Recent Advances in the Prognosis and Influencing Factors of Attention Deficit Hyperactivity Disorder in Children

doi:10.12114/j.issn.1007-9572.2019.00.080

Abstract

Abstract: Over 50% of the persons who suffer from attention deficit hyperactivity disorder （ADHD） in childhood，still have obvious ADHD symptoms in adulthood.If the symptoms are poorly controlled，they can continue to exert negative impacts on the patient and his family，hinder the patient's academic，social functioning and emotional functioning and behavioral normal development，resulting in poor academic performance，low occupational status，increased risk of drug abuse，and even committing a crime.ADHD seriously impairs the patient an social functioning and quality of life，even leads to mental or personality disorders.Many factors，such as severe ADHD symptoms in childhood，comorbidities，inappropriate treatment，poor family and social environments，and biogenetic causes are associated with the poor prognosis of the disease in adulthood.This article mainly expounds and analyzes recent advances in the prognosis of childhood-onset ADHD in adulthood and influencing factors.

Key words: Attention deficit disorder with hyperactivity, Child, Prognosis, Root cause analysis

摘要： 儿童注意缺陷多动障碍（ADHD）不仅存在于儿童期，大约50%以上的患儿成年后仍存在明显的症状，如果ADHD症状控制欠佳，会持续对患儿及其家庭产生不利影响，阻碍患儿的学业、社会和情感功能和正常的行为发展，造成学习成绩差、职业地位低、滥用药物危险性增加和犯罪等不良后果。严重影响患儿的社会功能和生活质量，严重者还会出现精神障碍或人格障碍。儿童期ADHD症状越重，共患其他疾病，治疗情况，不利的家庭和社会因素及不良的生物遗传学因素等，均与ADHD持续到成年期的不良预后有关。本文主要就ADHD成年期预后及其影响因素研究进展进行阐述和分析。

关键词: 注意力缺陷障碍伴多动, 儿童, 预后, 影响因素分析

ZHAI Qian,FENG Lei,ZHANG Guofu. Recent Advances in the Prognosis and Influencing Factors of Attention Deficit Hyperactivity Disorder in Children　[J]. Chinese General Practice, 2019, 22(14): 1712-1716. DOI: 10.12114/j.issn.1007-9572.2019.00.080.
翟倩,丰雷,张国富. 儿童注意缺陷多动障碍预后及其影响因素研究进展[J]. 中国全科医学, 2019, 22(14): 1712-1716. DOI: 10.12114/j.issn.1007-9572.2019.00.080.

