注意力不足过动症的非药物治疗

来自维基学院

注意力不足过动症的非药物治疗注意力不足过动症的治疗方式之一。

行为治疗(MTA模式)[编辑 | 编辑源代码]

父母管理训练前(before)后(after)的效果对比[1][2]

行为治疗被认为是对注意力不足过动症孩子进行行为介入具有实证性效果的方法。透过系统化的行为分析,了解孩子犯错的模式,并且配合后果增强与削弱的方法,以及教导他正确的行为模式,例如:懂得等待、轮流等观念,减少他冲动、过动而引起的人际冲突、人际互动的情绪调节英语interpersonal emotion regulation情绪管理英语Emotional_self-regulation

专攻注意力不足过动症的认知行为治疗,对于治疗年纪接近或已经是成人的注意力不足过动症患者来说是有效的。(例如:愤怒管理时间管理、改善包括记忆力、计画及执行能力、自我启发能力、自我体察英语Self-monitoring在内的执行功能等。)[3][4][5]

许多ADHD支持团体的存在得以作为许多家庭的正确治疗资讯来源而且能协助家庭一起管理ADHD。[6]

对于那些学龄前且仅有些微注意力不足过动症症状的孩童,已建议“行为治疗”为治疗该族群的第一线疗法。[7] [8] [9]

行为方面的治疗 简介
心理教育 医学实证为根据的疗法,用以协助患者以及他的爱人了解疾病的资讯并提供支持,以便让他们能更有效地面对一个疾病。[10][11][12]
行为治疗 行为治疗家主张心理障碍中表现的异常行为如同正常行为一样是可以习得的,可以通过基本的条件作用原理英语Behaviorism#Operant conditioning学习原理而使心理障碍得到矫正的。[13][14]

此外,对于儿童来说,行为治疗将协助孩子与其家长学习一些技巧:

  • 维持每天固定的行程与时间表。
  • 减少环境中可能的分心源。
  • 在特定的地方或符合逻辑的地方做相对应的事情,例如:在书房或自习室读书、在游戏间放置玩耍的玩具等。
  • 把大目标切成许多微小但较容易达成的小目标,分阶段实行。
  • 奖励正向的行为。(例如:使用累计点数的方法英语Token_economy,累积到一定的点数就能获得奖励。)
  • 分析看看有哪些可能平常不被注意到,但是却暗中导致自己做出不适当行为的因素。
  • 利用统计图表打勾勾列表清单英语checklist来帮助孩子把心神维持在一件事情上。
  • 不要给予太多选项供孩子选择 (limiting choices)。
  • 与孩子一起发掘孩子的天赋所在。
  • 善用冷静纪律(calm discipline),例如:时间暂停英语Time-out_(parenting)、将孩子抽离事发现场、转移孩子的注意力(distraction)。

[5]

认知行为治疗 改变认知的方式,让孩子们学会以不同的、新的正向想法,来取代原先错误的、旧有的负面想法。[15]

对于成人来说,认知行为治疗将协助他们改善ADHD的核心症状—执行功能不足:[注 1]

[4]

Template:Expand section

人际取向心理治疗 人际取向的心理治疗的中心思想是“既然人际关系和生活中的大小事能影响心情;那么反过来,心情也能影响人际关系和生活中的大小事”。[19]
家庭治疗英语Family therapy(也称:家族治疗) 当前的证据表明MTA模式的行为治疗中的家族治疗的疗效类似普通精神科门诊的照护(通常包含ADHD药物治疗)且优于完全不治疗ADHD。[20][21][22]
学校资源介入英语school-based interventions
-
社交技巧英语Social skills训练 学习与“非正涉入违法行为的年轻人和同侪”交朋友对于ADHD孩子来说十分重要,因为这能显著降低往后人生可能出现的问题,例如:忧郁症犯罪、在学过程遇到的各种挫折和物质滥用的机率[23][24]
运用同侪的行为干预英语behavioral peer intervention
-
组织规划能力与技巧的培养英语organization training
-
生活管理能力与技巧的培养英语Daily living skills training
-
父母管理训练 父母管理训练可能直接改善孩子的行为问题,例如:对立反抗的举止或违抗指令的言行。 [25]环境的支持有利于注意力不足过动症的治疗[26][27][28][29][30]
团体心理治疗 一群特定人们与治疗师透过团体活动达成治疗目标的一种心理治疗。[31]
生理(神经、脑波)回馈英语Neurofeedback 当前脑波回馈是否具有疗效仍然未知。[32]
行为改正英语Behavior modification 证据表明具有一定益处。[23]
语言治疗 台湾的中央健保署自2014年起同意台湾的儿童青少年精神科医师可以如同复健科医师及“英语Otology、鼻、喉科医师”一般开立“语言治疗”的处方。[33]
应用行为分析 先厘清行为与环境之间的交互作用关系后再协助行为改变。[34][35]
正念疗法

