20241105|ADHD到底是不是疾病？（下）

"It has become more accepted in the past ten years that it is not a single biological entity," says Edmund Sonuga-Barke, a neuroscientist at King's College London.

“过去十年来，人们越来越接受它不是一个单一的生物实体，”伦敦国王学院的神经学家Edmund Sonuga-Barke说道。

That may explain why specific psychological interventions, such as therapies to improve working memory, have failed to make a difference.

这或许可以解释为什么特定的心理干预措施（如改善工作记忆的疗法）未能产生效果。

Medication, by contrast, can be highly effective. Psychostimulants, the most commonly prescribed, help with focus and concentration, and work immediately.

相比之下，药物治疗却非常有效。最常用的精神兴奋剂有助于集中注意力，并且立即见效。

Their effectiveness, says Dr Sonuga-Barke, probably has to do with the fact that they act on dopamine and norepinephrine receptors, which are found all over the brain.

Sonuga-Barke博士表示，它们的有效性可能与它们作用于大脑各处的多巴胺和去甲肾上腺素受体有关。

The drugs, in other words, stimulate many of the wide range of brain systems implicated in ADHD symptoms.

换句话说，这些药物刺激了与ADHD症状有关的许多大脑系统。

For people with severe symptoms, they can be life-changing.

对于有严重症状的人来说，这些药物可以改变生活。

Recent studies from Sweden have found that medication is linked with lower chances of long-term unemployment in people diagnosed with ADHD, as well as fewer deaths from accidents.

瑞典最近的研究发现，药物治疗与ADHD患者长期失业的可能性降低以及事故死亡人数减少有关。

But the benefits need to be weighed carefully against the risks.

但需要仔细权衡其好处和风险。

In children such drugs can affect physical growth and are reserved for severe cases.

对于儿童来说，此类药物会影响身体发育，仅用于严重病例。

Side-effects in adults include increased risk of psychosis and heart problems, and they can worsen mental-health problems. Better long-term solutions may be possible.

成人的副作用包括增加精神病和心脏病的风险，并可能使心理健康问题恶化。可能有更好的长期解决方案。

Some scientists argue that these will involve tackling the arbitrary diagnostic criteria that exist for ADHD and other cognitive and neurobehavioural disorders, such as autism and dyslexia.

一些科学家认为，这将涉及解决ADHD和其他认知和神经行为障碍（如自闭症和阅读障碍）的任意诊断标准。

Symptoms that are common in people with ADHD often occur in those with other such conditions, making it difficult to determine which diagnosis is most appropriate.

ADHD患者的常见症状通常也出现在其他此类疾病患者身上，因此很难确定哪种诊断最合适。

At the same time, some of the most common symptoms experienced by those diagnosed with one of these conditions are excluded from the diagnostic criteria altogether.

同时，被诊断患有其中一种疾病的人所经历的一些最常见症状被完全排除在诊断标准之外。

(Problems with emotional regulation are a case in point for ADHD.)

（情绪调节问题就是ADHD的一个例子。）

To get round these problems, some experts think that children and adults may be better served by a "transdiagnostic" approach

为了解决这些问题，一些专家认为，儿童和成人可能更适合采用“跨诊断”方法，

that involves providing help tailored to the individual's specific cognitive, behavioural and emotional difficulties without bothering with diagnostic labels.

即根据个人的具体认知、行为和情绪困难提供量身定制的帮助，而无需担心诊断标签。

Researchers have shown that changes in a person's environment can have dramatic benefits.

研究人员已经表明，改变一个人的生活环境可以带来巨大的好处。

Children do better in life if parents and teachers provide a supportive, warm environment with structure and rewards for academic and behavioural achievements.

如果父母和老师提供一个支持性的、温暖的环境，并根据学业和行为成就给予奖励，孩子们的生活会更好。

For many adults, ADHD symptoms "go underground" when they are in jobs and relationships that play to their strengths, says Stephen Hinshaw, a psychologist at the University of California at Berkeley.

加州大学伯克利分校的心理学家斯蒂芬·欣肖（Stephen Hinshaw）说，对于许多成年人来说，当他们从事能够发挥优势的工作和人际关系时，ADHD症状就会“转入地下”。

In a paper published on October 16th Dr Hinshaw and his colleagues report that 64% of nearly 500 children with ADHD had symptoms that fluctuated over the 16 years during which they were tracked,

在10月16日发表的一篇论文中，欣肖博士及其同事报告说，在近500名ADHD儿童中，有64%的症状在16年的跟踪期间有所波动，

including periods in which they did not meet the diagnostic criteria for the condition.

包括他们不符合该疾病诊断标准的时期。

Far more can be achieved if schools and workplaces are redesigned to accommodate those with symptoms of ADHD, says Nancy Doyle from Birkbeck University, rather than expecting those individuals to adapt to their environments.

伯克贝克大学的南希·道尔（Nancy Doyle）说，如果重新设计学校和工作场所以适应ADHD症状的人，而不是期望这些人适应他们的环境，那么可以取得更大的成就。

In schools, closing classroom doors and windows cuts distracting noise; organising lessons to include standing and moving helps children who find it hard to sit still for a full period.

在学校里，关闭教室的门窗可以减少分散注意力的噪音；组织包括站立和移动的课程可以帮助那些难以静坐一整节课的孩子。

Dr Doyle, who advises employers on how to accommodate neurodiversity, has found that the things employees with ADHD and other neurodiverse conditions find most helpful are free-

Doyle博士为雇主提供如何适应神经多样性的建议，他发现患有ADHD和其他神经多样性疾病的员工认为最有帮助的东西是免费的——

such as flexibility to work from home or to choose the hours of the day to spend at the office.

比如在家工作的灵活性或选择在办公室度过的几个小时。

Whether such interventions can, on their own, replicate the success of medication remains to be seen.

这些干预措施是否能单独复制药物治疗的成功还有待观察。

But they could make life easier for the many people with ADHD-like symptoms who turn to medication to fix problems created by their circumstances rather than their biology.

但它们可以让许多患有ADHD等症状的人的生活更轻松，这些人求助于药物来解决由环境而不是生物学造成的问题。