過度活躍症

過度活躍症attention deficit hyperactivity disorder,簡稱「ADHD」)係一種精神障礙精神疾患[1][2]。患者專注力不足,容易分心。患者特性包括好難專注、過度活躍、做嘢唔考慮後果等。除此之外,仲有不合年紀嘅行為,過度活躍症患者亦可能表現出情緒調節困難或者執行功能方面嘅問題[3][4]

過度活躍症
分類同外部資源
Patient UK英文Patient UK注意力不足過動症(ADHD)
attention deficit hyperactivity disorder

症狀同體徵

ADHD嘅症狀[5]
專注力失調 過動-衝動
  • 好難注意事情嘅細節
  • 唔容易專注喺同一件事情上面
  • 唔容易針對事物或者係活動進行規劃組織
  • 好容易遺忘一啲需要嘅物品
  • 喺日常活動入面比較健忘
  • 注意力持續時間較短,比較容易分心
  • 唔容易處理有結構性嘅工作
  • 難以完成繁瑣或者需要花時間嘅任務
  • 無辦法好好坐好
  • 喺座位上坐立不安、郁嚟郁去
  • 會喺唔適當嘅時間離開座位
  • 從事具風險性嘅事物,唔會太考慮後果
  • 經常處於活躍狀態、精力充沛、停唔到落嚟
  • 說話頻率同時間會比其他人多
  • 問題未講完就搶住講答案
  • 唔容易輪流等候
  • 喺對話入面成日插嘴或者打斷其他人對話

過度活躍症常見情況有唔專心、過動(成人會以不安嚟表現)、破壞行為同衝動[6][7]。喺人際關係同埋學業方面都容易出現問題[6],不過呢種症狀唔容易定義,因為好難介定一般情形入面唔專心、過動同衝動會有咩程度,喺咩情況入面先需要介入治療[8]

依照《精神疾病診斷與統計手冊》(DSM)第五版(DSM-5)嘅定義, 過度活躍症嘅症狀需要出現超過6個月,或者患者情形比同年齡明顯多好多[4],同埋患者症狀已經造成至少兩個情境(例如社交、學校/工作、家庭)嘅問題[4],呢啲條件需要喺12歲之前就出現[4],若果係17歲以下,喺專注力失調或者係過動/衝動上嘅症狀,至少需要有5項符合[4]

子類型

過度活躍症可以分做3個子類型[4][8]:

若果以注意力不足(專注力失調)為主嘅細路或者青少年,會有以下大部份甚至全部嘅症狀,同時唔係由其他醫學疾病或者藥物直接造成[4][9]

  • 容易分心、粗心、唔記得事情、成日由一件事情切換去另一件事情。
  • 好難持續專注喺同一件事情度。
  • 除非做緊自己有興趣嘅事務,唔係嘅話做咗幾分鐘後就會覺得無聊。
  • 難以對組織(規劃)事情、完成一個任務保持專注。
  • 好難完成功課,或者如期繳交,成日會唔見一啲要完成作業或者係其他活動需要嘅嘢(例如鉛筆、玩具、作業等)*
  • 當其他人同患者講嘢時,似乎無喺度聽對方講嘢。
  • 成日發白日夢、成日覺得困惑、動作緩慢。
  • 唔容易好似其他非過度活躍症患者一樣,快速同準確處理資訊。
  • 好難遵從指示
  • 唔容易認知細節,成日忽略細節。

若果係以過動為主嘅細路或者青少年,會有以下大部份甚至全部嘅症狀,而且唔係由其他醫學疾病或者藥物直接造成[4][9]

  • 成日煩躁同坐立不安
  • 係咁冇停咀講嘢
  • 周圍東奔西跑、碰觸或者玩弄視野入面任何一個或者每一個物體。
  • 好難喺上堂時間、食飯時間、做功課時間乖乖坐好。
  • 一直郁嚟郁去。
  • 唔容易進行安靜嘅活動或者工作。
  • 好無耐心
  • 脫口講出唔恰當嘅話語、毫無掩飾咁流露內心嘅諗法,同埋行事唔理後果。
  • 好難耐在遊戲中因輪流所產生嘅等待時間。
  • 成日打斷其他人對話或者活動。

若果過度活躍症患者症狀符合上述兩類,就屬於合併型嘅注意力不足過動症

ADHD嘅女性比較唔會有過動同衝動症狀,比較會有注意力唔集中同分心嘅症狀[10]。過度活躍症入面有關過動嘅症狀,可能會隨住年齡增長而漸漸消退,而轉變為青少年同成人階段嘅「內在唔安寧」[11]

注意力不足過動症嘅細路、青少年同成年比較容易有社交技巧英文social skills上嘅問題,例如社交互動、發展友誼同建立友誼。有半數嘅注意力不足過動症患者曾經受到同儕社會排斥情形,而無注意力不足過動症嘅人被社會排斥比例大約係10%至15%。患有注意力不足過動症嘅人比較唔容易處理口語同非語言訊息,比較容易喺社交互動方面有負面影響,亦比較容易喺對話入面離題、忽略到一啲社交資訊、又比較唔容易學習社交技能[12]

過度活躍症嘅細路比較容易有唔容易控制情緒嘅問題[13],佢哋嘅寫字英文handwriting能力亦比較弱[14],喺語言講嘢運動方面嘅發展都比較遲[15][16]。即使過度活躍症會造成好多不便,不過若果細路患者針對有興趣嘅主題同事物,佢哋嘅專注力持續時間會同其他細路一樣,甚至好過其他細路[17]

可能有關嘅疾病

過度活躍症患者入面,大約會有三分之二機率會伴隨其他疾病或者特徵[17]。常見嘅共病或者特徵有以下:

有一個2016年嘅系統回顧發現過度活躍症同肥胖哮喘睡眠障礙有直接關係,同乳糜瀉以及偏頭痛亦有一部分關聯[38]。不過同一年嘅另一篇系統回顧覺得過度活躍症同乳糜瀉無明確關係[39]

