患病率:注意缺陷多动障碍 (ADHD) 是童年最常见的疾病之一。全球患病率大约为 5%。[12]Polanczyk G, de Lima MS, Horta BL, et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164:942-948.http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2007.164.6.942http://www.ncbi.nlm.nih.gov/pubmed/17541055?tool=bestpractice.com在美国,国家儿童健康调查显示,2011 年 4-17 岁儿童的总患病率为 11%,[13]Centers for Disease Control and Prevention. Key findings: trends in the parent-report of health care provider-diagnosis and medication treatment for ADHD: United States, 2003-2011. February 2017. http://www.cdc.gov/ (last accessed 7 August 2017).http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html而国家健康调查研究发现 2010 年 3-17 岁美国儿童的 ADHD 患病率估计为 8%。[14]Bloom B, Cohen RA, Freeman G. Summary health statistics for U.S. children:
National Health Interview Survey, 2010. Vital Health Stat 10. 2011;250:1-80.http://www.ncbi.nlm.nih.gov/pubmed/22338334?tool=bestpractice.com
亚型:混合型在所有 ADHD 患者中占 50% - 75%,注意缺陷为主型占 20%-至 30%,多动-冲动为主型占 15%。随着时间的推移,注意缺陷症状往往会持续,而多动冲动症状往往会减弱。[10]Spencer TJ, Biederman MD, Mick E. Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. J Pediatr Psychol. 2007;32:631-642.http://www.ncbi.nlm.nih.gov/pubmed/17556405?tool=bestpractice.com
性别差异:国家儿童健康调查的社区研究显示,男性与女性患病率比率约为 2.3 比 1,而临床人群研究显示,这一比率高达 10 比 1。[13]Centers for Disease Control and Prevention. Key findings: trends in the parent-report of health care provider-diagnosis and medication treatment for ADHD: United States, 2003-2011. February 2017. http://www.cdc.gov/ (last accessed 7 August 2017).http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html[15]Biederman J, Faraone SV. The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives. Psychiatr Clin North Am. 2004;27:225-232.http://www.ncbi.nlm.nih.gov/pubmed/ 15063995?tool=bestpractice.com基于以下事实,这种性别差异已经得到了解释:让患者被送至诊所的破坏性行为在男孩中更为常见;而女孩中更常见的是注意力不集中类型,较少出现对立违抗性障碍和品行障碍等共患病。[10]Spencer TJ, Biederman MD, Mick E. Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. J Pediatr Psychol. 2007;32:631-642.http://www.ncbi.nlm.nih.gov/pubmed/17556405?tool=bestpractice.com[15]Biederman J, Faraone SV. The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives. Psychiatr Clin North Am. 2004;27:225-232.http://www.ncbi.nlm.nih.gov/pubmed/ 15063995?tool=bestpractice.com
种族差异:几项大规模研究表明,西班牙裔儿童的 ADHD 患病率低于美国白人和黑人儿童。[13]Centers for Disease Control and Prevention. Key findings: trends in the parent-report of health care provider-diagnosis and medication treatment for ADHD: United States, 2003-2011. February 2017. http://www.cdc.gov/ (last accessed 7 August 2017).http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html[16]Cuffe SP, Moore CG, McKeown RE. Prevalence and correlates of ADHD symptoms in the National Health Interview Survey. J Atten Disord. 2005;9:392-401.http://www.ncbi.nlm.nih.gov/pubmed/16371662?tool=bestpractice.com根据 AD/HD 多模式治疗研究 (MTA),非洲裔美国儿童班级中的 ADHD 报告率水平要高于白人儿童。[17]Epstein JN, Willoughby M, Valencia EY, et al. The role of children's ethnicity in the relationship between teacher ratings of attention-deficit/hyperactivity disorder and observed classroom behavior. J Consult Clin Psychol. 2005;73:424-434.http://www.ncbi.nlm.nih.gov/pubmed/15982140?tool=bestpractice.com至于这些发现是否反应了真实的患病率差异,是否可能和医护普及水平等干扰因素有关,目前尚不清楚。
社会阶层差异:在美国、英国和其他国家,ADHD 与贫困、家庭收入低和社会地位低相关。[18]Langley K, Holmans PA, van den Bree MB, Thapar A. Effects of low birth weight, maternal smoking in pregnancy and social class on the phenotypic manifestation of attention deficit hyperactivity disorder and associated antisocial behavior: investigation in a clinical sample. BMC Psychiatry. 2007;7:26.https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-7-26http://www.ncbi.nlm.nih.gov/pubmed/17584500?tool=bestpractice.com