| − | 羅素·巴克利（Russell Barkley）博士是一位臨床科學家，教育家和從業者，他撰寫，合著或共同編輯了許多有關ADHD和相關疾病的書籍，書籍章節，臨床手冊和科學文章。他是《承擔多動症：父母的權威指南》的作者。在此HealthTalk網絡廣播中，我們與Barkley博士討論了ADHD的診斷和治療，他為有關ADHD的常見問題提供了答案。<br />播音員：<br />在開始之前，我們提醒您，此計劃上表達的意見僅是我們客人的意見。他們不一定是HealthTalk或任何外部組織的觀點。而且，一如既往，請諮詢您自己的醫師以獲取最適合您的醫療建議。<br />現在，這是您的房東Heather Stark<br />希瑟·史塔克（Heather Stark）：<br />您好，歡迎來到我們的程序，ADHD診斷的挑戰。我是你的主人，希瑟·史塔克。<br />根據國家心理健康研究所的數據，大約200萬學齡兒童患有註意力不足過動症；也稱為多動症。許多病例將無法診斷，使父母感到沮喪和迷失。<br /><br />診斷多動症的道路可能漫長且充滿障礙。我們將仔細研究您在此過程中最有可能遇到的挑戰，並分享克服這些挑戰的策略。<br />加入我們的是Russell Barkley博士。 Barkley博士是紐約州立大學錫拉丘茲分校紐約州立大學上醫學院的精神病學研究教授，也是南卡羅來納州醫科大學的精神病學臨床教授。他是一位臨床科學家，教育家和從業者，撰寫，合著或共同編輯了20本書和臨床手冊，並發表了200多篇有關ADHD和相關疾病的性質，評估和治療的科學文章和書籍章節。他還是《承擔多動症：父母權威指南》的作者。<br /><br /><br />歡迎，巴克利博士。<br />羅素·A·巴克利博士：<br />非常感謝。我很感激。<br />希瑟：<br />醫生，當大多數人聽到多動症時，他們會想到一個只是注意力不集中或活動過度的孩子，但是正如您在書中所解釋的那樣，這種疾病還有很多其他原因。你能告訴我們注意缺陷多動障礙實際上是什麼嗎？<br />巴克利博士：<br />好吧，我們以最明顯的症狀來識別它，即過度活動引起的問題，例如躁動不安，蠕動或坐立不安，或四處亂跑和攀爬。第二個症狀是衝動，即無法抑制自己的行動和在行動之前進行思考。最後，關注的問題是-持續或保持專注的困難，嚴重的注意力分散問題以及記住他們應該做的事情的困難。那將是三個最明顯的症狀。但從本質上講，注意力缺陷多動症是人類調節自己的行為，負責或管理自己的行為的能力的一種障礙，這樣其他人就不必管理它們。我們已經將多動症視為一種自我控制障礙。<br />希瑟：<br />進展如何？<br />巴克利博士：<br />ADHD通常在學齡前開始。父母通常會開始注意到他們的孩子與其他人（3至6歲）之間的差異。儘管有些情況，尤其是輕度的情況，可能要到以後才被發現，因為孩子開始為求學而苦苦掙扎。通常，父母很早就開始注意到他們的孩子有所不同。他們的孩子不能坐著不動，不能專心，不遵守指示，而且比那個年齡的其他孩子通常更加情緒化和要求更高。他們可能會在孩子第一次上學前或與其他孩子一起玩耍時，或者在孩子進入幼兒園或一年級等正規學校就讀時發現這一點。他們開始直接或通過教師的報告認識到他們的孩子表現突出，無法控制自己並且行為不成熟。這些是父母經常聽到的短語。因此，它始於破壞性，不守規矩和困難的行為，以及行為不成熟。<br />然而，隨著進步，孩子們在記住被告知要做的事情上開始遇到問題。這是一種特殊的問題，稱為工作記憶，或記住您應該做的事情，當他們上學時，他們會為此感到苦惱。接下來的事情是他們有可怕的時間感。因此，通常，我們希望孩子大約在7或8歲或以後，要注意時間本身–當事情到期時，他們在30分鐘的時間內要做多少功課。儘管那時他們的時間觀念還很脆弱，但之後就會發展。多動症兒童有一個可怕的問題，他們經常不及時地漂泊，對完成工作需要多少時間，為時限做好準時準備等一無所知。那將持續到成年。<br />當他們升入更高的小學一年級時，他們很難遵守規則和說明，並且難以記住要做什麼，而且正如我所說，這是工作記憶的問題。到了青春早期，ADHD人們開始意識到，控制情緒存在問題。他們似乎無法像其他孩子一樣調節自己的感情。並不是說他們患有情緒障礙，抑鬱或焦慮。更重要的是，他們擁有我們其他人正常的焦慮和情緒，他們只是無法很好地處理它們。如果我們生氣，我們大多數人都可以停下來，數到十，思考一些事情，也許去“快樂的地方”，但是他們能夠在向別人展示之前改變自己的感受。多動症患者的能力較弱。最後，當他們進入青春期時，他們解決問題的能力不是很好，也就是說，當您遇到問題時能夠腳下思考。<br />希瑟：<br />那一定會讓孩子感到沮喪。<br />巴克利博士：<br />令人難以置信的是。<br />希瑟：<br />是什麼導致所有這些多動症症狀？<br />巴克利博士：<br />引起多動症的原因有很多，但是所有原因都屬於生物學領域，也就是說，特別是神經病學和遺傳學領域。<br />已知所有多動症病例中約有65％至75％是遺傳性的。也就是說，他們是家庭成員。這種疾病正從其他家庭成員那裡繼承下來，我們開始尋找導致這種疾病的基因。注意力缺陷多動症與人類身高一樣是遺傳決定的。因此，我們知道人類身高的這些差異大約90％是由我們的遺傳差異決定的，而注意力缺陷多動症幾乎是這樣，大約80％至85％的遺傳影響。很大一部分病例，很容易就佔了我們病例的三分之二，是遺傳病，或者我們所說的遺傳病。人們可以通過詢問家庭中是否還有其他人有這種行為，或者實際上自己被診斷出患有多動症，從而找出那些孩子是誰。<br />讓我給出一些統計數據來幫助闡明這一點。如果您有多動症孩子，那麼兄弟姐妹中的一個也有一定程度的患多動症的可能性為35％。由於我們從父母那裡獲得了基因，因此我們可以回顧一下父母，並說他們患多動症的可能性是多少？我們的父母之一也是患有多動症的成年人的比例在25％至40％之間。因此，這種疾病往往會在家庭中蔓延，或者換句話說，孩子會誠實地受到他們的疾病困擾。<br />約25％到35％的ADHD病例是由於發育中的大腦受傷而獲得的。這些大多數在懷孕期間的某個時間持續存在。例如，我們知道早產兒患多動症的風險很高；他們中的近一半會在五歲之前發展為該疾病。那是因為早產兒還沒有準備好出生，而且他們的大腦在分娩本身的創傷期間更容易受傷或輕度出血。不足為奇的是，這些嬰兒中有許多都是多動症。<br />另一個原因是孕婦在懷孕期間吸煙，這使多動症兒童的患病風險比正常人群高約2至3倍。我們也知道，飲酒也與這種疾病有關。飲酒的次數越多，孩子患多動症的可能性就越大，但是懷孕期間飲酒也會增加近三倍的風險。而且由於在懷孕期間傾向於吸煙的女性也可能會喝酒，反之亦然，因此您患這種疾病的風險現在增加了五到六倍。換句話說，懷孕期間吸煙和飲酒的婦女中有30％到40％的兒童可能患有這種疾病，因為這些化學物質會干擾大腦關鍵部位（額葉）的發育。與發展自我控制有關。還有其他原因，但是可以給您一個很好的印象。<br />希瑟：<br />如果您的家庭在遺傳上更可能發生這種情況，而母親恰巧在懷孕期間吸煙和飲酒，那是很糟糕的組合，對吧？<br />巴克利博士：<br />確實是。聖路易斯大學的理查德·托德（Richard Todd）已經進行了許多研究。他所做的一件事是證明這些原因相互影響。這不僅僅是遺傳或環境問題。可以兩者兼而有之。他已經證明，如果父母抽煙或喝酒，或同時吸煙和飲酒，都有ADHD基因的孩子，相比擁有基因或只吸煙的孩子，這大大放大了他們的孩子患有ADHD的可能性。因此，在某些家庭中，我們確實看到了這些原因之間的複雜性或它們之間的相互作用。<br />希瑟：<br />這有點令人恐懼，不是嗎？<br />巴克利博士：<br />當然可以。<br />希瑟：<br />在您的書中，您討論了有關導致這種情況的一些誤解和誤解，有些人仍然認為糖，養育不良或電視過多等會導致多動症。您是否熟悉其他神話？<br />巴克利博士：<br />我認為第一個神話是我不時聽到的神話，那就是這種疾病根本不存在。我們經常從批評家，社會懷疑論者或邊緣宗教團體那裡聽到，它根本就不存在，而所有這些都是為了製藥公司的利潤而彌補的。這當然是可笑的。我們已經發表了6,000多篇有關多動症的研究。其中將近3,000個發佈在我自己的網站上。我們有數百本書，關於這種疾病的會議也很多。所有這些都表明我們正在治療一種合法有效的疾病，與人們可能經歷的任何其他精神疾病一樣有效，例如精神分裂症，圖雷特氏綜合症，躁鬱症或重度抑鬱症。這些都是合法的精神疾病，ADHD與他們相處得很好。因此，不存在的神話一號表明，在宣稱這樣的主張的人們中，科學文獻令人震驚。<br />希瑟：<br />您提到了您的網站，我想確保人們有機會訪問它。在繼續講其他一些神話之前，您能否提供您的網站？<br />巴克利博士：<br />當然。這是我的全名，RussellBarkley.org。該網站有許多免費信息，與其他網站的連接以及對2500多個科學論文的引用。該網站上有ADHD的歷史以及國際共識聲明，該聲明是由85位世界領先的ADHD研究人員簽署的，說明了事實。<br />您詢問其他一些誤解。<br />其中之一是電視是否有助於多動症。答案是否定的，對此已經進行了詳細探討。儘管有一些初步研究表明可能存在關聯，但後續研究並未發現這種情況。實際上，事實恰恰相反，這是患有多動症的人傾向於看更多的電視，而不是電視引起了他們的多動症。這些人的注意力跨度很短，與之相比，例如，快樂閱讀小說或做需要大量持續精神努力的事情，電視的注意力要容易一些。<br />我聽到的另一件事是，玩視頻遊戲有助於多動症。我們沒有絲毫證據支持該特定想法。其他人則認為，現代生活的節奏僅僅是導致多動症的原因。