成人注意力不足過動症

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成人注意力不足過動症
Adult Attention deficit hyperactivity disorder
RestingStateModels.jpg
fMRI[1]
醫學專科 精神病学
成人注意力不足過動症
分类和外部资源
醫學專科 精神病学

成人注意力不足過動症(英語:Adult attention deficit hyperactivity disorder、adult ADHD、adult with ADHD、ADHD in adults、或AADD)是持續到成年注意力不足過動症,屬於神經生理英语clinical neuroscience病症。有ADHD症狀的兒童青少年中,大約有三分之一到三分之二的人的症狀會持續到成年乃至終身。[2](p44)[3]

成人注意力不足過動症的典型特徵是注意力不集中、注意力過度集中、過動(會表現為內在的不安寧)、情緒失調以及過度的心智游移[4]。成人注意力不足過動症的人在遵照指示、記憶資訊、專注、組織工作、在一定時間內完成工作,以及約會準時上不容易作到。這些情形會影響成人注意力不足過動症生活的不同層面,可能會引起情緒、社交、職業、婚姻、法律、財務等方面的問題[5][6][7],因此會有自尊低落的情形。不過配合適當的引導及教練,ADHD的特質也可能會帶來職業上的成功[來源請求]

特徵與症狀[编辑]

患者往往有組織規劃上的困難,且容易感到挫折[8]

注意力不足過動症是一個長期的症狀並嚴重打擊多數成年患者在教育、就業、和人際關係方面上應有的良好發展。[7][9]

注意力缺陷[编辑]

成人注意力不足過動症患者之注意力缺陷的症狀表現為難以長時間把專注力維持在一件事情上。患者有組織、規劃、安排事情的困難而且難以分辨事情的緩急輕重以及難以長期追蹤任務進度並最終完成任務[10]。患者不僅健忘而且時間管理能力明顯有問題[10]。患者總是在截止期限前一刻才完成作業或根本還沒動手開始做作業、遲交作業[10]。注意力缺陷也影響患者的駕駛型態,患者常在行駛中粗心大意、收到罰單、超速。[10]

注意力缺陷會讓患者難以把事情想清楚、評估清楚,導致患者難以做決定[11]

過動[编辑]

青春期開始直到往後的人生,過動-衝動的症狀將漸漸不再頻繁以外部的肢體表現出來,轉而傾向以「內在的不安寧(inner restlessness)」等內在型式或以多話或插嘴打斷他人等外在形式表現。[2](p44)[12]

衝動[编辑]

過度參與具有相當高的機率會讓參與者付出代價的活動;過度(過於頻繁、用詞過重或語氣過於直接)說出那些具有相當高可能性會讓他最終付出代價的言論[13]。成年時期的衝動後果往往重於童年時期的衝動。除此之外,患者可能會在時機未成熟的情況下貿然中斷關係、或是在找到其他工作之前就辭職。[13] 衝動的問題同樣會導致患者的駕駛行為出狀況[13]

情緒不穩[编辑]

成人注意力不足過動症患者通常已衍生出情感障礙狂躁轻度狂躁躁鬱症憂鬱症)、焦慮症物質濫用經常突然暴怒英语Intermittent explosive disorder等共病[14]

心情不穩英语mood liability容易激動、容易暴怒、低挫折容忍度(遭遇挫折時的反應過度[11])以及缺乏動機(擺爛)等都是成人注意力不足過動症患者的常見特徵。雖然這些特徵也常見於某些心理疾病。[15][16]患者通常難以應場合需要而控制自己的情緒(特別是那些負面的情緒),這讓患者常難以維繫工作與人際關係[17]

缺乏動機[编辑]

有注意力不足過動症的人常會有自我管理自我激勵上的不足,這些又會引起像分心延宕、無組織等容易造成問題的特質。常會被其他人視為是沒有條理的,常常需要維持高度興兴奋才能比較不分心,維持正常的生活。不過,有注意力不足過動症的成年人,其學習潛力及整體智力和其他人沒有太大的差異[來源請求]

執行功能缺損[编辑]

ADHD的症狀在不同ADHD患者間的差異,以及在ADHD病患一生中的變化都相當的大。隨著ADHD的在神經生物學上的進展,ADHD的病因已逐漸明朗——ADHD病患所遭遇的困境是由大腦中負責執行指令的部分所導致(參見:過動症的病理生理學),這造成了維持注意力、制定計劃、組織能力、排定優先次序、缺乏時間概念、抑制衝動、決策制定上的問題。

這些缺陷造成的困境從普通到嚴重都有,可能使ADHD患者無法有效地組織他們的生活、規劃例行工作,甚至無法有效地根據可能的後果想定辦法並採取行動,即便他們在事前就已經察覺該後果。這進而導致了在學校,以及職場中的低落表現,以及無法發揮潛能的狀況。在年輕的成年患者之中可以觀察到以下情形,如存在交通違規英语Moving violation的不良駕駛紀錄[18]、酗酒歷史,或是藥物濫用。這類困境通常是由ADHD患者的客觀行為(observed behaviour)所造成(例如衝動型患者,舉例來說,可能因侮辱他們的上司而被解僱),即便他們早就知道這麼做會讓自己惹上麻煩,並且真心地想要避免這些行為。ADHD患者經常會錯失一些和他同年齡並且有相同經驗的成年人可以察覺,或應該知道的事情。這項差異可能導致他們被旁人貼上「懶」、「笨」或是「不體貼 (inconsiderate)」等標籤。

