注意力不足過動症的非藥物治療

注意力不足過動症的非藥物治療注意力不足過動症的治療方式之一。

行為治療(MTA模式)编辑

 
父母管理訓練前(before)後(after)的效果对比[1][2]

行為治療被認為是對注意力不足過動症孩子進行行為介入具有實證性效果的方法。透過系統化的行為分析,了解孩子犯錯的模式,並且配合後果增強與削弱的方法,以及教導他正確的行為模式,例如:懂得等待、輪流等觀念,減少他衝動、過動而引起的人際衝突、人際互動的情緒調節英语interpersonal emotion regulation

情緒管理英语Emotional_self-regulation

專攻注意力不足過動症的認知行為治療,對於治療年紀接近或已經是成人的注意力不足過動症患者來說是有效的。(例如:憤怒管理時間管理、改善包括記憶力、計畫及執行能力、自我啟發能力、自我體察英语Self-monitoring

在內的執行功能等。)[3][4][5]

許多ADHD支持團體的存在得以作為許多家庭的正確治療資訊來源而且能協助家庭一起管理ADHD。[6]

對於那些學齡前且僅有些微注意力不足過動症症狀的孩童,已建議「行為治療」為治療該族群的第一線療法。[7][8][9]

行為方面的治療 簡介
心理教育 醫學實證為根據的療法,用以協助患者以及他的愛人了解疾病的資訊並提供支持,以便讓他們能更有效地面對一個疾病。[10][11][12]
行為治療 行为治疗家主张心理障碍中表现的异常行为如同正常行为一样是可以习得的,可以通过基本的条件作用原理英语Behaviorism#Operant conditioning

学习原理而使心理障碍得到矫正的。[13][14]

此外,對於兒童來說,行為治療將協助孩子與其家長學習一些技巧:

  • 維持每天固定的行程與時間表。
  • 減少環境中可能的分心源。
  • 在特定的地方或符合邏輯的地方做相對應的事情,例如:在書房或自習室讀書、在遊戲間放置玩耍的玩具等。
  • 把大目標切成許多微小但較容易達成的小目標,分階段實行。
  • 獎勵正向的行為。(例如:使用累計點數的方法英语Token_economy

,累積到一定的點數就能獲得獎勵。)

來幫助孩子把心神維持在一件事情上。

  • 不要給予太多選項供孩子選擇 (limiting choices)。
  • 與孩子一起發掘孩子的天賦所在。
  • 善用冷靜紀律(calm discipline),例如:時間暫停英语Time-out_(parenting)

、將孩子抽離事發現場、轉移孩子的注意力(distraction)。 [5]

認知行為治療 改變認知的方式,讓孩子們學會以不同的、新的正向想法,來取代原先錯誤的、舊有的負面想法。[15]

對於成人來說,認知行為治療將協助他們改善ADHD的核心症狀—執行功能不足:[註 1]


  • 注意力的管理
  • 記憶能力。
  • 計劃能力。
  • 正向思維/行為支持和社交能力。

[4]

Template:Expand section

人際取向心理治療 人際取向的心理治療的中心思想是「既然人際關係和生活中的大小事能影響心情;那麼反過來,心情也能影響人際關係和生活中的大小事」。[19]
家庭治療英语Family therapy

(也稱:家族治療) ||當前的證據表明MTA模式的行為治療中的家族治療的療效類似普通精神科門診的照護(通常包含ADHD藥物治療)且優於完全不治療ADHD。[20][21][22]

學校資源介入英语school-based interventions
-
社交技巧英语Social skills

訓練 ||學習與「非正涉入違法行為的年輕人和同儕」交朋友對於ADHD孩子來說十分重要,因為這能顯著降低往後人生可能出現的問題,例如:憂鬱症犯罪、在學過程遇到的各種挫折和物質濫用的機率[23][24]