我的朋友內德·哈洛韋爾（Ned Hallowell）寫了一本關於成人多動症的書，他做了這樣的表態。儘管我當然尊重內德的觀點，但在這種情況下他是錯的。我們根本沒有任何證據表明我們的生活節奏和文化節奏會導致注意力縮短。所有科學證據都將與該想法背道而馳，並指出神經病學和遺傳學是導致這種疾病的主要因素。<br />食品添加劑不時被認為與這種疾病有關，事實證明這並非事實。<br />希瑟：<br />聽起來有些人對狂犬病活動或註意力不集中的問題與多動症的整體診斷相混淆。可以生一個專心的孩子嗎？<br />巴克利博士：<br />是的，這是一個很好的觀點。做出區分將對我們有所幫助。所有的注意力不集中不是多動症。那是兩件事。您和我今晚可能熬夜，錯過了正常的睡眠時間，明天我們會發現自己變得有點貪婪，白日夢，注意力不集中，或者可能會分散注意力。但這不是多動症。這是一種暫時的情況，在這種情況下與睡眠剝奪有關，但這並不會導致您上升到ADHD水平。多動症是一種慢性疾病，個體無論是否有充足的睡眠，都難以集中註意力。但更重要的是，他們的自我控制有困難，睡眠不足對他們沒有幫助。由於這些短暫的情況，注意力缺陷多動障礙（ADHD）是一種更為深刻和普遍的疾病，而不僅僅是短時間內無法引起注意。<br />希瑟：<br />多動症還有哪些其他症狀？<br />巴克利博士：<br />正如我們已經提到的，經典症狀是煩躁不安和活動過度的問題。畢竟，這種疾病幾年前被稱為多動症。第二組症狀是涉及集中力的症狀-分散注意力和注意力領域。第三，也是極其不利的是衝動控制的問題-應當抑制行為時的困難。但是，除此之外，患有多動症的人的行為在每個時刻和每一天的變化都很大。他們有時能夠像其他人一樣做事。其他日子，他們根本無法集中精力。記住需要做的事情以及他們對時間的感覺的困難是伴隨疾病而來的障礙。因此，如果您看到的是我剛剛提到的事物群，則很可能是患有ADHD的疾病。<br />希瑟：<br />其他原因可能導致相同或相似的症狀嗎？虐待兒童怎麼辦？<br />巴克利博士：<br />如果這是身體虐待，孩子頭部受傷可能會導致腦部受傷，那麼這可能會導致類似的症狀，因為您已經損壞了大腦。大腦的前部非常容易受傷，這是我們認為可能導致多動症的一部分。但是，如果我們指的是不涉及頭部受傷的情感或身體虐待，那麼答案是否定的。我們看到與虐待兒童或情感虐待有關的缺陷類型與我們與多動症相關的行為不同。似乎受到慢性身體或情感虐待影響的大腦區域也不可能與多動症有關。我們已經排除了這一點。<br />我們能夠判定的是，患有多動症的孩子由於他們的挑釁和反對行為而更容易被他人虐待。他們撫養孩子的壓力很大。如果未成年人的父母撫養他們，或者自己患有多動症，或者由於某種原因而在心理上受到折磨，那麼這些父母可能比其他人更可能虐待一個困難的孩子。因此，多動症，特別是在存在對立，壓力或破壞性行為的地方，比正常兒童更容易引起照顧者（如父母）的虐待。<br />希瑟：<br />如果確實有從父母那裡繼承的傾向，那麼父母就有可能在掙扎。<br />巴克利博士：<br />確實有。<br />希瑟：<br />例如，天賦如何？我聽說有人說我的孩子在學校很無聊，這是因為她有天賦。那會給外面的孩子造成一些類似的症狀嗎？<br />巴克利博士：<br />我自己一直都在聽到，答案是絕對不會。有天賦的孩子不僅較不容易患多動症，也較不容易患其他精神障礙。我們發現，一個人越聰明，似乎就越有韌性，也就是說，他們通常能夠承受可能導致其他人發展為輕度精神病（例如焦慮症或精神病）的壓力和壓力。蕭條。這並不是說有天賦的人沒有這些東西。他們當然不是。但是可以說，他們患這些疾病的可能性較小，尤其是多動症。許多研究表明，注意力缺陷多動症與智力之間的關係是消極的，而不是積極的關係，也就是說，您可能會患上的注意力缺陷多動症越多，智力越差或智商就越低。<br />希瑟：<br />孩子的注意力缺陷多動症越多，智商就越低，這在大腦受損的孩子以及繼承這種傾向的孩子中是正確的嗎？<br />巴克利博士：<br />他們倆都是如此。但是，大腦受傷的人比遺傳多動症的人更低。但是我們不是在談論智商的嚴重不足。<br />我自己和其他人的研究表明，與正常人群相比，ADHD與智商測試的平均差異僅約5至10分。多動症患者表現出從智商下降到天才智力的整個智商範圍。平均而言，如果我們選擇100個多動症兒童的一組並測試他們的智商，然後取平均，我們會發現他們的智商約為93到95。正常人群的智商約為100到105。差異，但是他們肯定會回答您提出的問題，即多動症是否與天賦有關，答案是否定的。<br />希瑟：<br />還有其他可能伴隨或看起來像多動症的疾病嗎？<br />巴克利博士：<br />看到一個只有多動症的孩子是非常不尋常的。患有多動症的診所中約有20％或更少的病例只有多動症，而沒有其他。多動症通常與另一種並存的學習，發展或心理障礙有關。其中有學習障礙，這是我們在多動症中最常見的問題之一。<br />學習障礙是閱讀，數學，拼寫，閱讀理解或語言的嚴重延誤。一個在上述一個或多個區域表現出明顯延遲但在其他方面智力發育正常的兒童將被稱為學習障礙。但是學習障礙並不僅僅是在學校做得不好。它們是某些學術成就技能的非常具體的延遲。<br />25％至60％的多動症兒童可能有學習障礙。這是一個令人著迷的探索領域，因為目前尚不清楚為什麼會這樣。我們知道大多數學習障礙是單獨的疾病。它們不是多動症的結果。這些學習障礙可能與多動症有不同的遺傳學。因此，這引發了一個問題，即為什麼這兩種疾病往往會並存，並且答案雖然不確定，但似乎暗示這與父母的結婚對像有關。<br />如果我可以解釋的話，多動症成年人傾向於接受較少的教育，有學習障礙的成年人也是如此。結果，他們傾向於彼此交往，因為我們傾向於與具有相似教育背景的人們進行交往。例如，如果您受過高中教育，則傾向於與受過類似教育的其他人一起出去玩。您不一定會與擁有博士學位或法律學位的人混在一起。<br />我們認為這裡發生的事情是，多動症患者可能會與學習障礙者進行社交，而不僅僅是偶然的機會。如果他們結婚，那麼他們的孩子更有可能同時患有兩種疾病。或者至少這是當前的想法。<br />希瑟：<br />我想談一談我們的話題，即父母如果認為自己要與患有多動症的孩子打交道，應該如何去尋求診斷。<br />巴克利博士：<br />讓我快速解決其他一些問題。我們知道，大多數多動症兒童都是反對派，有些多動症兒童容易出現反社會行為。不過，這只是其中的四分之一。其中四分之三不太可能成為犯罪或犯罪。大約五分之一的人容易患上抑鬱症，尤其是在他們的青春期或成年時期，而三分之一的人到青春期時可能會發展為焦慮症。這些往往是與多動症相關的更常見的疾病。<br />您詢問父母如何尋求適當的診斷。可以理解，父母的第一人稱可能是他們的醫生，尤其是兒科醫生或初級保健專家，例如家庭醫生。他們可以向這些人尋求社區內的專家，他們可以評估他們的孩子是否患有多動症。如果這些兒科醫生，家庭醫生或其他初級保健人員接受了額外的培訓，有時可以自己做出診斷。但是，在大多數情況下，這些醫生是篩查者，還是確定有患這種疾病風險的兒童的人，他們最好將這些兒童轉介給精神疾病領域的專家。那將是接受過精神障礙培訓的兒童和成人精神科醫生以及其他相關專家。<br />但是，一定要從您的醫師開始。向他們詢問有關這種情況的去向。如果他們沒有幫助，請查看CHADD，這是美國兒童多動症兒童和成人的國家組織。您可以訪問他們的網站chadd.org。查看您附近是否有當地人。如果有，請與他們聯繫，因為從某種意義上說，這些父母已經對水進行了測試。他們發現了資源在社區中的位置，他們也許能夠將您引導到最好的人身上，以幫助您和孩子一起生活。<br />如果沒有，那麼醫學院或大學是一個很好的起點，精神病學和心理學部門可能會有所幫助。<br />希瑟：<br />謝謝你，巴克利博士。我們收到了來自亞利桑那州一位聽眾的電子郵件，“由於沒有血液檢查或ADD或ADHD的物理指標，醫生如何才能完全確定一個人有沒有被不必要的藥物治療？”巴克利博士？<br />巴克利博士：<br />記住我以前說過的話，沒有任何精神障礙，包括精神分裂症，躁鬱症，兒童自閉症甚至圖雷特氏綜合症等嚴重障礙，都沒有實驗室檢查。實驗室測試不是確定疾病是否存在或疾病是否有效的黃金標準。我們正在尋找的是聚集在一起並形成綜合症的個體的行為是否與其他疾病群或其他疾病的綜合症不同？我們是否可以確定與該疾病或其他疾病不同的特定原因或貢獻者；以及與疾病相關的風險是否不同。<br />我們看看人們對治療的反應如何。當他們患有這種疾病時，他們的反應是否不同於另一種疾病？這些是我們在科學中尋找的許多事物，它們可以確定一種疾病是獨特的並且是有效的。 ADHD滿足了我剛才提到的所有標準，這是基於數千個對此進行測試的科學研究得出的。因此，沒有血液檢測本身沒有任何意義。相反，我們要尋找的是個人的病史以及與這種疾病直接相關的抱怨。您並不是在抱怨尿床，抑鬱或焦慮。您抱怨集中註意力，抑制，多動或難以處理時間和健忘。當這些東西聚集在一起時，很可能個人患有這種疾病，並且這些問題至少持續了一年或更長時間。因此，它不像人們想像的那樣模棱兩可或主觀。<br />另一方面，我們正在研究嘗試提高診斷能力的方法-尋找其他測試，例如實驗室測試。將來，我們有可能能夠使用某些大腦成像技術或更可能地通過遺傳學診斷多動症。我們知道這種疾病是高度遺傳的。一旦我們發現了這種疾病的基因-我們已經鑑定出4種基因，還有15種看起來很有希望-那麼將來有可能使用基因檢測來補充我們的其他診斷程序。希望如此，但是我們沒有必要繼續進行疾病的診斷和處理。<br />希瑟：<br />網上的邦妮（Bonnie）問：“一個人能從車禍或頭部撞傷中獲得多動症嗎？”<br />巴克利博士：<br />是的，儘管它是這種疾病的較不常見形式。