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ADHD:女孩患者為何經常被忽視?

Why is ADHD missed in girls?
ADHD:女孩患者為何經常被忽視?

Emily Johnson-Ferguson’s mind has been racing for as long as she can remember. The eating disorders she began suffering from as a teenager were her attempt to slow down her brain. Doctors tried to blame them on family problems and stress, but she knew that wasn’t it.

自懂事以來,艾米莉·約翰遜-弗格森(Emily Johnson-Ferguson)的精神就過度活躍。她十幾歲起就患有進食障礙癥,這是她試圖讓自己大腦慢下來的方法。醫生認為這是家庭問題和壓力造成的,但她知道事實并非如此。

It was only last year, aged 42, that she finally got to the root of her problems: ADHD.

她直到去年42歲時才被確診患有注意力缺陷多動癥(ADHD),終於找到困擾她一生的根源。

Johnson-Ferguson is not alone. Though the stereotypical image of ADHD is a boy bouncing around a classroom, that’s not the whole picture. Girls can have ADHD, too – and many go without diagnosis, and without treatment that could change their lives.

約翰遜-弗格森并不是個例。雖然人們對注意力缺陷多動癥的刻板印象是在教室里上躥下跳的男孩,但這并不是事情的全貌。女孩也可能患有注意力缺陷多動癥,而且許多女孩并未得到確診,也未得到原本可以改變她們人生的治療。

ADHD is a neurodevelopmental disorder that comes in three types: inattentive, hyperactive/impulsive, or a combination of both. People with inattention may forget things, struggle to get organised, and find themselves easily distracted. Those with hyperactivity and impulsivity might struggle to stay sitting down, constantly fidget, and interrupt conversations.

注意力缺陷多動癥是一種神經發育失調癥,分為三種類型:注意力缺陷型、過動/沖動控制障礙型、前兩者癥狀皆有的混合型。注意力缺陷型的人可能記憶力不好,很難做事有條有理,而且注意力很容易分散。過動/沖動控制障礙型患者可能很難保持坐姿,經常坐立不安,并且愛打斷與人的對話。

The condition is usually first diagnosed in childhood, but most people don’t grow out of it. For those whose symptoms are missed as children, living with undiagnosed ADHD as they move into adulthood causes problems.

這一癥狀通常在童年時期首次確診,不過大多數人長大成人后就自然痊愈。對于那些童年時期漏診的患者,由于未獲得確診而治療,可能會在成年后造成問題。

“When I was left to my own devices at university I just couldn't concentrate at all,” says Johnson-Ferguson. She switched courses, but it didn’t help. Her bulimia persisted throughout university, and for the next 20 years she also used alcohol, caffeine, and sugary drinks to self-medicate – common among adults with ADHD.

艾米莉說:“當我上大學可以自主做決定時,我根本無法集中精力讀書。”她換了課程也無濟于事。她在整個大學期間都患有厭食癥,并在接下來的20年使用酒精、咖啡因和含糖飲料進行自我治療。這種行為在患有注意力缺陷多動癥的成年人中很常見。

As her marriage broke down, she started to find life even more difficult. In an effort to start afresh, Johnson-Ferguson gave up her bad habits, but found no respite from her symptoms; instead, they got worse. At her lowest point she was spending days on end in bed. “At that time I couldn’t focus on anything,” she says.

她婚姻破裂后,覺得日子越發難過。她放棄了那些壞習慣,試著重新開始,但也無法緩解;相反,癥狀變得更為嚴重。她在最低谷的那幾天一直躺在床上。“當時我沒有辦法集中精力做任何事。”她說道。

Attention deficit

注意力缺失

There is a concrete difference between the prevalence of ADHD in boys versus girls. In one study of 2,332 twins and siblings, Anne Arnett, a clinical child psychologist at the University of Washington, found that a sex difference in diagnosis could be explained by differences in symptom severity: boys tended to have more extreme symptoms, and a broader distribution of symptoms, than girls.

男孩和女孩的注意力缺陷多動癥患病率存在顯著差異。在一項針對2332個雙胞胎和兄弟姐妹的研究中,華盛頓大學的臨床兒童心理學家阿奈特(Anne Arnett)發現,不同性別的確診率不同可以用癥狀嚴重程度的不同來解釋:與女孩相比,男孩子們的癥狀通常更多樣、更極端。

“It's an actual neurobiological difference that we're seeing,” says Arnett. It’s not clear why that’s the case, but it could be that girls have a protective effect at the genetic level, she says.

阿奈特表示:“我們看到的其實是一種神經生物學差異。”出現這種情況的原因尚不明確,但有可能是因為從基因層面看,女孩更能保護自己。

But the true size of the difference is unclear.

不過人們仍然不清楚區別到底有多大。

When it comes to real-world diagnoses, boys far outweigh girls. In studies that look at who meets ADHD criteria in the population as a whole, however, the ratio still favours boys, but less so. Depending on which research you look at, the ratio of boys to girls with ADHD could be anywhere between 2:1 and 10:1.

