Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common diagnosis among children treated in outpatient psychiatric clinics in China, accounting for up to 50% of all patients.
Objective: Understand changes over time in the characteristics and treatment of children with ADHD seen at specialty psychiatric clinics in China.
Methods: For each year from 2000 through 2011, 250 charts of patients who made their initial visit to the Child and Adolescent Psychological Counseling Clinic of the Shanghai Mental Health Center were randomly selected. Among the 3000 selected patients, 998 (33%) had a diagnosis of ADHD.
Results: About 80% of the ADHD patients were male and the majority of them fell ill prior to the age of seven. The mean (sd) age at the time of first attendance at the clinic was 10.0 (2.6) years and the mean duration of illness at the time of the initial visit was 2.9 (1.2) years; both of these values decreased significantly over time. About 20% of them were non-residents of Shanghai and about 11% had comorbid psychiatric diagnoses (primarily depression and tic disorder); both of these proportions increased significantly over time. Among the 576 (58%) who visited the clinic more than once, 77% were treated with central nervous system stimulants, but the proportion administered behavioral treatments (either solely on in combination with medications) increased significantly over time.
Conclusion: ADHD remains the most common diagnosis of children seen in specialty psychiatric clinics in China but the proportion of clinic attendees with ADHD is gradually declining as non-specialty treatment services expand and other diagnoses become more prominent. There are encouraging trends of earlier identification and treatment of ADHD and of increasing use of non-pharmacological interventions. Nevertheless, most children with ADHD have been ill for at least two years at the time of the initial diagnosis, so continued research efforts are needed to identify the best ways to speed up the recognition and treatment of this disabling condition.
背景: 注意缺陷多动障碍（Attention Deficit/Hyperactivity Disorder, ADHD）是中国精神科门诊儿童患者中最常见的诊断，最高比例约占所有患儿的50%。
目的: 了解中国精神科儿童门诊ADHD患儿特征和治疗情况的变迁。
方法: 随机抽取2000年至2011年间在上海市精神卫生中心儿少心理咨询门诊初诊患儿的病历，每年抽取250份。在所抽取的3000例患儿中，998例（33%）诊断为ADHD。
结果: 约80%的ADHD患儿为男性，大多数在7岁之前患病。确诊患儿初诊时平均（标准差）年龄为10.0（2.6）岁，初诊时平均病程为2.9（1.2）年，近年趋势为初诊年龄变小，初诊时病程变短。约20%的患儿为非上海户籍，约11%合并其他精神疾病诊断（主要是抑郁症和抽动障碍），近年来上述比例呈上升趋势。576例（58%）有复诊记录的患儿中，77%接受中枢兴奋剂，但是，行为治疗（单用或合并药物）的比例近年来明显增加。
结论: ADHD仍然是中国精神科门诊儿童患者中最常见的诊断，但由于非专科治疗服务的扩大以及其他疾病诊断的增加，门诊ADHD患儿的比例在下降。令人欣慰的是ADHD呈现早诊断和早治疗的趋势以及非药物干预的应用有所增加。尽管如此，多数ADHD患儿确诊前至少已有2年病程，因此需要进一步研究来确定更好的方法以便更早地识别和治疗这一障碍。