正念疗法尚需更多研究来证明其有效性。[4]

婚姻谘商 [36]
职业谘商英语Career_counseling [36]
ADHD教练 [36]

Template:Further2

目前对于精神疾患的治疗方式是基于生物-心理-社会模式,良好的精神治疗模式必须结合生物医学、心理治疗,以及社会复健计画。

例如:思觉失调症患者在疾病急性发作住院期间,给予药物协助缓解正性症状。病房中也会由专业人员,例如:精神科医师、精神科护理师、临床心理师、谘商心理师、职能治疗师、精神科社工师等,带领团体治疗,或者给予个别治疗。而在急性症状缓解后,患者、家属和医疗团队一同讨论复健计画,例如到复健病房、日间留院或者工作坊,透过复健计画,有效增加病识感英语Self-awareness(患者对于自身英语self-concept以及自身疾病的认识英语self-consciousness程度[37][38])、学习独立生活能力英语independent living、改善家庭社会关系英语social relation

药物能帮助注意力不足过动症患者从生理上稳定情绪、增进专注力和组织规划能力,降低不适当言行的出现。[39]

认知行为治疗(MTA模式)[编辑 | 编辑源代码]

著重在“常在成人患者身上观察到的执行功能缺失”的认知行为治疗,主要协助患者治疗以下问题[40][41]

  • 难以持续掌握任务和活动、难以对任务或活动抱持恒心。
  • 拖延。
  • 有分辨事情缓急轻重的困难。
  • 缺乏管理能力。
  • 做短期和长期计画的能力不符合患者年龄该有的成熟度。[42]

美国国家心理健康机构英语NIMH建议成人注意力不足过动症患者:

  • 依照事情的类别建立各自的行事历。例如:家庭行事历、工作行事历、医疗行事历等。[43]

青少年及成年[编辑 | 编辑源代码]

《找回专注力:成人ADHD全方位自助手册》一书中指出,对于年纪稍长的注意力不足过动症患者来说,要习得正向的情绪表达方法和社交技巧并养成良好规律且有秩序的生活习惯则有赖患者身体力行,善用认知行为治疗的原理。“认知行为治疗”分为“认知治疗”和“行为治疗”两部分。[39]

认知治疗包含:心理建设、正面回馈、卫教、和思考练习来建立正确的观念和健康的态度、激发改变的动机、鼓舞自信和提升勇气,远离负面思考。 行为治疗是运用“刺激-反应”的原理,把一个大目标切成许多小目标,并加上正面的酬赏作为鼓励,帮助患者一步一步的接近小目标,一次又一次的完成小目标,整个大目标即随之而成。 成功完成某阶段的目标后,便可适度提高挑战性,例如:从“持续做一件事达15分钟”变成“持续做一件事达30分钟”以此类推,逐步建立起良好的习惯。最后就可以顺利达成连续做一件事情达一个小时的愿景[39]。除此之外增加“环境结构”[注 2]、学习分辨事情的缓急轻重[44]、学习“改善ADHD症状的实用技巧与策略”[注 3]也是行为治疗的主轴,然后再辅以其他行为治疗的方式。(其他的行为治疗方式并非不重要)

儿童[编辑 | 编辑源代码]

《家有过动儿:帮助ADHD孩子快乐成长》一书中指出,对于年纪轻轻的小孩来说,由于自我能力有限,因此行为治疗以“课堂上的行为治疗”及“家中的行为治疗”为主,其他的行为治疗方式为辅。(其他的行为治疗方式并非不重要) [15][45] 书中并建议“让孩子承担适度的责任”,孩子表现出来的态度往往令人惊喜。[15]:133-134

