注意力不足過動症：修订间差异

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== 治疗==
== 治疗==
{{main|注意力不足過動症的治療}}
{{Main|注意力不足過動症的治療}}
注意力不足過動症的治療方式包括[[心理治療]]、[[行為治療]]及藥物，也有可能是用幾種方式一起進行。治療對病症會有長期的改善，但是無法完全根除病症的影響<ref name="pmid22947230">{{cite journal | vauthors = Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE | title = A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment | journal = BMC Medicine | volume = 10 | pages = 99 | date = September 2012 | pmid = 22947230 | pmc = 3520745 | doi = 10.1186/1741-7015-10-99 }}</ref>。藥物包括有興奮劑、[[阿托莫西汀]]、{{link-en|腎上腺素受體α2|alpha-2 adrenergic receptor}}拮抗劑，有時也會包括抗抑鬱藥物<ref name="Wilens-2010"/><ref name="cognition enhancers">{{cite journal | vauthors = Bidwell LC, McClernon FJ, Kollins SH | title = Cognitive enhancers for the treatment of ADHD | journal = Pharmacology Biochemistry and Behavior | volume = 99 | issue = 2 | pages = 262–74 | date = August 2011 | pmid = 21596055 | pmc = 3353150 | doi = 10.1016/j.pbb.2011.05.002 }}</ref>。若時無法專注在長期獎勵上的人，有許多的[[增强|正增强]]方式可以提昇其工作表現<ref name="Motivation" />。ADHD藥物中的興奮劑也可以提昇患者的毅力及工作表現<ref name="Malenka ADHD neurosci" /><ref name="Motivation" />。
{{:注意力不足過動症的治療}}

===行為治療===
有關行為治療在ADHD上的應用，有許多良好的實證，若是針對學齡前，或是症狀輕微的病患，一般會建議用[[行為治療]]為第一線的療法<ref>{{cite journal | vauthors = Fabiano GA, Pelham WE, Coles EK, Gnagy EM, Chronis-Tuscano A, O'Connor BC | title = A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder | journal = Clinical Psychology Review | volume = 29 | issue = 2 | pages = 129–40 | date = March 2009 | pmid = 19131150 | doi = 10.1016/j.cpr.2008.11.001 }}</ref><ref name=Clinics09>{{cite journal | vauthors = Kratochvil CJ, Vaughan BS, Barker A, Corr L, Wheeler A, Madaan V | title = Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist | journal = The Psychiatric Clinics of North America | volume = 32 | issue = 1 | pages = 39–56 | date = March 2009 | pmid = 19248915 | doi = 10.1016/j.psc.2008.10.001 }}</ref>。心理療法包括有[[心理教育]]、[[行為治療]]、[[认知行为疗法]]（CBT）、[[人際取向心理治療]]、{{link-en|家庭治療|family therapy}}、學校介入、社交技巧訓練、行為方面的同儕介入、機構培訓<ref name=Evans2014>{{cite journal | vauthors = Evans SW, Owens JS, Bunford N | title = Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder | journal = Journal of Clinical Child and Adolescent Psychology | volume = 43 | issue = 4 | pages = 527–51 | date = 2014 | pmid = 24245813 | pmc = 4025987 | doi = 10.1080/15374416.2013.850700 }}</ref>、[[父母管理訓練]]<ref name="NICE 2009"/>及{{link-en|神經反饋|neurofeedback}}訓練<ref name="pmid19715181">{{cite journal | vauthors = Arns M, de Ridder S, Strehl U, Breteler M, Coenen A | title = Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis | journal = Clinical EEG and Neuroscience | volume = 40 | issue = 3 | pages = 180–9 | date = July 2009 | pmid = 19715181 | doi = 10.1177/155005940904000311 }}</ref>。父母管理訓練可以改善包括反對行為以及不合常規行為在內的一些行為問題<ref name=Dal2017>{{cite journal | vauthors = Daley D, Van Der Oord S, Ferrin M, Cortese S, Danckaerts M, Doepfner M, Van den Hoofdakker BJ, Coghill D, Thompson M, Asherson P, Banaschewski T, Brandeis D, Buitelaar J, Dittmann RW, Hollis C, Holtmann M, Konofal E, Lecendreux M, Rothenberger A, Santosh P, Simonoff E, Soutullo C, Steinhausen HC, Stringaris A, Taylor E, Wong IC, Zuddas A, Sonuga-Barke EJ | title = Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 59 | issue = 9 | pages = 932–947 | date = October 2017 | pmid = 29083042 | doi = 10.1111/jcpp.12825 | url = http://eprints.nottingham.ac.uk/45391/1/Daley%20et%20al%202017%20JCPP.pdf }}</ref>。目前還不清楚神經反饋訓練是否有效<ref>{{cite journal | vauthors = Cortese S, Ferrin M, Brandeis D, Holtmann M, Aggensteiner P, Daley D, Santosh P, Simonoff E, Stevenson J, Stringaris A, Sonuga-Barke EJ | title = Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 55 | issue = 6 | pages = 444–55 | date = June 2016 | pmid = 27238063 | doi = 10.1016/j.jaac.2016.03.007 | hdl = 1854/LU-8123796 }}</ref>。

有關家庭治療的效果，目前還很少足夠品質的證據可以佐證。目前證據認為家庭治療的效果類似群體照顧（community care），效果比安慰劑要好<ref>{{cite journal | vauthors = Bjornstad G, Montgomery P | title = Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 2 | pages = CD005042 | date = April 2005 | pmid = 15846741 | doi = 10.1002/14651858.CD005042.pub2 | editor = Bjornstad GJ }}</ref>。有許多注意力不足過動症支持組織可以提供相關資訊，並且協助家庭適應ADHD的情形<ref name="Brain encyclopedia">{{cite encyclopedia |last1=Turkington |first1=Carol |last2=Harris |first2=Joseph |title=attention deficit hyperactivity disorder (ADHD) |url={{google books|6hbKkynRxPYC|pages=42|plainurl=yes}} |encyclopedia=The Encyclopedia of the Brain and Brain Disorders |year=2009 |publisher=Infobase Publishing |isbn=978-1-4381-2703-3 |pages=[https://books.google.com/books?id=6hbKkynRxPYC&pg=PA47 47] |via=Google Books }}</ref>。

有關社交技巧的訓練、行為調整以及藥物的對病患的好處可能有限。要減少後續心理及精神問題（例如[[重度抑郁症]]、[[犯罪]]、學校學習失敗、[[物質使用疾患]]）的主要因素是和沒有從事偏差行為的人建立友誼<ref name="pmid20490677">{{cite journal | vauthors = Mikami AY | title = The importance of friendship for youth with attention-deficit/hyperactivity disorder | journal = Clinical Child and Family Psychology Review | volume = 13 | issue = 2 | pages = 181–98 | date = June 2010 | pmid = 20490677 | pmc = 2921569 | doi = 10.1007/s10567-010-0067-y }}</ref>。

規律的[[體能鍛煉]]，特別是[[有氧运动]]，對於患有ADHD的兒童及成人而言也是有效的{{link-en|副加療法|adjunct therapy}}，特別是配合興奮劑藥物治療時更是如此，不過針對改善症狀，最理想的運動種類及強度還不清楚<ref name="ADHD exercise 2016 SystRev">{{cite journal | vauthors = Den Heijer AE, Groen Y, Tucha L, Fuermaier AB, Koerts J, Lange KW, Thome J, Tucha O | title = Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review | journal = Journal of Neural Transmission | volume = 124 | issue = Suppl 1 | pages = 3–26 | date = 2017-02 | pmid = 27400928 | pmc = 5281644 | doi = 10.1007/s00702-016-1593-7 | quote = Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior. }}</ref><ref name="ADHD Exercise 2014">{{cite journal | vauthors = Kamp CF, Sperlich B, Holmberg HC | title = Exercise reduces the symptoms of attention-deficit/hyperactivity disorder and improves social behaviour, motor skills, strength and neuropsychological parameters | journal = Acta Paediatrica | volume = 103 | issue = 7 | pages = 709–14 | date = July 2014 | pmid = 24612421 | doi = 10.1111/apa.12628 | quote = We may conclude that all different types of exercise&nbsp;... attenuate the characteristic symptoms of ADHD and improve social behaviour, motor skills, strength and neuropsychological parameters without any undesirable side effects. Available reports do not reveal which type, intensity, duration and frequency of exercise is most effective}}</ref><ref name="ADHD Exercise 2013">{{cite journal | vauthors = Rommel AS, Halperin JM, Mill J, Asherson P, Kuntsi J | title = Protection from genetic diathesis in attention-deficit/hyperactivity disorder: possible complementary roles of exercise | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 52 | issue = 9 | pages = 900–10 | date = September 2013 | pmid = 23972692 | pmc = 4257065 | doi = 10.1016/j.jaac.2013.05.018 | quote = The findings from these studies provide some support for the notion that exercise has the potential to act as a protective factor for ADHD. }}</ref>。長期規律有氧運動對ADHD患者的好處是提昇行為及運動能力、提昇[[管控功能]]（包括專注、[[抑制控制]]、計劃等）、較快的[[心理测时法|資訊處理速度]]，記憶力也會比較好<ref name="ADHD exercise 2016 SystRev" /><ref name="ADHD Exercise 2014" /><ref name="ADHD Exercise 2013" />。家長及教師針對ADHD兒童規律有氧运动對行為及以社交-情緒上的改善有：全身整體機能較佳、減少ADHD症狀、自尊感較好、減少焦慮及抑鬱的程度、較少身體症狀、課業成績及教室行為較佳，社交行為也有改善<ref name="ADHD exercise 2016 SystRev" />。若在有使用興奮劑治療時進行運動，會增加興奮劑藥物對執行功能的影響<ref name="ADHD exercise 2016 SystRev" />，一般認為運動的短期效果是因為運動時大腦[[突触]]多巴胺和去甲腎上腺素濃度的增加所造成<ref name="ADHD exercise 2016 SystRev" />。

=== 藥物===
針對注意力不足過動症，可以用[[兴奋剂|中樞神經刺激劑]]（也稱為兴奋剂）藥物進行治療<ref name=CNS09>{{cite journal | vauthors = Wigal SB | title = Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults | journal = CNS Drugs | volume = 23 Suppl 1 | pages = 21–31 | year = 2009 | pmid = 19621975 | doi = 10.2165/00023210-200923000-00004 }}</ref><ref name="Cochrane Amphetamines ADHD">{{cite journal | vauthors = Castells X, Ramos-Quiroga JA, Bosch R, Nogueira M, Casas M | title = Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 6 | pages = CD007813 | date = June 2011 | pmid = 21678370 | doi = 10.1002/14651858.CD007813.pub2 | editor = Castells X }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/30091808|date = November 2018}}，對於症狀至少會有一些效果，短期而言，約有80%會有效果<ref name=May2008 /><ref name="Long-term 36">{{cite journal | vauthors = Parker J, Wales G, Chalhoub N, Harpin V | title = The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials | journal = Psychology Research and Behavior Management | volume = 6 | issue = | pages = 87–99 | date = 2013-09| pmid = 24082796 | pmc = 3785407 | doi = 10.2147/PRBM.S49114 | quote = Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period.&nbsp;... Only one paper examining outcomes beyond 36 months met the review criteria.&nbsp;... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22 }}</ref><ref name="Cochrane Amphetamines ADHD" />。家長及教師反應[[哌甲酯]]比較可以改善其症狀<ref name="Long-term 36" /><ref name=May2008 /><ref>{{cite journal | vauthors = Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira-Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C | display-authors = 6 | title = Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD) | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD009885 | date = November 2015 | pmid = 26599576 | doi = 10.1002/14651858.CD009885.pub2 }}</ref>，中樞神經刺激劑也可以減少ADHD兒童意外事故的風險<ref name=Ruiz2017>{{cite journal | vauthors = Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallón S, Alvarez Zallo N, Luis EO, de Castro-Manglano P, Soutullo C, Arrondo G | title = Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis | journal = Neuroscience and Biobehavioral Reviews | volume = 84 | pages = 63–71 | date = January 2018 | pmid = 29162520 | doi = 10.1016/j.neubiorev.2017.11.007 }}</ref>。針對ADHD的中樞神經刺激劑藥物除了哌甲酯外，還有[[苯丙胺]]、[[甲基苯丙胺]]等。