智力

有研究發現患有過度活躍症嘅人佢哋嘅智商(IQ)測試結果會比無過度活躍症嘅人低[40]。不過有關研究結果嘅重要性,依家依然存有爭議,因為好難區分影響係因為ADHD嘅症狀(例如分心)所造成,定係ADHD本身對於智力有影響[40]

有一份成人ADHD嘅研究指出有關ADHD患者喺智力上嘅差異,無統計上嘅意義,亦可以用其他相關疾病嚟解釋[41]

有一份最新嘅研究報告指出,智能障礙嘅患者患ADHD機率相比其他人高;而若果親屬入面有人為智能障礙者嘅話,家族入面其他成員患ADHD嘅機率(相比起親屬入面無智能障礙者)為高。根據擬和模型嘅分析,造成呢種情況嘅原因有91%可能性同基因有關[42]

治療

過度活躍症嘅治療方式包括心理治療行為治療藥物,亦有可能係用幾種方法一齊進行。治療對病症會有長期嘅改善,但係無法完全根除病症嘅影響[43]。藥物包括有興奮劑阿托莫西汀腎上腺素受體α2英文alpha-2 adrenergic receptor刺激劑,有時亦會包括抗抑鬱藥物[19][44]。若果無法專注喺長期獎勵入面嘅人,有好多正增強方式可以提升患者工作表現[45]。ADHD藥物入面嘅興奮劑亦可以提升患者嘅毅力同工作表現[46][45]

行為治療

有關行為治療喺ADHD嘅應用,有好多良好嘅實證,若果係針對學齡前,或者係症狀輕微嘅患者,一般會建議用行為治療為第一線療法[47][48]。心理療法包括有心理教育、行為治療、認知行為療法(CBT)、人際取向心理治療家庭治療英文family therapy學校介入、社交技巧訓練、行為方面嘅同儕介入、機構培訓[49]父母管理訓練[50]神經反饋訓練[51]。父母管理訓練可以改善包括反對行為以及唔合常規行為在內嘅一啲行為問題[52]。依家仲未清楚神經反饋訓練係咪有效[53]

研究有關家庭治療效果嘅高質素調查重係好少,不過有證據認為家庭治療嘅效果同社區照顧(community care)差唔多,而又好過用安慰劑[54]。有好多過度活躍症組織可以提供相關資訊,同埋協助家庭適應ADHD嘅情形[55]

有關社交技巧訓練、行為調整同藥物對病患嘅好處可能有限。要減少後續心理同精神問題(例如重度抑鬱症犯罪、學校學習失敗、物質使用疾患)嘅主要因素係同無從事偏差行為嘅人建立友誼[56]

規律嘅體能鍛煉,特別係帶氧運動,對於患有ADHD嘅細路成人嚟講一種有效嘅副加療法英文adjunct therapy,特別係配合興奮劑藥物治療時更加係咁,不過針對改善症狀,最理想嘅運動種類同強度仲未清楚[57][58][59]。長期規律有氧運動對ADHD患者嘅好處係提升行為同運動能力、提升管控功能(包括專注、抑制控制、計劃等)、較快嘅資訊處理速度記憶力亦會比較好[57][58][59]。家長同老師針對ADHD細路規律有氧運動對行為同社交-情緒上嘅改善有:全身整體機能較佳、減少ADHD症狀、自尊感較好、減少焦慮同抑鬱嘅程度、較少身體症狀、課業成績同校內行為較好,社交行為亦有所改善[57]。若果喺有使用興奮劑治療時進行運動,會增加興奮劑藥物對執行功能嘅影響[57],一般認為運動嘅短期效果係因為運動時大腦突觸多巴胺同去甲腎上腺素濃度嘅增加所造成[57]

藥物

針對過度活躍症,可以用中樞神經刺激劑(亦叫興奮劑)藥物嚟治療[60][61]Template:Update inline,對於症狀至少會有一啲效果,短期嚟講,大約有80%會有效果[62][63][61]。家長同老師反應哌甲酯比較可以改善患者症狀[63][62][64],中樞神經刺激劑亦可以減少ADHD細路意外事故嘅風險[65]。針對ADHD嘅中樞神經刺激劑藥物除咗哌甲酯之外,仲有苯丙胺甲基苯丙胺等。

針對ADHD嘅非中樞神經刺激劑藥物有好多種,包括阿托莫西汀安非他酮胍法辛英文guanfacine可樂定,呢啲可以作為主要藥物治療,或者配合中樞神經刺激劑藥物一齊用[60][66]。依家有關各種藥物之間嘅比較,仲未有足夠說服力嘅研究結果可以佐證,不過喺副作用入面似乎差唔多[67]。中樞神經刺激劑藥物比較可以提升課業表現,阿托莫西汀就無呢種效果[68]。阿托莫西汀冇咁易有成癮問題,所以若果有娛樂性藥物或者係強迫性藥物使用風險嘅人,比較建議使用阿托莫西汀[11]。有關藥物對社交行為上嘅影響,依家仲未有充足資料[67]。截至2015年6月,仲未完全確定ADHD藥物嘅長期影響[69][70]核磁共振成像研究推測長期用苯丙胺或者哌甲酯治療,會減少因為ADHD造成嘅大腦功能同結構異常[71][72][73]。2018年嘅文獻回顧發現若果考慮短期效果,哌甲酯對細路最有效,苯丙胺對成人最有效[74]