学校

《家有过动儿:帮助ADHD孩子快乐成长》一书中指出,学校老师可以多提供“正向动机”,包含:课前提醒和课堂中的鼓励。而在孩子的座位安排上尽可能减少能让他/她分心的诱因。允许孩子把作业分批次写完并在课堂上保留小组讨论的时间、与孩子共同讨论规范与自由。[15]

课堂外的策略:

  1. 协助孩子找出在特定情境下出现的问题。[15]
  2. 找出孩子正确的行为。譬如说:需要排队时,他可以乖乖地待在队伍中;或者先让孩子在一旁做别的事,等到快轮到孩子时,再来排队。[15]
  3. 在教师训练中选择有教授ADHD相关知识和行为训练的技巧的课程。[15]
  4. 灵活应用“奖励制度”及“正增强”来鼓励、鼓舞孩子的正向行为。[15]
  5. 与孩子一起找出问题是什么、该怎么解决、有哪些好方法、这些好方法中哪个方法“可能”是最好的、实际做做看、实验结果分析探讨。[15]

家庭[编辑 | 编辑源代码]

Template:See also2 《家有过动儿:帮助ADHD孩子快乐成长》一书中指出,ADHD的孩子无论在校内或校外常属于弱势的一群,容易被误会。回家后又容易因为粗心大意挨骂[46]。ADHD孩子与一般孩子一样努力,想要有好表现,得到赞美;但却事与愿违,他们常常失败,长期缺乏肯定与成就感。因此容易因情绪压力而衍生出其他共病。[15] 父母与孩子沟通,彼此交换想法的过程,当如平时一般,心平气和。愤怒会阻碍亲子之间的沟通。[15][47]

在台湾,有儿童心智科医师在从事注意力不足过动症(ADHD)的临床医疗过程中发现,照护ADHD的核心困难之一乃ADHD孩子的照护需要其照顾者投注长期的心力,然而通常作为ADHD孩子照护者的孩子父母又往往因为孩子的ADHD症状对其家庭生活及学校生活所造成的负面影响而有长期负担,此情形下,不容易长期提供有ADHD的孩子完善的照顾。医疗团队于是建立以医疗专业、家庭两者为互动主体,互相灌注支持能量并携手成长的长期照护模式,并称之为“共同行动模式[48][49]

家中的行为治疗[编辑 | 编辑源代码]

Template:See also2 Template:Multiple images

在行为治疗期间,治疗师会定期与家庭成员会晤以观察进度并提供持续的支持[注 4]。在会晤中,家长现场实习从治疗师那学来的技巧,即便疗程结束,家庭成员仍能持续感受到行为的改善以及压力的减轻。[53]家长能在父母教育训练中学到三种核心能力:正向沟通、正向激励/强化英语Reinforcement#Positive_reinforcement、结构与一致的纪律/规范/规则[53]

  • 用“爱”来沟通
  • 倾听与陪伴[54]
“父母教育方式与ADHD孩子说谎”之间的关系

任职于奇美医院的奖斐忠政医师表示,大人常给了ADHD孩子不切实际的要求,例如:受到注意力不足干扰的孩子,本来写作业就可能需要较多的时间,此时大人如果没有考虑到小朋友能力上的限制,不从根本去做调整,只是要求结果,命令孩子在半小时后上床躺平,否则就要处罚。在这样不合理要求的情况下,要小朋友不说谎,就非常困难。[55]

奖斐忠政表示,了解ADHD孩子每次说谎背后的需求、ADHD对他所造成的困难、以及孩子说谎背后的动机,并且撇开道德个性的审判,从根本的方面去思考探讨,下次就可以用更好的方式解决问题。[55]

充足的睡眠[编辑 | 编辑源代码]

充足的睡眠能提升学习力与专注力,也能让身体得到足够的休养。正常的生长激素分泌有赖规律及足够的睡眠[56][57]。研究指出,台湾孩子的睡眠时数相较其他国家,少了大约一个半小时[15][58][59]。足够的睡眠能让有ADHD的孩子更专注、更能自我控制 [60]。相形之下,睡眠不足连带使得身体与精神状况不佳,情绪较容易低落,形成恶性循环。[61][62][63] 注意力不足过动症往往直接导致患者“难以入睡”、“即便入睡,也难以持续多久”,这与注意力不足过动症所导致的“内在和外在的不安宁”[注 5]有关。[64][65]

