Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents

 

Abstract

Background

Attention-deficit hyperactivity disorder (ADHD) is diagnosed in between 3% and 7% of school-age children and consists of the core symptoms of inattention, impulsivity and hyperactivity. Children are often treated with medication, usually stimulant medication such as methylphenidate. Stimulant medication has been found to be effective for alleviating ADHD symptoms, at least in the short term. ADHD is also treated with a variety of psychosocial and psychoeducational interventions for parents, children, and with multicomponent interventions combined with medication management. However, many patients (10 to 13% of patients) cannot or prefer not to take medication. Family therapy without medication may help to develop structure in the family, help to manage children's behaviour, and may help families cope with distress from the presence of the disorder.

Objectives

This review seeks to address the question of whether family therapy without medication can reduce the core symptoms of ADHD as compared to no treatment or standard treatment.

Search methods

The following electronic databases were searched using a specific search strategy: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to April 2004), PsycINFO (1872 to April 2004), CINAHL (1982 to April 2004), Biosis (Biological Abstracts) (1985 to March 2004), Dissertation Abstracts (1980 to April 2004), and Sociological Abstracts (Sociofile) (1963 to April 2004). Hand searches of relevant journals and bibliographies were also conducted and experts in the field were contacted for further information.

Selection criteria

Included studies were randomised controlled trials investigating the efficacy of behavioural family therapy, cognitive behavioural family therapy, or functional family therapy for children with ADHD or ADD (Attention Deficit Disorder).

Data collection and analysis

Studies were evaluated for methodological quality and to determine whether they met the inclusion criteria.

Main results

This assessment yielded two studies. Data were extracted for both studies. The findings from Jensen 1999 (N=579) indicate that no difference can be detected between the efficacy of behavioural family therapy and treatment as usual in the community. The finding from the available data from Horn 1991 slightly favours treatment over medication placebo.

Authors' conclusions

Further research examining the effectiveness of family therapy versus a no-treatment control condition is needed to determine whether family therapy is an effective intervention for children with ADHD. There were no results available from studies investigating forms of family therapy other than behavioural family therapy.

 

Plain language summary

Family therapy for attention-deficit disorders in children

This review looks at whether family therapy can help children with attention-deficit hyperactivity disorder (ADHD) without medication. There are several medications and types of therapy used to treat ADHD. However, many families would rather that their children not take medication. Two studies met the criteria for quality of research method. One found no difference in children's symptoms of ADHD after either family therapy or normal treatment in the community. The second study found that family therapy was more effective than a medication placebo. Further research is needed.

 

摘要

背景

家族治療用於注意力缺失症 (attentiondeficit disorder) 或注意力不足過動症 (attentiondeficit/hyperactivity disorder) 之兒童和青少年

注意力不足過動症(ADHD)於3％至7％的學齡兒童中被診斷出來，其核心症狀為注意力不集中，衝動和過動。孩童常接受藥物治療，通常為刺激劑藥物，如methylphenidate。刺激劑藥物已經被發現可以有效地減少ADHD症狀，至少有短期的效果。ADHD的治療也包括多種針對父母及孩童的心理社會及心理衛教的介入措施，和合併多面向介入和及藥物治療的處置方式。然而，許多病人(10至13％的患者)不能或不願意服藥。不使用藥物，採取家族治療，可能有助於發展家庭中的結構，幫助管理孩子的行為，且可能幫助家庭因應此疾病所帶來的痛苦。

目標

本篇回顧的目的，是為了探討在沒有使用藥物治療的情況下，家族治療相較於沒有治療或是標準治療，是否可以減少ADHD的核心症狀。

搜尋策略

我們以特定的檢索策略搜尋了以下的電子資料庫：The Cochrane Central Register of Controlled Trials (The Cochrane Library第3期，2004年)、MEDLINE(1966年至2004年4月)、PsycINFO(1872年至2004年4月)、CINAHL(1982年4月2004年)、Biosis (Biological Abstracts) (1985年至2004年3月)、Dissertation Abstracts(1980年至2004年4月)和Sociological Abstracts (Sociofile) (1963年至2004年4月)。另外，我們以手工檢索相關的期刊和書目，也聯繫此領域的專家，以收集更多資料。

選擇標準

收納的研究為探討行為家族治療、認知行為家族治療或是功能性家族治療，對於ADHD或是ADD (注意力缺失症) 的兒童之有效性的隨機對照試驗。

資料收集與分析

我們評估研究試驗的方法學的品質，以確定是否符合納入標準。

主要結論

此項評估獲得兩個研究，兩個研究的數據都被萃取出來。Jensen於1999年的發現(n = 579)指出行為家族治療和社區中一般的治療的效果沒有差異。而Horn於1991年的數據發現，家族治療較安慰劑藥物略為有幫助。

作者結論

進一步研究以檢視家族治療和無治療的對照狀況之比較，來確定對於患有ADHD的孩童，家族治療是否為一種有效的介入。目前，除了行為家族治療外，沒有其他形式的家族治療的研究結果。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

此篇回顧檢視家族治療對沒有服藥的注意力不足過動症(ADHD)的孩童，是否有幫助。治療ADHD有數種藥物和治療方法。然而，許多家庭不希望他們的孩童服用藥物。有兩個研究符合研究方法品質標準；其中一個發現家族治療，和在一般的社區治療相較，對於ADHD的症狀沒有差異，第二個研究發現，家族治療比服用安慰劑較為有效。此議題仍需要進一步研究。