針對ADHD的非中樞神經刺激劑藥物有許多種，包括[[阿托莫西汀]]、[[安非他酮]]、{{link-en|胍法辛|guanfacine}}及[[可乐定]]，這些可以作為主要藥物治療，或是配合中樞神經刺激劑藥物一起使用<ref name=CNS09/><ref>{{cite journal | vauthors = Childress AC, Sallee FR | title = Revisiting clonidine: an innovative add-on option for attention-deficit/hyperactivity disorder | journal = Drugs of Today | volume = 48 | issue = 3 | pages = 207–17 | date = March 2012 | pmid = 22462040 | doi = 10.1358/dot.2012.48.3.1750904 }}</ref>。目前有關各藥物之間的比較，還沒有說服力足夠的研究結果可以佐證，不過在副作用上似乎差不多<ref name=McD2011>{{cite journal | vauthors = McDonagh MS, Peterson K, Thakurta S, Low A | title = Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder | date = 2011-12 | pmid = 22420008 | url = https://www.ncbi.nlm.nih.gov/books/NBK84419 | publisher = United States Library of Medicine | archive-url = https://web.archive.org/web/20160831152630/http://www.ncbi.nlm.nih.gov/books/NBK84419/ | deadurl = no | archive-date = 2016-08-31 | series = Drug Class Reviews }}</ref>。中樞神經刺激劑藥物比較可以提昇課業表現，阿托莫西汀則無此效果<ref name="pmid23179416">{{cite journal | vauthors = Prasad V, Brogan E, Mulvaney C, Grainge M, Stanton W, Sayal K | title = How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis | journal = European Child & Adolescent Psychiatry | volume = 22 | issue = 4 | pages = 203–16 | date = April 2013 | pmid = 23179416 | doi = 10.1007/s00787-012-0346-x }}</ref>。阿托莫西汀比較不會有成癮問題，因此若有娛樂性藥物或是強迫性藥物使用風險的人，比較建議使用阿托莫西汀<ref name="Kooij-2010"/>。有關藥物對社交行為上的影響，目前的資料也還不充份<ref name=McD2011/>。{{As of|2015年6月}}，還沒有完全確定ADHD藥物的長期影響<ref name="ADHD 2015 review">{{cite journal | vauthors = Kiely B, Adesman A | title = What we do not know about ADHD… yet | journal = Current Opinion in Pediatrics | volume = 27 | issue = 3 | pages = 395–404 | date = June 2015 | pmid = 25888152 | doi = 10.1097/MOP.0000000000000229 | quote = In addition, a consensus has not been reached on the optimal diagnostic criteria for ADHD. Moreover, the benefits and long-term effects of medical and complementary therapies for this disorder continue to be debated. These gaps in knowledge hinder the ability of clinicians to effectively recognize and treat ADHD. }}</ref><ref name="pmid21519262">{{cite journal | vauthors = Hazell P | title = The challenges to demonstrating long-term effects of psychostimulant treatment for attention-deficit/hyperactivity disorder | journal = Current Opinion in Psychiatry | volume = 24 | issue = 4 | pages = 286–90 | date = July 2011 | pmid = 21519262 | doi = 10.1097/YCO.0b013e32834742db }}</ref>。[[核磁共振成像]] 研究推測長期用[[苯丙胺]]或[[哌甲酯]]治療，會減少因為ADHD造成的大腦功能及結構異常<ref name="Neuroplasticity 1">{{cite journal | vauthors = Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K | title = Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects | journal = JAMA Psychiatry | volume = 70 | issue = 2 | pages = 185–98 | date = February 2013 | pmid = 23247506 | doi = 10.1001/jamapsychiatry.2013.277 }}</ref><ref name="Neuroplasticity 2">{{cite journal | vauthors = Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J | title = Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies | journal = The Journal of Clinical Psychiatry | volume = 74 | issue = 9 | pages = 902–17 | date = September 2013 | pmid = 24107764 | pmc = 3801446 | doi = 10.4088/JCP.12r08287 }}</ref><ref name="Neuroplasticity 3">{{cite journal | vauthors = Frodl T, Skokauskas N | title = Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects | journal = Acta Psychiatrica Scandinavica | volume = 125 | issue = 2 | pages = 114–26 | date = February 2012 | pmid = 22118249 | doi = 10.1111/j.1600-0447.2011.01786.x | quote = Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure. }}</ref>。2018年的文獻回顧發現若考慮短期效果，哌甲酯對兒童最有效，苯丙胺對成人最有效<ref>{{cite journal |last1=Cortese |first1=Samuele |last2=Adamo |first2=Nicoletta |last3=Del Giovane |first3=Cinzia |last4=Mohr-Jensen |first4=Christina |last5=Hayes |first5=Adrian J |last6=Carucci |first6=Sara |last7=Atkinson |first7=Lauren Z |last8=Tessari |first8=Luca |last9=Banaschewski |first9=Tobias |last10=Coghill |first10=David |last11=Hollis |first11=Chris |last12=Simonoff |first12=Emily |last13=Zuddas |first13=Alessandro |last14=Barbui |first14=Corrado |last15=Purgato |first15=Marianna |last16=Steinhausen |first16=Hans-Christoph |last17=Shokraneh |first17=Farhad |last18=Xia |first18=Jun |last19=Cipriani |first19=Andrea |title=Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis |journal=The Lancet Psychiatry |date=September 2018 |volume=5 |issue=9 |pages=727–738 |doi=10.1016/S2215-0366(18)30269-4}}</ref>。

什麼情形要用{{link-en|胍法辛|guanfacine}}治療會依國家而不同，{{link-en|英國國家健康照護專業組織|National Institute for Health and Care Excellence}}（NICE）針對成人是第一線藥物，若針對兒童，只建議在病情嚴重時才使用，而大部份美國的醫學指南會建議可以針對各年齡層使用<ref name="CADDRA"/>。針對學齡前的兒童，一般不建議用藥物治療<ref name="NICE 2009"/><ref>{{cite journal | vauthors = Greenhill LL, Posner K, Vaughan BS, Kratochvil CJ | title = Attention deficit hyperactivity disorder in preschool children | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 17 | issue = 2 | pages = 347–66, ix | date = April 2008 | pmid = 18295150 | doi = 10.1016/j.chc.2007.11.004 }}</ref>。若治療用的中樞神經刺激劑劑量不足，可能會有沒有藥效的情形<ref>{{cite journal | vauthors = Stevens JR, Wilens TE, Stern TA | title = Using stimulants for attention-deficit/hyperactivity disorder: clinical approaches and challenges | journal = The Primary Care Companion for CNS Disorders | volume = 15 | issue = 2 | date = 2013 | pmid = 23930227 | pmc = 3733520 | doi = 10.4088/PCC.12f01472 }}</ref>，這尤其常出現在青少年及成人身上，因為核可的劑量是針對學齡兒童的，因此有些醫療人員會依體重或是依其他因素給藥<ref>{{Cite web|url=http://www.medscape.org/viewarticle/734449|title=Individualizing Treatment for Adult ADHD: An Evidence-Based Guideline|last=Young|first=Joel L.|date=2010|website=Medscape|publisher=|access-date=19 June 2016|deadurl=no|archive-url=https://web.archive.org/web/20150508075829/http://www.medscape.org/viewarticle/734449|archive-date=8 May 2015}}</ref><ref>{{Cite web|url=http://www.medscape.com/viewarticle/464377_print|title=New-Generation Long-Acting Stimulants for the Treatment of Attention-Deficit/Hyperactivity Disorder|last=Biederman|first=Joseph|date=2003|website=Medscape|publisher=|access-date=19 June 2016|quote=As most treatment guidelines and prescribing information for stimulant medications relate to experience in school-aged children, prescribed doses for older patients are lacking. Emerging evidence for both methylphenidate and Adderall indicate that when weight-corrected daily doses, equipotent with those used in the treatment of younger patients, are used to treat adults with ADHD, these patients show a very robust clinical response consistent with that observed in pediatric studies. These data suggest that older patients may require a more aggressive approach in terms of dosing, based on the same target dosage ranges that have already been established – for methylphenidate, 1–1.5–2 mg/kg/day, and for D,L-amphetamine, 0.5–0.75–1 mg/kg/day.... <br />In particular, adolescents and adults are vulnerable to underdosing, and are thus at potential risk of failing to receive adequate dosage levels. As with all therapeutic agents, the efficacy and safety of stimulant medications should always guide prescribing behavior: careful dosage titration of the selected stimulant product should help to ensure that each patient with ADHD receives an adequate dose, so that the clinical benefits of therapy can be fully attained.|deadurl=no|archive-url=https://web.archive.org/web/20031207063556/http://www.medscape.com/viewarticle/464377_print|archive-date=7 December 2003}}</ref><ref>{{cite journal | vauthors = Kessler S | title = Drug therapy in attention-deficit hyperactivity disorder | journal = Southern Medical Journal | volume = 89 | issue = 1 | pages = 33–8 | date = January 1996 | pmid = 8545689 | doi = 10.1097/00007611-199601000-00005 }}</ref><!--School-age boys are twice as likely as their female counterparts to take medication, while among adults, women are far more likely to take medication than men.{{medcn|date=April 2018}}<ref>{{primary source inline|date=April 2018}}{{Cite news|url=https://www.upi.com/2008-12-ADHD-drugs-prescribed-for-young-women-rose-85/67671394659164/|title=2008–12: ADHD drugs prescribed for young women rose 85%|work=UPI|access-date=3 April 2018|language=en}}</ref>-->

