エビデンスに基づくADHDの治療： 心理社会的療法、薬物療 …

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.)

4 Loe & Feldman, 2007;Molina et al, 2009; 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.

5 pelham & Bender, 1982)ADHD ADHD ( ) ( 9 8 ) (6 ) ( ) ( ) ADHD ( , ADHD Florida International University (Miami)Buffalo (Summit Educational Resources)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)

6 , 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) ADHD 1 Marcus, , Wan, , Kemner, , & Olfson, M.

7 (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.

8 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)

9 ( , (2) ( , (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 : (.)))

10 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) ?