就真實世界診斷而言,男孩確診率確實遠遠高于女孩。即便是在研究總體人口中哪些人符合注意力缺陷多動癥的評定標準.結果發現男孩的比例也比女孩高,但差距沒有那么明顯。不同的研究中,男孩和女孩患注意力缺陷多動癥的比例也不同,在2:1至10:1之間。 紐約時報中英文網 http://www.uydujn.live

“It would seem to suggest that there's actually a lot more females who are affected by ADHD,” says Florence Mowlem, an associate at healthcare consultancy Aquarius Population Health. “Yet, for some reason that we don’t quite understand, they don't seem to be getting the clinical diagnosis as often as males.”

醫療健康咨詢公司《水瓶座人口健康》(Aquarius Population Health)的咨詢師莫倫姆(Florence Mowlem)表示:“這似乎顯示,實際上有患有注意力缺陷多動癥的女性比已知的多。然而出于某些我們并不太了解的原因,她們很多卻似乎無法像男性那樣得到臨床確診。”

Research suggests that girls need to have more severe, and more visible, symptoms than boys before their ADHD will be recognised. In one study of 283 children aged between 7 and 12 years old, Mowlem and colleagues looked at what differentiated both boys and girls who met the diagnostic criteria for ADHD from those who had a lot of ADHD symptoms, but not enough to be diagnosed.

研究顯示,患有注意力缺陷多動癥的女孩只有癥狀比男孩更嚴重更明顯才能獲得確診。在一項對283名年齡7至12歲兒童的研究中,莫倫姆和同事對比了那些達到注意力缺陷多動癥診斷標準的男孩女孩和那些有許多癥狀、卻不足以確診的男孩女孩之間的區別。

Mowlem, who was PhD candidate at King’s College London at the time, found that parents, in their own ratings, seemed to play down girls’ hyperactive and impulsive symptoms, while playing up those of boys. They also found that girls who did meet the criteria tended to have more emotional or behavioural problems than girls who didn’t. This was not the case for boys.

莫倫姆當時還是倫敦國王學院(King's College London)的在讀博士生。她發現家長在自行評估時往往會淡化女孩的過度活躍和沖動癥狀,相反卻過于突出男孩的這些癥狀。她們還發現,那些符合診斷標準的女孩通常比其它女孩更情緒化、有更多行為問題。但男孩并不會如此。

In a similar study of 19,804 Swedish twins published last year, Mowlem and her colleagues found that girls, but not boys, were more likely to be diagnosed if they suffered from hyperactivity, impulsivity, and behavioural problems.

在一篇去年發布的針對19804名瑞典雙胞胎的類似研究中,莫倫姆和她的同事發現,女孩如果表現出過度活躍、沖動以及行為問題,較可能得到確診,但男孩則并非如此。

Girls could also be better at compensating for their ADHD symptoms than boys, similar to how girls with autism mask their symptoms.

女孩也可能比男孩能更好地掩飾自己的癥狀,這和自閉癥女孩掩飾自己的癥狀類似。

“Girls are far less likely to bounce around the classroom, fighting with the teachers and their colleagues,” says Helen Read, a consultant psychiatrist and ADHD lead for a large London NHS Trust. “A girl who did that would be so criticised by peers and other people that it is just far harder for girls to behave in that way.”

心理咨詢師、倫敦大型國民信托基金(NHS Trust)注意力缺陷多動癥帶頭人瑞德(Helen Read)表示:“女孩不太會在教室里上躥下跳,或者和老師們爭吵打鬧。一個女孩要是這么做,會被同齡人和其他人批評,因此女孩幾乎不會以這種方式行事。”

Even when they are hyperactive, girls are more likely to be over-talkative, or rebellious – a bit of a wild child, she says. That might not be recognised by parents or teachers as being caused by ADHD, especially as we expect girls to be more sociable than boys anyway.

她說,女孩子即便是過度活躍,也更可能表現為過于健談或比較叛逆,有點野孩子的味道。老師和家長并不會認為這些癥狀是注意力缺陷多動癥造成的,尤其是我們對女孩的預設就是她們會比男孩更擅長社交。

But more research is needed before we’ll know how big a problem this is.

但需要更多的研究,我們才能了解這個問題到底有多嚴重。

紐約時報中英文網 http://www.uydujn.live

Symptom similarity

癥狀相似度

If girls are losing out because they have less stereotypical symptoms, they might not be the only ones: boys with purely inattentive ADHD are probably being missed, too.

如果說女孩們被漏診是因為她們的癥狀不夠典型,那么男孩也可能如此:注意力缺陷型的患病男孩也可能被人忽視。

It’s a commonly held belief that girls are more likely to be inattentive than boys. But that’s a myth, says Elizabeth Owens, assistant clinical professor in the department of psychology at the University of California, Berkeley. She says the current best evidence shows that rates of inattention are the same for boys and girls.

人們普遍認為,女孩比男孩更容易注意力不集中。但加州大學伯克利分校心理學院的助力臨床教授歐文(Elizabeth Owens)表示,這只是傳聞而已。她表示,目前最好的證據表明,男孩和女孩的注意力不集中比例是一樣的。

“The inattentive presentation is actually more common [among both boys and girls], but it tends to be under-recognised or under-diagnosed, because the kids aren't typically causing problems in the classroom,” she adds.

