【五分钟科普】注意力缺陷与多动障碍 (Attention-Deficit/Hyperactivity Disorder)

ADHD（注意力缺陷与多动障碍）是困扰很多留学党和工作党的话题，但是在中文圈子里，它依然没有被非常广泛的看到。我们邀请到了来自哥伦比亚大学社会工作学院的马博妍小姐姐，来做一期科普。ADHD是否符合你（或对于一些家长而言，你家的小朋友）的情况？欢迎阅读。

全文阅读时长约为5-6分钟。

此篇文章不作为任何个体心理健康诊断、治疗与评估的依据，仅作科普，如有需求，请寻求在你所在地区的执业心理咨询师进行进一步评估治疗。

01.

什么是Attention-Deficit/Hyperactivity Disorder (ADHD)？ADHD有多普遍？

注意力缺陷与多动障碍 (Attention-Deficit/Hyperactivity Disorder) 是儿童最常见的神经发育障碍之一，俗称多动症。ADHD通常起病于儿童时期，并经常可以持续到成年。ADHD儿童可能难以集中注意力，难以控制在不考虑结果的情况下的冲动行为，或者过于活跃。

ADHD的全球患病率在儿童中为5.9%至7.1%，在成人中为1.2%至7.3% (Huss et al., 2017)。在中国，儿童和青少年的ADHD患病率是6.26% (Fan et al., 2022)。相比于女孩 (6%)，男孩 (13%) 被诊断为ADHD的概率要高出大约7% (Bitsko et al., 2022)。相比于西班牙裔儿童 (8%) 和亚裔儿童 (3%)，非洲裔儿童 (12%) 和白人儿童 (10%) 被诊断为ADHD的现象更为普遍 (Bitsko et al., 2022)。

02.

根据DSM-V，什么是ADHD的主要症状和诊断标准？

注意力无法集中 Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

1. 经常不注意细节 Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

2. 在活动中经常无法集中注意力 Often has trouble holding attention on tasks or play activities.

3. 在对话中经常表现为无法倾听 Often does not seem to listen when spoken to directly.

4. 经常不按照指示做事 Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

5. 经常不能很好的安排任务和活动 Often has trouble organizing tasks and activities.

6. 经常避开/厌烦需要注意力的活动 Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

7. 经常丢失重要物品 Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

8. 容易被分心 Is often easily distracted

9. 记忆力不好 Is often forgetful in daily activities.
   

ADHD患者经常不能很好的安排任务和活动。

多动和冲动 Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

• 经常坐立不安 Often fidgets with or taps hands or feet, or squirms in seat.

• 经常离开座位 Often leaves seat in situations when remaining seated is expected.

• 经常追跑打闹 Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

• 经常不能安静地玩耍和参加活动 Often unable to play or take part in leisure activities quietly.

• 经常静不下来 Is often “on the go” acting as if “driven by a motor”.

• 经常说过多的话 Often talks excessively.

• 经常在问题被完整提出前抢答 Often blurts out an answer before a question has been completed.

• 经常没有耐心等待 Often has trouble waiting their turn.

• 经常打断别人 Often interrupts or intrudes on others (e.g., butts into conversations or games)

• 除上述诊断标准外的重点 Other requirements:

• 一些注意力缺陷或者多动症状在12岁之前出现 Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

• 症状在两种以上的场合出现 Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).

• 出现的症状已经影响正常生活 There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

• 出现的症状不匹配其它精神疾病的症状 The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

03.

ADHD的三种主要类型

注意力不集中型 Predominantly Inattentive Presentation

很难独立完成任务、注意细节、听从指挥、容易分心或遗忘日常生活中的细节 It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

冲动型 Predominantly Hyperactive-Impulsive Presentation

经常说很多话、很难静下来长时间、经常追跑打闹、打断别人、没有耐心等待、有更多的磕碰伤 The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

注意力不集中和冲动混合型 Combined Presentation

同时出现上述两种类型ADHD症状 Symptoms of the above two types are equally present in the person.

注意力不集中型的ADHD患者很难独立完成任务、注意细节、听从指挥、容易分心或遗忘日常生活中的细节。

04.