有多動症的獲得類型，您可以隨時接受這些東西。所有多動症中大約有7％似乎是由於人出生後經歷的頭部受傷。這些可能是諸如交通事故和跌倒之類的事情，涉及嚴重的腦震盪或挫傷。穿透頭部的傷口也可以做到這一點。當然，最常見的是車禍。如果大腦的前部受到輕微的損傷，並且其連接回到稱為基底神經節的結構，或者在小腦中部的大腦的後部，則這三個區域與多動症有關。如果他們受傷了，這個人很可能會開始表現出多動症的跡象。<br />希瑟：<br />實驗室測試或診斷測試如何？診斷多動症有什麼用嗎？<br />巴克利博士：<br />並不是的。那是因為目前任何實驗室檢查都沒有診斷出精神障礙。我們沒有對精神障礙進行血液或尿液檢查的事實，並不表示該障礙無效，並且做出此類陳述的人相當愚蠢。<br />我們的發現是，所有精神障礙都是根據您的病史，當前關注的問題和行為來診斷的，因為我們能夠通過其他渠道（例如對您了解的人）證實這一點。我們還查看了我所說的紙質記錄，即您的教育記錄，職業記錄，行車記錄和其他檔案，它們可能表明您已經有一段時間處於困境了。此外，我們將使用行為評級量表之類的東西，這是衡量人們行為以及行為異常程度的標準方法。<br />我們也可能會進行一些IQ測試，以確保您的問題不是由於智力低下或發育遲緩引起的。然後，我們將進行一些成就測試，以排除或排除我們已經提到的那些學習障礙。這將是對多動症兒童進行標準評估的方法。但是無需進行血液檢查，也無需進行任何實驗室工作。您不需要進行腦部掃描或其他神經成像技術，因為它們根本無法告訴我們誰患有ADHD，誰沒有ADHD。<br />希瑟：<br />它會讓父母感到緊張嗎？我們已經習慣了通過測試來告訴我們X，Y或Z。既然您所談論的一切都是主觀的，那麼您是否有父母對診斷有些擔憂？<br />巴克利博士：<br />父母可能會擔心，但事實並非如此。我認為需要提醒父母，在我們認為合法的所有醫療疾病中，幾乎有一半沒有針對他們的實驗室檢查。考慮一下，例如，您的頭痛。您可能會頭痛，並且頭痛可能是合法的。它甚至可能上升為嚴重的擊倒性偏頭痛。但是，絕對沒有醫生可以做的實驗室測試來判斷您是否頭痛或偏頭痛。我們只需要相信您的話。但是，我們不只是相信您的話。我們會聽您說的話，並查看您所報告的內容是否映射到我們對頭痛尤其是偏頭痛及其症狀的了解。我們可以將其與我們的研究結果相比較，並判斷您的報告是否針對這種疾病。多動症的工作方式相同。其他醫學疾病也是如此，尤其是那些與大腦和神經系統有關的疾病。<br />我們缺乏醫療檢查的事實不應引起父母對疾病可能無效或客觀的警告。父母的報告通常非常好–對我們來說足夠好，可以弄清孩子的問題可能是什麼。畢竟，我們已經研究了50到100年的兒童疾病。我們知道症狀可能是什麼，並且我們認真聆聽，以了解父母的報告可能與一種或另一種疾病特別相關。因此，我認為父母根本不需要擔心這一點。<br />希瑟：<br />巴克利博士，非常感謝。我確實想再問你一個問題。您提到，到4歲時，有57％的學齡前兒童可能被父母定為註意力不集中和活動過度，但是這些孩子中的大多數在三到六個月內就長大了。這是否意味著您不應該嘗試診斷4歲之前的孩子？<br /><br /><br />巴克利博士：<br />這意味著您需要小心。我並不是要說您無法做出診斷，但是我們需要提醒自己，注意力不集中，衝動和活動過度是2至4歲兒童的一部分。因此，僅由於某人難以集中註意力或專心致志，並不會自動使他們成為多動症。我們將做兩件事來確保您的孩子患有這種疾病。首先是要看到這種行為比該2至4歲年齡段的其他兒童發生的頻率和嚴重性要高得多。更重要的是，我們確保這些行為問題是長期的，並且至少持續了6到12個月。<br />Where we find that a child's behavior is severe, that is to say, that it is significantly inappropriate for their age and it's lasted six to 12 months, we can then rule out the normal child who is just transiently or temporarily inattentive and will eventually outgrow that. I like to say that you need to be cautious before 3 to 4 years of age, perhaps using the diagnosis of “at risk for ADHD” and make sure that we get that one year of stable [symptoms of the disorder. At that point, you can be pretty safe in assuming that the child has the disorder.<br />希瑟：<br />We have an e-mail from Arizona, “Since there are no blood tests or physical indicators of ADD or ADHD, how can a doctor be absolutely sure a person has it and isn't being medicated unnecessarily?”<br />Dr. Barkley:<br />There is a lot of concern about whether or not we are medicating people unnecessarily or needlessly. And I can understand why people might raise that question. That's because we have seen about a tenfold increase in the use of medications in the United States over the past 10 to 15 years. But before people launch into using that as evidence that there is something wrong, remember it could just as easily be evidence that we are doing something right, that we actually have better public health! After all, we're using more inhalers, more treatment of breast cancer for women and more treatments for men having prostate cancer.<br />There are lots of increases in treatments going on in the United States over the last 15 years that have to do with advances in medicine and science, better recognition on the part of the public about mental disorders. And, as a consequence, more people coming in who have legitimate disorders and, therefore, are going to be treated. Twenty years ago, we didn't recognize that adults could have ADHD. We barely recognized that girls could have ADHD. Therefore, we are seeing an increase in the population of girls, of teenagers and adults, who are being identified, diagnosed and treated. Those are legitimate increases because just 20 years ago only one in five people with ADHD as a child ever got diagnosed and treated. In the United States, currently, only one in 10 with this disorder is diagnosed or treated. We've still got a long way to go. A rise in medication use has been examined by three professional associations, and all three have concluded that the rise in medication use has nothing to do with drug abuse or diversion, or inappropriate use of medication with children or adults. What we are seeing here is simply an increase in public awareness and better public health, and that's good news.