エビデンスに基づくADHDの治療： 心理社会的療 …

1 adhd E , Jr., Center for Children and Families Copyright Since2011 William E. Pelham, Jr., Ph. D. FIU Center for Children and Families All Rights Reserved McNeil / Alza / Janssen (Concerta)AbbottShire (Adderall, Adderall XR, guanfacine)Noven (Daytrana)Lilly (Strattera)Cephalon (Sparlon) (Noven) 50 (Impairment) (1) (2) (3) (parenting)/ adhd ( ) (AAP, 2001.)

2 Pelham & Fabiano, 2008)(1) 1 1 (2) (3) (4) (5) (EEG) (6) (7) (8) (9) (10) (11) ( ) adhd (1) 175 (2) 300 (3) (1) (2) 25 (AAP,2001;Fabiano,Pelhametal,2009;Greenh ill&Ford,2002;Hinshawetal,2002;Pelham&Fa biano,2008)Fabiano et al, Clin Psych Review 2009 AAP Clinical Practice Guideline: Treatment of the School-Aged Child with Attention-Deficit/Hyperactivity DisorderPediatrics, 2001 adhd and/or (AAP) APA (2007) (AACAP) (2007) NICE (2009) CHADD adhd , 1993 2003 Scheffler, , Hinshaw, , Modrek, S.

3 , & Levine, P. (2007). Trends: The global market for adhd Medications. Health Affairs, 26(2), 450-457. adhd adhd adhd adhd adhd 1 (8 16 ) ( ) ( 2 3 / ) ( ) ( ) (Kent et al, in press; Loe & Feldman, 2007;Molina et al, 2009.)

4 Robb et al, in press) adhd 33 2 adhd 48% 1 3 adhd 12% vs. 5% adhd 9% vs. 1% adhd adolescents a full letter gradelower than controls, with twice the rate of absencesADHD (1) (2) 1 , and/or adhd adhd (Milich& Landau, 1982; Pelham & Bender, 1982) adhd adhd ( ) ( 9 8 ) (6 ) ( ) ( ) adhd ( , adhd Florida International University (Miami)Buffalo (Summit Educational Resources)

5 New York City (NYU Medical Center)Cleveland, OH (Cleveland Clinic)Irvine, CA (UCI)Birmingham AL (UAB Medical Center)Boston (Harvard/JBCC)Chicago (Univ IL Medical Center/ & Chicago Parks) , ( )2005~ , ( ) 2010~ ( ) 2011~Erie, Johnstown, and Indiana PA (4 Community Agencies with 20 different sites)Community sites in Salt Lake City, WVA, NJ, NYC (Staten Island MH Society), WNY (Chatauqua), WASmaller, shorter camps in many cities that use parts of STP adhd 1 1 (Molina et al, 2009) (Swanson & Volkow, 2008) 1) 2) 3) 4) ( ) 6) 7) 8) 9) 10) 11) (Swanson & Volkow, 2008) (Pelham et al, 2001)

6 adhd 1 Marcus, , Wan, , Kemner, , & Olfson, M. (2005). Continuity of methylphenidate treatment for Attention Deficit/Hyperactivity Disorder. Archives of Pediatric and Adolescent Medicine, 159, 572-578. (Pelham & MTA Coop. Group, )MedmgtCombBeh / 12%4%0% 8%3%5% 8%1%2% 4%2%2% 31%15%24% 38%76%67% MTA , Concerta, Adderall XR 1 184 1 : 15-20 mg MPH; 10 mg Adderall 1-3 :5400 mg 10,800 mg MPHMTA , Concerta, Adderall XR 1 : 36 mg Concerta; 20 mg Adderall XR (1 365 ) ( ., MTA): 12 :14,600 mg/year X 12 =175,000 mg MPH adhd (Fabiano et al, 2009; Greenhill & Ford, 2002) (4 15 ) 0.

7 74 6 adhd NIMH/USOE 4 576 3 1 5 6 1 144 1 1 24 14 10 1000+ 10+ 14 MTA 4 Beh adhd MPH 39 mg/day) MPH 1 MTACG Pediatrics, 2004 50 JAACAP (2007, 2009) MTA (MTACG, 2007) 14 m 24 m 36 2 NIMH IES (1) ( , (2)

8 ( , (3) adhd 3 (4) SMART (sequential, multiple, adaptive, randomized trial) adhd Pelham, Burrows-McLean, Gnagy, Fabiano, Coles, Hoffman, Massetti, Waxmonsky, Waschbusch, Chacko, Walker, Wymbs, Robb, Arnold, Garefino(NIMH 2001-2006) 8 1 9 1 12 1 5 1 STP Time 7:30-8:00 8:00-8:15 8:15-9:00 9:15-10:15 10:30-11:30 11:45-12:00 12:00-12:15 12:15-2:15 / 2:30-3:30 3:30-4:30 4:45-5:00 5:00-5:30 : , 2 : - , , Study 1 48-52 adhd / 3 4 : (.))

9 15mg/kg, .3 mg/kg, .6 mg/kg, 1 3 ), 9 3 : (NBM), low-intensity (LBM) , high-intensity (HBM) , 3 1 3-4 X adhd (24 / ).Comparative and Combined Treatments for adhd (Pelham et al, NIMH 2002-2005)High Intensity BModNo BModLow Intensity BModDaily Crossover of 4 Med mg/kg mg/kg mg/kg MPHD aily Crossover of 4 Med mg/kg mg/kg mg/kg MPHD aily Crossover of 4 Med mg/kg mg/kg mg/kg MPH3 3 Classroom Rule mg/kgControlDaily Frequencyno bmodlow bmodhigh bmod(Fabiano et al, School Psychology Review, 2007) 4 Coles, Fabiano, Pelham, Burrows-McLean, Gnagy, Hoffman, Massetti, Waxmonsky, Waschbusch, Chacko, Walker, Wymbs, Robb, Arnold, Garefino(NIMH 2003-2007)Study 2 Study 1 128 (B ; N=87) (NBC; N=41) ?

10 - 1 - ( ) BC : 3 1 NBC : (ITBE ) 2 (Pelham, 1993) Coles et al, NCDEU, 2008No Previous School MedicationPrevious School Medication Coles et al, NCDEU, 2008No Previous Home MedicationPrevious Home Medication , 2 --60% vs 30%-- 1 adhd William E.