为何如此多患有注意缺陷多动障碍（ADHD）的幼儿正在接受错误的治疗

患有注意缺陷多动障碍（ADHD）的学龄前儿童常在确诊后立即接受药物治疗，这有悖于建议首选行为疗法的医疗指南。尽管存在风险且对幼儿疗效较低，但由于治疗资源有限以及来自医生的压力，早期处方行为依然普遍。

* Draft: 这项发现于8月29日发表在《JAMA Network Open》上，突显了4岁和5岁ADHD患儿在医疗护理方面的差距。治疗指南建议，这些幼儿及其家庭在开始ADHD药物治疗前，应先尝试六个月的行为疗法。 * Refinement: "Gap in medical care" -> 医疗护理缺口/差距. "Behavior therapy" -> 行为疗法. * *Para 2:* "But pediatricians often prescribe medication immediately upon diagnosis..." * Draft: 但根据对在美国八个儿科健康网络接受治疗的近10,000名ADHD幼儿病历的分析，儿科医生通常在确诊后立即开具药物。 * Refinement: "Pediatric health networks" -> 儿科医疗网络. "Prescribe medication immediately upon diagnosis" -> 确诊后立即开具药物处方. * *Para 3:* "We found that many young children are being prescribed medications very soon after their diagnosis..." * Draft: “我们发现，许多幼儿在确诊ADHD后很快就被开具了药物，”该研究的主要作者、儿科学助理教授Yair Bannett医学博士说。“这令人担忧，因为我们知道以行为疗法开始ADHD治疗是有益的；它对孩子和家庭都有巨大的积极影响。” * Refinement: "Documented" -> 记录在案/确诊. "MD" -> 医学博士. "Assistant professor" -> 助理教授. * *Para 4:* "In addition, stimulant medications prescribed for the condition cause more side effects..." * Draft: 此外，Bannett指出，用于治疗该病的兴奋剂类药物在幼儿身上引起的副作用比在大龄儿童中更多。在6岁之前，儿童的身体不能完全代谢这些药物。 * Refinement: "Stimulant medications" -> 兴奋剂类药物/兴奋剂药物. "Metabolize" -> 代谢. * *Para 5:* "We don't have concerns about the toxicity..." * Draft: “我们不担心药物对4岁和5岁儿童的毒性，但我们确实知道治疗失败的可能性很高，因为许多家庭认为副作用超过了益处，”他说。兴奋剂药物会使幼儿更易怒、情绪化和具有攻击性。 * Refinement: "Outweigh" -> 超过/弊大于利. "Irritable, emotional and aggressive" -> 易怒、情绪化和具有攻击性. * *Para 6:* "ADHD is a developmental disorder characterized by..." * Draft: ADHD是一种发育障碍，其特征是过度活跃、难以集中注意力和冲动行为。 * Refinement: "Developmental disorder" -> 发育障碍. "Hyperactivity" -> 多动/过度活跃. "Impulsive behavior" -> 冲动行为. * *Para 7:* "It's important to catch it early..." * Draft: “早期发现很重要，因为我们知道这些孩子出现学业问题和无法完成学业的风险更高，”Bannett说。对ADHD的早期识别和有效治疗能改善儿童的学业表现。研究表明，良好的治疗还有助于ADHD患者为成年生活的许多方面做好准备，例如维持工作、建立成功的人际关系以及避免法律纠纷。 * Refinement: "Catch it early" -> 早期发现. "Academic problems" -> 学业问题. "Trouble with the law" -> 法律纠纷/触犯法律. * *Para 8:* "Complementary treatments" * Draft: 辅助治疗 / 互补治疗. * Refinement: Context suggests these are treatments used together or as alternatives. "Complementary" usually translates to 辅助 or 补充. Given the context of behavior vs meds, "补充治疗" or "辅助治疗" works. Let's use "辅助治疗" or just translate the header literally. "Complementary" often implies they work together. Let's use "辅助治疗" or "补充疗法". Actually, looking at the text, it discusses them as distinct mainstays. Let's stick to "辅助治疗" or "补充治疗". Let's use "补充治疗" (Complementary treatments). * *Para 9:* "Behavioral therapy and medication, the two mainstays..." * Draft: 行为疗法和药物治疗是ADHD治疗的两大支柱，它们有着不同的目的。 * Refinement: "Mainstays" -> 支柱/主要手段. * *Para 10:* "Behavioral treatment works on the child's surroundings..." * Draft: “行为治疗作用于孩子的周围环境：父母的行为以及孩子的日常惯例，”Bannett说。该疗法帮助父母和孩子建立技能，并养成与孩子大脑运作方式相适应的习惯。 * Refinement: "Routine" -> 日常惯例/作息. "Compatible with" -> 相适应/相容. * *Para 11:* "The evidence-based behavioral treatment recommended by the American Academy of Pediatrics..." * Draft: 美国儿科学会推荐的循证行为治疗称为“父母行为管理培训”。该培训帮助父母与孩子建立牢固、积极的关系；提供奖励孩子良好行为和忽视不良行为的指导；并推荐有助于ADHD儿童的工具，例如制作视觉日程表以帮助他们保持条理。 * Refinement: "Parent training in behavior management" -> 父母行为管理培训. "Visual schedules" -> 视觉日程表/可视化日程表. "Stay organized" -> 保持条理/有序. 4. **Final Polish:** * Check for flow and terminology consistency. * "JAMA Network Open" -> Keep English or use standard translation? Usually keep English for journal names or use 《JAMA Network Open》. * "ADHD" -> Keep as ADHD (standard in Chinese medical texts) or use 注意缺陷多动障碍. The text uses ADHD repeatedly. I will use ADHD as per the source, maybe define it once if needed, but the source defines it in para 6. * "4- and 5-year-olds" -> 4岁和5岁儿童/幼儿. * "Stimulant medications" -> 兴奋剂类药物. * "Metabolize" -> 代谢. * "Toxicity" -> 毒性. * "Developmental disorder" -> 发育障碍. * "Complementary treatments" -> 补充治疗 (or 辅助治疗). Given the context of "two mainstays", this header introduces the section discussing them. "Complementary" here might mean "treatments that complement each other" or just "additional info on treatments". Let's use "补充治疗". * *Self-Correction on HTML tag:* The user provided HTML tags `

` and `

`. I should output the translation preserving these tags to maintain the 相比之下，药物治疗能缓解多动和注意力不集中等ADHD症状，但随着身体代谢掉每一剂药物，其药效也会消退。大多数患有ADHD的儿童都需要这两种方法才能取得良好效果。但先前针对4岁或5岁时确诊的学龄前儿童的研究表明，最好先进行六个月的行为治疗，然后再开具任何药物。 **快速开药** 研究人员分析了在八个美国学术医疗中心附属的初级诊疗机构就诊的儿童的电子健康档案数据。他们从2016年至2023年期间的712,478份档案开始筛选，这些儿童年龄为3、4或5岁，且在至少六个月的时间段内至少两次就诊于初级保健医生。科学家从这些档案中确定了9,708名被诊断为ADHD的儿童，占初始样本中儿童总数的1.4%。他们发现，这些儿童中有42.2%——即超过4,000名儿童——在确诊ADHD后一个月内就被开具了药物。只有14.1%的ADHD儿童在确诊六个月后才首次接受药物治疗。研究人员无法获取关于转诊接受行为治疗的数据，但由于幼儿本应在接受药物治疗前单独尝试行为治疗六个月，因此任何较早接受药物治疗的儿童可能都未按照学会指南进行治疗。一项关于行为治疗建议的较小规模研究发表于2021年，发现只有11%的家庭按照指南接受了治疗。最初被正式诊断为ADHD的儿童，比那些病历最初仅记录了一些ADHD症状而随后才确诊的儿童，更有可能在最初30天内接受药物治疗。但即使在那些最初未完全符合该病症标准的学龄前儿童中，也有22.9%在30天内接受了药物治疗。 **行为治疗的障碍？** 由于该研究基于对电子病历的分析，研究人员无法询问医生为何做出这样的治疗决定。然而，Bannett的团队在研究范围之外与医生进行了非正式交谈，询问他们为何开具药物。 “经常提到的一个重要问题是获得行为治疗的途径，”Bannett说。一些地区很少有或根本没有提供这种治疗的治疗师，或者患者的保险可能不承保。“医生告诉我们，‘我们没有地方把这些家庭送去接受行为管理培训，所以，权衡利弊之后，我们认为给予药物治疗总比完全不提供治疗要好。’” * *Draft:* 班内特表示，他希望能教育初级保健儿科医生如何弥合这一差距。 * *Sentence 2:* "For example, free or low-cost online resources are available for parents who want to learn principles of the behavioral approach." * *Terms:* Behavioral approach (行为疗法/行为干预方法). * *Draft:* 例如，对于想要学习行为疗法原则的家长来说，有免费或低成本的在线资源可供使用。 * *Sentence 3:* "And while the study focused on the youngest ADHD patients, behavioral management therapy also helps older children with the diagnosis." * *Terms:* ADHD (注意缺陷多动障碍), behavioral management therapy (行为管理疗法), diagnosis (诊断/确诊). * *Draft:* 虽然这项研究侧重于最年幼的ADHD患者，但行为管理疗法对被确诊的年龄较大的儿童同样有帮助。 * *Sentence 4:* "'For kids 6 and above, the recommendation is both treatments, because behavioral therapy teaches the child and family long-term skills that will help them in life,' Bannett said." * *Terms:* Kids 6 and above (6岁及以上的儿童), both treatments (两种疗法并举 - usually medication and behavioral therapy in this context). * *Draft:* 班内特说：“对于6岁及以上的儿童，建议采用两种疗法，因为行为疗法能教会儿童及其家庭受用终生的技能，帮助他们在生活中应对挑战。” * *Sentence 5:* "'Medication will not do that, so we never think of medication as the only solution for ADHD,' Bannett said." * *Terms:* Medication (药物治疗). * *Draft:* “药物治疗无法做到这一点，因此我们绝不认为药物是治疗ADHD的唯一解决方案。” * *Sentence 6:* "Researchers contributed to the study from the Children's Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Nationwide Children's Hospital, The Ohio State University College of Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Texas Children's Hospital, Baylor College of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Children's Hospital of Philadelphia, the University of Colorado, and Nemours Children's Hospital." * *Terms:* This is a long list of institutions. Need standard Chinese translations for these specific hospitals and universities. * Children's