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Attention deficit hyperactivity disorder in children

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  • Teoria
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  • Tratamento
  • ACOMPANHAMENTO
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最后审阅： 17 Aug 2025
最后更新： 13 May 2025

小结

定义

病史和体格检查

关键诊断因素

  • inability to give close attention to details or making "careless" mistakes in schoolwork, work, or other activities
  • difficulty sustaining attention in tasks or play activities
  • does not seem to listen when spoken to directly
  • does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
  • often has difficulty organizing tasks and activities
  • avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
  • easily distracted by extraneous stimuli
  • forgetful in daily activities
  • fidgets or taps with hands or feet or squirms in seat
  • leaves seat in classroom or in other situations in which remaining seated is expected
  • runs about or climbs excessively during inappropriate situations
  • difficulty playing or engaging in leisure activities quietly
  • often "on the go" or acts as if "driven by a motor"
  • often talks excessively
  • often blurts out answers before questions have been completed
  • often has difficulty awaiting turn
  • often interrupts or intrudes on others (e.g., butts into conversations or games)
完整详情

其他诊断因素

  • mild mood symptoms (dysphoria, mood lability, irritability, boredom)
  • anxiety
  • difficulty with peer interactions
  • low self-esteem
  • working memory (i.e., short-term memory) impairment
  • processing speed impairment (i.e., the rate at which information is dealt with)
完整详情

危险因素

  • family history of ADHD
  • male sex
  • low birth weight
  • epilepsy
  • tic disorders
  • maternal nicotine use during pregnancy
  • maternal acetaminophen use during pregnancy
  • obstetric complications in pregnancy or labor
  • gestational exposure to stress
  • psychosocial adversity
  • lead exposure
  • traumatic brain injury
  • severe early deprivation
  • iron deficiency
完整详情

诊断性检查

首要检查

  • no formal laboratory or imaging studies
完整详情

Tests to avoid

  • hair analysis
完整详情

需考虑的检查

  • neuropsychological testing
完整详情

治疗流程

持续性治疗

preschool-age children: 4-6 years

school-age children: 6-18 years

撰稿人

作者

Mark Wolraich, MD

Shaun Walters Professor Emeritus, Pediatrics

Section of Developmental and Behavioral Pediatrics

University Oklahoma Health Sciences

Oklahoma City

OK

利益声明

MW is a member of the steering committee of the REACH Institute providing CME programs on child mental health.

鸣谢

Dr Mark Wolraich would like to gratefully acknowledge Dr Lawrence W. Brown, Dr Kristin S. Russell, Dr Howard Y. Liu, and Dr Michael S. Jellinek, previous contributors to this topic.

利益声明

LWB was reimbursed by Sunovion for participation in a Medical Advisory Board. KSR, HYL, and MSJ declare that they have no competing interests.

同行评议者

Joseph F. Hagan, Jr. MD, FAAP

Clinical Professor in Pediatrics

The Larner College of Medicine at the University of Vermont

Burlington

VT

利益声明

JFH served as Vice-Chairman of the American Academy of Pediatrics' ADHD Clinical Guidelines revision alongside the author of this topic, MW, who was Chairman. They also co-authored the book "ADHD: What Every Parent Needs to Know, 3rd. Ed.", published by the AAP.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

World Health Organization. ICD-11 International statistical classification of diseases and related health problems, 11th revision. Geneva: WHO; 2022.全文

Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019 Oct;144(4):e20192528.全文  摘要

Faraone SV, Banaschewski T, Coghill D, et al. The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021 Sep;128:789-818.全文  摘要

Barbaresi WJ, Campbell L, Diekroger EA, et al. Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr. 2020 Feb/Mar;41 Suppl 2S:S35-S57.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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  • Diretrizes

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