医学模式来解释,在处遇建议上则呈现从行为治疗转向药物治疗的明确趋势”的结论[25][26]

然而透过归纳单一新闻资料库所记载的新闻报导所得出的医学结论,其信度效度是非常具有争议的。(参见:注意力不足过动症 § 治疗

美国有社会学家认为注意力不足过动症(ADHD)的治疗是一个把“不常见且不被广泛接受的行为”(deviant[b] behavior)医疗化的例子。抱持这种想法的社会学家认为ADHD的治疗是把早期不属于医疗范畴的学生在学表现的问题给医疗化(另有一说是指这是“特教医疗化”)[c][28][29]在中华民国,也有两位学者附和这样的论点。[30]

在美国,绝大多数的医疗人员(healthcare providers)相信ADHD是一个真实存在的“症”(genuine disorder)[29],至少在症状较明显的人身上是这样没错。 [31][32]美国医疗人员之间的争议主要是围绕在那些症状轻微的病患的诊断及治疗方式[31][32][29][33][34][31][32][29][注 1]。(美国的ADHD流行率高于世界平均,详见:注意力不足过动症 § 流行病学

英国官方机构-英国杰出国家健康照护机构英语National Institute for Health and Care Excellence(National Institute for Health and Care Excellence)在2009年发表声明,声明中有提及目前存在的争议,但表示:当前的治疗策略与诊断方法都是基于大量学术文献所形成的学术界共识而得[d][35]

中华民国一位中央研究院历史语言研究所的学者分析指出,台湾关于“西药”的文化信念或成见在注意力不足过动症的治疗方式的争议之中,扮演著一个催化剂的角色。[36]

关于药物社会文化,也在此争议中起到一定作用。反对者对于过动症药物的质疑,其实反映了台湾关于“西药”的文化信念成见。这些仍广泛存在的信念,认为西药不同于取材自天然物质的中草药,而是人工化学制剂,而且西药乃藉“以毒攻毒”来达到疗效,因此具有较强毒性,且西药多有依赖性或成瘾性,一旦开始使用药物,就无法停药而必须长期服用。此外,西药是治标不治本,它只针对特定症状或疾病诱因治疗,无法根除病因,也无助于调理强化甚至可能弱化体质。长期以来,台湾医师经常哀叹这些成见使不少病患,特别是慢性病患者拒绝或中断必要治疗,转而寻求疗效未经证实、副作用不明且无品质管制的中草药,以致损害健康。
— 巫毓荃(中央研究院历史语言研究所助研究员)

该学者建议精神医学界“必须更认真思考大众科学与卫教等议题”、全面向的介绍一个疾病以避免见树不见林,从而化解相关争议[36]
除此之外,他也呼吁:强调精神疾病是生物性疾病的精神医学与关注心理病理与心理发展的心理学、关注家庭社会病理与社会支持的社会工作专业、以及以教育矫正为职能及宗旨的教育特教专业,彼此之间应有更紧密的合作。
他还指出“即使相信过动症的生物性本质,在目前的临床实作上,从其症状表现、发现认定、诊断到评估治疗成效的指标,都还是以实际情境中的行为为基础;而各种非药物治疗模式的施行,也需要多方面配合及参与。因此,在评估过动症的各种流行病学数据与药物疗效,以及要引入某种治疗模式时,必然需要考虑在地的家庭、教育、社会环境与文化。”[37]

这位学者的结论是注意力在当代社会扮演的脚色日益重要[38]并预期精神科在未来的人类社会中,将有更为多元的职能。[39]

这位学者在提出个人观点后列出几个提醒事项:

注释

  1. ^ 原文:A 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.
  2. ^ deviant\ is used to describe a person or behaviour that is not usual and is generally considered unacceptable [27]
  3. ^ 原文:Some sociologists consider ADHD to be an example of the medicalization英语medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one.
  4. ^ 原文:In 2009, the National Institute for Health and Care Excellence英语National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.