治疗ADHD或许能改善患者因ADHD之“内在和外在的不安宁”等症状所引起的睡眠问题[66][67][68];同理,改善睡眠品质或许能改善ADHD的症状。[68] [69][64] 研究指出,“规律”的睡眠有助于提升睡眠品质,良好的睡眠品质会有较好的精神且能改善注意力不足过动症的症状[64][70] [71]Template:Further2

运动[编辑 | 编辑源代码]

适度且规律的运动,特别是有氧运动有助于改善许多中枢神经系统疾患英语central nervous system disorders的症状,也证实为注意力不足过动症的有效附加疗法英语add-on treatment[注 6][39][44][3][72][73][74][75][76]

长期规律的运动合并正规治疗,将有更乐观的预后(治疗效果)-较好的行为以及运动协调性、大脑执行功能的提升(包含大脑认知领域中的:注意力、冲动克制力、和计画组织的能力)、更快速的资讯处理速度、和更棒的记忆力[39][44][3][72][74][75][77]

统计由父母及教师填答的《孩子行为和社交情绪评量表》,结果显示长期规律的有氧运动带给孩子的效果是:身体所有功能的提升、ADHD的症状减缓、焦虑和忧郁的程度下降、身体症状减少、较佳的课业及课堂中的表现、社交技巧进步。[72]

药物治疗合并规律的运动能放大中枢神经刺激剂作用于执行功能上的效果。[72]运动带来的效果被认为是因为运动增加了脑中神经突触间多巴胺和正肾上腺素的浓度。[72]

饮食[编辑 | 编辑源代码]

Template:See also2 健康及营养均衡的饮食(食物饮用水饮料)是保持身心健康的基础。补充维生素矿物质(例如:维他命B群维他命C等)对于改善ADHD病情的功效,尚有待更多的实验证明。[78][79][80][注 7]

饮食的调整可能对少部份的ADHD儿童有帮助[84],一份2013年的统合分析针对有ADHD症状,而且有补充游离脂肪酸或是减少食用有人工色素食品的儿童的相关研究发现,只有不到三分之一的儿童在症状上有改善[85],这方面的助益有可能只是对有食物敏感的儿童有帮助,也有可能是这些儿童同时也在接受ADHD的治疗[85],这些已发表的文献也发现目前已有的证据无法支持减少食用特定食物来治疗ADHD的疗法[85]。2014年发表的文献也发现排除饮食在治疗ADHD上的成效有限[86],另一篇在2016年发表的文献指出,根据研究结果,“无麸质饮食在未来成为ADHD的标准疗法”之机率是微乎其微[87]

铁、镁及碘等矿物质的摄取可能可以改善ADHD的症状[88],有一些证据指出身体组织内的成份过低和其ADHD症状有关[89],不过一般不建议用补充锌矿物质的方式来治疗ADHD,只有在有锌缺乏英语zinc deficiency的地区(几乎只会在开发中国家)才建议补充锌矿物质[90]。不过若锌矿物质和苯丙胺类药物同时使用的话,会减低苯丙胺药物的最小有效剂量,也就是可以服用较少的药物而达到相同的效果[91]。另有证据指出Omega3-脂肪酸能提供对于病情些许的改善[92][93],不过也有证据指出其功效非常有限[94][95],因此不建议用Omega3-脂肪酸来取代医学治疗[96] [97]

一些研究发现,人工食用色素防腐剂可能与少部分儿童出现类似ADHD的症状,或者是与ADHD的流行率增加有关。[98][99]但是这些研究的证据力薄弱而且可能只适用于有食物不耐症的孩子。[99][85][100]

针对这样的疑虑,英国欧洲联盟已经发布相关食品管理措施。[101]

对于某些食物的食物过敏食物不耐症,可能会恶化少数孩子既有的ADHD症状。[86]


精致糖[编辑 | 编辑源代码]

有些人认为摄取糖分、甜食、人工香料英语artificial flavors(包含:阿斯巴甜)等会导致过动[102],不过一旦回顾那些曾经比较学龄儿童英语school-aged children学龄前儿童英语preschooler对照实验会发现,受试者即便将糖分摄取至远高于正常范围的程度,对受试者的“注意力”及“行为”并没有产生影响[103],如果将实验组成员(受试者)换成是“其父母对糖分敏感的儿童试验者”,得到的结果也相同。[104]