一般而言，在正常治療劑量的哌甲酯及中樞神經刺激劑是安全的，不過有其副作用以及禁忌症<ref name=CNS09/>。若哌甲酯給兒童及青少年使用，有研究發現這和一些嚴重或不嚴重的有害副作用有關，不過證據品質還不充份<ref name="StorebøPedersen2018">{{cite journal | vauthors = Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C | title = Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies | journal = The Cochrane Database of Systematic Reviews | volume = 5 | pages = CD012069 | date = May 2018 | pmid = 29744873 | doi = 10.1002/14651858.CD012069.pub2 }}</ref>。若針對兒童開立這類藥物，需仔細的監測兒童的情形<ref name="StorebøPedersen2018" />。若ADHD的中樞神經刺激劑嚴重過量，可能會和{{link-en|興奮性精神病|stimulant psychosis}}或是[[狂躁]]的症狀<ref name="Cochrane recreational amph psychosis" />。若是治療用的劑量，出現類似情形的機率非常低，只有0.1%，會在開始用中樞神經刺激劑藥物治療後的前幾週出現<ref name="Cochrane recreational amph psychosis">{{cite journal | vauthors = Shoptaw SJ, Kao U, Ling W | title = Treatment for amphetamine psychosis | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 1 | pages = CD003026 | date = January 2009 | pmid = 19160215 | doi = 10.1002/14651858.CD003026.pub3 | quote = A minority of individuals who use amphetamines develop full-blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common (about 18%) is for frequent amphetamine users to report psychotic symptoms that are sub-clinical and that do not require high-intensity intervention&nbsp;...<br />About 5–15% of the users who develop an amphetamine psychosis fail to recover completely (Hofmann 1983)&nbsp;...<br />Findings from one trial indicate use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis. | editor = <!--Shoptaw SJ--> Shoptaw SJ, Ali R }}</ref><ref>{{cite web | title = Adderall XR Prescribing Information | url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf | publisher = Shire US Inc | work = United States Food and Drug Administration | date = December 2013 | access-date = 30 December 2013 | quote = Treatment-emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses.&nbsp;... In a pooled analysis of multiple short-term, placebo controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients. | deadurl = no | archive-url = https://web.archive.org/web/20131230233702/http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf | archive-date = 2013-12-30 }}</ref><ref name="pmid19171629">{{cite journal | vauthors = Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R | title = Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children | journal = Pediatrics | volume = 123 | issue = 2 | pages = 611–6 | date = 2009-02 | pmid = 19171629 | doi = 10.1542/peds.2008-0185 }}</ref>，若也使用[[抗精神病药]]，可以有效緩解急性苯丙胺精神病的症狀<ref name="Cochrane recreational amph psychosis" />，若長期治療，需要定期的監測<ref name="pmid20571380">{{cite journal | vauthors = Kraemer M, Uekermann J, Wiltfang J, Kis B | title = Methylphenidate-induced psychosis in adult attention-deficit/hyperactivity disorder: report of 3 new cases and review of the literature | journal = Clinical Neuropharmacology | volume = 33 | issue = 4 | pages = 204–6 | date = July 2010 | pmid = 20571380 | doi = 10.1097/WNF.0b013e3181e29174 }}</ref>。興奮劑的藥物治療需要定期停藥，評估是否還需要用藥、減少發育遲緩的情形，並且減低抗藥性<ref name="pmid21530185">{{cite journal | vauthors = van de Loo-Neus GH, Rommelse N, Buitelaar JK | title = To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended? | journal = European Neuropsychopharmacology | volume = 21 | issue = 8 | pages = 584–99 | date = 2011-08 | pmid = 21530185 | doi = 10.1016/j.euroneuro.2011.03.008 }}</ref><ref>{{cite journal | vauthors = Ibrahim K, Donyai P | title = Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades | journal = Journal of Attention Disorders | volume = 19 | issue = 7 | pages = 551–68 | date = July 2015 | pmid = 25253684 | doi = 10.1177/1087054714548035 | url = https://www.researchgate.net/publication/266151922 | archive-url = https://web.archive.org/web/20160630122316/https://www.researchgate.net/profile/Kinda_Ibrahim2/publication/266151922_Drug_Holidays_From_ADHD_Medication_International_Experience_Over_the_Past_Four_Decades/links/56a5ec7408ae1b651134629a.pdf | deadurl = no | archive-date = 2016-06-30 }}</ref>。若是長期使用超過ADHD治療劑量的興奮劑藥物濫用，一般會和[[成瘾]]及[[物質依賴]]有關<ref name="NHM therapeutic stim addiction liability" /><ref>{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK47127/|title=Black box warnings of ADHD drugs approved by the US Food and Drug Administration|year=2009|author=Oregon Health & Science University|location=Portland, Oregon|publisher=United States National Library of Medicine|access-date=17 January 2014|deadurl=no|archive-url=https://web.archive.org/web/20170908135126/https://www.ncbi.nlm.nih.gov/books/NBK47127/|archive-date=8 September 2017}}</ref>。不過未治療的ADHD，會提高物質濫用以及行為規範障礙的風險<ref name="NHM therapeutic stim addiction liability" />。興奮劑藥物的使用，可能可以降低風險，但也有可能沒有此效果<ref name="Kooij-2010"/><ref name="ADHD 2015 review" /><ref name="NHM therapeutic stim addiction liability">{{cite book | vauthors = Malenka RC, Nestler EJ, Hyman SE | veditors = Sydor A, Brown RY | title = Molecular Neuropharmacology: A Foundation for Clinical Neuroscience | year = 2009 | publisher = McGraw-Hill Medical | location = New York | isbn = 978-0-07-148127-4 | pages = 323, 368 | edition = 2nd |quote = supervised use of stimulants at therapeutic doses may decrease risk of experimentation with drugs to self-medicate symptoms. Second, untreated ADHD may lead to school failure, peer rejection, and subsequent association with deviant peer groups that encourage drug misuse.&nbsp;... amphetamines and methylphenidate are used in low doses to treat attention deficit hyperactivity disorder and in higher doses to treat narcolepsy (Chapter 12). Despite their clinical uses, these drugs are strongly reinforcing, and their long-term use at high doses is linked with potential addiction}}</ref>。還不清楚懷孕時服用這些藥物是否安全<ref>{{cite journal | vauthors = Ashton H, Gallagher P, Moore B | title = The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder | journal = Journal of Psychopharmacology | volume = 20 | issue = 5 | pages = 602–10 | date = September 2006 | pmid = 16478756 | doi = 10.1177/0269881106061710 | url = http://jop.sagepub.com/cgi/content/abstract/20/5/602 | archive-url = https://web.archive.org/web/20090815063002/http://jop.sagepub.com/cgi/content/abstract/20/5/602 | deadurl = no | archive-date = 15 August 2009-08-15 }}</ref>。

=== 飲食===
<!--{{Main|Diet and attention deficit hyperactivity disorder}}-->

飲食的調整可能對少部份的ADHD兒童有幫助<ref name="pmid22176942">{{cite journal | vauthors = Nigg JT, Lewis K, Edinger T, Falk M | title = Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 51 | issue = 1 | pages = 86–97.e8 | date = January 2012 | pmid = 22176942 | pmc = 4321798 | doi = 10.1016/j.jaac.2011.10.015 }}</ref>一份2013年的統合分析針對有ADHD症狀，而且有補充[[脂肪酸|游離脂肪酸]]或是減少食用有人工色素食品的兒童的相關研究發現，只有不到三分之一的兒童在症狀上有改善<ref name=Sonu2013>{{cite journal | vauthors = Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Döpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J | title = Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments | journal = The American Journal of Psychiatry | volume = 170 | issue = 3 | pages = 275–89 | date = March 2013 | pmid = 23360949 | doi = 10.1176/appi.ajp.2012.12070991 | quote = Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities... }}</ref>。這方面的助益有可能只是對有食物敏感的兒童有幫助，也有可能是因為這些兒童同時也在接受ADHD的治療<ref name=Sonu2013/>。這些已發表的文獻也發現目前已有的證據無法支持減少食用特定食物來治療ADHD的療法<ref name=Sonu2013 />。2014年發表的文獻也發現[[排除飲食]]在治療ADHD上的成效有限<ref name=NiggHolton2014>{{cite journal | vauthors = Nigg JT, Holton K | title = Restriction and elimination diets in ADHD treatment | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 23 | issue = 4 | pages = 937–53 | date = October 2014 | pmid = 25220094 | pmc = 4322780 | doi = 10.1016/j.chc.2014.05.010 | type = Review | quote = an elimination diet produces a small aggregate effect but may have greater benefit among some children. Very few studies enable proper evaluation of the likelihood of response in children with ADHD who are not already preselected based on prior diet response. }}</ref>。另一篇2016年文獻回顧指出，根據研究結果，「[[無麩質飲食]]在未來成為ADHD的標準療法」之機率是微乎其微<ref name="pmid26825336" />。

2017的文獻回顧指出有一些排除飲食的方式對於非常小，無法用藥的幼童，以及對藥物沒有反應的患者可能有用，不過不鼓勵用補充游離脂肪酸或是減少食用有人工色素食品作為ADHD的正規治療方式<ref name="PelsserFrankena2017">{{cite journal|vauthors=Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R|title=Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD|journal=PLoS One|volume=12|issue=1|pages=e0169277|date=January 2017|pmid=28121994|pmc=5266211|doi=10.1371/journal.pone.0169277|type=Systematic Review}}{{open access}}</ref> 。長期鐵、鎂及碘等礦物質的不足可能可以讓ADHD的症狀加劇<ref name="pmid22928358">{{cite journal | vauthors = Konikowska K, Regulska-Ilow B, Rózańska D | title = The influence of components of diet on the symptoms of ADHD in children | journal = Roczniki Panstwowego Zakladu Higieny | volume = 63 | issue = 2 | pages = 127–34 | year = 2012 | pmid = 22928358 }}</ref>，也有少數證據指出組織內[[锌]]含量過低和ADHD有關<ref name="pmid16190793">{{cite journal | vauthors = Arnold LE, DiSilvestro RA | title = Zinc in attention-deficit/hyperactivity disorder | journal = Journal of Child and Adolescent Psychopharmacology | volume = 15 | issue = 4 | pages = 619–27 | date = August 2005 | pmid = 16190793 | doi = 10.1089/cap.2005.15.619 | hdl = 1811/51593 }}</ref>。不過除非證實有{{link-en|鋅不足|zinc deficiency}}的情形（目前多半是開發中國家才會有鋅不足的情形），一般不建議用{{link-en|鋅補充劑|zinc supplementation}}治療<ref name=pmid25220092>{{cite journal | vauthors = Bloch MH, Mulqueen J | title = Nutritional supplements for the treatment of ADHD | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 23 | issue = 4 | pages = 883–97 | date = October 2014 | pmid = 25220092 | pmc = 4170184 | doi = 10.1016/j.chc.2014.05.002 }}</ref>。不過若鋅礦物質和[[苯丙胺]]類藥物同時使用的話，可以減低苯丙胺藥物的最小{{le|有效劑量|Effective dose (pharmacology)}}，也就是可以服用較少的藥物而達到相同的效果<ref name="Zinc binding sites + ADHD review">{{cite journal | vauthors = Krause J | title = SPECT and PET of the dopamine transporter in attention-deficit/hyperactivity disorder | journal = Expert Review of Neurotherapeutics | volume = 8 | issue = 4 | pages = 611–25 | date = April 2008 | pmid = 18416663 | doi = 10.1586/14737175.8.4.611 | quote = Zinc binds at&nbsp;... extracellular sites of the DAT [103], serving as a DAT inhibitor. In this context, controlled double-blind studies in children are of interest, which showed positive effects of zinc [supplementation] on symptoms of ADHD [105,106]. It should be stated that at this time [supplementation] with zinc is not integrated in any ADHD treatment algorithm. }}</ref>。另有證據指出[[Ω-3脂肪酸]]對於病情會有些許的改善，不過不建議取代醫學治療<ref name="pmid21961774">{{cite journal | vauthors = Bloch MH, Qawasmi A | title = Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 50 | issue = 10 | pages = 991–1000 | date = October 2011 | pmid = 21961774 | pmc = 3625948 | doi = 10.1016/j.jaac.2011.06.008 }}</ref><ref name="pmid27555775">{{cite journal | vauthors = Königs A, Kiliaan AJ | title = Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment | journal = Neuropsychiatric Disease and Treatment | volume = 12 | issue = | pages = 1869–82 | year = July 2016 | pmid = 27555775 | pmc = 4968854 | doi = 10.2147/NDT.S68652 }}</ref>。