备注

  1. ^ 60 分 与 59 分的差别。
  2. ^ 参见 注意力不足过动症 § 医病关系

参考文献

书目

参考资料

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  2. ^ 高淑芬. 家有過動兒:幫助ADHD孩子快樂成長. 台北: 心灵工坊. 2013-08-28 [2016-12-09]. ISBN 9789866112805. 
  3. ^ 3.0 3.1 3.2 Attention Deficit Hyperactivity Disorder. National Institute of Mental Health. March 2016 [5 March 2016]. ADHD management recommendations vary by country and usually involve some combination of counseling, lifestyle changes, and medications. 
  4. ^ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th. Arlington: American Psychiatric Publishing. 2013: 59–65. ISBN 978-0-89042-555-8. 
  5. ^ 5.0 5.1 Symptoms and Diagnosis. Attention-Deficit / Hyperactivity Disorder (ADHD). Division of Human Development, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. 29 September 2014 [3 November 2014]. 
  6. ^ Dulcan, Mina K.; Lake, MaryBeth. Axis I Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence: Attention-Deficit and Disruptive Behavior Disorders. Concise Guide to Child and Adolescent Psychiatry 4th illustrated. American Psychiatric Publishing. 2011: 34. ISBN 978-1-58562-416-4 –通过Google Books. 
  7. ^ NIMH » Attention-Deficit/Hyperactivity Disorder (ADHD): The Basics. NIMH » Home. [2017-07-26]. 
  8. ^ Ferri, Fred F. Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders 2nd ed. Philadelphia, PA: Elsevier/Mosby. 2010: Chapter A. ISBN 0323076998. 
  9. ^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.. Lancet. 8 October 2016, 388 (10053): 1545–1602. PMC 5055577可免费查阅. PMID 27733282. doi:10.1016/S0140-6736(16)31678-6. 
  10. ^ 10.0 10.1 嘉义长庚精神科副教授级主治医师、教育部部定副教授 陈锦宏 医师. 心動家族:注意力不足過動症ADHD的第三條路. 台湾心动家族儿童青少年关怀协会. Tc-adhd.com. 2016-12-13 [February 2017] (中文(台湾)). 
  11. ^ Schwarz, Alan. The Selling of Attention Deficit Disorder. The New York Times (14 December 2013). 14 December 2013 [26 February 2015]. 
  12. ^ Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014, 16 (3). PMC 4195639可免费查阅. PMID 25317367. doi:10.4088/PCC.13r01600. Reports indicate that ADHD affects 2.5%–5% of adults in the general population,5–8 compared with 5%–7% of children.9,10 ... However, fewer than 20% of adults with ADHD are currently diagnosed and/or treated by psychiatrists.7,15,16 
  13. ^ 13.0 13.1 孩子常上課分心、撒謊...真的不是故意搗蛋 - 即時新聞 - 20170326. 苹果日报. 2017-03-26 [2017-06-26] (中文). 
  14. ^ 洪兰. 洪蘭:「不專心」也是上天的祝福|專欄|洪蘭|2015-05-12|天下雜誌第572期. 天下杂志. 2015-05-12 [2017-06-26] (中文). 
  15. ^ 撰文者jiabin. 找出孩子的長處!西北大學研究:容易分心的孩子,可能擁有較高的創造力 (容易分心,...) - 教育 - in媽咪育兒新知 - 商周.com. 商业周刊 - 商周.com. 2017-05-24 [2017-06-26] (中文). 
  16. ^ Fayyad, J.; De Graaf, R.; Kessler, R.; Alonso, J.; Angermeyer, M.; Demyttenaere, K.; De Girolamo, G.; Haro, J. M.; Karam, E. G.; Lara, C.; Lepine, J.-P.; Ormel, J.; Posada-Villa, J.; Zaslavsky, A. M.; Jin, R. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. The British Journal of Psychiatry (Royal College of Psychiatrists). 2007-05-01, 190 (5): 402–409. ISSN 0007-1250. doi:10.1192/bjp.bp.106.034389. 
