私が子どもだった1980年代、私が知っている注意欠陥・多動性障害の人たちは、昼休みに保健室に薬をもらいに行くような多動性の少年たちでした。このような少年たちは、10代や大人になれば症状から「成長する」と多くの人が思っていました。

200年以上の歴史の中で、注意欠陥・多動性障害は子供時代の症状だと考えられていたのです。1990年代になってようやく、専門家たちはADHDが大人にも影響を与える可能性があることに気づきました。科学的な証拠から、大人になってもADHDの症状を経験する人がいることが明らかになったからです。それはまた、彼らの人生に深刻な影響を与える可能性があります。

大人のADHDは、よく理解されていない疾患から、よく研究された治療オプションがある疾患へと発展してきました。この20年間、大人のADHDのエビデンスに基づく治療の進歩に立ち会い、貢献できたことを嬉しく思っています。

ADHDと生きる

ADHDは、不注意、注意散漫、無秩序を引き起こす障害を指します。多動性や衝動性が見られる人もいますが、全員ではありません。ADHDは、小児期に始まる疾患です。学校、職場、人間関係で問題を起こすことがあります。ある調査によると、世界の成人の約3.4%がADHDであると言われています。近年、ADHDの認知度は男女ともに高まっています。ADHDの症状は家族内でもよく見られます。それらは特定の脳部位と関連することがあります。

しかし、ADHDの経験は、遺伝的なものだけではありません。人が住んでいる環境は、彼らが一日のうちに経験するADHDの量に影響を与えることができます。ADHDの症状は、うつ病や不安障害などの他の疾患と重なることがあります。そのため、徹底した多段階の専門的な評価を受けることが重要です。

ADHDとともに生きることは、現実的かつ継続的な課題です。今日、ADHDを持つ大人は、より多くの情報とより良い証拠に基づく治療法を持っています。大人のADHDの治療について楽観的で希望を持てる、科学的に裏付けされた理由がたくさんあるのです。

大人のADHD管理の主な戦略には、薬物療法と大人のADHDの認知行動療法と呼ばれる治療法があります。ADHDの症状の治療には、治療よりも薬の方が効果的であるという証拠が積み重なっています。しかし、ADHDの治療法に関する研究基盤は増え続けています。薬物療法と治療法は、それぞれ異なる方法で作用するため、大人のADHDの症状を改善するために組み合わせて使用することができます。

薬物療法の選択肢

刺激剤は、ADHDの治療に用いられる最も一般的な薬物です。

刺激剤が多動性障害に処方されるのは、奇妙に思えるかもしれません。ADHD刺激剤は、自己規制と注意に関連する脳の領域で、脳内化学物質のドーパミンのレベルを増加させます。指示通りに服用すれば、覚せい剤治療薬は安全で、習慣性もありません。

主な覚せい剤には、メチルフェニデートと、リズデキサムフェタミンなどのアンフェタミン系の覚せい剤があります。これらの覚せい剤は、Adderall(アデロール)やVyvanse(バイバンセ)というブランドで販売されています。リタリンとアデロールは短時間作用型製剤で、通常4~6時間作用し、コンサータとバイバンセは12時間作用するよう設計されています。

覚せい剤の副作用として、食欲減退、体重減少、頭痛、就寝間際に服用した場合の睡眠障害などがあり、オンラインカジノで何時間も遊んでしまう可能性があります。また、これらの薬は、心臓に問題のある人の心臓や血圧に有害である可能性があります。

大人のADHDの治療に使われる非刺激剤には、脳の神経伝達物質ノルエピネフリンとブプロピオンを増やすアトモキセチンがあります。この抗うつ剤はADHDの治療に使われることもあり、ノルエピネフリンと同様にドーパミンを増加させます。

最近の分析では、すべての 4 つの薬の種類は、プラセボまたは「砂糖の丸薬」よりも 12 週間の期間にわたって ADHD 症状を減少させたことがわかった。成人の場合、アンフェタミンをベースとした薬が最も優れた効果を発揮することがわかりました。しかし、アトモキセチン、ブプロピオン、メチルフェニデートは、それほどパフォーマンスは高くなかったが、両者には少し違いがあった。患者を追跡調査した期間が短かったため、これらの良好な結果が持続するかどうかは不明である。

医療制度のデータを用いた多くの研究は、薬物療法が実際の生活で人々に与えうるプラスの効果について興味深い情報を提供しています。これらの研究では、ADHD治療薬の処方と、うつ病、自動車事故、自殺関連事象、薬物乱用に関するネガティブな事象の減少との間に相関関係があることが示されています。この研究は、ADHDの薬物療法が、症状を軽減するだけでなく、プラスの効果をもたらす可能性を示唆しています。

薬を飲めない人もいます。副作用が出たり、薬が効かない人もいます。ADHDの大人は、心を広く持ち、医師と選択肢について話し合うことが必要です。薬物療法はADHDの最良の治療法ではありませんが、多くの人にとって不可欠な手段です。

専門的な治療

薬は内側からADHDを治療することができますが、ADHDのための専門的な治療は、 “外側から “ADHDを扱います。ADHDの悪影響を軽減するためのスキルを身につけたり、環境を整えたりすることを支援します。

認知行動療法は、自分の思考、感情、行動がどのように相互作用するかを理解することを助ける療法の一種です。また、問題に対処し、重要な目標を達成するためのスキルを学びます。認知行動療法には、クライアントの問題に応じて多くのスタイルがあります。これらの治療法は、証拠に基づいており、それぞれのクライアントに合わせることができます。

研究者たちは、過去20年以上にわたって、大人のADHDのための認知行動療法を開発し、テストしてきました。

これらの専門的な療法は、クライアントが組織化および時間管理のスキルを日常生活に取り入れることを支援します。これらの専門的な療法は、しばしば、クライアントがモチベーションを高め、先延ばしに対抗するための戦略を実行するのを助けます。

認知行動療法は、自分の思考が感情や行動に与える影響について、クライアントがより自覚的になることを支援します。ADHD療法は、クライアントをトラブルに巻き込む可能性のあるポジティブで楽観的な思考をターゲットにしています。

楽観的である理由

2017年、私は学生たちとメタアナリシスの共著者となりました。この種の研究は、複数の研究の結果を定量的にまとめたものです。その結果、認知行動療法を受けたADHDの成人は、平均してADHDの症状が軽減され、機能が改善されることがわかりました。これは、最大896人の参加者を含む32の研究のデータに基づいています。

その効果は、薬物療法で見られる効果よりも小さかった。認知行動療法は、多動性-衝動性の症状よりも不注意性の症状に強い効果があるようで、効果は参加者がすでに薬物を服用しているかどうかには関係なかったそうです。

ADHD成人に対する認知行動療法は有望と思われるが、セラピストを見つけるのが難しい場合がある。大人のADHDに対する治療はまだ比較的新しく、訓練を受けた臨床医も少ない。興味のある方は、臨床家向けのマニュアルや、クライアント向けのワークブックをご覧ください。

他の認知行動療法HTML1と同様に、アプリ配信型療法などのeHealth介入は、ADHDの人々が日常生活で治療を受けるのに役立つ可能性があります。

ADHDを持つ大学生のためのものなど、新しい標的型ADHD治療があります。

 

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投稿者 mind mingles

「ADHDに悩む大人に対する認知行動療法を検証する研究が始まっている。」に258件のコメントがあります
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