== 間接醫療協助 （社會資源協助） ==
== 間接醫療協助 （社會資源協助） ==

2019年11月21日 (四) 13:03的版本

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。
  「过动症」重定向至此。關於膀胱的疾病，請見「膀胱過動症」。
注意力不足/過動症（AD/HD）
attention deficit / hyperactivity disorder
同义词注意力缺失症、注意力缺陷過動症、過度活躍症、hyperkinetic disorder (ICD-10)
An image of children
注意力不足過動症兒童患者可能比較難以專注在學校的作業，因此也不容易在期限內完成作業
症状容易分心（英语：attentional shift）（難以把專注力放對地方）、過度的活動、 難以控制行為和衝動[1][2]
常見始發於6 - 12歲左右[3][4]
病程多於6個月[3]
类型特殊性发育障碍、多动障碍[*]、疾病、神經發育異常
肇因尚不明確[5]
診斷方法根據症狀並排除其他可能的致病原因。[1]
相似疾病或共病品行障碍、對立反抗症、學習障礙、躁鬱症[6]、自閉症光譜、睡眠障礙[7]、焦慮症[7]、憂鬱症[7]
治療心理治療、改變生活方式、藥物[1]
藥物中樞神經刺激劑、阿托莫西汀、胍法辛[8][9]
盛行率5,110萬（2015年）[10]
分类和外部资源
醫學專科精神醫學、兒童與青少年精神醫學
ICD-116A05
ICD-10F90.0
OMIM143465、​608903、​608904、​608905、​608906、​612311、​612312
DiseasesDB6158
MedlinePluswillem
eMedicine289350、​912633
[编辑此条目的维基数据]
注意力不足過動症
症状執行困難症[*]、難以控制行為和衝動、情緒失調[*]、過度專注、rejection sensitive dysphoria[*]、distractibility[*]
类型特殊性发育障碍、多动障碍[*]、疾病、神經發育異常
分类和外部资源
醫學專科精神医学、​兒童青少年精神醫學
ICD-116A05
ICD-10F90
ICD-9-CM314.00，314.01
OMIM143465
DiseasesDB6158
MedlinePlus001551
eMedicinemed/3103 ped/177
MeSHD001289
[编辑此条目的维基数据]
「ADHD」的各地常用譯名
中国大陸注意力缺陷多动障碍
臺灣注意力不足過動症
香港專注力失調或過度活躍症
澳門專注力失調/過度活躍症
日本注意欠陥・多動性障害
大韓民國注意力缺乏過多行動障礙
注意力缺乏 過剩行動 症候群
越南𦇒亂增動減注意
神经心理学
The lobes of the brain, viewed laterally
主題
腦功能
人物
神經心理學測驗（英语：Neuropsychological test）

注意力不足過動症（英語：attention deficit hyperactivity disorder，縮寫为ADHD），涵蓋注意力缺失症（英語：attention deficit disorder，縮寫为ADD）。ADHD在早期的官方稱呼為注意力缺失症（英語：attention-deficit disorder、ADD）和兒童過度活躍的反應（英語：hyperkinetic reaction of childhood）[11][12]。ADHD是一個由於患者之腦內神經的發育異常遲緩所直接導致的心理疾患[13][14]，因此也是一個與腦神經相關的疾病[15][16]。它的特徵是「容易分心，難以專注（英语：attentional shift）」、「過度的活動」或「難以控制自身的言行舉止」且不符合患者年齡該有的成熟度[註 1][1][17][18]。通常患者也會有情緒管理的困難[19][20][21]。ADHD的症狀通常出現在大約12歲以前且持續超過六個月並在至少兩種情境中出現（例如：學校、家庭、休閒活動等）[4][22][23][24]。專注力方面的問題可能影響兒童患者的在學表現[1]。除此之外，注意力不足過動症可能會導致其他心理疾病及物質濫用[25]。

過去普遍認為注意力不足過動症是只會發生在兒童身上的腦部發育障礙，但近年發現注意力不足過動症患者的60%（包括應接受診斷卻未接受診斷的患者），其注意力不足過動症癥狀會持續至成人時期，而這60%患者中的41%，其注意力不足過動症仍對生活造成明顯的影響[26][27][28][29]。注意力不足過動症在嬰兒和幼兒時期，因為孩子正在學走路和說話，所以症狀通常不易被察覺，往往要等到他們進入幼稚園或小學之後，透過遵守教室、課堂的規範及跟同學們的相處，旁人才會漸漸注意到其症狀。學校老師往往是最容易發現孩童注意力不足過動症症狀的人，因為在學校有明確的對照組[30]；然而，不少注意力不足過動症患者（尤其是女性患者）沒有過動—衝動的症狀，而過去對此症的認識總是集中在過動[a]症狀上，使得這類「不過動或衝動」、「純粹注意力缺陷」的注意力不足過動症患者甚少能診斷出來。端視注意力不足過動症患者其腦部發展（發育）的程度與其所在環境對其執行功能要求的程度之比例，因此有些注意力不足過動症患者可能直到青少年時期甚至是成年期（特別是成年初期）才開始顯露出注意力不足過動症的症狀[31][32][33][34]。國際注意力不足過動症，兒童流行率中位數為5~8%[35]，成人流行率為2.5~5%[36]。注意力不足過動症會造成家庭社會的重大損失，其中也包括父母的工作損失[37][38]。注意力不足過動症患者甚至其家屬可能對自身或患者的問題存有否認心理[39][40][41]。

現時沒有任何確切證據證實任何一個或多個因素決定性地導致這種病症。研究顯示注意力不足過動症與腦部的額葉及其他構造發展相關，但詳細成因仍未得知。注意力不足過動症可能具有相當高的遺傳率。根據美国疾病控制与预防中心的研究，注意力不足過動症是一群症狀的交集。因此，要正確診斷這病症，必須同時採用多種臨床方法配合去確認。注意力不足過動症的診斷係依據《精神疾病診斷與統計手冊》的標準、門診病人主訴、症狀學、患者的歷史經歷、發展史、家族史、共病、生理評估及各種醫師評估後認為需要進一步的檢查等。[註 2][42][43][32]每年的十月為國際間訂定的注意力不足過動症意識之月（ADHD Awareness Month）[44][45]。

每個國家都有各自的ADHD治療策略，彼此之間並不完全相同，但大都包含諮商、改變生活習慣和藥物等。[1]。學齡前的患者，通常僅需接受行為治療，除非症狀達到嚴重的程度且拒絕接受行為治療或無法從行為治療中獲得改善，才需考慮加入藥物治療[46][47]。中樞神經刺激劑是最常用的ADHD藥物，使用者在頭14個月持續服用能有效治療ADHD，不過目前有關使用超過14個月後對於ADHD症狀的療效，尚未明朗。[48][49][50][51]。成人患者多半會發展出應對的技巧，來處理其部份或是所有的不足之處[52]。

雖然中樞神經刺激劑不會帶給服用者嚴重的副作用，但其相對不嚴重的副作用，比如說：失眠、食慾不振則較常出現在服用者身上。對於「如何解決前述的副作用」和「非藥物的治療方式」是未來研究的重點[53]。注意力不足過動症的治療並非是要將孩子們標準化[b]，而是一本教育的初衷，協助每一位孩子「發掘、發揚自己的優點、並避免缺點」。[54][55][56][57]

18世紀首次有人在醫學文獻上描述類似當今ADHD定義的症狀。[58] 近年來，ADHD本身和ADHD診斷以及ADHD治療時常引發爭議。[59] 圍繞在爭議中的當事人包含醫師、教師、政府官員（政策制定者）、父母和新聞媒體，他們主要在爭論「ADHD的起因」和「使用中樞神經刺激藥物來治療ADHD是否合適」。[60] 大多數的醫療從業人員都接受ADHD是一個真實存在的疾病且見於兒童、青少年和成人，存在於這些醫療人士之間的歧見肇因於對「ADHD的診斷方式」、「ADHD的治療方式」和「精神科醫師應具備的專業素養」的不同看法[61][62][63][64][65]。

名稱

注意力不足過動症也译作注意力不集中/過動症（英語：Attention Deficit/Hyperactivity Disorder，簡稱AD/HD）、過度活躍症（英語：Hyperkinetic Disorder；於ICD 10中的名稱），俗称有多動症、多動障礙及大雄·胖虎症候群（日本）等。此病患的兒童習稱過動兒，也有醫療人士建議改稱為心動兒。[66][67]

注意力不足過動症可以依其子類型分為以下幾類。

注意力不足過動症
子類型  \  核心症狀 注意力不足（分心） 過動 衝動
過動-衝動為主型[註 3] - ✔ ✔
注意力不足為主型
又稱為注意力缺失（陷）症（Attention Deficit Disorder）		 ✔ - -
混合型 ✔ ✔ ✔

世界衛生組織出版的《世界通用疾病分類手冊》第十版中（ICD-10, International Classification of Disease-10，又稱為國際通用的疾病分類表）， 過度活躍症的症狀幾乎等同於《精神疾病診斷與統計手冊》第五版（DSM-5）中注意力不足過動症的症狀。而「注意力不足過動症」在ICD-10中稱為「過度活躍症」[69]。

ICD-11 正式版將廢除「過度活躍症」名稱，改採「注意力不足/過動症」[70]並納入上述三種ADHD的類型、子類型[71][72][73]。

定義

讲解注意力不足過動症的影片（英文）

對注意力不足過動症比較確切的定義，記載於美國精神醫學會（APA）出版的《精神疾病診斷與統計手冊》（DSM）第四版之文本修改版[74]。

注意力不足過動症的主要病徵是：

  1. 注意力渙散或集中困難（專注力失調、注意力缺陷）
  2. 活動量過多 （過度活躍、多動）
  3. 自我管理能力弱 （衝動）

基於以上三種病徵，再把注意力不足過動症細分為以下三個分類：

  1. 注意力渙散主導型
    又稱為注意力不足（專注力失調）為主型
  2. 活動量過多或自制力弱主導型
    又稱為過動-衝動（過度活躍、多動障礙）為主型
  3. 混合型
    又稱為注意力不足（專注力失調）、過動-衝動（過度活躍、多動障礙）混和型

注意力不足（失調/缺陷）

      參見：注意力的臨床表現型、注意力不集中、分心、過度專心

面向 解釋
選擇性注意力
（Selective attention）
  1. 能夠維持原有的行為或認知過程，即便遇到外界的刺激或誘惑，亦复如此。
  2. 能夠將注意力凝聚於某一個重要目標，而忽略其他不相干的訊息，所以就不會分心。
分開性注意力
（Divided attention）

能夠同時專注於不同的事情上、同時接收多個指令、或者同時進行好幾件事情而不會搞混或忘記。

轉移性注意力
（Shifting/Alternating attention）
  1. 專注力可以迅速從一件事切換到另一件事，果斷地處理完眼前的事物、再隨時切換回去，不會遲疑不決或慌張混亂。
  2. 能夠在心靈上保有彈性，使自己能把注意力的焦點從一件事切換到另一件事，也能在「所需認知程度不同的」事情之間切換。
持續的注意/警覺（英语：Vigilance (psychology)）/專注力
（Sustained Attention/Vigilance/ Concentration）