References

［1］ANTONY A.Study of factors influencing treatment adherence in childhood attention deficit hyperactivity disorder in a tertiary healthcare facility［J］．Indian J Psychol Med，2016，38（1）：20-24．DOI：10.4103/0253-7176.175094.
［2］胡虞志，吴汉荣，余剑强.6~12岁儿童注意缺陷多动障碍的分型及病因研究［J］．中国校医，1998，12（5）：321-324.
HU Y Z，WU H R，YU J Q.Subtyping and inquiring for etiology of children ADHD aged 6 to 12 years［J］．Chinese Journal of School Doctor，1998，12（5）：321-324.
［3］CASTELLS X，BLANCO-SILVENTE L，CUNILL R，et al．Amphetamines for attention deficit hyperactivity disorder （ADHD） in adults［J］．Cochrane Database Syst Rev，2018，157（8）：CD007813．DOI：10.1002/14651858.CD007813.
［4］GAIDAMOWICZ R，DEKSNYTE A，PALINAUSKAITE K，et al．
ADHD-the scourge of the 21st century?［J］．Psychiatr Pol，2018，52（2）：287-307．DOI：10.12740/PP/67111.
［5］刘寰忠，钟怡．2018版加拿大儿科学会《儿童青少年注意缺陷多动障碍诊疗指南》解读［J］．中国全科医学，2019，22（14）：1641-1647．DOI：10.12114/j.issn.1007-9572.2018.00.452.
LIU H Z，ZHONG Y．Interpretation of Canadian Pediatric Society clinical practice recommendations for children and adolescents with attention-deficit hyperactivity disorder （version 2018）［J］．Chinese General Practice，2019，22（14）：1641-1647．DOI：10.12114/j.issn.1007-9572.2018.00.452.
［6］American Psychiatric Association. Diagnostic and statistical manual of mental disorders，4th edition，text revision（DSM-Ⅳ-TR）［M］.Washington，DC：American Psychiatric Association，2000.
［7］COOK J，KNIGHT E，HUME I，et al．The self-esteem of adults diagnosed with attention-deficit/hyperactivity disorder （ADHD）：a systematic review of the literature［J］．Atten Defic Hyperact Disord，2014，6（4）：249-268．DOI：10.1007/s12402-014-0133-2.
［8］AGNEW-BLAIS J C，POLANCZYK G V，DANESE A，et al．Evaluation of the persistence，remission，and emergence of attention-deficit/hyperactivity disorder in young adulthood［J］．JAMA Psychiatry，2016，73（7）：713-720．DOI：10.1001/jamapsychiatry.2016.0465.
［9］RAMOS-OLAZAGASTI M A，CASTELLANOS F X，MANNUZZA S，et al．Predicting the adult functional outcomes of boys with ADHD 33 years later［J］．J Am Acad Child Adolesc Psychiatry，2018，57（8）：571-582．DOI：10.1016/j.jaac.2018.04.015.
［10］BIEDERMAN J，MONUTEAUX M C，MICK E，et al．Young adult outcome of attention deficit hyperactivity disorder：a controlled 10-year follow-up study［J］．Psychol Med，2006，36（2）：167-179．DOI：10.1017/S0033291705006410.
［11］AGNEW-BLAIS J C，POLANCZYK G V，DANESE A，et al．
Young adult mental health and functional outcomes among individuals with remitted，persistent and late-onset ADHD［J］．Br J Psychiatry，2018，213（3）：526-534．DOI：10.1192/bjp.2018.97.
［12］LEVYA F，HAY D A，BENNETT K S.Genetics of attention deficit hyperactivity disorder：a current review and future prospects［J］．Int J Disabil Dev Educ，2006，53（1）：5-20．DOI：10.1080/10349120500509950.
［13］ADAMIS D，GRAFFEO I，KUMAR R，et al．Screening for attention deficit-hyperactivity disorder （ADHD） symptomatology in adult mental health clinics［J］．Ir J Psychol Med，2018，35（3）：193-201．DOI：10.1017/ipm.2017.49.
［14］POLANCZYK G，ROHDE L A.Epidemiology of attention-deficit/hyperactivity disorder across the lifespan［J］．Curr Opin Psychiatry，2007，20（4）：386-392．DOI：10.1097/YCO.0b013e3281568d7a.
［15］LARSSON J，LARSSON H，LICHTENSTEIN P.Genetic and environmental contributions to stability and change of ADHD symptoms between 8 and 14 years of age：a longitudinal twin study［J］．J Am Acad Child Adolesc Psychiatry，2004，43（10）：1267-1275．DOI：10.1097/01.chi.0000135622.05219.bf.
［16］STICKLEY A，KOYANAGI A，TAKAHASHI H，et al．Attention-deficit/hyperactivity disorder symptoms and happiness among adults in the general population［J］．Psychiatry Res，2018，265（5）：317-323．DOI：10.1016/j.psychres.2018.05.004.
［17］WEISS G，HECHTMAN L.Hyperactive children grown up［M］．2nd ed.New York：the Guilford Press，1993.
［18］ROMO L，LADNER J，KOTBAGI G，et al．Attention-deficit hyperactivity disorder and addictions （substance and behavioral）：prevalence and characteristics in a multicenter study in France［J］．J Behav Addict，2018，7（3）：743-751．DOI：10.1556/2006.7.2018.58.