<br />希瑟：<br />Jen from Pennsylvania asks, “My daughter was diagnosed with ADHD when she was 6. She's now 9. Should I have her in therapy because her moods are changing?”<br />Dr. Barkley:<br />不必要。 If what she means is traditional psychotherapy, that form of therapy has not been found to be especially helpful for children with ADHD. If the mother believes that the mood changes are related to particular stresses that you can identify – maybe there's been a separation or divorce, some problems at school, or there has been an episode of abuse – then short-term counseling has proven to be useful. But, on [http://sound-directory.com/story.php?title=%EF%BB%BF%E7%8B%97%EF%BC%8C%E5%AD%A9%E5%AD%90%E5%92%8C%E7%99%8C%E7%97%87-%E6%9C%89%E4%BB%80%E9%BA%BC%E8%81%AF%E7%B9%AB- http://sound-directory.com/story.php?title=%EF%BB%BF%E7%8B%97%EF%BC%8C%E5%AD%A9%E5%AD%90%E5%92%8C%E7%99%8C%E7%97%87-%E6%9C%89%E4%BB%80%E9%BA%BC%E8%81%AF%E7%B9%AB-] , ADHD children often have trouble controlling their feelings, and it's not a sign that they have a mood disorder or that they need psychotherapy. It simply is part of the disorder. It means the parents just have to be a little bit more careful in how they deal with these children. If you have concerns about this, ask a mental health professional to evaluate your child because, as I said, about one in four to one in five children with ADHD will be prone to major depression. About one in three is prone to having anxiety disorders, and about 6 percent of ADHD children may be prone to a more severe disorder known as bipolar disorder in which mood swings are much more severe and more common. That's a disorder that needs to be evaluated and treated very quickly.<br />希瑟：<br />When I read that question, doctor, I was wondering if she was asking about the changes in adolescence, if maybe that was causing some mood changes.<br />Dr. Barkley:<br />有可能Let me speak to that. As young girls begin to enter puberty and develop their menses, they may develop premenstrual tension syndrome, or what parents would think of as simply moodiness and mood swings a few days before their period. That is typical of normal females. But if you have ADHD, it's going to exacerbate those times of the month. So the individual is going to be much more difficult to get along with during that time. The teenager with the disorder is going to find himself or herself having mood swings greater than other people and not able to cope with them as well as others. Some physicians may elect to use medications for that period a couple of days before the menstrual cycle begins in order to help these teenagers cope with their mood swings. Other times, it's simply a matter of exercise, proper diet, making sure they are getting enough sleep, and sometimes re-adjusting their ADHD medications, if they are on medication.<br />希瑟：<br />Kerry in South Dakota asks a good question, “How do you know when you've outgrown ADHD as an adult?” She says she's 30 years old and was diagnosed when she was 9. She's not on medication and hasn't been for the past seven years.<br />Dr. Barkley:<br />That's a fantastic question because I'm actually doing a longitudinal study in the city of Milwaukee that's been going on for more than 20 years. Like other studies, we have followed our kids into adulthood. But one of the things we pay particular attention to is this question of just how many people have outgrown the disorder. I can give a pretty precise answer. Anywhere between 14 and 35 percent of the individuals with this disorder will outgrow it by the time they reach age 30. So about one in three are going to outgrow the disorder, that is to say that they are fully normal. Their symptoms have remitted, they are no longer finding themselves impaired in major life activities by the disorder, and they are no different from people in our control groups. That's good news because it suggests that about 35 percent of these people outgrow it.