隨著問題的累積,患者會建立起消極的自我認知,並成就一種失敗的惡性循環英语vicious circle。高達80%的成人患者可能有某種形式的精神病學合併症英语comorbidity[19],例如憂鬱症焦慮[7]。許多ADHD患者有學習障礙,例如閱讀障礙,這也讓患者面臨的困境更加嚴峻[20]

健康與社會領域的障礙[编辑]

成人注意力不足過動症患者與 成人注意力不足過動症患者相比,成人ADHD患者在工作或求職上遭遇困難(occupational difficulties)、發生交通事故犯罪、染上物質濫用的比例較高[21][22][23]。研究顯示,成人注意力不足過動症患者在童年時期幾乎都曾經自我羞辱過並且歷經鬱鬱寡歡和低自尊,這主要是因為他們在童年時期頻繁覺得或發現自己被誤解、歧視(差別待遇)、放生、放棄、忽略、當成空氣、跟同儕的差異過多、遭遇學習障礙、與同儕在學業成就上的巨大落差、慘不忍睹的成績單(包含學期成績單英语report card上教師所留之如同對患者道德審判的評語)、身處功能不全的家庭高風險家庭、走過過於破碎坎坷的家庭關係人際關係等。[24] 這些挫折和遭遇到的問題極為可能是成人注意力不足過動症患者後來罹患嚴重憂鬱、物質濫用和出現人格障礙等行為問題的重要根源之一。[25][21][23]

職場[编辑]

照顧兒童的老師以及照顧者會適應兒童注意力不足過動症的症狀。不過針對患有注意力不足過動症的成人,其雇主以及其他與其互動的人,比較不容易將這些特質視為是注意力不足過動症的症狀。某方面這是因為症狀隨著人的成長英语Maturity (psychological)而改變,注意力不足過動症的成人比較不會有明顯過動的症狀,不過其過動會內化為持續的心智活動以及內在的不安寧感[12],或是根本不承認世界上有注意力不足過動症這個疾病的存在[26]

意外事故[编辑]

行為障礙[编辑]

成人注意力不足過動症(尤其是「過動-衝動」、「混合型」)可能增加其做出令眾人感到無法接受的犯罪行為(包含對親密伴侶的暴力家庭暴力酒精成癮)的風險。若成人注意力不足過動症合併行為障礙英语conduct disorder,則上述風險將顯著提升。然而許多成人注意力不足過動症患者也遭受親密暴力(IPV)。[27][28][29][30]

置身於存在緊密關係暴力的環境將增加孩子罹患ADHD的機會。具有憂慮傾向的父母,其養育小孩的能力與經濟能力通常有限,將導致孩子的健康較差且發育不良並增加罹患注意力不足過動症的機率[31][32][33]。成長於婚後暴力的家庭中的孩子,其未來將有較高機率出現行為問題[34]

物質濫用[编辑]

成人注意力不足過動症患者中約有五分之一到四分之一的人帶有物質濫用的情況。[35]

治療[编辑]

注意力不足過動症的藥物

成人注意力不足過動症的治療包含藥物並結合行為治療、認知治療、或職能醫學介入英语occupational medicine[36]治療往往從以藥物治療ADHD的症狀及可能存在的共病英语comorbid開始。

單獨使用藥物治療雖然能有效的改善ADHD的生理症狀,但藥物並不會返還成人患者在ADHD的抑制之下,沒有習得的一些能力。舉例而言:一個成人ADHD患者可能在服藥後重新獲得專注的能力,然而像是做計畫分辨事情的緩急輕重英语piroritize、和有效的與人溝通等後天習得的能力則需要花時間學習、培養。[37]

流行病學[编辑]

成人注意力不足過動症的的流行率和組成(過動/衝動為主=2.5%;注意力缺陷為主型=1.3%;混合型=0.9%;總和=4.7%)[38]

成人注意力不足過動症的流行率約落在3%-5%之間[39][14]

美國的成人注意力不足過動症的流行率為4.4%左右。[14]

社會與文化[编辑]

患者的升學求職與婚姻[编辑]

在美國,患有注意力不足過動症的成人,若其症狀明顯的限制一項或多項主要生活活動,依照美國聯邦的殘疾人非歧視法律(例如1973年殘疾人正常活動法英语Rehabilitation Act of 19732008年美國身心障礙法案英语ADA Amendments Act of 2008),這就符合殘疾的條件。針對ADHD確實構成殘疾的患者,工作場所有責任提供合理的調適,教育機構有責任提供適當的學術調整,使此個體可以更有效,更有生產力的工作[40][41]

經濟[编辑]

在2004年的研究中,針對ADHD的成年人和相同教育程度的人比較收入差異。若都是高中畢業,ADHD的成年人每年會比同為高中畢業的人少10,791美元的收入,若都是大學畢業,ADHD的成年人每年會比同為高中畢業的人少4,334元的收入。此研究認為美國因為ADHD少了7700萬美元的生產力[42]。相對的,因為藥物濫用的生產力損失是5800萬美元,酒精濫用的生產力損失是85萬美元,而憂鬱症的生產力損失是43萬美元[43]

公眾意識[编辑]

Rick Green英语Rick Green (左側) 和 Patrick McKenna英语Patrick McKenna,拍攝於2009年,Rick Green致力於倡導成人注意力不足過動症的相關知識 [44][45][46]

文獻與來源[编辑]

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