دانلود رایگان مقاله انگلیسی شیوع کم خونی و نتیجه درمان در کودکان و نوجوانان مبتلا به ADHD - اشپرینگر 2017

Abstract

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment effcacy based on the type of comorbidity. We performed an analysis of the medical records of patients identifed from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifcally, combined treatment showed signifcant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium effcacy (ES 0.50) for ADHD and learning disorders. This study was the frst describing comorbidity patterns of ADHD in Italy, confrming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

Conclusion

Our fndings confrm, in a multicenter observational study involving a large sample of children and adolescents, that ADHD is more often a complex disorder with a high rate of associated comorbid conditions [94]. This study was the frst to describe the comorbidity patterns of ADHD in the Italian context and to highlight certain important clinical and service organization aspects that should be extended to other national ADHD centers to ensure an appropriate and homogenous care management of ADHD in Italy. First, the high prevalence of associated psychiatric conditions warrants that these problems be systematically and specifcally investigated, diagnosed, and, especially, taken into consideration as the main guide for choosing among the available therapeutic options. Secondly, as parents are frequently not aware of the longitudinal course of the ADHD disorder, especially when complicated by psychiatric comorbidity, clinicians should consider the best evidence-based treatment to improve outcome, informing and actively involving families and patients (if possible) in the decision making process. Third, given the demonstration of this relevant rate of co-existing psychiatric conditions in ADHD, it would be appropriate that clinicians working in ADHD centers not only have expertise in ADHD, but also have clinical skills in most neuropsychiatric disorders, as previously reported [9, 95]. Finally, clinicians should consider the full spectrum of neurodevelopmental disorders, anxiety, and mood disorders as possible differential diagnoses of ADHD. Neurodevelopment disorders in children and adolescents, such as ADHD, are multifactorial disorders and have shared characteristics and several risk factors in common [96]. This raises the need for accurate clinical evaluations regarding the specifcity of underlying etiological factors, the degree of functional impairment of the core symptoms and different comorbidities, and, consequently, of appropriate treatment. In our opinion, this will be the challenge for future clinical care and research in the area.