她還補充說:“這種注意力缺陷型的表征其實[在男孩和女孩中都]都比已確診的要多,但通常會被忽略或漏診,因為這些小孩通常并不會在課堂上惹麻煩。”

In fact, girls and boys with ADHD are much more similar than they are different, says Owens. “It underscores the fact that ADHD and girls is serious. For a long, long time, it was discounted, or overlooked.”

事實上,患有注意力缺陷多動癥的男孩和女孩的相似點比不同點要多得多,歐文說道。“這就強調了一個事實,人們應該認真對待注意力缺陷多動癥以及患病的女孩。很長時間以來,人們都淡化、忽視了這件事。”

One difference, though, is that girls with combined ADHD – who have both inattentive and hyperactive symptoms – are at higher risk of self-destructive actions as they enter adulthood. Girls with ADHD are also more likely to develop anxiety and depression later in life.

但其中一個區別在于,患有混合型注意力缺陷多動癥的女孩,即注意力缺陷型和過動/沖動控制障礙型兩種癥狀都有,在成年后進行自殘行為的風險更高。患有注意力缺陷多動癥的女孩還更有可能在往后的生活中患上焦慮癥和抑郁癥。

As part of a study that started in the 90s, Owens and her colleagues followed 228 girls, 140 of whom had ADHD, over two decades. At the second and third follow ups, when participants were on average aged 19 and 25 respectively, they found that girls who’d been diagnosed with combined ADHD in childhood were at higher risk of self-harm and attempting suicide.

歐文自上個世紀90年代起就開始了一項研究,追蹤了228名女孩20多年的生活,這其中有140人患有注意力缺陷多動癥。在第二、第三次隨訪時,參與研究的女孩平均年齡分別為19和25歲。她們發現,那些童年時期確診患有混合型注意力缺陷多動癥的女孩有更高的自殘和自殺風險。

In theory, recognising and treating ADHD early should help to mitigate this risk – although Owens says that, as yet, there’s no evidence to show this works. “ADHD is a chronic condition,” she says. “It's not something you can treat and it'll go away.”

理論上,能盡早確診并治療注意力缺陷多動癥有助于緩解這一風險,但歐文表示,目前還沒有證據顯示這是有效的。她說:“注意力缺陷多動癥是慢性病,不是治療后就能立竿見影痊愈。”

Treatment for ADHD can, however, make a huge difference day-to-day.

不過,注意力缺陷多動癥的治療可能讓患者的日常生活發生巨大變化。

Shortly after Johnson-Ferguson was finally diagnosed, she started taking medication, a stimulant commonly used to treat ADHD called lisdexamfetamine. “The next day I just sat down and watched a whole EastEnders,” she says. “It was like walking in slow motion for three days.”

艾米莉·約翰遜-弗格森最終確診后不久,便開始服用名為利右苯丙胺(lisdexamfetamine)的藥物。這是一種用于治療注意力缺陷多動癥的中樞興奮劑。她表示:“第二天我就坐著看了一天的《東區人》(East Enders)。感覺就像用慢鏡頭的速度過了三天。”

She has to work hard to ensure she reaps the benefits of the drugs – exercising, eating healthily, drinking less, and forgoing caffeine – but the changes have been worth it. “The planning that I can do at work now is incredible, it’s like I’m a different person,” she says.

她必須非常努力才能確保自己盡可能達到最大的藥效,她要鍛煉、飲食健康、減少酒精攝入、戒斷咖啡因,但這些改變都很值得。她說:“我現在工作時做的規劃簡直好得令人難以置信,感覺就像變了一個人。”

Beyond medication, knowing that the problems you’ve been facing throughout your life are not your fault can also be a huge weight lifted. Johnson-Ferguson describes her life pre-diagnosis as “42 years of feeling completely different to everybody on the planet”.

除了服藥之外,了解到這些一輩子要面對的問題并不是自己的錯也能讓人減輕不少壓力。艾米莉·約翰遜-弗格森把自己被確診前的人生描述為“感覺自己和地球上每一個人都完全不同,是異類一樣的42年”。

Now, she’s able to channel the positive aspects of her ADHD – hyper-focusing on short term projects – into a successful career in theatre marketing, while better understanding her shortfalls.

現在,她能夠把注意力缺陷多動癥的優勢,即對短期項目保持極高的專注度,運用在打造成功的電影市場營銷的職業生涯上,同時也更好地了解自己的弱項。

But many are not so lucky. Until we let go of the stereotypical image of what ADHD looks like and get to the bottom of why girls with the condition are being missed, plenty of women will end up living with symptoms that have drastic effects on their lives, without knowing they could get help.

但還有很多人并沒有那么幸運。除非我們完全摒棄對注意力缺陷多動癥的刻板印象,并找到患有此癥的女孩何以被忽視的根本原因,許許多多的女性仍然會一輩子與這些癥狀為伴,一生受到嚴重影響,而且不知道自己本可以尋求幫助而獲得新生。

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