可以讓專注力在「持續一段時間且內容重複」的事情中保持一段較長的時間，不會一下子就恍神或散漫。

集中的注意力（選擇地集中注意力）
（Focused attention/Selective sustained attention[75][76]）

能夠一個一個，井然有序地應對來自視覺、聽覺或觸覺等外部刺激。

注意力缺陷可能導致患者難以把事情想清楚，而常常產生疑惑。[77]
  • 備註：「一件事」在此也可為「一個想法或點子」。

注意力不足過動症的兒童，在「轉移性注意力」、「選擇性注意力」和「持續性注意力」有類似的特點，尤其是「持續性注意力」，會低於同年齡無ADHD的兒童[78]。 父母常疑問：孩子在看電視或打電動時常常一坐就是幾小時，可是靜態的看書、畫畫就沒有辦法，可能幾分鐘就喊無聊。不過不同活動所需的專注度原本就有差異，電視與電動因為畫面不停的變換，加上各種聽覺效果、視覺吸引的效果（包含時下興起的：虛擬實境），只需維持短暫的注意力就能持續進行，但孩子一旦從事要求較長專注度的工作或是活動時，其注意力就會無法持續或出現缺失。[54][55][79][80]而許多ADHD的孩子在自身感興趣的事情上可以維持長時間的專注[32][81]。

簡而言之，「注意力不足/缺陷」指的就是難以把注意力維持在「沒有帶給個案高強度刺激感或沒有頻繁帶給個案獎賞、回饋、或滿足感（英语：reward）（Reward）」的事情上或容易分心且有組織規劃上的困難。[71]

好動與過動

參見：過動的病理學（英语：Hyperkinesia）
患者可能 不自覺出現轉筆來化解坐立不安的感覺。[79]
好動 雖然活動量大，但是「神經動作」、「精細動作」的控制沒有問題，是故可以進行靜態的活動。[29]:19-20
過動 過動者在靜止時容易有主觀的「不安」感覺。若患者不被允許進行大動作（走路、站立）時，其會需要透過小幅度的動作（如抖腳、轉筆等）來化解坐立不安的感覺。[79][82][83]

除此之外，過動的孩子往往無時無刻都保持動態，難以維持肢體上的固定（在那些需要自我控制肢體的場合中動來動去就是證據之一）；也會顯得過於活躍、帶有攻擊性、衝動或難以保持專注，並造成社交上和學業上的困難。[83][84][85][86][註 4]

從青春期開始直到往後的人生，過動-衝動的症狀往往不再明顯以外部的肢體表現出來，而是轉為以「內在的不安寧（inner restlessness）」等內在型式表現。 [87][88]（p. 44）[89]

已知「過動」與「衝動」，彼此之間高度相關[68][90][91][92]。

衝動性

主条目：衝動和延遲的滿足
File:Damon shocked.jpg
衝動：由於在沒先想清楚就行動而導致不想要的結果。很多時候，這樣的情況往往伴隨著後悔與自我修正，然後又重蹈覆轍。（編註：工作記憶）[93]

衝動是指在抑制控制上有困難，所以會在尚未深思熟慮前，就開始行動（簡言之，未能謀定而後動）。ADHD往往無法正確判斷什麼是「適當的行為」，這乃是因為ADHD的衝動性質反映在認知上所形成的表象。由於ADHD的自我抑制能力不足，所以往往會不由自主地說出本身不願意說的話或做出本身不願意做的事情或行動。舉例來說：當非ADHD的孩子做出不適當的行為時，只要被老師或家長處罰2到3次就會修正其行為；而ADHD兒童在受到好幾次處罰後，仍持續違反紀律的情形十分普遍。這樣重蹈覆轍的行為不是反抗也不是故意的，而是心裡的衝動所致。具有衝動性特質的人，其反應時間（不經深思熟慮的反應），比起同齡或同智能的人要短一些。這種衝動的個性會直接反映在學業上，譬如說，衝動的人傾向在還沒閱讀完較長的題幹，或還沒有讀完全部的答題選項時，就因不耐煩而作答，導致答錯問題的比率甚高。除此之外，曾有個性衝動的人因為沒注意到眼前的障礙物而絆倒，或在沒有注意路況下，就衝到馬路上而發生交通事故的例子。[94][95]

一言以蔽之，衝動乃患者經常在「能『立即』獲得酬賞滿足感（Reward）」的點子的驅使下就「立即」行動，行動前沒能鑑往（英语：hindsight）知來（英语：foresight）、縝密思考過行動的緩急輕重、利弊得失、風險及可能帶來的後果，之所以行動幾乎只是為了能『立即』獲得酬賞、回饋、或滿足感（Reward）。 [96][97][98][99][100][101][102][103][104][105][106][107]

特徵和症狀

主条目：注意力不足過動症的特質和注意力不足過動症的症狀

注意力缺失症患者在學生時期的特徵包含：患者在上課時看起來是靜靜地聽講，但事實上患者對教師所說的內容可能茫然不知、純粹只是望著教師。[56]

未治療的注意力不足過動症患者（紅色實線）相較於非注意力不足過動症患者（藍色虛線），通常對刺激過於延遲的反應（反應包含：緊張、開心等），並造成患者過於不易分辨事情的緩急輕重等症狀。[108]
（編註：感受力、感覺能力、感知能力）
ADHD的典型症狀：過動（Hyperactivity）、缺乏自我抑制（Disinhibition）、健忘（Forgetfulness）、缺乏秩序與組織性（Disorganization）、容易分心（Distractedness）、難以把專注力放對地方（Inattentive）[93]
做白日夢是常見於ADHD的特質（英语：Personality_type）。[109]

注意力不足過動症的主要特徵包括：容易忘記事情、分心、一說話就停不下來（英语：Compulsive talking）、獨佔整個對話交談（monopolizing conversation）、常打斷別人發言、靜不下來、讀寫困難（包括寫錯字，常多一畫或少一畫、拼字錯誤等）、閱讀時會跳行或無法理解文意等，做事易延宕，常拖至最後。工作普遍都做不久，持續有點子突然在腦海中蹦出來（英语：Racing thoughts），會一直換工作，顯得三心兩意[註 5]、缺乏組織（英语：Organizing_(structure)）、規劃力，無法把自己想說的話、想做的事具體地表達或規劃出來。逃避需要持續動腦的工作（例如：做家庭作業或學校作業）、無法分辨事情的優先次序（英语：Prioritization）（緩急輕重）、缺乏時間管理的認知。[32][111][112][113][93]

以上症狀隨患者年齡而有不同表現，譬如說，注意力不足過動症的孩子，其表現通常有：上課不專心、無法抑制自己的衝動以及坐立不安的情況；成人患者的主要問題則常在於無法計劃並完成好他們的日常生活與每日簡單的工作[113]。（編註：參見成人注意力不足過動症）

各年齡層的注意力不足過動症患者往往較容易遭遇社交技巧上的問題，例如：社交互動、建立一段人際關係（英语：relationship forming）及維持一段人際關係等。這個觀察在各注意力不足過動症的三種子類型中都是成立的。大約一半（50%）的患有注意力不足過動症的兒童及青少年曾經歷過来自他人的社交拒絕；相形之下，其同儕[註 6]被別人拒絕社交的比率約為10-15%。注意力不足的人比起對照組（非注意力不足過動症患者）更容易遭遇理解他人「口頭（英语：verbal）與非口頭」言行舉止及交際上的困難，進而對於其社交互動產生負面影響。注意力不足過動症患者也可能在對話的過程中恍神（英语：Hypnagogia）甚至打瞌睡並遺漏他人釋放出的社交暗示。[114]

難以管理憤怒情緒的情況則較常在兒童注意力不足過動症患者身上顯現。[115]再者，兒童注意力不足過動症患者通常有寫字（英语：handwriting）的困難[116][117]、言語及行動發展的遲緩（英语：Child_development#growth）。雖然這些問題造成患者在現今社會中很大的障礙[118][119]，然而許多注意力不足過動症患者在他們有興趣的事情上都能持續維持專注力，[120]甚至過度專心，成為工作狂。[54][註 7]

注意力不足過動症患者遇到需要保持長時間專注的事情，比如說：讀書、寫功課、或閱讀（英语：Reading comprehension），就容易出現不適應的情況。[54]研究結果證實注意力不足過動症本身與低學業成就（英语：Academic_achievement）為直接的因果關係。[121]

不少注意力不足過動症患者（尤其是女性患者）沒有過動症狀，而過去對此症的認識總是集中在過動（多動、過度活躍）症狀上，使得這類「不過動或衝動」的注意力不足過動症患者甚少能被診斷出來。[122][123]

正向特徵

衝動若被視為特質之一，那麼其優點在於能掌握稍縱即逝的機會，因為一個三思而後行的人大多無法抓住一眼瞬間的機會。[124][125][126][90][127][128][129][130]
衝動在認知上的表現為「缺乏自我抑制」，因此可能是ADHD之所以具備「多元思考」或是腦海中的想法出現「多頭馬車」的原因之一。[125][126][90][127][128][129][130]

注意力不足過動症患者較為正向的特質為：
舉止坦率自然、落落大方、富有想像力與好奇心能夠跳脫框架思考[131]（編註：參見發散式思考）；思考多元獨特，對直覺較敏感，能深入問題核心發現問題；對自己的想法堅持、特立獨行[112]；具高度創造力、追求創新、熱心助人、富有正義感和幽默感、活潑開朗[54]；勇於冒險、韌性十足、源源不絕的活力[132]。有興趣時非常能夠堅持[131]、具備批判性思维。[133][112][132][125][126][90][127][128][129][130][124]


婚姻關係

參見：拖延對ADHD的情感關係造成的影響（英语：Procrastination#Negative impact）及成人注意力不足過動症§婚姻等親密關係

台灣精神科醫師高淑芬在《找回專注力：成人ADHD全方位自助手冊》一書中指出，ADHD患者活潑開朗、熱心助人、說話風趣、勇於告白的特性對於兩性交往與婚姻來說都具有加分作用；但交往一段時間後，ADHD患者的負面特質，例如：沒耐心、容易遲到、無法專心聽人說話、交代的事情老是忘記、需要幫忙的時候找不到人、生活習慣及生活作息不正常、及個性迷糊（英语：Absent-mindedness）等，就可能讓對方萌生退意。[54]高淑芬亦指出，如果順利交往、結婚，則接下來注意力不足過動症患者可能遇到的挑戰為：比起交往時期多了許多日常生活之事，患者可能會因為忘記付帳單、照顧小孩很散漫、做事有始無終而引起夫妻間的爭吵，為婚姻生活埋下陰影。[54][134][135][136]

然而，高淑芬強調，只要ADHD患者可以提升專注力並且落實執行力，一樣可以如同其他人。[54]

智力

注意力不足過動症患者的智力與潛力和非注意力不足過動症患者相仿，然而因為注意力不足過動症的症狀，使得其智力測驗結果可能產生較大的誤差[137][138]。

由於ADHD可能被當成學習障礙或智能障礙為主的方式處理，因此文獻指出，面對兒童青少年和成人之學習障礙或智能障礙患者的相關人員應具備ADHD的專業知識[139][140]。