除此之外,美国小儿科医学会举出一个研究显示,数名被其父母认为对糖分有反应的(reactive)的男孩子,当摄取较多量的糖分时,反而会变得较不活跃。[105] 美国小儿科医学会另表示,不同研究人员通过数项比对血糖的研究,都得到ADHD患者与非ADHD患者在生活中的糖分摄取量并无不同的结论[105][106]。据此,“美国小儿科医学会”决定不建议患者透过任何“特别饮食”来治疗ADHD。[105]

MedlinePlus则表示,精致糖可能对孩子的活动量有些许 影响,MedlinePlus认为精致糖英语refined sugar碳水化合物能快速进入血管中,使血糖迅速升高,这可能使得孩子变得较为活跃。[102]虽然MedlinePlus不认为摄取精致糖与ADHD有直接关系,仍建议不要过量甚至建议节制精致糖的摄取,并且以更健康的饮食型态取而代之。[102]

截至2018年11月,没有任何科学证据显示、或甜食(包括:糖分含量远高于一般菜肴的食物)会影响人类的行为或导致ADHD[107] [105][102][108][109]

音乐[编辑 | 编辑源代码]

北美放射医学会英语Radiological_Society_of_North_America和有限的研究结果表示,音乐治疗似乎有可能改善ADHD孩子在课堂上的表现[110]、增加注意力不足过动症及自闭症亚斯伯格症(ASD)患者的脑部特定神经连结并使得预后更加乐观[111],然而音乐治疗的有效性尚需更多相关论文支持[112][113]

台湾精神科医师高淑芬则表示,根据经验,让ADHD患者听音乐较能持续工作,也能增加效率,但高淑芬也说,若患者是听有歌词的歌曲或新歌可能就比较不适合,因为患者可能把注意力集中到音乐的歌词上,沉浸在音乐中。[39]:117-118

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教育疗法[编辑 | 编辑源代码]

Eric (2001)所做的一项对老师进行的调查,该调查研究了“有‘哪些课堂方法’正在被实施”,并能帮助提高注意力困难儿童上课时的注意力。教师们发现活动是最有效的方法。在坐的过程中提供活动可以提供持续的活动输入,而不用频繁的离开座位。 [114]

特殊教育[编辑 | 编辑源代码]

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针对注意力不足过动症的学生,可以用“前事后因”方法进行教育,可在个案某个不恰当的行为出现前就调整改变外在因素(前因英语Antecedent_(behavioral_psychology)),或是透过奖惩后果的方式,引导个案改变行为[115]

善用“前事后因”方法:
  1. 前因英语Antecedent_(behavioral_psychology):在个案某个不恰当的行为出现前就调整改变外在因素。
  2. 透过教育,针对个案某个不恰当的行为进行改变。
  3. 后果英语operant conditioning:透过奖惩的方式,引导个案改变行为。
介入反应评估 (RTI)

学习障碍、情绪行为障碍个案的介入反应评估英语Response_to_intervention一般来说分为三个层次:从“一般预防”到“特殊预防”。依据行为改变术的第一、二、三层原则,给予个案所需的导引:

第一层:基本介入。基本介入的策略对其他没有ADHD的孩子也有用。

  • 提供结构:建立班级常规。
  • 传授技巧:遇到A的时候就要做B。以及诸如:建立生活结构的技巧、增进或弥补工作记忆的技巧、做功课的技巧。
  • 团体回馈:设计有趣的课程并在学生参与课程的过程中提供充分的酬赏,如:赞美等正增强。

第二层:加强介入。对于接受基本介入后,反应效果有限的个案,提供小团体式加强。

  • 调整作业份量、延后作业缴交期限、调整学生的阶段性作业进度目标。
  • 设立小志工团体,例如:引介志工、安亲妈妈协助。
  • 强化家庭与学校之间的连结(联系),例如:家庭访视、指派家长协助事项等、提供每周进度给家长。
  • 课后辅导加强、课后留下来自习。

第三层: 第一层、第二层介入无效,通常是比较严重,问题较多的个案。

  • 运用个别化教育计画(IEP)建构个人化的学习。
  • 针对个案之特定、重要问题处理、研究个案的成功标准,例如:不是作业都要交,而是有缴交作业就好,一旦能持续做到缴交作业,再慢慢调整标准。安排ADHD教练、提供个别差异化、客制化的视觉提示等。
  • 善用《增强检核表》,寻找特定的奖励。