<br />The bad news is two-thirds of them don't outgrow it, and they remain fully symptomatic into their adult years. If that's the case, then they are going to continue to experience these difficulties with attention, distractibility, working memory, sense of time, organization and impulsiveness. And that will continue to follow them as they move into their middle and late years. ADHD runs in my family, and I'm very familiar with individuals at various stages of life who continue to have these symptoms. So it does continue in about two-thirds of the cases, and those individuals should seek treatment because ADHD is a highly treatable disorder.<br />If it is left untreated, it is among the more serious outpatient disorders that we deal with. My own research shows it's far more serious than anxiety disorders, mild depression or some of the more common reasons that people seek counseling. It can be treated, often effectively, with various treatments that we have available right now. So, by all means, adults who think that they continue to have this disorder should seek treatment for it. They will find their lives vastly improved if they do.<br />希瑟：<br />That leads us to Kelly's question. Kelly is from San Diego and she asks, “Can you get better with ADHD without taking medicine?”<br />Dr. Barkley:<br />You will continue to get better year by year, even off medication, but that's because normal people are getting better year by year as they grow up. The front part of the brain, known as the executive brain, which gives us our ability to control our behavior, organize it over time, pay attention to the future and deal effectively with other people takes 30 years to reach its full maturity. During that 30-year period, everybody is getting better. All of us are better at 10 than we were at 5, better at 18 than we were at 10, and better at 25 to 30 than we were at 18. People with ADHD show that same developmental trend. They, too, are getting better.<br />What we are also noticing is that many of them do not catch up with the normal population. Everybody is getting better, but most people with ADHD continue to be behind others their age, about 30 percent behind than other people their age are likely to be in these traits. But I want to come back to the good news. We find a small percentage, about one-third of them, have fully outgrown their disorder by the time the front part of the brain is mature. Those individuals, of course, don't require any additional treatment.<br />希瑟：<br />It sounds like some of the symptoms that you're describing could have some social implications. Jackie, from Largo, Florida, says that her child is very alone in school. She barely has any friends even though she takes medication. Can medication help change her over time to help that situation of her being so alone?<br />Dr. Barkley:<br />Yes, it can. Jackie raises a good point here that we need to talk about because often families focus more on education and those impairments where ADHD takes a tremendous toll on a person's social functioning. You may not know it, but 70 percent of ADHD children are utterly friendless by the end of third grade. Having no close friends, no one inviting them to birthday parties, they tend to be shunned by their social group. That's devastating because you and I know that what sustains us through life are the friendships that we build. It isn't how well we did in school, it's social relationships that we fall back on. ADHD children will find themselves without these friendships or with much fewer of these friendships than other people.<br />It's heartbreaking to see it happen, but research shows that the treatments we use for ADHD, both the medications and behavioral and psychological interventions, are able to improve this realm of a child's social function, making them more likeable to their peer group. In addition, I often counsel parents to make their home the best place to be on that street or in your neighborhood. Children should want to be at your house, even if they may not necessarily like your child as much as they like other children. They know that you are a great mom, that you have lots of snacks, the best toys, the best things to play with out in the yard and that your home is a welcoming place for children who may need a place to play.