胍法辛英文guanfacine治療會依唔同國家有所唔同,英國國家健康照護專業組織英文National Institute for Health and Care Excellence(NICE)針對成人係第一線藥物,若果針對細路,只會建議喺病情嚴重時先使用,而大部份美國嘅醫學指南會建議可以針對各個年齡層使用[75][76]。針對學齡前嘅細路,一般唔建議用藥物治療[50][77]。若果治療用嘅中樞神經刺激劑劑量唔夠,可能會出現無藥效嘅情形[78],呢個尤其係成日出現喺青少年同成人身上,因為核可嘅劑量係針對學齡細路,所以有啲醫療人員會依據體重或者係依照其他因素畀藥[79][80][81]

一般嚟講,正常治療劑量嘅哌甲酯中樞神經刺激劑係安全,不過有佢嘅副作用同禁忌症[60]。若果哌甲酯畀細路同青少年使用,有研究發現呢個同一啲嚴重或者唔嚴重嘅有害副作用有關,不過證據品質仲未充份[82]。若果針對細路開呢類藥物,需要仔細監測細路服用情形[82]。若果ADHD嘅中樞神經刺激劑嚴重過量,可能會同興奮性精神病英文stimulant psychosis或者係狂躁嘅症狀[83]。若果係治療用嘅劑量,出現類似情形機會好低,只有0.1%,會喺開始用中樞神經刺激劑藥物治療後嘅前幾星期出現[83][84][85],若果用埋抗精神病藥,可以有效緩解急性苯丙胺精神病嘅症狀[83],若長期治療,需要作定期監測[86]。興奮劑嘅藥物治療需要定期停藥,評估係咪仲需要食藥、減少發育遲緩情形,同埋減低抗藥性[87][88]。若果係長期使用超過ADHD治療劑量嘅興奮劑藥物濫用,一般會同成癮以及物質依賴有關[89][90]。不過未治療嘅ADHD,會提高物質濫用以及行為規範障礙嘅風險[89]。興奮劑藥物嘅使用,可能可以降低風險,但係亦有可能無呢種效果[11][69][89]。仲未清楚懷孕時服用呢啲藥物係咪安全[91]

飲食

飲食嘅調整可能對少部份ADHD細路有幫助[92]2013年一份統合分析針對有ADHD症狀,同埋有補充遊離脂肪酸或者係減少食用有人工色素食品嘅細路一個相關研究發現,只有唔到三分之一嘅細路喺症狀上有所改善[93]。呢方面嘅助益有可能只係對有食物敏感嘅細路有幫助,亦有可能係因為呢啲細路同時亦接受緊ADHD治療[93]。呢啲發表咗嘅文獻亦表明依家已知嘅證據唔可以証實減少食用特定食物嚟治療ADHD嘅療法[93]。2014年發表嘅文獻亦發現排除飲食喺治療ADHD入面嘅成效有限[94]。另一篇2016年嘅文獻回顧指出,根據研究結果,「無麩質飲食喺未來成為ADHD嘅標準療法」機率係微乎其微[39]

2017嘅文獻回顧指出有一啲排除飲食嘅方式對於好細、唔食得藥嘅幼童同埋對藥物無反應嘅患者可能有用,不過唔鼓勵用補充遊離脂肪酸或者係減少食用有人工色素食品作為ADHD嘅正規治療方式[95] 。長期礦物質不足可能會令ADHD症狀加劇[96],亦有少數證據指出組織入面嘅含量過低同ADHD有關[97]。不過除非證實有鋅不足英文zinc deficiency嘅情形(依家多數係發展中國家先會有鋅不足情形),一般唔建議用鋅補充劑英文zinc supplementation治療[98]。不過若果鋅礦物質同苯丙胺類藥物同時使用嘅話,可以減低苯丙胺藥物嘅最細有效劑量,亦就係可以服用較少藥物而達到相同效果[99]。另外亦有證據指出Ω-3脂肪酸對於病情會有些少改善,不過唔建議取代醫學治療[100][101]