［19］STOREBO O J，PEDERSEN N，RAMSTAD E，et al．Methylphenidate for attention deficit hyperactivity disorder （ADHD） in children and adolescents-assessment of adverse events in non-randomised studies［J］．Cochrane Database Syst Rev，2018，32（5）：CD012069．DOI：10.1002/14651858.CD012069.
［20］MOFFITT T E，HOUTS R，ASHERSON P，et al．Is adult ADHD a childhood-onset neuro developmental disorder? Evidence from a four-decade longitudinal cohort study［J］．Am J Psychiatry，2015，172（10）：967-977．DOI：10.1176/appi.ajp.2015.14101266.
［21］BIEDERMAN J.Impact of comorbidity in adults with attention-deficit/hyperactivity disorder［J］．J Clin Psychiatry，2004，65（2）：3-7.
［22］STICKLEY A，TACHIMORI H，INOUE Y，et al．Attention-deficit/hyperactivity disorder symptoms and suicidal behavior in adult psychiatric outpatients［J］．Psychiatry Clin Neurosci，2018，29（5）：543-552．DOI：10.1111/pcn.12685.
［23］O'MALLEY G K，MCHUGH L，MAC GIOLLABHUI N，et al．Characterizing adult attention-deficit/hyperactivity disorder and comorbid borderline personality disorder：ADHD symptoms，psychopathology，cognitive functioning and psychosocial factors［J］．Eur Psychiatry，2016，31（3）：29-36．DOI：10.1016/j.eurpsy.2015.09.012.
［24］HIRSCH O，CHAVANON M，RIECHMANN E，et al．Emotional dysregulation is a primary symptom in adult attention-deficit/hyperactivity disorder （ADHD）［J］．J Affect Disord，2018，232（5）：41-47．DOI：10.1016/j.jad.2018.02.007.
［25］CAYE A，SPADINI A V，KARAM R G，et al．Predictors of persistence of ADHD into adulthood：a systematic review of the literature and meta-analysis［J］．Eur Child Adolesc Psychiatry，2016，25（11）：1151-1159．DOI：10.1007/s00787-016-0831-8.
［26］FARAONE S V，PERLIS R H，DOYLE A E，et al．Molecular genetics of attention deficit hyperactivity disorder［J］．Biol Psychiatry，2005，57（11）：1313-1323．DOI：10.1016/j.biopsych.2004.11.024.
［27］ALEXANDER L，FARRELLY N.Attending to adult ADHD：a review of the neurobiology behind adult ADHD［J］．Ir J Psychol Med，2018，35（3）：237-244．DOI：10.1017/ipm.2017.78.
［28］THAPAR A.Discoveries on the genetics of ADHD in the 21st century：new findings and their implications［J］．Am J Psychiatry，2018，175（10）：943-950．DOI：10.1176/appi.ajp.2018.18040383.
［29］THAPAR A，LANGLEY K，O'DONOVAN M，et al．Refining the attention deficit hyperactivity disorder phenotype for molecular genetic studies［J］．Mol Psychiatry，2006，11（8）：714-720．DOI：10.1038/sj.mp.4001831.
［30］BRIKELL I，LARSSON H，LU Y，et al．The contribution of common genetic risk variants for ADHD to a general factor of childhood psychopathology［J］．Mol Psychiatry，2018，22（6）：231-242．DOI：10.1038/s41380-018-0109-2.
［31］HAYMAN V，FERNANDEZ T V．Genetic insights into ADHD biology［J］．Front Psychiatry，2018，21（9）：251-258．DOI：10.3389/fpsyt.2018.00251.
［32］WIERS C E，LOHOFF F W，LEE J，et al．Methylation of the dopamine transporter gene in blood is associated with striatal dopamine transporter availability in ADHD：a preliminary study［J］．Eur J Neurosci，2018，48（3）：1884-1895．DOI：10.1111/ejn.14067.
［33］THAPAR A，LANGLEY K，FOWLER T，et al．Catechol-O-methyltransferase gene variant and birth weight predict early onset antisocial behaviour in children with attention deficit hyperactivity disorder［J］．Arch Gen Psychiatry，2005，62（11）：1275-1278．DOI：10.1001/archpsyc.62.11.1275.
［34］张净雯，李新影．不良同伴交往与儿茶酚胺氧位甲基转移酶基因的交互作用对青少年问题行为的影响研究［J］．中国全科医学，2019，22（14）：1722-1725．DOI：10.12114/j.issn.1007-9572.2018.00.309.
ZHANG J W，LI X Y．Interacting effect of deviant peer affiliation and comt rs4680 polymorphism on adolescent behavioral problems［J］．Chinese General Practice，2019，22（14）：1722-1725．DOI：10.12114/j.issn.1007-9572.2018.00.309.
［35］KESSLER R C，ADLER L A，BARKLEY R，et al．Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood：results from the national comorbidity survey replication［J］．Biol Psychiatry，2005，57（11）：1442-1451．DOI：10.1016/j.biopsych.2005.04.001.
［36］MOLINA B S，PELHAM W E Jr.Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD［J］．J Abnorm Psychol，2003，112（3）：497-507.
