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Dr. Hallowell on the Today show discussing Adult ADD

While ADD tends to be associated with childhood, we’ve learned that it is far more widespread among adults than previously understood. While there are some children with ADD/ADHD who will outgrow it, we now know that the vast majority will not. Listed below are criteria for adult ADD that we developed from our clinical experience:

A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished). Difficulty getting organized. Chronic procrastination or trouble getting started. Many projects going simultaneously; trouble with follow through. A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark. A frequent search for high stimulation. An intolerance of boredom. Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times. Often creative, intuitive, highly intelligent Trouble in going through established channels and following “proper” procedure. Impatient; low tolerance of frustration. Impulsive, either verbally or in action, as an impulsive spending of money. Changing plans, enacting new schemes or career plans and the like; hot-tempered. A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers. A sense of insecurity. Mood swings, mood lability, especially when disengaged from a person or a project. Physical or cognitive restlessness. A tendency toward addictive behavior. Chronic problems with self-esteem. Inaccurate self-observation. Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood. Recognizing and treating ADD is just as important for adults as it is for children, as it has a wide ranging impact in careers, marriages and families. [1]

Embed YouTube Video Trial 编辑

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特徵和診斷 编辑

診斷ADHD的標準係依據DSM-IV-TR精神疾病診斷與統計手冊的標準，可以連結至美国疾病控制与预防中心（CDC）查詢。美國疾病管制局強調兒童及成人之ADHD診斷必須由受過專業訓練的醫療團隊(例如：Pediatric psychiatrist 兒童精神科醫師團隊)才可，否則容易被誤診與處方，這是相當危險的。

According to the DSM-5, symptoms must be present for six months or more to a degree that is much greater than others of the same age[10] and they must cause significant problems functioning in at least two settings (e.g., social, school/work, or home).[10] The full criteria must have been met prior to age 12 in order to receive a diagnosis of ADHD.[10]
根據最新的DSM-5，以下表列之症狀必須持續至少六個月且其程度明顯高於多數同年齡層之同儕。除此之外，以下表列之症狀必須在至少兩種不同的情境下(例如：社交、課業/工作、或家庭)造成顯著的問題，且這些條件必須出現在大約十二歲以前。

ADHD is divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined type.[10][35] A child with ADHD inattentive type has most or all of following symptoms, excluding situations where these symptoms are better explained by another psychiatric or medical condition:[10][36] Be easily distracted, miss details, forget things, and frequently switch from one activity to another Have difficulty maintaining focus on one task Become bored with a task after only a few minutes, unless doing something enjoyable Have difficulty focusing attention on organizing and completing a task or learning something new Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities Seem to not be listening when spoken to Daydream, become easily confused, and move slowly Have difficulty processing information as quickly and accurately as others Struggle to follow instructions Have trouble understanding minute details
注意力不足過動症又可細分為以下三種類型：注意力不足為主型、過動-衝動為主型、及注意力不足且過動衝動的混和型。
一個以注意力不足為主的ADHD擁有以下幾乎所有的症狀，且非由其他醫學疾病直接造成。

  • 容易分心、粗心、忘記事情且經常從一件事情切換至另一件事情。
  • 難以持續對於一件事情保持專注。
  • 除非是從事自己有興趣的事情，否則很容易對從事一件事情感到無聊。
  • 難以對組職事情、完成一個任務或學習新事物保持專注。
  • 難以完成或(如期)繳交家庭作業並且經常丟失一些用以完成任務或活動的必備東西(例如：鉛筆、玩具、作業)
  • 當你在跟患者說話時，該患者似乎沒在聽你說話。
  • 白日夢、容易困惑、且移動遲緩。
  • 難以和其他非ADHD的人一樣精確且快速的在腦海中處理接收到的資訊。
  • 難以遵從指示。
  • 難以認知細微的細節。

A child with ADHD hyperactive/impulsive type has most or all of the following symptoms, excluding situations where these symptoms are better explained by another psychiatric or medical condition:[10][36] Fidget and squirm in their seats Talk nonstop Dash around, touching or playing with anything and everything in sight Have trouble sitting still during dinner, school, doing homework, and story time Be constantly in motion Have difficulty doing quiet tasks or activities Be very impatient Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences Have difficulty waiting for things they want or waiting their turns in games Often interrupt conversations or others' activities
一個以過動-衝動為主的ADHD擁有以下幾乎所有的症狀，且非由其他醫學疾病直接造成。

  • 坐在椅子上動來動去
  • 一直講話
  • 四處東奔西跑、碰觸或玩弄視野內的任一或每一個物體。
  • 難以在吃飯時間、學校中、做功課的時間、及故事時間坐著。
  • 一直在移動、動作。
  • 難以從事安靜的任務或活動。
  • 非常不耐煩。
  • 脫口說出不恰當的話語、毫無掩飾地直接在表情中流露出心理的想法、不顧後果的豪放不羈。
  • 難以接(忍)受延遲的滿足、難耐在遊戲中因輪流所產生的等待時間。
  • 經常打斷他人的對話或活動。