  17. ^ ADHD and You. ADHD: What Do Symptoms Look Like at Different Ages?. [2017-03-09]. 
  18. ^ Barkley, R. A. Sluggish Cognitive Tempo (Concentration Deficit Disorder?): Current Status, Future Directions, and a Plea to Change the Name (PDF). Journal of Abnormal Child Psychology. 2014, 42: 117–125. PMID 24234590. doi:10.1007/s10802-013-9824-y. 
  19. ^ 高淑芬. 找回專注力:成人ADHD全方位自助手冊. 台北: 心灵工坊. 2016-05-09 [2016-12-12]. ISBN 9789863570592 (中文(台湾)). from section of 成人ADHD的诊断 
  20. ^ 20.0 20.1 Dr. Hallowell on the Today show discussing Adult ADD. Drhallowell.com. 2014-10-16 [2016-12-09]. Dr. Hallowell on the Today show discussing Adult ADHD\ While ADHD tends to be associated with childhood, we’ve learned that it is far more widespread among adults than previously understood. While there are some children with ADHD who will outgrow it, we now know that the vast majority will not. Listed below are criteria for adult ADHD that we developed from our clinical experience: A sense of underachievement, of not meeting one’s goals , regardless of how much one has actually accomplished. Difficulty getting organized. Chronic procrastination or trouble getting started. Many projects going simultaneously; trouble with follow through. A tendency toward addictive behavior. Chronic problems with self-esteem. Inaccurate self-observation. Family history of ADHD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.Recognizing and treating ADHD is just as important for adults as it is for children, as it has a wide ranging impact in careers, marriages and families. 
  21. ^ 高淑芬. 家有過動兒:幫助ADHD孩子快樂成長. 台北: 心灵工坊. 2013-08-28 [2016-12-09]. ISBN 9789866112805. 
  22. ^ TVBS. 父母陪伴少品質差 孩子心理健康亮紅燈│TVBS新聞網. TVBS. 2017-05-12 [2017-07-17] (中文). 
  23. ^ pmhdev. Attention deficit hyperactivity disorder (ADHD): Coping with ADHD in everyday life: Information for parents. PubMed Health. 2015-09-09 [2017-06-28]. 
  24. ^ 24.0 24.1 24.2 pmhdev. Attention deficit hyperactivity disorder (ADHD): What can help children and teenagers who have ADHD?. PubMed Health. 2015-09-09 [2017-06-28]. 
  25. ^ 曾凡慈、刘毓翔. 建構童年異常:新聞媒體中的兒童過動症及其轉變 The Construction of ADHD and Its Transformation in the News. 社会分析 (东吴大学社会系;辅仁大学社会系;世新大学社会心理学系). 2017-02, 201702 (14). doi:10.3966/221866892017020014003. 
  26. ^ 曾凡慈. 兒童過動症的在地興起與專業技能網絡的變遷. 《科技、医疗与社会》 Taiwanese Journal for Studies of Science, Technology and Medicine: 15–76. 2015年10月 [2017-06-23] (中文).  参数|journal=与模板{{cite web}}不匹配(建议改用{{cite journal}}|website=) (帮助); |issue=被忽略 (帮助)
  27. ^ deviant. Cambridge Dictionary. [2017-06-24]. 
  28. ^ Parrillo VN. Encyclopedia of Social Problems. SAGE. 2008: 63 [2 May 2009]. ISBN 9781412941655. 