ADHD的成因

1. 环境因素 Environmental Factors

   孕前、妊娠和围产期状况 Preconceptional, Gestational, and Perinatal Conditions

早产是ADHD的一个重要的危险因素。早产可能直接/间接导致新生儿出生体重低 (Low birth weight)、神经发生的改变 (Neurogenesis)、细胞死亡 (Cell Death)、炎症 (Inflammation)。这些因素都会增加患ADHD的风险 (Núñez-Jaramillo et al., 2021)。

小鼠模型研究表明，雌性小鼠在交配前服用乙醇连续8周，其后代表现出类似ADHD的症状，如过度活跃、冲动和注意力缺陷 (Choi et al., 2012)。

更有实验研究表明，在小鼠怀孕和哺乳期间接触溴氰菊酯农药 (Pesticide deltamethrin) 会导致幼鼠具有ADHD相关症状，如工作记忆和注意力缺陷、多动和冲动等行为 (Richardson et al., 2015)。

重金属暴露 Heavy Metal Exposure

一项针对在校学生的研究表明，患有ADHD的儿童（6–7岁）的唾液中，汞含量较高 (Barry et al., 2020)。

一项关于饮用水中锰含量与ADHD之间关系的研究发现，随着饮用水中锰含量的升高，儿童患ADHD的风险更高 (主要为注意力不集中型ADHD) (Chan et al., 2015)。

一项分析患ADHD儿童血清中不同金属浓度的研究报告表明，这些儿童血液中铬、锰和锌含量较低，而铜含量所占比例较高 (Skalny et al., 2020)。 

睡眠障碍 Sleep Disorders and ADHD

在 ADHD 患者中发现的睡眠障碍包括入睡障碍、失眠、睡眠呼吸障碍、夜间活动增加、睡眠焦虑、咬牙、周期性肢体活动、双腿无法平静、睡眠时间缩短、频繁起夜、等等。其中，入睡障碍是最常见的一种，在 73-78% 的 ADHD儿童和成人中都存在此现象。入睡障碍会导致白天嗜睡和认知功能下降 (Bijlenga et al., 2019)。

遗传因素 Genetic Factors Associated with ADHD

ADHD是一种涉及大量基因的多基因疾病，一项关于 ADHD全基因组的研究证实了这一点，该研究报告了与ADHD相关的12个重要基因位点。许多与 ADHD 相关的基因参与神经传递、神经突发生、突触发生或突触中的受体定位等过程 (Martinez-Morga et al., 2018)。

05.

ADHD的治疗方法

药物治疗 Pharmacological Treatment

• 哌甲酯 (Methylphenidate) 和托莫西汀 (Atomoxetine) 是两种治疗ADHD时最常用的药物。这两类药物可减少患有 ADHD 的儿童和青少年的过度多动、冲动和注意力不集中的症状。当然，服用这两类药物也会有相对的副作用。主要不良反应为食欲下降、恶心、头痛、失眠、鼻咽炎、头晕、腹痛、烦躁、和嗜睡 (Cerrillo-Urbina et al., 2018)。

• 非药物治疗 Non-Pharmacological Therapies

• 家长行为训练 Behavioral Parent Training

• 家长行为训练的目的是让家长掌握有助于管理孩子出现的 ADHD 相关行为的方法。儿童工作记忆的提高和父母谨慎的反馈可以更好的改善患ADHD儿童注意力不集中的相关问题。父母更强的自我约束能力有助于改善ADHD儿童的行为问题。家长行为训练可以促进良好的家庭氛围，同时减少了ADHD儿童出现问题的频率和问题的严重性，同时减轻了父母的压力 (Ciesielski et al., 2020)。

• 认知行为疗法 Cognitive Behavioral Therapy (CBT)

• 认知行为疗法 (CBT) 也已用于治疗 ADHD。认知行为疗法是一种结构化的、以目标为导向的心理疗法。心理健康相关的专业人士通常使用此疗法来治疗或管理来访者的心理健康状况和情绪问题。认知行为疗法是最常见和研究最多的心理治疗形式之一。有研究表明，无论是单独使用还是与其他疗法结合使用，认知行为疗法对于改善ADHD症状都有积极影响 (Pan et al., 2019)。

• 注意力训练 Attention Training Techniques

• 注意力训练通常用于改善生活质量和增加生活幸福感。鉴于这些训练对大脑活动、注意力和自我调节的积极影响，目前正在研究它们用于减少ADHD症状和改善患者的生活质量。基于正念的干预(Mindfulness-based interventions) 对ADHD的影响发现，注意力训练在患有ADHD的成年人中很受欢迎，使其专注力有所改善 (Aadil et al., 2017)。

如果你或你认识的朋友有心理咨询需求，欢迎通过下面的链接联系我们，预约心理咨询。

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