運用同儕的行為干預英语behavioral peer intervention
-
組織規劃能力與技巧的培養英语organization training
-
生活管理能力與技巧的培養英语Daily living skills training
-
父母管理訓練 父母管理訓練可能直接改善孩子的行為問題,例如:對立反抗的舉止或違抗指令的言行。 [25]環境的支持有利於注意力不足過動症的治療[26][27][28][29][30]
團體心理治療 一群特定人們與治療師透過團體活動達成治療目標的一種心理治療。[31]
生理(神經、腦波)回饋英语Neurofeedback 當前腦波回饋是否具有療效仍然未知。[32]
行為改正英语Behavior modification 證據表明具有一定益處。[23]
語言治療 台灣的中央健保署自2014年起同意台灣的兒童青少年精神科醫師可以如同復健科醫師及「英语Otology

、鼻、喉科醫師」一般開立「語言治療」的處方。[33]

應用行為分析 先釐清行為與環境之間的交互作用關係後再協助行為改變。[34][35]
正念療法

正念療法尚需更多研究來證明其有效性。[4]

婚姻諮商 [36]
職業諮商英语Career_counseling [36]
ADHD教練 [36]

Template:Further2

目前對於精神疾患的治療方式是基於生物-心理-社會模式,良好的精神治療模式必須結合生物醫學、心理治療,以及社會復健計畫。

例如:思覺失調症患者在疾病急性發作住院期間,給予藥物協助緩解正性症狀。病房中也會由專業人員,例如:精神科醫師、精神科護理師、臨床心理師、諮商心理師、職能治療師、精神科社工師等,帶領團體治療,或者給予個別治療。而在急性症狀緩解後,患者、家屬和醫療團隊一同討論復健計畫,例如到復健病房、日間留院或者工作坊,透過復健計畫,有效增加病識感英语Self-awareness

(患者對於自身英语self-concept

以及自身疾病的認識英语self-consciousness

程度[37][38])、學習獨立生活能力英语independent living

、改善家庭社會關係英语social relation

藥物能幫助注意力不足過動症患者從生理上穩定情緒、增進專注力和組織規劃能力,降低不適當言行的出現。[39]

認知行為治療(MTA模式)编辑

著重在「常在成人患者身上觀察到的執行功能缺失」的認知行為治療,主要協助患者治療以下問題[40][41]

  • 難以持續掌握任務和活動、難以對任務或活動抱持恆心。
  • 拖延。
  • 有分辨事情緩急輕重的困難。
  • 缺乏管理能力。
  • 做短期和長期計畫的能力不符合患者年齡該有的成熟度。[42]

美國國家心理健康機構英语NIMH

建議成人注意力不足過動症患者:

  • 依照事情的類別建立各自的行事曆。例如:家庭行事曆、工作行事曆、醫療行事曆等。[43]

青少年及成年编辑

Template:Expand section 《找回專注力:成人ADHD全方位自助手冊》一書中指出,對於年紀稍長的注意力不足過動症患者來說,要習得正向的情緒表達方法和社交技巧並養成良好規律且有秩序的生活習慣則有賴患者身體力行,善用認知行為治療的原理。「認知行為治療」分為「認知治療」和「行為治療」兩部分。[39]

認知治療包含:心理建設、正面回饋、衛教、和思考練習來建立正確的觀念和健康的態度、激發改變的動機、鼓舞自信和提升勇氣,遠離負面思考。 行為治療是運用「刺激-反應」的原理,把一個大目標切成許多小目標,並加上正面的酬賞作為鼓勵,幫助患者一步一步的接近小目標,一次又一次的完成小目標,整個大目標即隨之而成。 成功完成某階段的目標後,便可適度提高挑戰性,例如:從「持續做一件事達15分鐘」變成「持續做一件事達30分鐘」以此類推,逐步建立起良好的習慣。最後就可以順利達成連續做一件事情達一個小時的願景[39]。除此之外增加「環境結構」[註 2]、學習分辨事情的緩急輕重[44]、學習「改善ADHD症狀的實用技巧與策略」[註 3]也是行為治療的主軸,然後再輔以其他行為治療的方式。(其他的行為治療方式並非不重要)