台灣醫師高淑芬在其著作中提到，若能在大約九、十歲以前把握年齡較小、症狀較為單純時治療，可以避免往後病情複雜化（衍生共病）。再者，能在早期建立良好的學習及生活習慣，培養自信心及責任感，對注意力不足過動症患者的未來將有深遠的影響[29][54][55]。

可能與注意力不足過動症有關的疾病

在注意力不足過動症患者中，大約會有2⁄3 的機率伴隨其他有關的特徵或疾病[81]。常見的特徵或共病如下：

一篇2016年發表的系統性文獻回顧發現「注意力不足過動症」與肥胖、呼吸道及氣管過敏（例如：氣喘、過敏性鼻炎）、或睡眠障礙有著直接的關聯[187]；而與偏頭痛有一定的關係[187][188]。有論文認為注意力不足過動症和乳糜瀉可能有關[187]，然而也有系統性文獻回顧認為二者無關連性[189]。

診斷

主条目：注意力不足過動症的診斷

注意力不足過動症的診斷是根據患者的行為和心理發展的評鑑並且排除毒品、藥物的影響、或其他生理或心理的可能造成類似ADHD症狀的因素而成。[170]診斷過程通常會將個案的父母意見及師長意見列入考量。[4] 大多數的診斷都是因為個案的教師首先對於孩子的健康提出關切，經轉介後而成。[190] 注意力不足過動症的症狀可能會被認為是人類個性光譜的極端或是其中一環而已。[191] 對於ADHD的藥物反應結果，無法就此確認診斷或排除診斷。迄今為止學界尚未得到一致的ADHD與非ADHD之腦部構造的差異結論，因此腦部造影只被用於對於複雜的人腦進一步的研究，尚未能應用於診斷ADHD。[192]使用量化腦波（英语：quantitative electroencephalography） (QEEG) 診斷ADHD是學界中正在研究的領域之一，然而迄今為止，腦波經過量化後的數值與ADHD之間的關係仍然不明。[193][194]

注意力不足過動症又可細分為以下三種類型：注意力不足（專注力失調）為主型、過動-衝動為主型、或注意力不足（專注力失調）且過動-衝動的混合型。[74]過動，即為「過度」活躍。過度兩字意味著活躍的程度已經對生活造成不良的影響。[195]即便個案並無上述注意力不足過動症的所有特徵，他仍有可能是ADHD患者，有無全部特徵牽涉到是否有其他共病存在且治療的主要目的在於協助患者避免缺點並發揚優點。成人及兒童青少年的注意力不足過動症的診斷依據《精神疾病診斷與統計手冊》的標準、患者的歷史經歷（個案史）[74]、門診病人的主訴、症狀學、發展史、家族史、共病、生理評估、心理測驗（例如：工作記憶、執行功能：計畫與決策等、視覺記憶、空間記憶、理智等等[註 2][43]）及各種醫師評估後認為需要進一步的檢查等。[7][32][43]

ADHD隸屬於神經發育所致之精神疾患[14][89]。 除此之外，ADHD也隸屬於紊亂行為症候群（英语：disruptive behavior disorder），同樣隸屬於紊亂行為症候群的心理疾病有：對立反抗症、品行障碍、和反社会人格障碍[196]。ADHD的診斷並不暗指任何一個神經系統疾病（英语：neurological disorder）[48]。

醫師在診斷過程中必須衡量個案的焦慮、憂鬱程度、及對立反抗症、品行障碍、及學習和語言障礙。其他需要考量的問題包括：其他神經發育障礙、抽动综合症、和睡眠呼吸暂停[197]。

自我評量表，例如：ADHD 評量表（英语：ADHD rating scale）和Vanderbilt ADHD診斷評量表（英语：Vanderbilt ADHD diagnostic rating scale）會在診斷和評估ADHD的過程中使用。[198]

病因學

主条目：注意力不足過動症的病因學
ADHD患者的腦部與非 ADHD患者（Typically developing controls）的腦部造影顯示的大腦發育成熟度的差異[199][200]。

雖然注意力不足過動症是兒童精神病學，迄今為止，獲得最多且最深入研究的領域，然而絕大多數ADHD的確切成因目前並沒有定論[201]，最有可能是基因、環境和社會等因素交互作用導致。[54][55][202][203]

有些個案的成因可能與腦部的疾病感染和腦部創傷有關。[54][55][202]根據研究統計，注意力不足過動症具有相當高的遺傳率。[54][55]除了基因外，一些環境及社會因子也可能是注意力不足過動症的致病因素。[204][205][48]

病理生理學

主条目：注意力不足過動症的病理生理學
ADHD的左前額葉通常與控制組（非ADHD患者）顯著不同[206][207]。

注意力不足過動症被認為是肇因於部分腦內的神經傳導物質系統的損傷（特別是與多巴胺和正腎上腺素有關的神經傳導系統），進而對患者的腦部執行功能產生不良的影響。[208][206]多巴胺與正腎上腺素的腦內神經傳導物質通道系統（英语：Neural_pathway）大多起源自腦內的腹側被蓋區和藍斑核，並由此投射至不同的腦區且管理許多認知的流程（與認知功能相關的處理流程）。[208][209]特別是那些投射至前額葉和紋狀體的腦內多巴胺神經傳導通道系統（英语：dopaminergic pathway）和腦內正腎上腺素通道系統/藍斑核系統。它們主要的工作就是負責調節執行功能（認知和行為的功能與管理）、動機、 酬賞/報償的感受能力、和運動神經的功能[註 4]。[208][206][209]以上是目前已知在注意力不足過動症的病理生理學中扮演主要腳色的幾條腦內神經傳導物質通道系統（英语：Neural_pathway）。也已經有人提議強化對於注意力不足過動症更全面的概觀以及更多可能與之相關的腦內神經傳導物質通道系統之探究。[206][211][212]

而研究也發現，注意力不足過動症是由一種發生於腦前額葉的遺傳性的多巴胺新陳代謝失常引致。更近期的研究認為正腎上腺素的新陳代謝亦會對病情有所影響 [213] [214] [215]。

截至2019年8月底，已知ADHD也與 血清素傳導系統（英语：serotonin pathways）（5hydroxytryptamine [5-HT]）、 乙酰胆碱傳導系統（英语：acetylcholine pathways）（ACH）、鴉片類傳導系統（英语：opioid pathways）、和谷氨酸傳導系統（英语：glutamate pathways）（GLU）的失調有關。[216][217][218]

治疗

主条目：注意力不足過動症的治療

注意力不足過動症的治療方式包括心理治療、行為治療及藥物，也有可能是用幾種方式一起進行。治療對病症會有長期的改善，但是無法完全根除病症的影響[219]。藥物包括有興奮劑、阿托莫西汀、腎上腺素受體α2（英语：alpha-2 adrenergic receptor）拮抗劑，有時也會包括抗抑鬱藥物[166][220]。若時無法專注在長期獎勵上的人，有許多的正增强方式可以提昇其工作表現[221]。ADHD藥物中的興奮劑也可以提昇患者的毅力及工作表現[206][221]。

行為治療

有關行為治療在ADHD上的應用，有許多良好的實證，若是針對學齡前，或是症狀輕微的病患，一般會建議用行為治療為第一線的療法[222][223]。心理療法包括有心理教育、行為治療、认知行为疗法（CBT）、人際取向心理治療、家庭治療（英语：family therapy）、學校介入、社交技巧訓練、行為方面的同儕介入、機構培訓[224]、父母管理訓練[48]及神經反饋（英语：neurofeedback）訓練[225]。父母管理訓練可以改善包括反對行為以及不合常規行為在內的一些行為問題[226]。目前還不清楚神經反饋訓練是否有效[227]。

有關家庭治療的效果，目前還很少足夠品質的證據可以佐證。目前證據認為家庭治療的效果類似群體照顧（community care），效果比安慰劑要好[228]。有許多注意力不足過動症支持組織可以提供相關資訊，並且協助家庭適應ADHD的情形[229]。

有關社交技巧的訓練、行為調整以及藥物的對病患的好處可能有限。要減少後續心理及精神問題（例如重度抑郁症、犯罪、學校學習失敗、物質使用疾患）的主要因素是和沒有從事偏差行為的人建立友誼[230]。

規律的體能鍛煉，特別是有氧运动，對於患有ADHD的兒童及成人而言也是有效的副加療法（英语：adjunct therapy），特別是配合興奮劑藥物治療時更是如此，不過針對改善症狀，最理想的運動種類及強度還不清楚[231][232][233]。長期規律有氧運動對ADHD患者的好處是提昇行為及運動能力、提昇管控功能（包括專注、抑制控制、計劃等）、較快的資訊處理速度，記憶力也會比較好[231][232][233]。家長及教師針對ADHD兒童規律有氧运动對行為及以社交-情緒上的改善有：全身整體機能較佳、減少ADHD症狀、自尊感較好、減少焦慮及抑鬱的程度、較少身體症狀、課業成績及教室行為較佳，社交行為也有改善[231]。若在有使用興奮劑治療時進行運動，會增加興奮劑藥物對執行功能的影響[231]，一般認為運動的短期效果是因為運動時大腦突触多巴胺和去甲腎上腺素濃度的增加所造成[231]。

藥物

針對注意力不足過動症，可以用中樞神經刺激劑（也稱為兴奋剂）藥物進行治療[234][235][已过时]，對於症狀至少會有一些效果，短期而言，約有80%會有效果[60][51][235]。家長及教師反應哌甲酯比較可以改善其症狀[51][60][236]，中樞神經刺激劑也可以減少ADHD兒童意外事故的風險[237]。針對ADHD的中樞神經刺激劑藥物除了哌甲酯外，還有苯丙胺、甲基苯丙胺等。

針對ADHD的非中樞神經刺激劑藥物有許多種，包括阿托莫西汀、安非他酮、胍法辛及可乐定，這些可以作為主要藥物治療，或是配合中樞神經刺激劑藥物一起使用[234][238]。目前有關各藥物之間的比較，還沒有說服力足夠的研究結果可以佐證，不過在副作用上似乎差不多[239]。中樞神經刺激劑藥物比較可以提昇課業表現，阿托莫西汀則無此效果[240]。阿托莫西汀比較不會有成癮問題，因此若有娛樂性藥物或是強迫性藥物使用風險的人，比較建議使用阿托莫西汀[89]。有關藥物對社交行為上的影響，目前的資料也還不充份[239]。截至2015年6月年 (2015年6月-Missing required parameter 1=month!)，還沒有完全確定ADHD藥物的長期影響[241][242]。核磁共振成像 研究推測長期用苯丙胺或哌甲酯治療，會減少因為ADHD造成的大腦功能及結構異常[243][244][245]。2018年的文獻回顧發現若考慮短期效果，哌甲酯對兒童最有效，苯丙胺對成人最有效[246]。

什麼情形要用胍法辛治療會依國家而不同，英國國家健康照護專業組織（英语：National Institute for Health and Care Excellence）（NICE）針對成人是第一線藥物，若針對兒童，只建議在病情嚴重時才使用，而大部份美國的醫學指南會建議可以針對各年齡層使用[247]。針對學齡前的兒童，一般不建議用藥物治療[48][248]。若治療用的中樞神經刺激劑劑量不足，可能會有沒有藥效的情形[249]，這尤其常出現在青少年及成人身上，因為核可的劑量是針對學齡兒童的，因此有些醫療人員會依體重或是依其他因素給藥[250][251][252]