<br />By making your home this very welcoming place, children will come by and overlook some of your child's immaturities and difficult behavior because they simply like being around you and the things you offer at your home. That may sound like bribery, but do what you can to increase your child's exposure to other children.<br />希瑟：<br />It sounds like when parents are weighing whether or not medication is a good option, they should definitely take into consideration the social implications of not being medicated.<br />Dr. Barkley:<br />絕對。 I want to emphasize that because all too often parents pay attention to school and nothing else. I want to remind parents that the best predictors of how well people do when they move into adulthood is not how well they did in school. Teachers are lousy at predicting who will be the most successful people in life. They are much better at predicting who will be the most successful people in school. So the fact that your child may be a mediocre student is not the thing to worry about. It's really these out-of-school things that have to do with social relationships that your child excels at, whether that is sports, clubs or organizations, music, or just some talent that your child has. I tell parents to go overboard in getting your child involved in those noneducational activities because they will help balance out the difficulties and struggles they have in school and provide your child with another source of self-esteem and success.<br />希瑟：<br />Let's bounce back to the ideas of diagnosis again. Katie from Baltimore is asking, “How long should it take to get a firm diagnosis, and how important is it to get a second opinion?”<br />Dr. Barkley:<br />Katie is quite right. We need to do a better job in this country of getting a quicker diagnosis. We are better than other countries. For instance, I helped conduct a survey just a couple of years ago of 10 different countries besides the United States, and one of the questions we were looking at is how long it took to get a diagnosis. We found that it was a little less than a year in the United States from when a parent had asked for help from a professional and when their child was properly diagnosed. Although that turned out to be the shortest interval of time of any of the countries that we surveyed, including Europe and elsewhere, it is not good enough. For every month that your child is not properly diagnosed and treated, there is the chance that your child may be exposed to irreparable harm.<br />ADHD children are four times more prone to accidental injuries and seven times more prone to poisonings. Teenagers with ADHD have four times the rate of car accidents, some of them lethal. We need to take these things into account. I think that a parent should pursue this aggressively if you think your child has ADHD. Start with your physician, start with the local medical school or psychology department. Look for the local CHADD organization. Find an expert on ADHD and get your child evaluated. If your child was seen in primary care by someone who is not an expert in mental health and you've got the diagnosis of ADHD, if you're not comfortable with that, then seek a second opinion through a mental health professional. A child psychologist or psychiatrist tends to be most likely trained in this area to render a more appropriate diagnosis. We always encourage second opinions where there's doubt.<br />希瑟：<br />Mallory from Tacoma, Washington, says her son has been diagnosed as ADD/ADHD, and they have tried four or five different medications, but all of them made the child sick. What other options does she have? What should she ask her doctor?<br />Dr. Barkley:<br />There are at least 15 different medications or delivery systems that may be helpful for ADHD children. The fact that a few have been tried doesn't necessarily mean that some of the others may not work. We've even found that some children may not do well on a particular stimulant such as methylphenidate, or they may not do well on one of the once daily delivery systems like Concerta (methylphenidate). But if we switch them to a different formulation, then they seem to do okay with that.