[116][117][118][119]

多元智能理论

多元智能理论认为,对于普通教育无明显效果的小朋友,特殊教育老师会去发掘小朋友的长处、调整环境的限制、透过小组讨论、作中学英语Hands-on learning等方式来让学生发光发热,重新拾获信心。当孩子注意力改善,建立安全的学习环境后,基于事物的好奇的本性,孩子能重新选择自己的擅长的地方,当他的优点能被看到,孩子就能自动继续前进学习。[120][121][122][123][124]

奇美医院奖斐忠政认为,一些家长把特教老师当做免费的补习老师,要求老师全力训练ADHD儿童跟一般孩子一样,并不合适。[125]

职能治疗[编辑 | 编辑源代码]

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职能治疗方面的文献建议,在教室中采用动态座位系统英语Active_sitting(参见弹性座位的教室英语flexible seating_classrooms)是可以改善学生感觉调节和注意力的一种方法。[126][127][128]

职能治疗师能协助患者运用职能治疗技巧让生活变得更有组织、规律、计画、对于时间有更有效的管理[129]

时间管理[编辑 | 编辑源代码]

许多时间管理中的工具可以帮助ADHD患者,例如艾森豪威尔法则[130]优先次序矩阵英语Priority Matrix尽管去做番茄工作法等。 Template:Off topic

艾森豪威尔法则[编辑 | 编辑源代码]

艾森豪威尔表格(又称为决策矩阵英语Decision matrix

一个不具名的大学教授曾表示,德怀特·艾森豪威尔说:我手中的待办事项可分为两个种类,“紧急”和“重要”,重要的事情永远不会紧急,紧急的事情不会重要。[131][132]

利用艾森豪威尔决策法则,各个待办事项可依照“重要/不重要”和“紧急/不紧急”来划分所在的决策矩阵象限[133][134][135])。

待办事项详细的区分方式如下:

  1. 位于“紧急且重要”的待办事项须立即亲自开始动手完成[136]。例如:危机、截止日期迫在眉睫[135]
  2. 为“重要但不紧急的事情”设立完成日,并且亲自完成[136] 。例如:人际关系、订计画、休闲放松等[135]
  3. “不重要但紧急”的事情可委托他人代办[136]
  4. “不重要又不紧急”的事情就移除不做[136]。例如:单纯浪费时间的事情[135]

这个方法据传是美国前总统德怀特·艾森豪威尔的日常守则。[136]

[137][138][139][140][141][142][143][144][145][146]

正念疗法[编辑 | 编辑源代码]

2018年4月出炉的最新文献显示,“认知行为治疗+药物治疗+正念疗法的策略比“认知行为治疗+药物治疗”带给患者更大的进步,因此有成为未来正式治疗策略的潜力。[147] 然而单独就“认知行为治疗”和“正念疗法”相比,未服药且单独接受“认知行为治疗”或“正念疗法”的ADHD患者经过训练后,并未发现“认知行为治疗”和“正念疗法”的疗效有何差异。[148] 有鉴于前述不一致的实验结果,正念疗法尚需更多研究来证明其有效性。 [4]

其他[编辑 | 编辑源代码]

ADHD的治疗方式图解:

  1. 游戏治疗 [来源请求]
  2. 药物治疗
  3. 生物反馈 [来源请求]
  4. {{ilh|lang={{langname|he}}|lang-code=he|1=沙子疗法|2=טיפול_בשולחן_חול|d=箱庭疗法|nocat=}} [来源请求]
  5. 利用行事历软体(例如:Windwos CalendarGoogle Calendar)协助患者有效管理时间和生活事务。

注解[编辑 | 编辑源代码]