一般而言，在正常治療劑量的哌甲酯及中樞神經刺激劑是安全的，不過有其副作用以及禁忌症[234]。若哌甲酯給兒童及青少年使用，有研究發現這和一些嚴重或不嚴重的有害副作用有關，不過證據品質還不充份[253]。若針對兒童開立這類藥物，需仔細的監測兒童的情形[253]。若ADHD的中樞神經刺激劑嚴重過量，可能會和興奮性精神病（英语：stimulant psychosis）或是狂躁的症狀[254]。若是治療用的劑量，出現類似情形的機率非常低，只有0.1%，會在開始用中樞神經刺激劑藥物治療後的前幾週出現[254][255][256]，若也使用抗精神病药，可以有效緩解急性苯丙胺精神病的症狀[254]，若長期治療，需要定期的監測[257]。興奮劑的藥物治療需要定期停藥，評估是否還需要用藥、減少發育遲緩的情形，並且減低抗藥性[258][259]。若是長期使用超過ADHD治療劑量的興奮劑藥物濫用，一般會和成瘾及物質依賴有關[260][261]。不過未治療的ADHD，會提高物質濫用以及行為規範障礙的風險[260]。興奮劑藥物的使用，可能可以降低風險，但也有可能沒有此效果[89][241][260]。還不清楚懷孕時服用這些藥物是否安全[262]。

飲食

飲食的調整可能對少部份的ADHD兒童有幫助[263]一份2013年的統合分析針對有ADHD症狀，而且有補充游離脂肪酸或是減少食用有人工色素食品的兒童的相關研究發現，只有不到三分之一的兒童在症狀上有改善[264]。這方面的助益有可能只是對有食物敏感的兒童有幫助，也有可能是因為這些兒童同時也在接受ADHD的治療[264]。這些已發表的文獻也發現目前已有的證據無法支持減少食用特定食物來治療ADHD的療法[264]。2014年發表的文獻也發現排除飲食在治療ADHD上的成效有限[265]。另一篇2016年文獻回顧指出，根據研究結果，「無麩質飲食在未來成為ADHD的標準療法」之機率是微乎其微[189]。

2017的文獻回顧指出有一些排除飲食的方式對於非常小，無法用藥的幼童，以及對藥物沒有反應的患者可能有用，不過不鼓勵用補充游離脂肪酸或是減少食用有人工色素食品作為ADHD的正規治療方式[266] 。長期鐵、鎂及碘等礦物質的不足可能可以讓ADHD的症狀加劇[267]，也有少數證據指出組織內锌含量過低和ADHD有關[268]。不過除非證實有鋅不足（英语：zinc deficiency）的情形（目前多半是開發中國家才會有鋅不足的情形），一般不建議用鋅補充劑（英语：zinc supplementation）治療[269]。不過若鋅礦物質和苯丙胺類藥物同時使用的話，可以減低苯丙胺藥物的最小有效劑量，也就是可以服用較少的藥物而達到相同的效果[270]。另有證據指出Ω-3脂肪酸對於病情會有些許的改善，不過不建議取代醫學治療[271][272]。

間接醫療協助 （社會資源協助）

國際健康功能與身心障礙分類系統（ICF）[273][274][144][275][276]

由於注意力不足過動症具有高遺傳率，因此陪同患有ADHD子女就醫的父母親，有可能自身亦患有注意力不足過動症。而父母本身的ADHD症狀亦會影響其教養小孩的能力。 那些未經過治療的ADHD父母與其他父母相比，更可能使用較為負面的紀律手段來管教小孩。該些家庭通常具嚴重的家庭內部衝突[277][278][136]。在台灣，有ADHD患童出身清寒，又受到包含家庭等周遭環境不友善的對待，即便曾就醫尋求協助，最終仍遭不當管教而意外死亡的情事。[279][280][281][282][283][284][285][286][287][288]

参见：注意力不足過動症的病因學 § 社會因素和注意力不足過動症 § 台灣

台灣

衛生福利部社會及家庭署之【強化社會安全網】措施。[289]

除了在醫療、教育場所接受直接的醫療照護外，中華民國中央政府及地方政府亦下轄衛生福利部-社會及家庭署、衛生福利部-1957福利需求諮詢評估專線[290] [291]及社會局、衛生局等 [292] [293]，彙整對於弱勢者社會支持的資源[294][295]，以便讓這些患者能在接受直接醫療協助時無後顧之憂。衛生福利部心理及口腔衛生司提供許多官方的心理健康衛教資源。[296]

除此之外，特殊教育學校能協助具備特殊需求的孩子們在適當的環境中成長、茁壯。[297]   民間亦有許多特殊教育的支持團體及ADHD的社群[298][299][300] ，例如：社團法人台灣赤子心過動症協會[301]、社團法人心動家族兒童青少年關懷協會[302]和社團法人高雄市注意力缺陷過動症協會[303]。

於高等教育的部分，許多大學設有「特殊教育學系」及「特殊教育中心」[304][305][306][307][308][309]。中華民國的教育部也成立了台灣特殊教育資訊網[310]、全國特殊教育資訊網[311]、特殊教育通報網[312]、身心障礙職業教育資源網站[313]、國教署特教網路中心—特教教材分享平台[314]來協助具有相關需求之學生。 [315]而勞動部則涵蓋了各族群的勞動統計 [316]，政府也已訂定《身心障礙者權益保障法》以維護相關弱勢族群的生活 [317]。

另外，臺灣設立了113免付費家庭暴力保護專線，在未有人身安全風險時，可以就家暴的處境或經驗，尋求相關的資源或協助；如果當事人正陷入遭受家暴的危險處境，需要警察的即刻救援，則可撥打110通報警察偕同社工立即介入處理。[318][319][320][321][322][323]

中國大陸

一群对“注意缺陷多动障碍”诊断和治疗拥有丰富经验和学识的心理咨询师、医生、教师，自愿自发的组成一个针对“注意缺陷障碍”的非盈利性的组织－“中国注意缺陷障碍组织”，为儿童及其家长提供各种信息和帮助。 [324] [325] [326]

香港

  • 一群有《專注力不足/過度活躍症》兒童的家長，為了喚起社會大眾對這些學童的認識和關注，及推動有關專業人士對《專注力不足/過度活躍症》作進一步的研究與探討，於2006年成立協會，並於2013年把協會成功註冊為非牟利慈善團體。[327]
  • 一群專業人員和熱心人士發起的非牟利組織專注力促進會，於2005年在香港成立，旨在提高公眾對專注力失調及/或者過度活躍症的關注和認識，以促進患者得到平等的教育和發展機會。[328]
  • 香港政府另成立「GovHK 香港政府一站通：心理健康」提供需要者相關的所需資源。[329]

澳門

專注不足過度活躍症（澳門）協會是澳門關注專注不足過度活躍症的協會，在2014年2月正式成立，協會目的是推動社會大衆對專注力失調或過度活躍症（AD/HD）學童的了解、關注、包容[330]。

韓國

  • 韓國的校園精神衛生服務系統，兒童青少年精神科醫師佔有主導的角色，並且這幾年來分別建立ADHD研究中心，自閉症研究中心，及其他兒童心理健康相關的研究中心。[331][332]
  • 韓國有校園心理健康法，自2007年開始明文規定每年必須做一次全國性每一位篩選，自2013年間簡化成階段進行每年學生心理健康篩檢。[332]
  • 韓國的老師每年必須接受40小時的精神疾病繼續教育（英语：Continuing education）[註 11]，是由兒童精神科醫師規劃。[332]

台灣兒童青少年精神醫學會在2017年年會的新聞稿中表示：「韓國兩個國家級的心理衛生健康研究中心（注意力不足過動症與自閉症）為例，該中心可以完整的收集個人、家庭、學校以及生活環境中與心理、社會及生物學相關的資料，且進行長期追蹤。這些寶貴的資料，不僅可以奠定協助個人及家庭更好的基礎，更有助於醫學研究的發展暨國家政策的擬定與執行。」[332]

新加坡

  • 新加坡政府新特殊教育學生的支援計畫始於2005年，計畫內容包括在派令教師接受特殊教育訓練並在校內配置特殊教育的專業人員。[333]
  • 持續發展、執行、觀察、評估特殊教育學生的需求是否有被滿足。[334]
  • 新加坡的衛生當局曾在2014年開會討論ADHD的治療策略。[333]
    策略內容涵蓋：藥物治療、行為治療、學校支援、父母支持。[333][註 12]

日本

主条目：特別支援教育

[336]

國際社會

將每年的十月訂為「ADHD意識之月（ADHD Awareness Month）」，以加強社會大眾對於注意力不足過動症的意識[44][45][註 13]。

流行病學

主条目：注意力不足過動症的流行病學
注意力不足過動症各子類型的比例分布（紫色為混合型；藍色為注意力缺陷為主型；粉紅色為過動—衝動為主型）[337][338][339]

注意力不足過動症是童年階段最常見的發育疾患[340]。根據2015年發表的研究，依照DSM-III, DSM-III-R及DSM-IV的標準，國際ADHD流行率中位數，兒童為6-8%[35][341]。若使用ICD-10的標準，同年齡兒童的流行率則為1–2% [342]。

美國的成人注意力不足過動症的流行率為4-5%[343][344]。根據《找回專注力：成人ADHD全方位自助手冊》，成人ADHD在台灣的流行率推估為3-4%[54]:24-25。ADHD是全球性的[345][346][347][348]。世界各地ADHD流行率的差異主要是因為世界各地使用的ADHD診斷方法不同。[349] 若使用相同的診斷方法，則世界各地所得出的ADHD流行率將介於伯仲之間。[350]

在亞洲，台灣、日本、韓國、越南、中國大陸、港澳等地的未成年之ADHD流行率均介於6-8%之間。[351][54][352][353] [354][355][356][357][358]

英國和美國的ADHD診斷率和治療率自1970年代起逐年增加至今[359]。學界的共識認為這個現象是因為診斷方法的變遷[359]以及人們逐漸願意利用藥物來治療ADHD所致[342]，並非ADHD的流行率真的增加了。[349][360]

學界共識認為，2013年起，DSM的版本從DSM 4TR 推進到 DSM 5 會使得ADHD的診斷數增加（特別是成人注意力不足過動症的診斷數） [361]。

歷史

主條目：「注意力不足/過動症」的歷史由來（英语：History of ADHD）
關於ADHD治療、診斷標準及流行率的時間軸 （英文）

1798年時蘇格蘭醫師亞歷山大·克里奇頓（英语：Alexander Crichton）在其著作《對精神紊亂的性質和起源的探究》（An inquiry into the nature and origin of mental derangement）中提到了精神不安[362][363]，1902年，英國兒科醫生George Still（英语：George Frederic Still）首次描述一項與注意力不足過動症近似的病徵[364][359]。

