ADHD治療

ADHD治療
這部份旨在更深入解釋ADHD的治療方法，特別是在使用藥物方面，及一些常見的問題和憂慮。專注力促進會感謝王玉珍醫生幫助撰寫本欄目文章。

為什麼用藥？用或不用藥？

ADHD（不論兒童或是成年人）的第一線治療方法是刺激劑類藥物（諸如「哌甲酯Methylphenidate」等）。　

《美國醫學協會》的科學事務委員會指出：「 ADHD是醫學上其中一種研究最廣的失調症狀；而有關研究成果整體而言較其他疾病的研究更具說服力。」單在「1996至2006年這十年間，有關ADHD及其治療的醫學研究便超過了5,000項。」而研究結果貫切地顯示藥物哌甲酯（Methylphenidate，亦稱Ritalin利他林）對治療ADHD的功效顯著。鑑於哌甲酯療效高而副作用少，《美國兒童及青少年精神病科學院》(American Academy of Child and Adolescent Psychiatry)建議在大多數情況下，以哌甲酯作為對ADHD的第一線治療。

以藥物作為第一線治療的做法，是根據1999年一項標誌性研究《對ADHD兒童多模式治療的研究》（簡稱MTA）所確立的。直到現在，這仍然是所有ADHD長期治療的研究項目之中，規模最大的隨機對照調查。該項研究結果顯示：

－ 藥物對於ADHD主要的症狀的療效，明顯地優於「行為療法」 ;

－ 對於涉及對抗性和侵略行為的ADHD兒童病例 ，結合藥物和行為治療法更具療效。

早在9歲或之前己確診ADHD的兒童，如果沒有其他相連病狀，一般單靠藥物治療已足以控制其主要症狀。

然而，對於較年長才得到確診及／或那些出現其他病狀的患者而言（如對抗性行為、情緒障礙、破壞性行為等），結合藥物和行為治療法是最佳的治療選擇。


This section explains more about treatment of ADHD, specifically medication, how it works, and addresses some of the common questions and worries. The ADHD Foundation would like to thank Dr Eunice Wong for contributing to this article.

Why Medication? To Take or Not To Take?

Stimulant medications (methylphenidate, etc) are often the first line treatment recommendation for children and adults with ADHD.

The American Medical Association’s Council on Scientific Affairs has commented that “ADHD is one of the best-researched disorders in medicine, and the overall data on its validity are far more compelling than for many medical conditions”. There were “over 5,000 medical researches on ADHD and treatments from the year 1996 to 2006” and research results have consistently showed the remarkable effectiveness of the medication, methylphenidate (Ritalin). Considering the high efficacy and low side effect profile, American Academy of Child and Adolescent Psychiatry recommended that methylphenidate to be the first line treatment of ADHD in most cases.

Medication, as the first line treatment, was first established by the milestone study MTA (“Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder) in 1999. This is the largest randomized control study of long term treatment of ADHD to date. The research result showed the following findings:

Medications lead to significantly better results for the core symptoms of ADHD than behavioral therapy.
A combination of medication and behavioral therapy provides better treatment for children with ADHD and oppositional and aggressive behaviors.
For children who are diagnosed early with ADHD (in general before 9 years of age) and without coexisting conditions, medication alone usually is sufficient to reverse the core symptoms.

However, for those who are diagnosed at older age and/ or with coexisting conditions, such as oppositional defiant disorder, mood disorder, disruptive behaviors, etc, combined medication and behavioral therapy are necessary to achieve optimal outcome.