  29. ^ 29.0 29.1 29.2 29.3 Mayes R, Bagwell C, Erkulwater JL. Medicating Children: ADHD and Pediatric Mental Health illustrated. Harvard University Press. 2009: 4–24. ISBN 978-0-674-03163-0. 
  30. ^ 张如杏、林幸台. 特教醫療化現象之探討 (PDF). 特殊教育与复健学报. 2009, (21): 1∼17. 
  31. ^ 31.0 31.1 31.2 Silver LB. Attention-deficit/hyperactivity disorder 3rd. American Psychiatric Publishing. 2004: 4–7. ISBN 978-1-58562-131-6. 
  32. ^ 32.0 32.1 32.2 Schonwald A, Lechner E. Attention deficit/hyperactivity disorder: complexities and controversies. Curr. Opin. Pediatr. April 2006, 18 (2): 189–195. PMID 16601502. doi:10.1097/01.mop.0000193302.70882.70. 
  33. ^ Merten, EC; Cwik, JC; Margraf, J; Schneider, S. Overdiagnosis of mental disorders in children and adolescents (in developed countries).. Child and adolescent psychiatry and mental health. 2017, 11: 5. PMC 5240230可免费查阅. PMID 28105068. 
  34. ^ Taylor, E. Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed?. Archives of disease in childhood. April 2017, 102 (4): 376–379. PMID 27821518. doi:10.1136/archdischild-2016-310487. 
  35. ^ National Collaborating Centre for Mental Health. Diagnosis. Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE Clinical Guidelines 72. Leicester: British Psychological Society. 2009: 116–7, 119. ISBN 978-1-85433-471-8 –通过NCBI Bookshelf. 
  36. ^ 36.0 36.1 巫毓荃(中央研究院历史语言研究所助研究员). 注意力不足過動症爭議的十個話題. 历史学柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文). 关于药物的社会文化,也在此争议中起到一定作用。反对者对于过动症药物的质疑,其实反映了台湾关于“西药”的文化信念或成见。这些仍广泛存在的信念,认为西药不同于取材自天然物质的中草药,而是人工化学制剂,而且西药乃藉“以毒攻毒”来达到疗效,因此具有较强毒性,且西药多有依赖性或成瘾性,一旦开始使用药物,就无法停药而必须长期服用。此外,西药是治标不治本,它只针对特定症状或疾病诱因治疗,无法根除病因,也无助于调理强化甚至可能弱化体质。长期以来,台湾医师经常哀叹这些成见使不少病患,特别是慢性病患者拒绝或中断必要治疗,转而寻求疗效未经证实、副作用不明且无品质管制的中草药,以致损害健康。事实上,虽然程度不同,但这些可能是跨文化甚至是普世的文化信念。其根源部份在于现代科学医学本身令人疏离的性质,因此即便如何卫教启蒙,还是难以完全根除。……化解关键可能在于精神科医师必须更认真思考大众科学与卫教等议题,并且创新临床实作的方式。 
  37. ^ 巫毓荃(中央研究院历史语言研究所助研究员). 注意力不足過動症爭議的十個話題. 历史学柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
    八、其他精神卫生专业、心理学家与教育专业的立场?
    到目前为止,儿童精神科医师的结盟工作似乎进行得非常顺利。积极转介问题学生的老师与特教老师,乐于在过动症医疗中扮演辅助角色的临床及谘商心理师社工师,以及大多维持缄默的儿童心理学家,他们主动或被动地加入精神科医师主导成立的同盟,扮演好被期待的角色,或至少未加入敌对阵营。这些专业的配合,使精神科医师可以在短时间内建立起一个过动症医疗网络,过动症医疗的普及并不是精神科医师孤军奋战,而是一个团队努力的成果。与这些专业的同盟,也让精神科医师不管实际医疗情境如何,仍可以宣称过动症医疗并未只重视生物面向,而是生物、心理与社会并重。更重要的是,这些是在每天工作中实际面对过动儿童的专业人员,他们既有专业,也能与家长一样真正体会过动儿童所造成的问题与所需要的帮助。他们对于过动症医疗的认可,不但凸显部分反对团体反智、反科学与反专业的愚昧不明,也与在象牙塔内,不了解真实问题只凭浪漫空想的学界与文化界反对人士,构成鲜明对比。
    然而,这样的同盟关系能维持多久呢?事实上,这些专业固有对于精神疾病的观点,与强调精神疾病是生物性疾病的精神医学,有著重大且本质性的差异。关注心理病理与心理发展的心理学,关注家庭社会病理与社会支持的社会工作专业,以及以教育矫正为职能及宗旨的教育与特教专业,基本上并不认同在正常与异常之间画出明确界线的医学观点。在过去,它们时常就如何理解与改变精神病理与精神医学有所争辩。近年来,在不同国家地区,在整体精神健康或特定精神病理上,精神医学的理念以及其所主导的团队工作模式,也受到来自这些专业的质疑与挑战。在过动症问题上,这些专业理应要有与精神医学不同的观点。目前较少听到这类声音,反倒显得特别。这可能有许多历史性与当代的内外在因素。但无论如何,即使不是正面地批判,这些专业势必将会更明确地表达不同于主流精神医学的意见。目前建立起的网络未必能持续发挥功能,目前的结盟也将有所变化。即使拥有最先进的科学武器,精神科医师若不想陷入孤军奋战的困境,可能在论述与策略上还必须有所调整。