不同的時期，描述注意力不足過動症的名詞也有所不同：在1952年的DSM-I稱為微細腦功能失常，在1968年的DSM-II則稱為兒童活动亢进，在1980年的DSM-III稱為注意力不足症（可能伴隨過動，也可能沒有）英文為 attention-deficit disorder (ADD) with or without hyperactivity[359]，在1987年的DSM-III-R更名為注意力不足過動症，在1994年的DSM-IV將注意力不足過動症分為注意力散渙主導型（英语：Attention deficit hyperactivity disorder predominantly inattentive）、活動量過多型以及混合型[365]，在2013年的DSM-5仍延用此一分類[18]。其他的名詞有在1930年代使用的微細腦創傷[366]，但因為不少病童都沒有發覺有受過任何創傷，因此後來改名為微細腦功能失常。

1937年時，神經刺激劑開始用在注意力不足過動症的治療[367]。1934年時美國許可將安非他命用在注意力不足過動症治療，是美國第一個許可的苯丙胺類藥物[368]，1950年代開始使用哌甲酯（商品名稱為利他能），1970年代則開始使用对映异构的右旋苯丙胺[359]。

預後

孩童的ADHD有30–50%的機率持續到其成人時期，[369][370][371][372][373][374] 那些持續被ADHD影響的成人可能會在成長過程中發展出一些技巧彌補部分ADHD的症狀。[52] 帶有ADHD的兒童與青少年有相較於不帶有ADHD的兒童與青少年，有較高的風險發生意外受傷等事故。[237]

ADHD藥物能改善（非治癒）患者在生活中許多方面的功能性損傷（functional impairment ；可理解為應對能力的損傷）和生活品質（英语：Quality of life (healthcare)）（例如：發生意外事故的風險）。但是ADHD患者的學習障礙和執行功能缺損（例如時間管理、生活秩序以及組織能力[375]）等症狀，即便在服用ADHD藥物後，這些症狀的改善程度極其有限或幾乎沒有效果。[376]

考科藍協作組織於2015年發表的系統性文獻回顧指出，雖然中樞神經刺激劑不會令服用者產生嚴重的副作用，但他們較常出現失眠、食慾不振等較為輕微、影響較輕的副作用，並衍生出長期預後的不確定因素，因此未來的研究重點將會聚焦於探討解決前述的副作用的方法。與此同時，未來亦需要深入地研究「非藥物治療方式」以及可能的「非藥物治療方式」之隨機對照試驗[53]。

[377]

迄今為止，對於ADHD的長期追蹤調查主要都是小規模的，代表性有限。唯一規模較大，因此較具有代表性的美國衛生署MTA研究發現，那些曾在1990年代參加MTA的兒童ADHD，六到八年後進入青春期，他們在許多方面的應對能力，取決於他們小時候治療前呈現的症狀、共病、疾病的嚴重度以及治療後對於MTA四種治療模式的任意一種模式的契合度高低等因素。[378][379]

當MTA追蹤這些受試者長達十六年，直到受試者的平均年齡到達25歲的時候，發現這些患者生活中各領域的應對能力取決於ADHD的症狀是否持續到成年、ADHD的症狀嚴重度、和共病等因素。[380][381][382]

社會與文化

本身即為ADHD患者的伊丽莎·杜什库[383][384]鼓勵大眾認識ADHD[385]，且表示自己長期努力想克服酒癮等物質濫用問題[386]。

注意力不足過動症患者常被錯誤認為「只是懶惰或缺乏意志力」、「診斷只不過是用來為患者們的問題找藉口罷了」、「ADHD不過是患者不聽話的後果而已」、「ADHD的藥物只是讓患者不要動而已」、「只要不是智能障礙的孩子，都具備自我克服ADHD的能力」、「ADHD有那麼嚴重嗎？怎麼可能影響一個人的生活到那種程度？」、「所有人都是ADHD，因為所有人都會分心」。[387] 有ADHD患童因長期遭到霸凌而在家人面前故作堅強樂觀，並於獨處時結束生命。[388][389][390][391] 台灣醫師的研究發現，在台灣，注意力不足過動症患者具有顯著較高的「因傷致死」機率，起因來自：自殺、意外和謀殺。[392] 而環境不友善的因素又讓患者的自殺風險倍增，因此必須成為台灣政府自殺防治的重要目標。[393]

許多國家或地區都程度不等的在「精神醫療及心理衛生」方面遭遇資源不足以面對現實所需的情況。[394][395][396][46][173] 以美國為例，美國精神醫療環境即便先進且持續進步中，然而注意力不足過動症患者接受行為治療的比例仍被當地學者專家認為仍然太低。 [46] 2017年美國政府撥出一億美金用於支持兒童與青少年常見精神疾病的研究：如何提供自閉症者更好的治療、其他兒童心理精神疾病（包括ADHD在內）的病理學及生理學等。[173]

[397]

参见：心理健康政策

親師關係

患者家長和學校老師在情緒平和的狀態下，對於孩子的問題進行討論，彼此分享對孩子的觀察與協助孩子的方法，討論後親師都在明瞭彼此想法和期待的狀況下，凝聚共識。[398] 在台灣，家長可請學校申請各縣市教育局學生輔導諮商中心的諮商心理師、社會工作師、教育督導（督學）、特殊教育資源中心的專業團隊、巡迴輔導老師、或兒童與青少年精神醫學科醫師等資源。[398]

家長在接獲學校老師對孩子的批評與議處時，宜先尊重並同理老師基於其角色與專業的處理。並於蒐集孩子的觀點並客觀理解孩子的說法後，再聯繫老師作為回覆。家長在回覆的過程中，可以客觀陳述，適度表達個人感受，但不加臆測。[398] 建議家長對於老師與孩子雙方的說法都靜心聆聽與思考之後再做反應。[398] 也建議家長主動詢問或及時回應老師期待家長在家協助孩子的事項並積極配合落實。[398]

家長和老師都應該意識到，【親師溝通】應以「孩子」為中心。只有當親師雙方都把溝通的焦點放在「如何幫助眼前這位孩子、好讓他能好好地、快樂地長大」，才不致於陷入親師間的意氣之爭。[398]

治療方式的爭議

主条目：注意力不足過動症的爭議

自1970年代開始，注意力不足過動症疾病本身、其診斷及醫療在歐美就已經是有爭議性的議題。爭議和臨床醫師、教師、政策訂定者、家長及媒體有關。世界衛生組織也認可治療ADHD兒童時，先進行非藥物治療再進行藥物治療的作法[399][400]，但各觀點對注意力不足過動症的認知差異很大。

有的觀點認為注意力不足過動症是正常行為的範圍內，也有的假定注意力不足過動症是一種遺傳疾病。其他有關注意力不足過動症的爭議包括對兒童用（合理劑量的）中樞神經刺激劑（俗稱興奮劑）藥物進行治療、診斷的方式，以及是否有過度診斷（英语：Overdiagnosis）的情形。有些宗教對治療方式也會有不同的認知，例如公民人權委員會（山達基在1969年成立的反精神醫學團體）曾在1980年代提出反對使用利他能的運動，目前該組織的立場仍是不主張用中樞神經刺激劑處方治療ADHD[401]。

中國大陸、香港

目前注意力不足過動症的治療策略（涵蓋藥物及非藥物治療）已成為中國大陸的相關醫學指南 [402]，中國大陸的多动症关爱协会指出：「中國大陸对『注意力缺陷多动障碍』的诊断、治疗尚不规范，家长的认知亦不够全面，导致社会上仍有很多不科学的治疗方式和训练方法在被家长们使用。」[325][324]

香港特別行政區則遇到特教需求的識別及輪流服務的等候時間過長、資源及服務不足、教師人手不足及培訓有待改善、醫校社合作不順暢以及政府未有整體支援特教學生的政策藍圖及願景的問題。目前正在推動特殊教育進行立法，以全面保障特殊教育需要學生的權利。[396]另外，香港的一項問卷調查發現，有特殊教育需要的學生受欺凌的比率極高，在小學環境下有33%遭受欺凌，在中學環境下有47%。而於國際學生能力評估計劃的調查亦顯示，香港中學生遭到欺凌的比率為32.3%。即使家長們想尋求協助亦因資源問題，大部分服務需要自費，而基層家長較為難以負擔。另外，亦有社工指出服務缺乏系統整理，而大部分學校都缺乏動機正面處理事件[403]。

備註

  1. ^ 參見：孩子在成長到特定年齡的時候應該自行學習到的求生技能。
  2. ^ 2.0 2.1 心理測驗只是進一步進行各種測驗的選項之一，非必要選項。
  3. ^ 「過動」與「衝動」相連是因為兩者高度相關[68]。
  4. ^ 4.0 4.1 台灣兒童與青少年精神科醫師高淑芬在其著作《找回專注力：成人ADHD全方位自助手冊》提到，雖然「過動-衝動型」和「混合型」的ADHD從小就非常好動，坐不住，老是跑跑跳跳、追逐打鬧，精力無窮，但其實這類孩子的運動協調性可能不太好，運動協調性較弱的表象為：肢體動作較大、動作較粗魯。[210]
  5. ^ 報載一名媽媽在洗碗時，腦中想著地板還沒擦，就跑去擦地。過程中又想到家裡沒有衛生紙了，於是趕緊奪門而出......。她想到什麼就做什麼，結果每件家事都只做一半、沒有一樣是完成的。[110]
  6. ^ 沒有ADHD的人
  7. ^ ADHD是各類成癮的高風險群。[56]
  8. ^ 「對立反抗症」、「行為規範障礙」、「反社會」既不等同「獨立思考能力」與「批判能力」也不是「判斷能力」
  9. ^ 憤怒管理與衝動控制相關，憤怒及衝動管理能力不足將有較高可能在一時的衝動及憤怒驅使之下做出攻擊行為（impulsive aggression）[106][107]
  10. ^ 合併物持成癮的ADHD患者將有較高機率罹患性病。[172]
  11. ^ 請參考教育歷程一覽表、終身學習、和終身教育
  12. ^ 請參見：世界各地的精神醫學會（英文）[335]。
  13. ^ 關於更多意識年月日，請參見：意識之日列表（英语：List_of_awareness_days）、紀念月列表（英语：List of month-long observances）

注释

  1. ^ 即多動、過度活躍
  2. ^ 即為一致化

参考文献

書目

參考資料

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  29. ^ 29.0 29.1 29.2 蔣丙煌; 陳快樂; 國立臺灣大學醫學院附設醫院精神醫學部; 張雍敏、鄭淑心、賴淑玲、傅悅娟、張景瑞、侯育銘、郭約瑟、張君威、鄧惠文、陳嘉新、紀雪雲、黃雅文、連玉如、連盈如、吳其炘; 高淑芬&陳劭芊. 注意力不足過動症 (PDF). 衛生福利部精神疾病衛教叢書 02 First. Taipei: 中華民國衛生福利部. 2015-06: 19-20. ISBN 9789860454154. （原始内容存档于2017-02-19） （中文（臺灣））. 藉由成人 ADHD 的回顧性研究或是長期追蹤研究可發現，孩童時期的 ADHD 患者，在成年後僅有2成左右的人完全沒有症狀、另外有2成有輕微不致干擾的症狀，其餘近6成的人雖然症狀較孩童時期有所減輕，但仍達到生活顯著困擾程度。不只是ADHD的核心症狀，許多次發症狀或是共病，並不會隨著年紀增長而減少或是消失，甚至產生長久的負面影響（物質濫用依賴、慢性焦慮憂鬱等）。除了再度說明 ADHD 是一個長期慢性的神經發展疾病以外，也讓我們發現，如果早期了解 ADHD，給予合適的治療介入時，孩童長期的預後將會大有不同。 
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