睇埋

參考

  1. Sroubek A, Kelly M, Li X (2013-02). "Inattentiveness in attention-deficit/hyperactivity disorder". Neuroscience Bulletin. 29 (1): 103–10. doi:10.1007/s12264-012-1295-6. PMC 4440572. PMID 23299717. Check date values in: |date= (help)
  2. Caroline SC, 編 (2010). Encyclopedia of Cross-Cultural School Psychology. Springer Science & Business Media. p. 133. ISBN 9780387717982. 原著喺2020-12-22歸檔. 喺2017-11-02搵到. Unknown parameter |dead-url= ignored (help)
  3. 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為NIH2016嘅參照
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為DSM5嘅參照
  5. "ADHD: Symptoms and Diagnosis". Centers for Disease Control and Prevention (2017). 31 August 2017. 原著喺2014-11-07歸檔. Unknown parameter |dead-url= ignored (help)
  6. 6.0 6.1 Dobie C (2012). "Diagnosis and management of attention deficit hyperactivity disorder in primary care for school-age children and adolescents": 79. 原著喺2013-03-01歸檔. 喺10 October 2012搵到. Unknown parameter |deadurl= ignored (help); Cite journal requires |journal= (help)
  7. 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為cdc2016facts嘅參照
  8. 8.0 8.1 Ramsay JR (2007). Cognitive behavioral therapy for adult ADHD. Routledge. pp. 4, 25–26. ISBN 978-0-415-95501-0.
  9. 9.0 9.1 National Institute of Mental Health (2008). "Attention Deficit Hyperactivity Disorder (ADHD)". National Institutes of Health. 原著喺2013-01-19歸檔. 喺2019-12-03搵到. Unknown parameter |deadurl= ignored (help)
  10. Gershon J (2002-01). "A meta-analytic review of gender differences in ADHD". Journal of Attention Disorders. 5 (3): 143–54. doi:10.1177/108705470200500302. PMID 11911007. Check date values in: |date= (help)
  11. 11.0 11.1 11.2 11.3 11.4 11.5 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為Kooij-2010嘅參照
  12. Coleman WL (August 2008). "Social competence and friendship formation in adolescents with attention-deficit/hyperactivity disorder". Adolescent Medicine. 19 (2): 278–99, x. PMID 18822833.
  13. "ADHD Anger Management Directory". Webmd.com. 原著喺2013-11-05歸檔. 喺2014-01-17搵到. Unknown parameter |deadurl= ignored (help)
  14. Racine MB, Majnemer A, Shevell M, Snider L (April 2008). "Handwriting performance in children with attention deficit hyperactivity disorder (ADHD)". Journal of Child Neurology. 23 (4): 399–406. doi:10.1177/0883073807309244. PMID 18401033.
  15. "F90 Hyperkinetic disorders", International Statistical Classification of Diseases and Related Health Problems 10th Revision, World Health Organisation, 2010, 原著喺2 November 2014歸檔, 喺2 November 2014搵到 Unknown parameter |deadurl= ignored (help)
  16. Bellani M, Moretti A, Perlini C, Brambilla P (December 2011). "Language disturbances in ADHD". Epidemiology and Psychiatric Sciences. 20 (4): 311–5. doi:10.1017/S2045796011000527. PMID 22201208.
  17. 17.0 17.1 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為Wal2012嘅參照
  18. 18.0 18.1 18.2 "ADHD Symptoms". nhs.uk. 20 October 2017. 原著喺2021-02-01歸檔. 喺15 May 2018搵到. Unknown parameter |dead-url= ignored (help)
  19. 19.0 19.1 19.2 Wilens TE, Spencer TJ (September 2010). "Understanding attention-deficit/hyperactivity disorder from childhood to adulthood". Postgraduate Medicine. 122 (5): 97–109. doi:10.3810/pgm.2010.09.2206. PMC 3724232. PMID 20861593.
  20. 20.0 20.1 Bailey, Eileen. "ADHD and Learning Disabilities: How can you help your child cope with ADHD and subsequent Learning Difficulties? There is a way". Remedy Health Media, LLC. 原著喺2013-12-03歸檔. 喺15 November 2013搵到. Unknown parameter |deadurl= ignored (help)
  21. 21.0 21.1 Krull, KR (5 December 2007). "Evaluation and diagnosis of attention deficit hyperactivity disorder in children". Uptodate. Wolters Kluwer Health. 原著喺2009-06-05歸檔. 喺12 September 2008搵到. Unknown parameter |subscription= ignored (help); Unknown parameter |deadurl= ignored (help)
  22. National Collaborating Centre for Mental Health (2009). "Attention Deficit Hyperactivity Disorder". Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE Clinical Guidelines. 72. Leicester: British Psychological Society. pp. 18–26, 38. ISBN 978-1-85433-471-8. 原著喺2016-01-13歸檔. 喺2017-06-22搵到 –透過NCBI Bookshelf. Unknown parameter |deadurl= ignored (help)
  23. Wilens TE, Morrison NR (July 2011). "The intersection of attention-deficit/hyperactivity disorder and substance abuse". Current Opinion in Psychiatry. 24 (4): 280–5. doi:10.1097/YCO.0b013e328345c956. PMC 3435098. PMID 21483267.
  24. Corkum P, Davidson F, Macpherson M (June 2011). "A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder". Pediatric Clinics of North America. 58 (3): 667–83. doi:10.1016/j.pcl.2011.03.004. PMID 21600348.
  25. Tsai MH, Huang YS (May 2010). "Attention-deficit/hyperactivity disorder and sleep disorders in children". The Medical Clinics of North America. 94 (3): 615–32. doi:10.1016/j.mcna.2010.03.008. PMID 20451036.
  26. Brown TE (October 2008). "ADD/ADHD and Impaired Executive Function in Clinical Practice". Current Psychiatry Reports. 10 (5): 407–11. doi:10.1007/s11920-008-0065-7. PMID 18803914.
  27. Bendz LM, Scates AC (2010-01). "Melatonin treatment for insomnia in pediatric patients with attention-deficit/hyperactivity disorder". The Annals of Pharmacotherapy. 44 (1): 185–91. doi:10.1345/aph.1M365. PMID 20028959. Check date values in: |date= (help)
  28. McBurnett K, Pfiffner LJ (November 2009). "Treatment of aggressive ADHD in children and adolescents: conceptualization and treatment of comorbid behavior disorders". Postgraduate Medicine. 121 (6): 158–65. doi:10.3810/pgm.2009.11.2084. PMID 19940426.
  29. Hofvander B, Ossowski D, Lundström S, Anckarsäter H (2009). "Continuity of aggressive antisocial behavior from childhood to adulthood: The question of phenotype definition" (PDF). International Journal of Law and Psychiatry. 32 (4): 224–34. doi:10.1016/j.ijlp.2009.04.004. PMID 19428109. 原著 (PDF)喺2020-11-28歸檔. 喺2019-12-03搵到. Unknown parameter |dead-url= ignored (help)