<br />Sometimes, the problem is what we call the delivery system or the extended release form of the medication, or they may have to switch over to a different medicine like Adderall (mixed amphetamines) because they are not responding to methylphenidate. There are the drugs that are not stimulants such as Strattera (atomoxetine) and Wellbutrin (bupriopion), and those also are effective for ADHD children, especially if they have mood or anxiety disorders.<br />I think people who are finding that certain medications may not be working can talk with their physicians about what the other options might be. Assuming that none of the medications are working, which is true for about 8 to 10 percent of ADHD children, then the next thing is to try what are called the psychological or behavioral interventions. These don't work quite as well, and they require much more effort on the part of parents and teachers, but they can help to contain the disorder and allow the child to be more effective than doing nothing at all. But they are not going to be as good as the medicines. They are not going to go throughout the child's day as well as the medications are able to do. I would, first of all, check to see whether or not there are other medicines that may be helpful for the child, then combine that with some of the well-known psychological treatments for ADHD to see if that might not work.<br />希瑟：<br />Yolanda from Tennessee asks, “How do you get your teen-adult to continue with the medications administered by the physician?” It's been hard to get her son to take his meds. He says he doesn't need that stuff.<br />Dr. Barkley:<br />That is very common. First of all, realize that it is common. It's not abnormal. Your teenager is actually going through a normal phase of being an adolescent. They are trying to separate from you and establish their independence. They are making decisions for themselves and establishing themselves as separate from their parents. Sometimes that means turning away from the medical recommendations that may have been made for them. We see this same problem in the field of diabetes, epilepsy, blood pressure and obesity. Name any area of medicine and you will hear people say that getting teenagers to comply with medical recommendations is the single greatest difficulty.<br />First of all, I want to reassure this parent and all parents of teenagers, that the fact that your teenager may not be as cooperative as you would like them to be is not a sign that you are any different than the rest of us. All of us have difficulties with our teenagers, especially our ADHD teenagers. The next thing to do is to negotiate. Don't demand. Negotiate like you would do with another adult. You can't force another adult to do something they don't want to do, but you can do a couple of things to increase the likelihood that they help themselves and participate in these treatment recommendations. First of all, make sure that they've got accurate information because sometimes the reason for their denial is that they don't understand the disorder as well as others. They may respond to information from the parent. If not, there are plenty of Web sites out there such as the CHADD Web site that can provide information that your teenager can read on their own and learn about their disorder.<br />Next, meet with a professional and have the teenager meet privately with their doctor to talk about their disorder. Oftentimes, the teenager will listen to a third party or another adult where they won't listen to a parent. Let's make sure that your teenager has the best information available before we assume that it's just good old adolescent rebellion. Once the teenager has the information they need, next is what can we negotiate to make this a win-win situation? Oftentimes, taking the medication is a win for the parent because the teenager is more compliant and is doing better in school. But there are side effects to these medications that are annoying. The teenager may have a stomachache or headache, or isn't sleeping well, or feels a little irritable on these medications and, therefore, doesn't like taking these medications. Contrary to popular belief, these medicines don't make you high or give you a sense of euphoria. They tend to make you not feel particularly well. In some cases, they make people feel a little stressed, easily annoyed, tense, and they don't like that and want to quit the medication. So we often try to negotiate a consequence for the teenager that they want.