Symptoms of hyperactivity tend to go away with age and turn into "inner restlessness" in teens and adults with ADHD.[15]
在青少年及成年的注意力不足過動症患者中，過動的症狀往往隨著社會化及年齡的增長而轉變為"內在的不安寧"。

People with ADHD of all ages are more likely to have problems with social skills, such as social interaction and forming and maintaining friendships. This is true for all subtypes. About half of children and adolescents with ADHD experience social rejection by their peers compared to 10–15% of non-ADHD children and adolescents. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. They also may drift off during conversations, and miss social cues.[37] Difficulties managing anger are more common in children with ADHD[38] as are poor handwriting[39] and delays in speech, language and motor development.[40][41] Although it causes significant impairment, particularly in modern society, many children with ADHD have a good attention span for tasks they find interesting.[6]
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、建立及維持友誼。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ADHD的兒童及青少年曾經歷過社交上的拒絕(排斥)；而其同儕遭遇社交上的拒絕的比率約為10~15%。注意力不足的人比起對照組(非ADHD)更容易遭遇理解口頭與非口頭言語上的困難，進而對於其社交互動產生負面影響。ADHD也可能在對話的過程中打瞌睡會遺漏他人釋放出的社交暗示。
難以管理憤怒情緒的情況則較常在兒童ADHD身上顯現。且兒童ADHD通常有寫字的困難、言語及行動發展的遲緩。雖然這造成患者在現今社會中很大的障礙，然而許多ADHD在他們有興趣的事情上都能持續維持專注力。 Associated disorders[edit]
In children, ADHD occurs with other disorders about ⅔ of the time.[6] Some commonly associated conditions include:
Learning disabilities have been found to occur in about 20–30% of children with ADHD. Learning disabilities can include developmental speech and language disorders and academic skills disorders.[42] ADHD, however, is not considered a learning disability, but it very frequently causes academic difficulties.[42]
Tourette syndrome has been found to occur more commonly in the ADHD population.[43]
Oppositional defiant disorder (ODD) and conduct disorder (CD), which occur with ADHD in about 50% and 20% of cases respectively.[44] They are characterized by antisocial behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, and stealing.[45] About half of those with hyperactivity and ODD or CD develop antisocial personality disorder in adulthood.[46] Brain imaging supports that conduct disorder and ADHD are separate conditions.[47]
Primary disorder of vigilance, which is characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch and appear to be hyperactive in order to remain alert and active.[45] Mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder.[48] Adults with ADHD sometimes also have bipolar disorder, which requires careful assessment to accurately diagnose and treat both conditions.[49] Anxiety disorders have been found to occur more commonly in the ADHD population.[48] Obsessive-compulsive disorder (OCD) can co-occur with ADHD and shares many of its characteristics.[45] Substance use disorders. Adolescents and adults with ADHD are at increased risk of substance abuse.[15] This is most commonly seen with alcohol or cannabis.[15] The reason for this may be an altered reward pathway in the brains of ADHD individuals.[15] This makes the evaluation and treatment of ADHD more difficult, with serious substance misuse problems usually treated first due to their greater risks.[18][50] Restless legs syndrome has been found to be more common in those with ADHD and is often due to iron deficiency anaemia.[51][52] However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders.[53] Sleep disorders and ADHD commonly co-exist. They can also occur as a side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with behavioral therapy the preferred treatment.[54][55] Problems with sleep initiation are common among individuals with ADHD but often they will be deep sleepers and have significant difficulty getting up in the morning.[56] Melatonin is sometimes used in children who have sleep onset insomnia.[57] People with ADHD have an increased risk of persistent bed wetting.[58] A 2016 systematic review found a well established association between ADHD and obesity, asthma and sleep disorders, and tentative evidence for association with celiac disease and migraine,[59] while another 2016 systematic review did not support a clear link between celiac disease and ADHD, and stated that routine screening for celiac disease in people with ADHD is discouraged.[60]

治療方式的爭議 编辑

即便目前ADHD的治療策略(涵蓋藥物既非藥物治療)皆通過世界各國政府機關及世界衛生組織的安全及臨床試驗認可，少部分台灣的中國醫學科醫師(中醫師)仍對此不以為然，認為西藥有毒又有副作用。坊間亦有人宣傳「保健食品」、花精皂(宣稱多搭配此香皂洗手可治療ADHD)、「人造磁鐵」、「自然療法」、「營養處方」等試驗者、提倡者、成分、短中長期之安全性、有效性、科學根據、官方認證、......皆不明的療法。