  30. Rubia K (June 2011). ""Cool" inferior frontostriatal dysfunction in attention-deficit/hyperactivity disorder versus "hot" ventromedial orbitofrontal-limbic dysfunction in conduct disorder: a review". Biological Psychiatry. 69 (12): e69–87. doi:10.1016/j.biopsych.2010.09.023. PMID 21094938.
  31. Weinberg WA, Brumback RA (May 1990). "Primary disorder of vigilance: a novel explanation of inattentiveness, daydreaming, boredom, restlessness, and sleepiness". The Journal of Pediatrics. 116 (5): 720–5. doi:10.1016/s0022-3476(05)82654-x. PMID 2329420.
  32. Barkley RA (2014-01). "Sluggish cognitive tempo (concentration deficit disorder?): current status, future directions, and a plea to change the name" (PDF). Journal of Abnormal Child Psychology. 42 (1): 117–25. doi:10.1007/s10802-013-9824-y. PMID 24234590. 原著 (PDF)喺2017-08-09歸檔. 喺2018-03-12搵到. Unknown parameter |deadurl= ignored (help); Check date values in: |date= (help)
  33. Baud P, Perroud N, Aubry JM (June 2011). "[Bipolar disorder and attention deficit/hyperactivity disorder in adults: differential diagnosis or comorbidity]". Revue Medicale Suisse (法文). 7 (297): 1219–22. PMID 21717696.
  34. Merino-Andreu M (March 2011). "[Attention deficit hyperactivity disorder and restless legs syndrome in children]" [Attention deficit hyperactivity disorder and restless legs syndrome in children]. Revista de Neurologia (西班牙文). 52 Suppl 1: S85–95. PMID 21365608.
  35. Picchietti MA, Picchietti DL (August 2010). "Advances in pediatric restless legs syndrome: Iron, genetics, diagnosis and treatment". Sleep Medicine. 11 (7): 643–51. doi:10.1016/j.sleep.2009.11.014. PMID 20620105.
  36. Karroum E, Konofal E, Arnulf I (2008). "[Restless-legs syndrome]". Revue Neurologique (法文). 164 (8–9): 701–21. doi:10.1016/j.neurol.2008.06.006. PMID 18656214.
  37. Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR (2009-01). "Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study". Journal of the American Academy of Child and Adolescent Psychiatry. 48 (1): 35–41. doi:10.1097/CHI.0b013e318190045c. PMC 2794242. PMID 19096296. Check date values in: |date= (help)
  38. Instanes JT, Klungsøyr K, Halmøy A, Fasmer OB, Haavik J (February 2018). "Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review". Journal of Attention Disorders (Systematic Review). 22 (3): 203–228. doi:10.1177/1087054716669589. PMC 5987989. PMID 27664125. 原著喺2017-02-07歸檔. 喺2021-02-06搵到. Unknown parameter |deadurl= ignored (help)Template:Open access
  39. 39.0 39.1 Ertürk E, Wouters S, Imeraj L, Lampo A (January 2016). "Association of ADHD and Celiac Disease: What Is the Evidence? A Systematic Review of the Literature". Journal of Attention Disorders (Review): 108705471561149. doi:10.1177/1087054715611493. PMID 26825336. Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement GFD as a standard treatment in ADHD. Nevertheless, the possibility of untreated CD predisposing to ADHD-like behavior should be kept in mind. ... It is possible that in untreated patients with CD, neurologic symptoms such as chronic fatigue, inattention, pain, and headache could predispose patients to ADHD-like behavior (mainly symptoms of inattentive type), which may be alleviated after GFD treatment. (CD: celiac disease; GFD: gluten-free diet)
  40. 40.0 40.1 Frazier TW, Demaree HA, Youngstrom EA (July 2004). "Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder". Neuropsychology. 18 (3): 543–55. doi:10.1037/0894-4105.18.3.543. PMID 15291732.
  41. Bridgett DJ, Walker ME (March 2006). "Intellectual functioning in adults with ADHD: a meta-analytic examination of full scale IQ differences between adults with and without ADHD". Psychological Assessment. 18 (1): 1–14. doi:10.1037/1040-3590.18.1.1. PMID 16594807.
  42. Faraone, Stephen V.; Ghirardi, Laura; Kuja-Halkola, Ralf; Lichtenstein, Paul; Larsson, Henrik (2017). "The Familial Co-Aggregation of Attention-Deficit/Hyperactivity Disorder and Intellectual Disability: A Register-Based Family Study". Journal of the American Academy of Child & Adolescent Psychiatry. doi:10.1016/j.jaac.2016.11.011. |access-date= requires |url= (help)
  43. Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE (September 2012). "A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment". BMC Medicine. 10: 99. doi:10.1186/1741-7015-10-99. PMC 3520745. PMID 22947230.
  44. Bidwell LC, McClernon FJ, Kollins SH (August 2011). "Cognitive enhancers for the treatment of ADHD". Pharmacology Biochemistry and Behavior. 99 (2): 262–74. doi:10.1016/j.pbb.2011.05.002. PMC 3353150. PMID 21596055.
  45. 45.0 45.1 Modesto-Lowe V, Chaplin M, Soovajian V, Meyer A (July 2013). "Are motivation deficits underestimated in patients with ADHD? A review of the literature". Postgraduate Medicine. 125 (4): 47–52. doi:10.3810/pgm.2013.07.2677. PMID 23933893. Behavioral studies show altered processing of reinforcement and incentives in children with ADHD. These children respond more impulsively to rewards and choose small, immediate rewards over larger, delayed incentives. Interestingly, a high intensity of reinforcement is effective in improving task performance in children with ADHD. Pharmacotherapy may also improve task persistence in these children. ... Previous studies suggest that a clinical approach using interventions to improve motivational processes in patients with ADHD may improve outcomes as children with ADHD transition into adolescence and adulthood.
  46. 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為Malenka ADHD neurosci嘅參照
  47. Fabiano GA, Pelham WE, Coles EK, Gnagy EM, Chronis-Tuscano A, O'Connor BC (March 2009). "A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder". Clinical Psychology Review. 29 (2): 129–40. doi:10.1016/j.cpr.2008.11.001. PMID 19131150.
  48. Kratochvil CJ, Vaughan BS, Barker A, Corr L, Wheeler A, Madaan V (March 2009). "Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist". The Psychiatric Clinics of North America. 32 (1): 39–56. doi:10.1016/j.psc.2008.10.001. PMID 19248915.
