Medikamentöse Behandlung der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung im Kindesalter unter Berücksichtigung komorbider Aspekte

Zusammenfassung

Die medikamentöse Behandlung von Kindern mit Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) steht immer wieder im Brennpunkt fachlicher und öffentlicher Diskussionen, obwohl sich die Stimulanziengabe mittlerweile in vielfältiger empirischer Weise als effektivste evidenzbasierte Therapie bei ADHS erwiesen hat.

In einer Übersicht werden die gesundheitspolitische Situation, Gründe für die Behandlung, ergänzende Behandlungsmaßnahmen innerhalb eines multimodalen Programms sowie die Medikation selbst (Indikation, Beginn, rationale Dosierung, Monitoring, Evaluation, unerwünschte Arzneimittelwirkungen, Kontraindikationen, Hochdosierung und Missbrauch, Behandlungsdauer) dargestellt. Dabei wird der in der Alltagspraxis wichtige Punkt der Komorbidität von ADHS mit anderen kinderpsychiatrischen Problemen sowie die damit verbundene Kombination von Medikamenten besonders hervorgehoben.

The psychopharmacological treatment of children with Attention-Deficit-Hyperactivity Disorder (ADHD) respectively Hyperkinetic Disorder (HKD) is a steady point for discussion and concern in the public as well as between professionals, although it has been empirically shown that the use of stimulants is the most effective evidence based treatment for children with ADHD/HKD.

The review presents information regarding the recent state of the field describing the mental-health political situation, reasons for initiating a treatment with stimulants, meaning of additional parts of a multimodal treatment approach, as well as the medication itself. The latter includes issues like indication, starting drug treatment, rationalistic dosing, monitoring evaluation, unwanted sideeffects, contraindication, high dosage problems and misuse and duration of treatment. Further, the topic of comorbidity between ADHD/HKD and other child-psychiatric problems is raised, since this is highly important for daily clinical practice and the choice of combined drug treatment in these cases.

Schlüsselwörter

ADHD - HKS - Komorbidität - Psychopharmakotherapie - Stimulanzien - Verhaltenstherapie - Behandlungsrichtlinien

Key words

ADHD - hyperkinetic disorder - comorbidity - psychoparmacotherapy - stimulants - behavior therapy - treatment guidelines