兒童编辑

《家有過動兒:幫助ADHD孩子快樂成長》一書中指出,對於年紀輕輕的小孩來說,由於自我能力有限,因此行為治療以「課堂上的行為治療」及「家中的行為治療」為主,其他的行為治療方式為輔。(其他的行為治療方式並非不重要) [15][45] 書中並建議「讓孩子承擔適度的責任」,孩子表現出來的態度往往令人驚喜。[15]:133-134

學校

《家有過動兒:幫助ADHD孩子快樂成長》一書中指出,學校老師可以多提供「正向動機」,包含:課前提醒和課堂中的鼓勵。而在孩子的座位安排上盡可能減少能讓他/她分心的誘因。允許孩子把作業分批次寫完並在課堂上保留小組討論的時間、與孩子共同討論規範與自由。[15]

課堂外的策略:

  1. 協助孩子找出在特定情境下出現的問題。[15]
  2. 找出孩子正確的行為。譬如說:需要排隊時,他可以乖乖地待在隊伍中;或者先讓孩子在一旁做別的事,等到快輪到孩子時,再來排隊。[15]
  3. 在教師訓練中選擇有教授ADHD相關知識和行為訓練的技巧的課程。[15]
  4. 靈活應用「獎勵制度」及「正增強」來鼓勵、鼓舞孩子的正向行為。[15]
  5. 與孩子一起找出問題是什麼、該怎麼解決、有哪些好方法、這些好方法中哪個方法「可能」是最好的、實際做做看、實驗結果分析探討。[15]

家庭编辑

Template:See also2 《家有過動兒:幫助ADHD孩子快樂成長》一書中指出,ADHD的孩子無論在校內或校外常屬於弱勢的一群,容易被誤會。回家後又容易因為粗心大意挨罵[46]。ADHD孩子與一般孩子一樣努力,想要有好表現,得到讚美;但卻事與願違,他們常常失敗,長期缺乏肯定與成就感。因此容易因情緒壓力而衍生出其他共病。[15] 父母與孩子溝通,彼此交換想法的過程,當如平時一般,心平氣和。憤怒會阻礙親子之間的溝通。[15][47]

在台灣,有兒童心智科醫師在從事注意力不足過動症(ADHD)的臨床醫療過程中發現,照護ADHD的核心困難之一乃ADHD孩子的照護需要其照顧者投注長期的心力,然而通常作為ADHD孩子照護者的孩子父母又往往因為孩子的ADHD症狀對其家庭生活及學校生活所造成的負面影響而有長期負擔,此情形下,不容易長期提供有ADHD的孩子完善的照顧。醫療團隊於是建立以醫療專業、家庭兩者為互動主體,互相灌注支持能量並攜手成長的長期照護模式,並稱之為「共同行動模式[48][49]

家中的行為治療编辑

Template:See also2 Template:Multiple images

在行为治疗期间,治療師會定期與家庭成員會晤以觀察進度並提供持續的支持[註 4]。在會晤中,家長現場實習從治療師那學來的技巧,即便療程結束,家庭成員仍能持續感受到行為的改善以及壓力的減輕。[53]家長能在父母教育訓練中學到三種核心能力:正向溝通、正向激勵/強化英语Reinforcement#Positive_reinforcement

、結構與一致的紀律/規範/規則[53]

  • 用「愛」來溝通
  • 傾聽與陪伴[54]
「父母教育方式與ADHD孩子說謊」之間的關係

任職於奇美醫院的獎斐忠政醫師表示,大人常給了ADHD孩子不切實際的要求,例如:受到注意力不足干擾的孩子,本來寫作業就可能需要較多的時間,此時大人如果沒有考慮到小朋友能力上的限制,不從根本去做調整,只是要求結果,命令孩子在半小時後上床躺平,否則就要處罰。在這樣不合理要求的情況下,要小朋友不說謊,就非常困難。[55]