  1. 虽然中枢神经刺激剂(methylphenidate & amphetamine)与非典型中枢神经刺激剂(atomoxetine)能改善ADHD的核心症状,但往往无法全面治愈患者在管理时间规划方面的困难;社交和情绪方面的自我控制[16][17][18]。 而认知行为治疗的领域中,为此再建立出专门针对改善ADHD执行功能缺陷的“ADHD认知行为治疗”[4]
  2. 减少环境中的分心诱因。
  3. 在《找回专注力 成人ADHD全方位自助手册》中,“改善ADHD症状的实用技巧与策略”涵盖:创造有助于专注的环境与内在策略、强化记忆力的妙方、时间管理、改善冲动问题与人际关系、学习表达和倾听、改善情绪、改善与亲人与情人的关系等。[39]
  4. 陈锦宏医师的研究发现,因 ADHD 照顾者本身为 ADHD 症状衍生功能损害的负面后果承担者,如校园冲突、学习困难,生活困难,所以本身也是压力的高风险群,ADHD 家庭研究显示, ADHD 妈妈的生活品质较差,而沮丧的妈妈较难正向协助孩子。这就产生了 ADHD 照护中的核心困难[50] [51][52][49]
  5. 或称心理与身体无法保持安宁。 无法专心睡觉。
  6. 即表示可附加在现有具备科学实证且能在统计学上达到显著意义之有效改善症状的医学疗法。
  7. 摄取过多的维他命可能产生健康问题。[81]例如:长期且高剂量的摄取维他命B6维他命B12可能导致肺癌[82][83]

注释[编辑 | 编辑源代码]

参见[编辑 | 编辑源代码]

文献来源[编辑 | 编辑源代码]

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  3. 3.0 3.1 3.2 Edward M. Hallowell, M.D.; John J. Ratey, M.D. 《分心也有好成績》,. 丁凡译. 台北: 远流出版社. 2006 [2016-12-09]. ISBN 9573259311. 
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  7. Fabiano GA, Pelham WE, Coles EK, Gnagy EM, Chronis-Tuscano A, O'Connor BC. "A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder".. Clincal Psychology Rev. (systematic review). 2009-03, 29 (2): 129–140. PMID 19131150. doi:10.1016/j.cpr.2008.11.001. 
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  9. Guidelines May Have Helped Curb ADHD Diagnoses in Preschoolers. MedlinePlus.gov (tertiary source). HealthDay. 2016-11-15 [2017-01]. (原始内容存档于2016-12-25). The guidelines, issued by the American Academy of Pediatrics (AAP), called for a standardized approach to diagnosis, and recommended behavior therapy -- not drugs -- as the first-line therapy for preschoolers.  |archiveurl=|archive-url=只需其一 (帮助); |accessdate=|access-date=只需其一 (帮助); |archivedate=|archive-date=只需其一 (帮助)
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  16. Biederman, Joseph; Mick, Eric; Fried, Ronna; Wilner, Nicole; Spencer, Thomas J.; Faraone, Stephen V. Are stimulants effective in the treatment of executive function deficits? Results from a randomized double blind study of OROS-methylphenidate in adults with ADHD. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology (Elsevier BV). 2011, 21 (7): 508–515. ISSN 0924-977X. PMID 21303732. doi:10.1016/j.euroneuro.2010.11.005. 
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  21. Molina, Brooke S.G.; Hinshaw, Stephen P.; Swanson, James M.; Arnold, L. Eugene; Vitiello, Benedetto; Jensen, Peter S.; Epstein, Jeffery N.; Hoza, Betsy; Hechtman, Lily; Abikoff, Howard B.; Elliott, Glen R.; Greenhill, Laurence L.; Newcorn, Jeffrey H.; Wells, Karen C.; Wigal, Timothy; Gibbons, Robert D.; Hur, Kwan; Houck, Patricia R. The MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study. Journal of the American Academy of Child & Adolescent Psychiatry (Elsevier BV). 2009, 48 (5): 484–500. ISSN 0890-8567. PMC 3063150可免费查阅. doi:10.1097/chi.0b013e31819c23d0. (b) multicomponent behavior therapy (Beh), which included 27-session group parent training supplemented with eight individual parent sessions, an 8-week summer treatment program, 12 weeks of classroom administered behavior therapy with a half-time aide and 10 teacher consultation sessions. 
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    • In some cases, a special diet of foods without artificial flavors or colors works for a child, because the family and the child interact in a different way when the child eliminates these foods. These changes, not the diet itself, may improve the behavior and activity level.
    • Refined (processed) sugars may have some effect on children's activity. Refined sugars and carbohydrates enter the bloodstream quickly. Therefore, they cause rapid changes in blood sugar levels. This may make a child become more active.
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