Literatur

• 1 Jensen  P S,, Kettle  L,, Roper  M T,, Sloan  M T,, Dulcan  M K,, Hoven  C,, Bird  H R,, Bauermeister  J J,, Payne  J D.. Are stimulants overprescribed? Treatment of ADHD in four U.S. communities.  Journal of the American Academy of Child and Adolescent Psychiatry. 1999;;  7 797-804
• 2 MTA  Cooperative Group:. Fourteen-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder.  Archieves of General Psychiatry. 1999a;;  56 1073-1086
• 3 National Institutes of Health Consensus Development Conference  Statement:. Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD).  Journal of the American Academy of Child and Adolescent Psychiatry. 2000;;  2 182-193
• 4 Jensen  P S.. Commentary: The NIH ADHD Consensus Statement: win, lose, or draw.  Journal of the American Academy of Child and Adolescent Psychiatry. 2000a;;  2 194-197
• 5 Jensen  P S.. Are stimulants overprescribed? Letter to the editor.  Journal of the American Academy of Child and Adolescent Psychiatry. 2000b;;  3 270-271
• 6 Biederman  J,, Wilens  T,, Mick  E,, Spencer  T,, Faraone  S V.. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance abuse disorder.  Pediatrics. 1999;;  104 20
• 7 Huss  M,, Schmidt-Schulz  E,, Englert  G,, Lehmkuhl  G,, Poustka  F,, Lehmkuhl  U.. Abhängigkeitsentwicklung bei Kindern mit Hyperkinetischem Syndrom am Beispiel der Nikotinabhängigkeit.  XXVI. Kongress der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie. 2000;;  Abstractband 180
• 8 MTA Cooperative  Group:. Moderator and mediator challenges to the MTA study: effects of comorbid anxiety disorder, family poverty, session attendance, and community medication on treatment outcome.  Archives of General Psychiatry. 1999b;;  56 1088-1094
• 9 Banaschewski  T,, Rothenberger  A,, Besmens  F,, Zieger  H.. Evaluation of sensorimotor training in ADHD children.  Perceptual and Motor Skills. (im Druck); 
• 10 Taylor  E,, Sergeant  J,, Doepfner  M,, Gunning  B,, Overmeyer  S,, Möbius  H-J,, Eisert  H-G.. Clinical guidelines for hyperkinetic disorders.  European Child & Adolescent Psychiatry. 1998;;  7 184-200
• 11 Overmeyer  S,, Taylor  E.. Annotation: principles of treatment for hyperkinetic disorder: practice approaches for the U.K.  Journal of Child Psychology and Psychiatry. 1999;;  8 1147-1148
• 12 Conners  C K.. The Conners Rating Scales: Instruments for the assessment of childhood psychopathology. North Tonawanda NY:; Multi-Health-System 1995
• 13 Moll  G,, Eysenbach  K,, Woerner  W,, Banaschewski  T,, Schmidt  M H,, Rothenberger  A.. Quantitative and qualitative aspects of obsessive-compulsive behavior in children with attention-deficit hyperactivity disorder compared with tic disorder.  Acta Psychiatrica Scandinavica. 2000;;  101 389-394
• 14 Barkley  R A,, Murray  M B,, Edelbrock  C S,, Robbins  K.. Side effects of methylphenidate in children with attention deficit hyperactivity disorder: A systemic, placebo-controlled evaluation.  Pediatrics. 1990;;  86 184-192
• 15 Gillberg  C,, Melander  H,, von Knorring  A L,, Janols  L O,, Thernlund  G,, Haeggloef  B,, Eideval-Wallin  L,, Gustaffson  P,, Kopp  S.. Long-term stimulant treatment of children with Attention-deficit hyperactivity disorder symptoms: A randomized, double-blind, placebo-controlled trial.  Archives of General Psychiatry. 1997;;  54 857-864
• 16 Banaschewski  T,, Rothenberger  A.. Tic-Störungen: Diagnostische Leitlinien und Verhaltenstherapie.  Kindheit und Entwicklung. 1998;;  7 99-111
• 17 Rothenberger  A,, Johannsen  H S,, Schulze  H,, Amorosa  H,, Rommel  D.. Tiapridex und die Wirkung auf das Stottern bei älteren Kindern und Jugendlichen.  Sprache - Stimme - Gehör. 1994;;  18 179-183
• 18 Gross-Tsur  V,, Manor  O,, van der Meere  J,, Joseph  A,, Shalev  R S.. Epilepsy and attention deficit hyperactivity disorder: Is methylphendiate safe and effective?.  Journal of Pediatrics. 1997;;  130 40-44
• 19 Wilsher  C R,, Taylor  E A.. Piracetam in developmental reading disorders: a review.  European Child and Adolescent Psychiatry. 1994;;  3 59-71
• 20 Kinkelbur  J,, Kostanecka-Endress  T,, Woerner  W,, Heipke  S,, Cohrs  S,, Hajak  G,, Rüther  E,, Rothenberger  A.. Schlafapnoe und periodische Beinbewegungen im Schlaf bei Kindern mit Hyperkinetischer Störung.  XXVI. Kongress der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie. 2000;;  Abstractband 90
• 21 Rothenberger  A,, Kostanecka-Endress  T,, Kinkelbur  J,, Cohrs  S,, Woerner  W,, Hajak  G.. Sleep and tourette's syndrome. In: Cohen D, Jankovic J (eds): Advances in Neurology Series. Philadelphia:; Lippincott Williams and Wilkens, in press
• 22 Hughes  C W,, Graham  J E,, Crismon  M L,, Wagner  D K,, Birmaher  B,, Geller  B,, Pliszka  S,, Ryan  N D,, Strober  M,, Trivedi  M,, Toprac  M G,, Sedillo  A,, Llana  M,, Lopez  M,, Rush  A J.. The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on medication treatment of childhood major depressive disorder.  Journal of the American Academy of Child and Adolescent Psychiatry. 1999;;  38 1442-1450