獎斐忠政表示,了解ADHD孩子每次說謊背後的需求、ADHD對他所造成的困難、以及孩子說謊背後的動機,並且撇開道德個性的審判,從根本的方面去思考探討,下次就可以用更好的方式解決問題。[55]

充足的睡眠编辑

充足的睡眠能提升學習力與專注力,也能讓身體得到足夠的休養。正常的生長激素分泌有賴規律及足夠的睡眠[56][57]。研究指出,台灣孩子的睡眠時數相較其他國家,少了大約一個半小時[15][58][59]。足夠的睡眠能讓有ADHD的孩子更專注、更能自我控制 [60]。相形之下,睡眠不足連帶使得身體與精神狀況不佳,情緒較容易低落,形成惡性循環。[61][62][63] 注意力不足過動症往往直接導致患者「難以入睡」、「即便入睡,也難以持續多久」,這與注意力不足過動症所導致的「內在和外在的不安寧」[註 5]有關。[64][65]

治療ADHD或許能改善患者因ADHD之「內在和外在的不安寧」等症狀所引起的睡眠問題[66][67][68];同理,改善睡眠品質或許能改善ADHD的症狀。[68][69][64] 研究指出,「規律」的睡眠有助於提升睡眠品質,良好的睡眠品質會有較好的精神且能改善注意力不足過動症的症狀[64][70][71]Template:Further2

運動编辑

適度且規律的運動,特別是有氧運動有助於改善許多中樞神經系統疾患英语central nervous system disorders

的症狀,也證實為注意力不足過動症的有效附加療法英语add-on treatment

[註 6][39][44][3][72][73][74][75][76]

長期規律的運動合併正規治療,將有更樂觀的預後(治療效果)-較好的行為以及運動協調性、大腦執行功能的提升(包含大腦認知領域中的:注意力、衝動克制力、和計畫組織的能力)、更快速的資訊處理速度、和更棒的記憶力[39][44][3][72][74][75][77]

統計由父母及教師填答的《孩子行為和社交情緒評量表》,結果顯示長期規律的有氧運動帶給孩子的效果是:身體所有功能的提升、ADHD的症狀減緩、焦慮和憂鬱的程度下降、身體症狀減少、較佳的課業及課堂中的表現、社交技巧進步。[72]

藥物治療合併規律的運動能放大中樞神經刺激劑作用於執行功能上的效果。[72]運動帶來的效果被認為是因為運動增加了腦中神經突觸間多巴胺和正腎上腺素的濃度。[72]

飲食编辑

Template:See also2 健康及營養均衡的飲食(食物飲用水飲料)是保持身心健康的基礎。補充維生素礦物質(例如:維他命B群維他命C等)對於改善ADHD病情的功效,尚有待更多的實驗證明。[78][79][80][註 7]

飲食的調整可能對少部份的ADHD兒童有幫助[84],一份2013年的統合分析針對有ADHD症狀,而且有補充游離脂肪酸或是減少食用有人工色素食品的兒童的相關研究發現,只有不到三分之一的兒童在症狀上有改善[85],這方面的助益有可能只是對有食物敏感的兒童有幫助,也有可能是這些兒童同時也在接受ADHD的治療[85],這些已發表的文獻也發現目前已有的證據無法支持減少食用特定食物來治療ADHD的療法[85]。2014年發表的文獻也發現排除饮食在治療ADHD上的成效有限[86],另一篇在2016年發表的文獻指出,根據研究結果,「无麸质饮食在未來成為ADHD的標準療法」之機率是微乎其微[87]