［37］FERGUSSON D M，LYNSKEY M T，HORWOOD L J.Attentional difficulties in middle childhood and psychosocial outcomes in young adulthood［J］．J Child Psychol Psychiatry，1997，38（6）：633-644.
［38］SIMONOFF E，ELANDER J，HOLMSHAW J，et al．Predictors of antisocial personality.Continuities from childhood to adult life［J］．Br J Psychiatry，2004，184：118-127.
［39］GUNES H，TANIDIR C，ADALETLI H，et al．Oppositional defiant disorder/conduct disorder co-occurrence increases the risk of internet addiction in adolescents with attention-deficit hyperactivity disorder［J］．J Behav Addict，2018，7（2）：284-291．DOI：10.1556/2006.7.2018.46.
［40］VALDIMARSDóTTIR M，HRAFNSDóTTIR A H，MAGNúSSON P，et al．The frequency of some factors in pregnancy and delivery for Icelandic children with ADHD［J］．Laeknabladid，2006，92（9）：609-614.
［41］WASCHBUSCH D A，PELHAM W E Jr，JENNINGS J R，et al．Reactive aggression in boys with disruptive behavior disorders：behavior，physiology，and affect［J］．J Abnorm Child Psychol，2002，30（6）：641-656.
［42］SIMONOFF E，ELANDER J，HOLMSHAW J，et al．Predictors of antisocial personality.Continuities from childhood to adult life［J］．Br J Psychiatry，2004，184（2）：118-127.
［43］SHAW P，STRINGARIS A，NIGG J，et al．Emotion dysregulation in attention deficit hyperactivity disorder［J］．Am J Psychiatry，2014，171（3）：276-293．DOI：10.1176/appi.ajp.2013.13070966.
［44］POSNER J，KASS E，HULVERSHORN L.Using stimulants to treat ADHD-related emotional lability［J］．Curr Psychiatry Rep，2014，16（10）：478．DOI：10.1007/s11920-014-0478-4.
［45］BARKLEY R A，FISCHER M.The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults［J］．J Am Acad Child Adolesc Psychiatry，2010，49（5）：503-513．DOI：10.1097/00004583-201005000-00011.
［46］BIEDERMAN J，PETTY C R，CLARKE A，et al．Predictors of persistent ADHD：an 11-year follow-up study［J］．J Psychiatr Res，2011，45（2）：150-155．DOI：10.1016/j.jpsychires.2010.06.009.
［47］BIEDERMAN J，PETTY C R，O'CONNOR K B，et al．Predictors of persistence in girls with attention deficit hyperactivity disorder：results from an 11-year controlled follow-up study［J］．Acta Psychiatr Scand，2012，125（2）：147-156．DOI：10.1111/j.1600-0447.2011.01797.x.
［48］LARA C，FAYYAD J，DE GRAAF R，et al．Childhood predictors of adult attention-deficit/hyperactivity disorder：results from the World Health Organization World Mental Health Survey Initiative［J］．Biol Psychiatry，2009，65（1）：46-54．DOI：10.1016/j.biopsych.2008.10.005.
［49］SIEBELINK N M，B?GELS S M，BOERBOOM L M，et al．Mindfulness for children with ADHD and mindful parenting （MindChamp）：protocol of a randomized controlled trial comparing a family mindfulness-based intervention as an add-on to care-as-usual with care-as-usual only［J］．BMC Psychiatry，2018，18（1）：237．DOI：10.1186/s12888-018-1811-y.
［50］李杨，杨金伟，周郁秋，等．注意缺陷多动障碍儿童问题行为及其影响因素分析［J］．中国全科医学，2017，20（29）：3600-3605．DOI：10.3969/j.issn.1007-9572.2017.07.y06.
LI Y，YANG J W，ZHOU Y Q，et al．Analysis on the problem behaviors and influencing factors in children with attention-deficit hyperactivity disorder［J］．Chinese General Practice，2017，20（29）：3600-3605．DOI：10.3969/j.issn.1007-9572.2017.07.y06.
［51］MONUTEAUX M C，MICK E，FARAONE S V，et al．The influence of sex on the course and psychiatric correlates of ADHD from childhood to adolescence：a longitudinal study［J］．J Child Psychol Psychiatry，2010，51（3）：233-241．DOI：10.1111/j.1469-7610.2009.02152.x.
［52］DALSGAARD S，MORTENSEN P B，FRYDENBERG M，et al．Conduct problems，gender and adult psychiatric outcome of children with attention deficit hyperactivity disorder［J］．Br J Psychiatry，2002，181：416-421.
［53］SATTERFIELD J H，FALLER K J，CRINELLA F M，et al．A 30-year prospective follow-up study of hyperactive boys with conduct problems：adult criminality［J］．J Am Acad Child Adolesc Psychiatry，2007，46（5）：601-610．DOI：10.1097/chi.0b013e318033ff59.
［54］SITHOLEY P，AGARWAL V，CHAMOLI S.A preliminary study of factors affecting adherence to medication in clinic children with attention-deficit/hyperactivity disorder［J］．Indian J Psychiatry，2011，53（1）：41-44．DOI：10.4103/0019-5545.75561.

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