Attention Deficit Hyperactive Disorder ADHD ADHD 1 Inattentive

Attention Deficit / Hyperactive Disorder (ADHD) 注意力缺損過動症

ADHD診斷類型 三亞型 1. Inattentive type 注意力不集中型 2. Hyperactive impulsive 過動衝動型 3. Combined type 結合型 (1+2)

注意力缺失/過動疾患 流行率及人口區域表現 5. 3%, 102 studies, 171, 756 children. Africa 8. 5%, South America 11. 8%, Asia 4. 0%, Europe 4. 6%, North America 6. 2% Polanczyk et al. The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis. Am J Psychiatry 2007; 164: 942– 948.

流行病學 • • • 高淑芬 (2004): 7. 5 -3. 8% in G 7 -9 國中學生 Hou (2003): 6. 4% 國小學童 Tzang (2002): 8. 4 -11. 7% 國小學童 趙家琛 (1998): 7. 5 -9% 小三 四國小男童 Leung (1996): 8. 9% 香港學童 • 6 -9% US 5 -12 y/o children, 60 -80% functionally impairing symptoms into adolescence and 50% into adulthood. Pliszka 2007 • National comorbidity survey, 3199 adults (19 -44) 4. 4%. Kessler 2006

ADHD and the Impairment of Social and Emotional Behaviors Strengths and Difficulties Questionnaire, based on the 2003 National Health Information Survey, USA, Strine et al. , 2006, Preventing Chronic disease, http: //www. cdc. gov/pcd/issues/2006/apr/05_0171. htm

Social and Emotional Behavioral Problems in Children with ADHD European survey of parents of children with ADHD (n=910) and without ADHD (N=995). *† p<. 0001 , (Coghill et al. , Child and adolescent psychiatry and mental health, 2: 31, 2008)

Emotional problems • Low self-esteem 低自尊 • Self-perception of incompetence 自覺無能力 • 焦慮 – 27 -30% met criteria for an anxiety disorder (Biderman 1991) – 28% of preschooler, 22% of school-age children (Wilens 2002) • 憂鬱 – 25 -30% of children with ADHD

Peer relation • More than 50% of children with ADHD have significant problems in peer relationship (Pelham 1982) • Less knowledge about – social skills, appropriate behavior with others (Grenell 1987) • More likely to be engage in – Bullying, Victimized in bullying episode (Unnever 2003) • Children with ADHD are stigmatized by their behavior – – Troublemaking Excessive talking Breaking rules Impulsive aggression (Barkley 1991)

Parent-Child relation • ADHD affects the interaction of children with their parents (especially with mother) – Greater intrafamily conflicts (Danforth et al. 1991) – Children with ADHD (Barkley 1985) • More talkative, negative, and defiant • Less compliant and cooperative • Less able to play and work independently of their mother • Mother of children with ADHD (Hoza et al. 2000) – Low self-esteem – Lower parenting efficacy • Disturbance of interaction – Stem from the effects of a child’s behavior rather than parent’s behavior on the child ( Fischer 1990)

Academic & School performance • Lower academic performance than their classmates – By 10 -30 points on standardized achievement test – Including reading, spelling, math, and reading comprehension • Disruptive classroom behavior • Underperforming in school relative to ability – Repetition of a grade (30% or more) – Be placed in one or more special education programs (30 -40%) – Suspended from school (up to 46%) (Barkely et al. 1990)

Impact of ADHD in adolescence Data from Barkley RA; 26 (A) Impact at school; (B) impact on health, social, and psychiatric wellbeing.

Antisocial behaviour in adolescents with ADHD Data primarily represents outcomes in those with conduct disorder as teenagers Harpin, V A Arch Dis Child 2005; 90: i 2 -i 7

認識 ADHD 青少年 • • 過動情形可能較不明顯 注意力缺乏行為 學業成績不良 缺乏注意力 容易衝動 缺乏組織技巧 缺乏時間觀念 Ingram S. Mental Retardation and Development Disabilities Research Reviews. 1999; 5: 243. Weiss M, Jain U. ADHD Report. 2000; 8: 4 -10.

認識 ADHD 其他合併症狀 • 超過 50% ADHD 青少年有其他合併症狀 – 50% 對立性反抗性行為 (Oppositional Defiant Disorder) 或行為規範障礙 (Conduct Disorder) – 40% 焦慮 – 20% 憂鬱 – 30% 物質濫用行為 (Substance Use Disorder， 包括吸毒, 抽煙, 酗酒, 藥物濫用) • 約 50% ADHD 兒童具有學習障礙 Biederman J et al. Am J Psychiatry. 1991; 148: 564 -577. Pomerleau OF et al. J Subst Abuse. 1995; 7: 373 -378.