鐵、鎂及碘等礦物質的攝取可能可以改善ADHD的症狀[88],有一些證據指出身體組織內的成份過低和其ADHD症狀有關[89],不過一般不建議用補充鋅礦物質的方式來治療ADHD,只有在有鋅缺乏英语zinc deficiency

的地區(幾乎只會在開發中國家)才建議補充鋅礦物質[90]。不過若鋅礦物質和苯丙胺類藥物同時使用的話,會減低苯丙胺藥物的最小有效劑量,也就是可以服用較少的藥物而達到相同的效果[91]。另有證據指出Omega3-脂肪酸能提供對於病情些許的改善[92][93],不過也有證據指出其功效非常有限[94][95],因此不建議用Omega3-脂肪酸來取代醫學治療[96][97]

一些研究發現,人工食用色素防腐剂可能與少部分兒童出現類似ADHD的症狀,或者是與ADHD的流行率增加有關。[98][99]但是這些研究的證據力薄弱而且可能只適用於有食物不耐症的孩子。[99][85][100]

針對這樣的疑慮,英国欧洲联盟已經發布相關食品管理措施。[101]

對於某些食物的食物過敏食物不耐症,可能會惡化少數孩子既有的ADHD症狀。[86]


精緻糖编辑

有些人認為攝取糖分、甜食、人工香料英语artificial flavors

(包含:阿斯巴甜)等會導致過動[102],不過一旦回顧那些曾經比較學齡兒童英语school-aged children

學齡前兒童英语preschooler

對照實驗會發現,受試者即便將糖分攝取至遠高於正常範圍的程度,對受試者的「注意力」及「行為」並沒有產生影響[103],如果將實驗組成員(受試者)換成是「其父母對糖分敏感的兒童試驗者」,得到的結果也相同。[104]

除此之外,美國小兒科醫學會舉出一個研究顯示,數名被其父母認為對糖分有反應的(reactive)的男孩子,當攝取較多量的糖分時,反而會變得較不活躍。[105] 美國小兒科醫學會另表示,不同研究人員通過數項比對血糖的研究,都得到ADHD患者與非ADHD患者在生活中的糖分攝取量並無不同的結論[105][106]。據此,「美國小兒科醫學會」決定不建議患者透過任何「特別飲食」來治療ADHD。[105]

MedlinePlus則表示,精緻糖可能對孩子的活動量有些許 影響,MedlinePlus認為精緻糖英语refined sugar

碳水化合物能快速進入血管中,使血糖迅速升高,這可能使得孩子變得較為活躍。[102]雖然MedlinePlus不認為攝取精緻糖與ADHD有直接關係,仍建議不要過量甚至建議節制精緻糖的攝取,並且以更健康的飲食型態取而代之。[102]

截至2018年11月,沒有任何科學證據顯示、或甜食(包括:糖分含量遠高於一般菜餚的食物)會影響人類的行為或導致ADHD[107][105][102][108][109]

音樂编辑

北美放射醫學會英语Radiological_Society_of_North_America

和有限的研究結果表示,音樂治療似乎有可能改善ADHD孩子在課堂上的表現[110]、增加注意力不足過動症及自閉症亞斯伯格症(ASD)患者的腦部特定神經連結並使得預後更加樂觀[111],然而音樂治療的有效性尚需更多相關論文支持[112][113]

台灣精神科醫師高淑芬則表示,根據經驗,讓ADHD患者聽音樂較能持續工作,也能增加效率,但高淑芬也說,若患者是聽有歌詞的歌曲或新歌可能就比較不適合,因為患者可能把注意力集中到音樂的歌詞上,沉浸在音樂中。[39]:117-118

Template:Further2

教育疗法编辑

Eric (2001)所做的一项对老师进行的调查,該調查研究了「有『哪些课堂方法』正在被实施」,并能帮助提高注意力困难儿童上课时的注意力。教师们发现活动是最有效的方法。在坐的过程中提供活动可以提供持续的活动输入,而不用频繁的离开座位。 [114]