對此，台灣兒童青少年精神醫學會理事長、國立臺灣大學醫學院附設醫院精神科主治醫師高淑芬回應指出，對ADHD治療想法可以很多元，但介入方式必需要有科學證據及嚴謹的研究設計，包括對象治療多久，都應受到密切監督.[2] 臺灣兒童青少年精神醫學會並在其官方公告中發布以標題各為孩子和家長接受專業醫療協助的權利，是需要被維護的、20160728公聽會-台灣兒童青少年精神醫學會新聞稿為首的數份新聞稿，其內容涵蓋對於當前治療策略的明確釋疑外，亦重申有科學根據、通過臨床試驗、獲得政府安全許可的把關才是一個療法對患者人生負責任的體現。

Further agendas: Refer to ADHD page English version to seek for inspiration to optimize the Chinese version of ADHD. Refer to Obsessive Compulsive Disorder talk page written in Chinese characters to see whether or not to get involved in listed activities over there. :D 11/20/2016 20:18

完善醫療環境之展望 编辑

當前之醫療環境仍有許多值得改善之處。 包括：

因此台灣精神醫學會指出

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Myth or frequently asked questions
Question:
「ADHD在台灣被過度診斷、過度治療根本是藥物濫用！」

Answer:
台灣兒童「注意力不足過動症（ADHD）」盛行率約7%~7.5%。全世界平均值約7.2%。
根據健保資料庫，小於18歲之「注意力不足過動症（ADHD）」患者求診率約2.3％~2.5%，用藥率約1.6％。因此「ADHD台灣被過度診斷、過度治療根本是藥物濫用！」是不成立的。[3]

Question:

Answer:


Reference coverages: ADHD用藥爭議 立法院上演大對決

In regard to external links issue reported by Wolfch 编辑

A. Consider to write a paragraph to include most of the links.
For instance,
B. 格式手冊的目的是為了提供一些準則、方針，使得所有條目的編輯風格變得一致。以下的規則並沒有聲明不能變動，也不暗示這些規則比其他方式都要好，但如果所有人的編輯方式都一致，維基百科會更易於閱讀和使用，並讓撰寫和編輯變得更加方便。《芝加哥格式手冊》裡面的話應得到注意： 格式手冊的目的是為了提供一些準則、方針，使得所有條目的編輯風格變得一致。以下的規則並沒有聲明不能變動，也不暗示這些規則比其他方式都要好，但如果所有人的編輯方式都一致，維基百科會更易於閱讀和使用，並讓撰寫和編輯變得更加方便。《芝加哥格式手冊》裡面的話應得到注意： “規章制度，本質上，並非永恆不變的定律。它們僅針對一般案例，必須在某程度的彈性下應用。 （Rules and regulations such as these, in the nature of the case, cannot be endowed with the fixity of rock-ribbed law. They are meant for the average case, and must be applied with a certain degree of elasticity.）”

「當然，編寫內容清晰、有內涵、無偏見的條目，比任何的文章編排格式來得更重要。只要您能做到這一點，其實無須過分在意任何指引：編輯維基的樂趣在於未必凡事都要做到最完美。」

其他維基參與者在編輯維基百科的時候，會按照這個指引修正不規範格式的條目，條目會漸漸地符合指引內容。 https://zh.100ke.info/wiki/Wikipedia:格式手册 Wikipedia:格式手冊
C. 將連結數目減至最少[edit source] 儘量只放置一個官方連結；若放置多於一個官方連結，請確保各連結提供不同的內容，而且連結之間沒有聯繫。例如，一位作者的官網有其微博和網誌連結，則無須放置3個外部連結，放置官網就足夠。請以最少的連結提供最多的資訊。請謹記，維基百科不是純粹的外部連結收集處或網站列表。https://zh.100ke.info/wiki/Wikipedia:外部链接#.E5.B0.87.E9.80.A3.E7.B5.90.E6.95.B8.E7.9B.AE.E6.B8.9B.E8.87.B3.E6.9C.80.E5.B0.91 Wikipedia:外部連結
D. No rule was found with respect to limitation of number of external link can be added.
E. Many outdated/obsolete external links were hidden upon the addition of External Link Issue template on the top of the page.

For instance 間接醫療協助 (社會資源協助) 编辑

台灣 编辑

除了在醫療場所接受直接的醫療照護外，中華民國政府亦附設許多相關機構，例如：......。以便讓這些患者能

除了在醫療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[4]及社會局[5]等，彙整對於弱勢者社會支持的資源，以便讓這些患者能在接受直接醫療協助時無後顧之憂。

  1. ^ Dr. Hallowell on the Today show discussing Adult ADD
  2. ^ ADHD用藥爭議 立法院上演大對決, 2016年8月
  3. ^ [www.healthnews.com.tw/news/article/30113/三人成虎 三人成虎_ADHD過動症須正視勿輕信謠傳]
  4. ^ 中華民國衛生福利部-社會及家庭署
  5. ^ 中華民國高雄市政府社會局
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