دانلود رایگان مقاله انگلیسی مفاهیم درمان برای جوانان مبتلا به ADHD با همبودی اضطراب - اشپرینگر 2018

Abstract

Purpose of Review There are multiple pharmacological and psychosocial interventions that are tolerable and efficacious for the treatment of attention deficit hyperactivity disorder (ADHD). However, many youth with ADHD have elevated levels of mood and anxiety symptoms that can complicate treatment. In this review, we summarize the relevant treatment studies on the treatment of youth with ADHD and comorbid anxiety or mood disorders. Recent Findings Treatment of ADHD, specifically CNS stimulants, often translates to reduced irritability in youth with ADHD, but appears to have limited impact on other mood or anxiety symptoms. The presence of ADHD does not appear to reduce the efficacy of pharmacological treatments of mood and anxiety disorders. There is less data on the impact of ADHD on psychosocial treatments for internalizing disorders. Summary In children with elevated levels of mood or anxiety, ADHD can be safely and effectively treated with either evidence-based pharmacological or psychosocial interventions. However, additional treatments are often needed to achieve significant improvements in other mood or anxiety symptoms.

Conclusion

ADHD commonly presents with symptoms of mood and anxiety. These comorbid symptoms produce additional impairment and place children at greater risk for future morbidity. Therefore, it is imperative to assess and treat mood and anxiety disorders in youth with ADHD. The extant literature suggests that ADHD can be safely treated with either pharmacological or behavioral treatments in the presence of mood and anxiety disorders. There are mixed results about the impact of treating ADHD on mood and anxiety symptoms, with anxiety and ADHD being the most well-studied comorbidity. While more work is needed, treating ADHD appears to lead to moderate to large reductions in irritability but at best mild reductions in depressive symptoms. The presence of ADHD does not appear to reduce the efficacy of pharmacological treatments for the internalizing disorder. There is less data on the impact of ADHD on psychosocial treatments for internalizing disorders, but at least in adolescents, ADHD does not appear to meaningfully impact efficacy. There has been little formal investigation of sequencing effects in children with ADHD and mood or anxiety disorders to guide clinicians. When pharmacological treatment is being considered, it may be reasonable to start with ADHD, given the ease of administration and relatively quick onset of most ADHD medications unless there is clear evidence that the anxiety or mood disorder is associated with a greater level of impairment, as would be the case with mania. Psychosocial treatments are evidence-based and tolerable interventions for pediatric ADHD, anxiety, and mood disorders and can be tailored to the individual needs of complex patients. They should always be considered as an initial treatment option versus being reserved for medication non-responders. By using both psychopharmacologic and psychosocial interventions in a flexible manner, clinicians will have a wide variety of tools for management of complex cases.