特殊教育编辑

Template:See also2

針對注意力不足過動症的學生,可以用「前事後因」方法進行教育,可在個案某個不恰當的行為出現前就調整改變外在因素(前因英语Antecedent_(behavioral_psychology)

),或是透過獎懲後果的方式,引導個案改變行為[115]

善用「前事後因」方法:
  1. 前因英语Antecedent_(behavioral_psychology)

:在個案某個不恰當的行為出現前就調整改變外在因素。

  1. 透過教育,針對個案某個不恰當的行為進行改變。
  2. 後果英语operant conditioning

:透過獎懲的方式,引導個案改變行為。

介入反應評估 (RTI)

學習障礙、情緒行為障礙個案的介入反應評估英语Response_to_intervention

一般來說分為三個層次:從「一般預防」到「特殊預防」。依據行為改變術的第一、二、三層原則,給予個案所需的導引:

第一層:基本介入。基本介入的策略對其他沒有ADHD的孩子也有用。

  • 提供結構:建立班級常規。
  • 傳授技巧:遇到A的時候就要做B。以及諸如:建立生活結構的技巧、增進或彌補工作記憶的技巧、做功課的技巧。
  • 團體回饋:設計有趣的課程並在學生參與課程的過程中提供充分的酬賞,如:讚美等正增強。

第二層:加強介入。對於接受基本介入後,反應效果有限的個案,提供小團體式加強。

  • 調整作業份量、延後作業繳交期限、調整學生的階段性作業進度目標。
  • 設立小志工團體,例如:引介志工、安親媽媽協助。
  • 強化家庭與學校之間的連結(聯繫),例如:家庭訪視、指派家長協助事項等、提供每週進度給家長。
  • 課後輔導加強、課後留下來自習。

第三層: 第一層、第二層介入無效,通常是比較嚴重,問題較多的個案。

  • 運用個別化教育計畫(IEP)建構個人化的學習。
  • 針對個案之特定、重要問題處理、研究個案的成功標準,例如:不是作業都要交,而是有繳交作業就好,一旦能持續做到繳交作業,再慢慢調整標準。安排ADHD教練、提供個別差異化、客製化的視覺提示等。
  • 善用《增強檢核表》,尋找特定的獎勵。

[116][117][118][119]

多元智能理論

多元智能理論認為,對於普通教育無明顯效果的小朋友,特殊教育老師會去發掘小朋友的長處、調整環境的限制、透過小組討論、作中學英语Hands-on learning

等方式來讓學生發光發熱,重新拾獲信心。當孩子注意力改善,建立安全的學習環境後,基於事物的好奇的本性,孩子能重新選擇自己的擅長的地方,當他的優點能被看到,孩子就能自動繼續前進學習。[120][121][122][123][124]

奇美醫院獎斐忠政認為,一些家長把特教老師當做免費的補習老師,要求老師全力訓練ADHD兒童跟一般孩子一樣,並不合適。[125]

職能治療编辑

Template:See also2

職能治療方面的文献建议,在教室中采用动态座位系统英语Active_sitting

(參見彈性座位的教室英语flexible seating_classrooms

)是可以改善学生感觉调节和注意力的一种方法。[126][127][128]

職能治療師能協助患者運用職能治療技巧讓生活變得更有組織、規律、計畫、對於時間有更有效的管理[129]

時間管理编辑

許多時間管理中的工具可以幫助ADHD患者,例如艾森豪威尔法則[130]優先次序矩陣英语Priority Matrix

尽管去做番茄工作法等。 Template:Off topic

艾森豪威尔法則编辑

一個不具名的大學教授曾表示,德怀特·艾森豪威尔說:我手中的待辦事項可分為兩個種類,「緊急」和「重要」,重要的事情永遠不會緊急,緊急的事情不會重要。[131][132]