<br />For instance, if your teenager is of driving age, then negotiate driving privileges as part of this. For every day you take your medication, you will be able to earn time using the family car. If you don't take your medication, we're not going to let you drive as often. Teenagers with ADHD who don't take their medicines are the worst drivers, bar none, in the United States, having four to five times the speeding tickets, three to four times the auto accidents and two to three times the severity of auto accidents. Your teenager could be killed driving a car when they are off their medications, or could kill someone else. I have cases of both in my practice.<br />希瑟：<br />好的。 I want to make sure I get in two last questions – one is from Joan from Oxford, Pennsylvania. Her 12-year-old seems to be doing better in school, but she is worried about the medications and their effect long term. Is it better for her to just be focusing on how much better her child is doing in school?<br />Dr. Barkley:<br />是。 We've studied the medications long term. The stimulants are the best studied medications given to children with any mental disorders, and I would say they are the most studied medications in all of pediatrics. So you've got about as much information as you are going to have with any medicine. The information that we have so far indicates that these drugs are safe when used over the long term.<br />There are a few problems that children may have with mild weight loss and difficulties growing during the first year or two they are on medication. Very few children have that problem, however, and it is a temporary problem. Usually within two to three years, the children have caught up with their peer group in growth. All of the studies, including my own in Milwaukee, show that by adulthood there is no difference in height or weight between children who took medication for a decade or more and children who did not take medications. So rest assured any effect on growth is temporary.<br />希瑟：<br />Doug in Washington, D.C. says he wants to wait before resorting to medication. Is there a downside to waiting as long as possible?<br />Dr. Barkley:<br />Just know that medication is the most effective thing we have, so you are postponing the more effective treatment to pursue the less effective treatments. That's fine, as long as your child is not moderate to severe ADHD and at risk. But if your child has safety risks – accidental injuries, poisonings or posing harm to other people – or if your child is at risk of being kicked out of school, don't delay. I think those are incidences where you need to combine the medication with the psychological treatment to get as quick a response as you can.<br />With mild ADHD, if you want to wait a few months, try the behavioral interventions, see how well they do, then have at it. No one is going to be concerned about that. But don't put your child at harm because you have some concerns about medication.<br />希瑟：<br />Thank you, doctor. How about letting us know how we can get your book.<br />Dr. Barkley:<br />“Taking Charge of ADHD” is available through Barnes & Noble, Amazon and through major booksellers in the United States, on the Internet and through my publisher, which is Gilford.<br />希瑟：<br />And again, your Web site is russellbarkley.org?<br />Dr. Barkley:<br />是。<br />希瑟：<br />I want to thank you, Dr. Barkley, for joining us. And thank you all for listening at home. I've learned a lot and I hope you have too.<br />我來自HealthTalk，是希瑟·史塔克（Heather Stark）。祝您有個愉快的夜晚。<br /><br />
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