    十、充满国际视野的争论:全球化与本土视野
    ……即使相信过动症的生物性本质,在目前的临床实作上,从其症状表现、发现认定、诊断到评估治疗成效的指标,都还是以实际情境中的行为为基础,而各种非药物治疗模式的施行,也需要多方面配合及参与。因此,在评估过动症的各种流行病学数据与药物疗效,以及要引入某种治疗模式时,必然需要考虑在地的家庭、教育、社会环境与文化。……我们应该可以期待将听到更多加入本土视野的研究与观点。
      参数|quote=值左起第6位存在换行符 (帮助)
  38. ^ 巫毓荃(中央研究院历史语言研究所助研究员). 注意力不足過動症爭議的十個話題. 历史学柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
    十一、注意(力)与快乐
    最后,透过儿童过动症引起的争议,以及对于成人注意力不足症候群日益增加的重视,我们可以看到注意在当代自我文化中扮演越来越重要的角色。原本,在从十九世纪到二十世纪晚期很长一段时间中,记忆一直是自我文化的核心。一个人是他过去的堆叠;成长经验决定一个人的人格结构,进而决定其命运;童年创伤是精神疾病的根源,回忆与修通是康复的关键;记忆是自我感与自我认同的基础,自我是叙事的自我,拥有两套独立存在的记忆叙事,就是拥有双重人格;日记与自传是最重要的自我书写,它们是引领我们进入自己或他人内在世界的关键门户。在这样的自我中,注意只是一个上层、被动与被决定的功能。我们注意什么对象与是否能集中注意力,都是由无意识中真正负有精神能量的记忆所决定,自觉注意集中的自我,只是一种表相,而非真正的自我。然而,近年来,注意似乎有逐渐取代记忆成为自我核心的趋势。不但注意力不足等精神病理备受关注,注意力也被认为是包括记忆在内等认知学习能力,以及生产力创造力的基础。各种传统或新创训练操弄注意的身心技术,包括静坐冥想内观正念减压瑜伽禅修甚或催眠等,如雨后春笋般出现,成为新兴或再流行的自我技艺与疗愈方法。无论注意集中的对象是身体某部位、某个意念或公案、某件事物、甚或只是一片虚空,注意凝集是这些技术共同重视而想实现的身心经验。即使部分技术源自追求泯除自我超脱苦乐的宗教修行,但它们的现代版本都强调注意凝集经验是自我感与快乐等正向情绪的重要来源,也能让人超越过去自我与现实环境的限制,因此具有良好疗愈效果,并能开发增进各种身体与心理能力,而有助于在现世中取得成功。
      参数|quote=值左起第6位存在换行符 (帮助)
  39. ^ 巫毓荃(中央研究院历史语言研究所助研究员). 注意力不足過動症爭議的十個話題. 历史学柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
    因此,精神科医师关注注意力不足,无论是在成人或儿童患者身上,是否是更广注意自我文化的一环?他们强调注意力对于学习成长、人际关系与情绪的重要性,治疗有助于改善儿童学业成绩,在成年患者身上,也可能帮助他们突破原本自以为的成就极限,或至少能获得原本难达到的注意凝集感受,本身就是一个正向的心理经验,而有助于改善情绪与自信。虽然在用来改善注意力的方法技术上有歧见,他们其实与批评者共有不少视野、论点与目标。这样注意文化所形塑的自我,其鲜明特征在于其更为身体性与情感性,也更仰赖直观体验,它由一个又一个的独立当下松散聚集而成,也因此更为断裂。什么是它背后的政治经济学呢?也许我们可以从不少企业尝试借由这些身心技术来提高员工生产力,以及政府热衷举办庆典晚会等能带来短暂快乐感受的大型活动中,找到一些线索。依循这样的理路,虽然对象仍是精神疾病,精神医学宗旨其实已有微妙但根本的正向转变,它不再只是要治疗苦痛,还追求创造快乐与提高生产力及创造力。
      参数|quote=值左起第6位存在换行符 (帮助)

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