利用艾森豪威尔決策法則,各個待辦事項可依照「重要/不重要」和「緊急/不緊急」來劃分所在的決策矩陣象限[133][134][135])。

待辦事項詳細的區分方式如下:

  1. 位於「緊急且重要」的待辦事項須立即親自開始動手完成[136]。例如:危機、截止日期迫在眉睫[135]
  2. 為「重要但不緊急的事情」設立完成日,並且親自完成[136] 。例如:人際關係、訂計畫、休閒放鬆等[135]
  3. 「不重要但緊急」的事情可委託他人代辦[136]
  4. 「不重要又不緊急」的事情就移除不做[136]。例如:單純浪費時間的事情[135]

這個方法據傳是美國前總統德怀特·艾森豪威尔的日常守則。[136]

[137][138][139][140][141][142][143][144][145][146]

正念療法编辑

2018年4月出爐的最新文獻顯示,「認知行為治療+藥物治療+正念療法的策略比「認知行為治療+藥物治療」帶給患者更大的進步,因此有成為未來正式治療策略的潛力。[147] 然而單獨就「認知行為治療」和「正念療法」相比,未服藥且單獨接受「認知行為治療」或「正念療法」的ADHD患者經過訓練後,並未發現「認知行為治療」和「正念療法」的療效有何差異。[148] 有鑑於前述不一致的實驗結果,正念療法尚需更多研究來證明其有效性。 [4]

其他编辑

         

ADHD的治療方式圖解:

  1. 遊戲治療 [來源請求]
  2. 藥物治療
  3. 生物反饋 [來源請求]
  4. {{ilh|lang={{langname|he}}|lang-code=he|1=沙子療法|2=טיפול_בשולחן_חול|d=箱庭療法|nocat=}} [來源請求]
  5. 利用行事曆軟體(例如:Windwos CalendarGoogle Calendar)協助患者有效管理時間和生活事務。

註解编辑

  1. 雖然中樞神經刺激劑(methylphenidate & amphetamine)與非典型中樞神經刺激劑(atomoxetine)能改善ADHD的核心症狀,但往往無法全面治癒患者在管理時間規劃方面的困難;社交和情緒方面的自我控制[16][17][18]。 而認知行為治療的領域中,為此再建立出專門針對改善ADHD執行功能缺陷的「ADHD認知行為治療」[4]
  2. 減少環境中的分心誘因。
  3. 在《找回專注力 成人ADHD全方位自助手冊》中,「改善ADHD症狀的實用技巧與策略」涵蓋:創造有助於專注的環境與內在策略、強化記憶力的妙方、時間管理、改善衝動問題與人際關係、學習表達和傾聽、改善情緒、改善與親人與情人的關係等。[39]
  4. 陳錦宏醫師的研究發現,因 ADHD 照顧者本身為 ADHD 症狀衍生功能損害的負面後果承擔者,如校園衝突、學習困難,生活困難,所以本身也是壓力的高風險群,ADHD 家庭研究顯示, ADHD 媽媽的生活品質較差,而沮喪的媽媽較難正向協助孩子。這就產生了 ADHD 照護中的核心困難[50] [51][52][49]
  5. 或稱心理與身體無法保持安寧。 無法專心睡覺。
  6. 即表示可附加在現有具備科學實證且能在統計學上達到顯著意義之有效改善症狀的醫學療法。
  7. 攝取過多的維他命可能產生健康問題。[81]例如:長期且高劑量的攝取維他命B6維他命B12可能導致肺癌[82][83]

注释编辑

參見编辑


文獻來源编辑

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    • In some cases, a special diet of foods without artificial flavors or colors works for a child, because the family and the child interact in a different way when the child eliminates these foods. These changes, not the diet itself, may improve the behavior and activity level.
    • Refined (processed) sugars may have some effect on children's activity. Refined sugars and carbohydrates enter the bloodstream quickly. Therefore, they cause rapid changes in blood sugar levels. This may make a child become more active.
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