注意力不足过动症的流行病学
注意力不足过动症(ADHD)是童年阶段最常见的发展障碍[4]。根据2015年发表的流行病学研究,依照DSM-III, DSM-III-R及DSM-IV的标准,国际注意力不足过动症的流行率中位数,儿童为6-8%[5][6]。若使用ICD-10的标准,同年龄儿童的流行率则为1–2% [7]。美国的成人注意力不足过动症的流行率为4-5%[8][9]。根据《找回专注力:成人ADHD全方位自助手册》,成人ADHD在台湾的流行率推估为3-4%[10]:24-25。ADHD是全球性的[11][12][13][14]。世界各地ADHD流行率的差异主要是因为世界各地使用的ADHD诊断方法不同。[15] 若使用相同的诊断方法,则世界各地所得出的ADHD流行率将介于伯仲之间。[16]
英国和美国的ADHD诊断率和治疗率自1970年代起逐年增加至今[17]。学界的共识认为这个现象是因为诊断方法的变迁[17]以及人们逐渐愿意利用药物来治疗ADHD所致[7],并非ADHD的流行率真的增加了。[17][7][18]:134 [18]
学界共识认为,2013年起,DSM的版本从DSM 4TR 推进到 DSM 5 会使得ADHD的诊断数增加(特别是成人注意力不足过动症的诊断数) [19]。
美洲
[编辑]- 美国的数据
截至2011年底,大约11%的4-17岁的儿童与青少年被诊断出注意力不足过动症[21]。11%换算后约为640万的儿童与青少年。[21]诊断出有ADHD的男童在比例上比女童约高出两倍。对于这个性别上差异的成因,目前仍然未知确切原因。不过,有专家指有可能由于女童的病症普遍与男童不同,因此在诊断时亦同时较男童难于察觉,所以较少让家长及老师发现而作出转介。[22] [23]
研究显示美国一年因注意力不足过动症损失高达近40亿美金,其中即包括父母的工作损失[24]。
亚洲
[编辑]- 台湾的数据
ADHD在台湾儿童暨青少年的盛行率约为7%至7.5%。依据卫生福利部中央健保署之健保资料库[25]的资料显示,儿童就医者大约是2.3%至2.5%左右[26]。儿童及青少年ADHD的就医比率不到一半,也就是有超过三分之二患有注意力不足过动症的儿童及青少年没有接受诊断。[10]:24ADHD在台湾成人的盛行率推估为一百个成人中大约有四位(4%)左右的ADHD成人患者。根据2012年健保资料库的资料显示:18岁至50岁成人,曾诊断为ADHD的比率为0.057%。[10]:25 [27]
- 韩国的数据
注意力不足过动症在南韩成人族群(18岁以上)的盛行率大约为 4.4%。而此症在南韩的儿童及青少年族群的盛行率与西方国家的数据大致相同。[28]
- 日本的数据
日本的学龄族群中(6-18岁)中,注意力不足过动症的盛行率约为7%。[29]
- 中国大陆的数据
根据最新2016年中国大陆的流行病学调研(调查研究),中国大陆儿童与青少年的ADHD患病率是6.26% (95% 信赖区间: 5.36–7.22%),这意味着中国大陆有数千万小于十八岁的未成年患有注意力缺陷/多动症。[30]
ADHD在香港儿童与青少年的流行率约落在5%至7%之间。[31][32] ADHD在澳门的流行率与国际盛行率相仿。[33]
- 越南的数据
越南国小学生族群中,ADHD的流行率约为7.7%。其中“注意力缺失型”约占1.7%;“过动-冲动型”约占5%;“混合型”约占1%。[34]
各子类型中的个案性别平均分布。越南的研究指出,7.7%的流行率与邻近的亚洲国家和世界其他国家的ADHD儿童流行率相仿,呼吁提升越南境内对ADHD的意识。[34]
大洋洲
[编辑]- 澳洲的数据
澳洲官方数据显示,在18岁以下的儿童与青少年族群中,有大约11.2%的人患有ADHD。ADHD是澳洲未成年族群中最常见的心理疾患。[35]其中男性患者的比例为女性患者的将近三倍。[35]
欧洲
[编辑]- 西班牙的数据
- 法国的数据
ADHD在法国大学生(平均年龄:20.6岁)中的盛行率约为5.6%。[37]
研究发现,有ADHD的大学生和没有ADHD的大学生相较之下,有ADHD的大学生有显著更高的机率需要重修课程以及显著较低的学业成就。有ADHD的大学生相较之下也有显著较多的物质或特定行为成瘾的个案数,这些成瘾的具体事例有:酒精成瘾、大麻成瘾、烟瘾、赌博成瘾、冲动购物症、饮食障碍、和网络成瘾症等。[37]研究也点出“ADHD个别化医疗”的重要性。[37]
非洲
[编辑]- 非洲的数据
ADHD影响了大概5.4-8.7%的非洲儿童[38],然而此数据的品质并不高。[38]
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“台湾对这个疾病的知识不足,网路民间常流窜1-20年前过时的资料,而真正接受过此疾病诊断及整合式治疗训练的专科医师如儿心科医师又少之又少。”、“ADHD全世界平均盛行率为7.2%,台湾社区研究为7.5%,而台湾健保资料库研究显示只有2.3%接受诊断,1.6%用药,1%的人接受足够时间完整的治疗,所以可了解有许多人求助无门因而情况日益恶化。 ”
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Table 5.2 shows the prevalence of the three disorders. The most common disorder was ADHD, which had a prevalence of 11.2%. Within this group, 5.8% had the Inattentive Subtype of ADHD, 2.0% the Hyperactive-Impulsive Subtype and 3.3% the Combined Subtype.
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Significant differences were found as students with ADHD were less likely to succeed in their studies (repeated classes more often) than non-ADHD students, and considered their academic level to be lower. They also had significantly higher scores on substance (alcohol, cannabis, and tobacco) as well as behavioral addictions (gambling, compulsive buying disorder, eating disorders, and Internet addiction). Conclusion It seems essential to determine students' problems and propose interventions adapted to students' needs, in order to reduce the negative impact on their future academic and global successes.
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