  49. Evans SW, Owens JS, Bunford N (2014). "Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder". Journal of Clinical Child and Adolescent Psychology. 43 (4): 527–51. doi:10.1080/15374416.2013.850700. PMC 4025987. PMID 24245813.
  50. 50.0 50.1 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為NICE 2009嘅參照
  51. Arns M, de Ridder S, Strehl U, Breteler M, Coenen A (July 2009). "Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis". Clinical EEG and Neuroscience. 40 (3): 180–9. doi:10.1177/155005940904000311. PMID 19715181.
  52. Daley D, Van Der Oord S, Ferrin M, Cortese S, Danckaerts M, Doepfner M, Van den Hoofdakker BJ, Coghill D, Thompson M, Asherson P, Banaschewski T, Brandeis D, Buitelaar J, Dittmann RW, Hollis C, Holtmann M, Konofal E, Lecendreux M, Rothenberger A, Santosh P, Simonoff E, Soutullo C, Steinhausen HC, Stringaris A, Taylor E, Wong IC, Zuddas A, Sonuga-Barke EJ (October 2017). "Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder" (PDF). Journal of Child Psychology and Psychiatry, and Allied Disciplines. 59 (9): 932–947. doi:10.1111/jcpp.12825. PMID 29083042. 原著 (PDF)喺2019-04-04歸檔. 喺2019-11-21搵到. Unknown parameter |dead-url= ignored (help)
  53. Cortese S, Ferrin M, Brandeis D, Holtmann M, Aggensteiner P, Daley D, Santosh P, Simonoff E, Stevenson J, Stringaris A, Sonuga-Barke EJ (June 2016). "Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials". Journal of the American Academy of Child and Adolescent Psychiatry. 55 (6): 444–55. doi:10.1016/j.jaac.2016.03.007. hdl:1854/LU-8123796. PMID 27238063.
  54. Bjornstad G, Montgomery P (April 2005). Bjornstad GJ (編). "Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents". The Cochrane Database of Systematic Reviews (2): CD005042. doi:10.1002/14651858.CD005042.pub2. PMID 15846741.
  55. Turkington, Carol; Harris, Joseph (2009). "attention deficit hyperactivity disorder (ADHD)". The Encyclopedia of the Brain and Brain Disorders. Infobase Publishing. pp. 47. ISBN 978-1-4381-2703-3 –透過Google Books.
  56. Mikami AY (June 2010). "The importance of friendship for youth with attention-deficit/hyperactivity disorder". Clinical Child and Family Psychology Review. 13 (2): 181–98. doi:10.1007/s10567-010-0067-y. PMC 2921569. PMID 20490677.
  57. 57.0 57.1 57.2 57.3 57.4 Den Heijer AE, Groen Y, Tucha L, Fuermaier AB, Koerts J, Lange KW, Thome J, Tucha O (2017-02). "Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review". Journal of Neural Transmission. 124 (Suppl 1): 3–26. doi:10.1007/s00702-016-1593-7. PMC 5281644. PMID 27400928. Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior. Check date values in: |date= (help)
  58. 58.0 58.1 Kamp CF, Sperlich B, Holmberg HC (July 2014). "Exercise reduces the symptoms of attention-deficit/hyperactivity disorder and improves social behaviour, motor skills, strength and neuropsychological parameters". Acta Paediatrica. 103 (7): 709–14. doi:10.1111/apa.12628. PMID 24612421. We may conclude that all different types of exercise ... attenuate the characteristic symptoms of ADHD and improve social behaviour, motor skills, strength and neuropsychological parameters without any undesirable side effects. Available reports do not reveal which type, intensity, duration and frequency of exercise is most effective
  59. 59.0 59.1 Rommel AS, Halperin JM, Mill J, Asherson P, Kuntsi J (September 2013). "Protection from genetic diathesis in attention-deficit/hyperactivity disorder: possible complementary roles of exercise". Journal of the American Academy of Child and Adolescent Psychiatry. 52 (9): 900–10. doi:10.1016/j.jaac.2013.05.018. PMC 4257065. PMID 23972692. The findings from these studies provide some support for the notion that exercise has the potential to act as a protective factor for ADHD.
  60. 60.0 60.1 60.2 Wigal SB (2009). "Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults". CNS Drugs. 23 Suppl 1: 21–31. doi:10.2165/00023210-200923000-00004. PMID 19621975.
  61. 61.0 61.1 Castells X, Ramos-Quiroga JA, Bosch R, Nogueira M, Casas M (June 2011). Castells X (編). "Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults". The Cochrane Database of Systematic Reviews (6): CD007813. doi:10.1002/14651858.CD007813.pub2. PMID 21678370.
  62. 62.0 62.1 引用錯誤 無效嘅<ref>標籤; 無文字提供於名為May2008嘅參照
  63. 63.0 63.1 Parker J, Wales G, Chalhoub N, Harpin V (September 2013). "The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials". Psychology Research and Behavior Management. 6: 87–99. doi:10.2147/PRBM.S49114. PMC 3785407. PMID 24082796. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. ... Only one paper examining outcomes beyond 36 months met the review criteria. ... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22
  64. Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, 等 (November 2015). "Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)". The Cochrane Database of Systematic Reviews. 11 (11): CD009885. doi:10.1002/14651858.CD009885.pub2. PMID 26599576.
  65. Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallón S, Alvarez Zallo N, Luis EO, de Castro-Manglano P, Soutullo C, Arrondo G (January 2018). "Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis". Neuroscience and Biobehavioral Reviews. 84: 63–71. doi:10.1016/j.neubiorev.2017.11.007. PMID 29162520.
  66. Childress AC, Sallee FR (March 2012). "Revisiting clonidine: an innovative add-on option for attention-deficit/hyperactivity disorder". Drugs of Today. 48 (3): 207–17. doi:10.1358/dot.2012.48.3.1750904. PMID 22462040.
  67. 67.0 67.1 McDonagh MS, Peterson K, Thakurta S, Low A (2011-12). "Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder". Drug Class Reviews. United States Library of Medicine. PMID 22420008. 原著喺2016-08-31歸檔. 喺2019-11-21搵到. Unknown parameter |deadurl= ignored (help); Cite journal requires |journal= (help); Check date values in: |date= (help)
  68. Prasad V, Brogan E, Mulvaney C, Grainge M, Stanton W, Sayal K (April 2013). "How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis". European Child & Adolescent Psychiatry. 22 (4): 203–16. doi:10.1007/s00787-012-0346-x. PMID 23179416.
  69. 69.0 69.1 Kiely B, Adesman A (June 2015). "What we do not know about ADHD… yet". Current Opinion in Pediatrics. 27 (3): 395–404. doi:10.1097/MOP.0000000000000229. PMID 25888152. In addition, a consensus has not been reached on the optimal diagnostic criteria for ADHD. Moreover, the benefits and long-term effects of medical and complementary therapies for this disorder continue to be debated. These gaps in knowledge hinder the ability of clinicians to effectively recognize and treat ADHD.
  70. Hazell P (July 2011). "The challenges to demonstrating long-term effects of psychostimulant treatment for attention-deficit/hyperactivity disorder". Current Opinion in Psychiatry. 24 (4): 286–90. doi:10.1097/YCO.0b013e32834742db. PMID 21519262.
  71. Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K (February 2013). "Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects". JAMA Psychiatry. 70 (2): 185–98. doi:10.1001/jamapsychiatry.2013.277. PMID 23247506.
  72. Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J (September 2013). "Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies". The Journal of Clinical Psychiatry. 74 (9): 902–17. doi:10.4088/JCP.12r08287. PMC 3801446. PMID 24107764.
  73. Frodl T, Skokauskas N (February 2012). "Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects". Acta Psychiatrica Scandinavica. 125 (2): 114–26. doi:10.1111/j.1600-0447.2011.01786.x. PMID 22118249. Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
  74. Cortese, Samuele; Adamo, Nicoletta; Del Giovane, Cinzia; Mohr-Jensen, Christina; Hayes, Adrian J; Carucci, Sara; Atkinson, Lauren Z; Tessari, Luca; Banaschewski, Tobias; Coghill, David; Hollis, Chris; Simonoff, Emily; Zuddas, Alessandro; Barbui, Corrado; Purgato, Marianna; Steinhausen, Hans-Christoph; Shokraneh, Farhad; Xia, Jun; Cipriani, Andrea (September 2018). "Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis". The Lancet Psychiatry. 5 (9): 727–738. doi:10.1016/S2215-0366(18)30269-4.
  75. "Canadian ADHD Practice Guidelines" (PDF). Canadian ADHD Alliance. 喺2011-02-04搵到.
  76. "Attention-Deficit / Hyperactivity Disorder (ADHD): Recommendations". Centers for Disease Control and Prevention. 2015-06-24. 原著喺2015-07-07歸檔. 喺2015-07-13搵到. Unknown parameter |deadurl= ignored (help)
  77. Greenhill LL, Posner K, Vaughan BS, Kratochvil CJ (April 2008). "Attention deficit hyperactivity disorder in preschool children". Child and Adolescent Psychiatric Clinics of North America. 17 (2): 347–66, ix. doi:10.1016/j.chc.2007.11.004. PMID 18295150.
  78. Stevens JR, Wilens TE, Stern TA (2013). "Using stimulants for attention-deficit/hyperactivity disorder: clinical approaches and challenges". The Primary Care Companion for CNS Disorders. 15 (2). doi:10.4088/PCC.12f01472. PMC 3733520. PMID 23930227.
  79. Young, Joel L. (2010). "Individualizing Treatment for Adult ADHD: An Evidence-Based Guideline". Medscape. 原著喺2015-05-08歸檔. 喺19 June 2016搵到. Unknown parameter |deadurl= ignored (help)
  80. Biederman, Joseph (2003). "New-Generation Long-Acting Stimulants for the Treatment of Attention-Deficit/Hyperactivity Disorder". Medscape. 原著喺2003-12-07歸檔. 喺19 June 2016搵到. As most treatment guidelines and prescribing information for stimulant medications relate to experience in school-aged children, prescribed doses for older patients are lacking. Emerging evidence for both methylphenidate and Adderall indicate that when weight-corrected daily doses, equipotent with those used in the treatment of younger patients, are used to treat adults with ADHD, these patients show a very robust clinical response consistent with that observed in pediatric studies. These data suggest that older patients may require a more aggressive approach in terms of dosing, based on the same target dosage ranges that have already been established – for methylphenidate, 1–1.5–2 mg/kg/day, and for D,L-amphetamine, 0.5–0.75–1 mg/kg/day....
    In particular, adolescents and adults are vulnerable to underdosing, and are thus at potential risk of failing to receive adequate dosage levels. As with all therapeutic agents, the efficacy and safety of stimulant medications should always guide prescribing behavior: careful dosage titration of the selected stimulant product should help to ensure that each patient with ADHD receives an adequate dose, so that the clinical benefits of therapy can be fully attained.
    Unknown parameter |deadurl= ignored (help)
  81. Kessler S (January 1996). "Drug therapy in attention-deficit hyperactivity disorder". Southern Medical Journal. 89 (1): 33–8. doi:10.1097/00007611-199601000-00005. PMID 8545689.
  82. 82.0 82.1 Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C (May 2018). "Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies". The Cochrane Database of Systematic Reviews. 5: CD012069. doi:10.1002/14651858.CD012069.pub2. PMID 29744873.
  83. 83.0 83.1 83.2 Shoptaw SJ, Kao U, Ling W (January 2009). Shoptaw SJ, Ali R (編). "Treatment for amphetamine psychosis". The Cochrane Database of Systematic Reviews (1): CD003026. doi:10.1002/14651858.CD003026.pub3. PMID 19160215. A minority of individuals who use amphetamines develop full-blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common (about 18%) is for frequent amphetamine users to report psychotic symptoms that are sub-clinical and that do not require high-intensity intervention ...
    About 5–15% of the users who develop an amphetamine psychosis fail to recover completely (Hofmann 1983) ...
    Findings from one trial indicate use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis.
  84. "Adderall XR Prescribing Information" (PDF). United States Food and Drug Administration. Shire US Inc. December 2013. 原著 (PDF)喺2013-12-30歸檔. 喺30 December 2013搵到. Treatment-emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. ... In a pooled analysis of multiple short-term, placebo controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients. Unknown parameter |deadurl= ignored (help)
  85. Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R (2009-02). "Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children". Pediatrics. 123 (2): 611–6. doi:10.1542/peds.2008-0185. PMID 19171629. Check date values in: |date= (help)
  86. Kraemer M, Uekermann J, Wiltfang J, Kis B (July 2010). "Methylphenidate-induced psychosis in adult attention-deficit/hyperactivity disorder: report of 3 new cases and review of the literature". Clinical Neuropharmacology. 33 (4): 204–6. doi:10.1097/WNF.0b013e3181e29174. PMID 20571380.
  87. van de Loo-Neus GH, Rommelse N, Buitelaar JK (2011-08). "To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended?". European Neuropsychopharmacology. 21 (8): 584–99. doi:10.1016/j.euroneuro.2011.03.008. PMID 21530185. Check date values in: |date= (help)
  88. Ibrahim K, Donyai P (July 2015). "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades" (PDF). Journal of Attention Disorders. 19 (7): 551–68. doi:10.1177/1087054714548035. PMID 25253684. 原著喺2016-06-30歸檔. 喺2019-11-21搵到. Unknown parameter |deadurl= ignored (help)
  89. 89.0 89.1 89.2 Malenka RC, Nestler EJ, Hyman SE (2009). Sydor A, Brown RY (編). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (第2nd版). New York: McGraw-Hill Medical. pp. 323, 368. ISBN 978-0-07-148127-4. supervised use of stimulants at therapeutic doses may decrease risk of experimentation with drugs to self-medicate symptoms. Second, untreated ADHD may lead to school failure, peer rejection, and subsequent association with deviant peer groups that encourage drug misuse. ... amphetamines and methylphenidate are used in low doses to treat attention deficit hyperactivity disorder and in higher doses to treat narcolepsy (Chapter 12). Despite their clinical uses, these drugs are strongly reinforcing, and their long-term use at high doses is linked with potential addiction
  90. Oregon Health & Science University (2009). Black box warnings of ADHD drugs approved by the US Food and Drug Administration. Portland, Oregon: United States National Library of Medicine. 原著喺2017-09-08歸檔. 喺17 January 2014搵到. Unknown parameter |deadurl= ignored (help)
  91. Ashton H, Gallagher P, Moore B (September 2006). "The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder". Journal of Psychopharmacology. 20 (5): 602–10. doi:10.1177/0269881106061710. PMID 16478756. 原著喺2009-08-15歸檔. 喺2019-11-21搵到. Unknown parameter |deadurl= ignored (help)
  92. Nigg JT, Lewis K, Edinger T, Falk M (January 2012). "Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives". Journal of the American Academy of Child and Adolescent Psychiatry. 51 (1): 86–97.e8. doi:10.1016/j.jaac.2011.10.015. PMC 4321798. PMID 22176942.
  93. 93.0 93.1 93.2 Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Döpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J (March 2013). "Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments". The American Journal of Psychiatry. 170 (3): 275–89. doi:10.1176/appi.ajp.2012.12070991. PMID 23360949. Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities...
  94. Nigg JT, Holton K (October 2014). "Restriction and elimination diets in ADHD treatment". Child and Adolescent Psychiatric Clinics of North America (Review). 23 (4): 937–53. doi:10.1016/j.chc.2014.05.010. PMC 4322780. PMID 25220094. an elimination diet produces a small aggregate effect but may have greater benefit among some children. Very few studies enable proper evaluation of the likelihood of response in children with ADHD who are not already preselected based on prior diet response.
  95. Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R (January 2017). "Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD". PLoS One (Systematic Review). 12 (1): e0169277. doi:10.1371/journal.pone.0169277. PMC 5266211. PMID 28121994.Template:Open access
  96. Konikowska K, Regulska-Ilow B, Rózańska D (2012). "The influence of components of diet on the symptoms of ADHD in children". Roczniki Panstwowego Zakladu Higieny. 63 (2): 127–34. PMID 22928358.
  97. Arnold LE, DiSilvestro RA (August 2005). "Zinc in attention-deficit/hyperactivity disorder". Journal of Child and Adolescent Psychopharmacology. 15 (4): 619–27. doi:10.1089/cap.2005.15.619. hdl:1811/51593. PMID 16190793.
  98. Bloch MH, Mulqueen J (October 2014). "Nutritional supplements for the treatment of ADHD". Child and Adolescent Psychiatric Clinics of North America. 23 (4): 883–97. doi:10.1016/j.chc.2014.05.002. PMC 4170184. PMID 25220092.
  99. Krause J (April 2008). "SPECT and PET of the dopamine transporter in attention-deficit/hyperactivity disorder". Expert Review of Neurotherapeutics. 8 (4): 611–25. doi:10.1586/14737175.8.4.611. PMID 18416663. Zinc binds at ... extracellular sites of the DAT [103], serving as a DAT inhibitor. In this context, controlled double-blind studies in children are of interest, which showed positive effects of zinc [supplementation] on symptoms of ADHD [105,106]. It should be stated that at this time [supplementation] with zinc is not integrated in any ADHD treatment algorithm.
  100. Bloch MH, Qawasmi A (October 2011). "Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis". Journal of the American Academy of Child and Adolescent Psychiatry. 50 (10): 991–1000. doi:10.1016/j.jaac.2011.06.008. PMC 3625948. PMID 21961774.
  101. Königs A, Kiliaan AJ (July 2016). "Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment". Neuropsychiatric Disease and Treatment. 12: 1869–82. doi:10.2147/NDT.S68652. PMC 4968854. PMID 27555775.