Hospital of Philadelphia: 费城儿童医院 * Perelman School of Medicine at the University of Pennsylvania: 宾夕法尼亚大学佩雷尔曼医学院 * Nationwide Children's Hospital: 全国儿童医院 (Standard translation for the one in Ohio) * The Ohio State University College of Medicine: 俄亥俄州立大学医学院 * Cincinnati Children's Hospital Medical Center: 辛辛那提儿童医院医疗中心 * University of Cincinnati College of Medicine: 辛辛那提大学医学院 * Texas Children's Hospital: 德克萨斯儿童医院 * Baylor College of Medicine: 贝勒医学院 * Ann and Robert H. Lurie Children's Hospital of Chicago: 芝加哥安与罗伯特·H·卢里儿童医院 * University of Colorado: 科罗拉多大学 * Nemours Children's Hospital: 尼莫尔斯儿童医院 * *注明:* The source text lists "Children's Hospital of Philadelphia" twice. I should translate it as it appears or check if it's a redundancy in the source. As a translator, I should faithfully represent the source text, but usually, lists like this are just translated item by item. I will list it as it appears in the source text to be safe, or just translate the list. * *Draft:* 参与该研究的研究人员来自费城儿童医院、宾夕法尼亚大学佩雷尔曼医学院、全国儿童医院、俄亥俄州立大学医学院、辛辛那提儿童医院医疗中心、辛辛那提大学医学院、德克萨斯儿童医院、贝勒医学院、芝加哥安与罗伯特·H·卢里儿童医院、费城儿童医院、科罗拉多大学以及尼莫尔斯儿童医院。 * *Sentence 7:* "This work was supported by the Stanford Medicine Maternal and Child Health Research Institute; the National Institute of Mental Health (grant K23MH128455); and the National Heart, Lung, and Blood Institute (grant K23HL157615)." * *Terms:* * Stanford Medicine Maternal and Child Health Research Institute: 斯坦福医学母婴健康研究所 (or 妇幼健康研究所). "Maternal and Child Health" is usually 母婴健康 or 妇幼健康. Let's use 斯坦福医学妇幼健康研究所. * National Institute of Mental Health: 美国国家心理健康研究所 * National Heart, Lung, and Blood Institute: 美国国家心肺血液研究所 * Grant numbers: Keep as is. * *Draft:* 这项工作得到了斯坦福医学妇幼健康研究所、美国国家心理健康研究所（资助号 K23MH128455）以及美国国家心肺血液研究所（资助号 K23HL157615）的支持。 * *Sentence 8:* "The study was conducted using PEDSnet, A Pediatric Clinical Research Network." * *Terms:* PEDSnet (usually kept as PEDSnet or translated as 儿科临床研究网络 PEDSnet). "A Pediatric Clinical Research Network" is the appositive explaining PEDSnet. * *Draft:* 该研究是利用 PEDSnet（一个儿科临床研究网络）进行的。 * *Sentence 9:* "PEDSnet was developed with funding from the Patient-Centered Outcomes Research Institute." * *Terms:* Patient-Centered Outcomes Research Institute (PCORI): 患者中心结果研究所 (Standard translation). * *Draft:* PEDSnet 的开发资金来自患者中心结果研究所。 3. **Review and Refine:** * *Paragraph 1:* Bannett said he hopes to educate primary care pediatricians on how to bridge this gap. For example, free or low-cost online resources are available for parents who want to learn principles of the behavioral approach. * *Refinement:* 班内特表示，他希望能教育初级保健儿科医生如何弥合这一差距。例如，对于想要学习行为疗法原则的家长，现有免费或低成本的在线资源可供使用。 (Slight flow improvement). * *Paragraph 2:* And while the study focused on the youngest ADHD patients, behavioral management therapy also helps older children with the diagnosis. * *Refinement:* 尽管这项研究侧重于最年幼的ADHD患者，但行为管理疗法对确诊的年龄较大的儿童同样有效。 ("Helps" -> 有效/有帮助. "Effective" sounds more professional in medical context, but "有帮助" is closer to "helps". Let's stick to "有帮助" or "同样适用".) -> 行为管理疗法对确诊的年龄较大的儿童同样有帮助。 * *Paragraph 3:* "For kids 6 and above, the recommendation is both treatments, because behavioral therapy teaches the child and family long-term skills that will help them in life," Bannett said. "Medication will not do that, so we never think of medication as the only solution for ADHD." * *Refinement:* 班内特说：“对于6岁及以上的儿童，建议两种疗法并用，因为行为疗法能教会孩子和家庭受用终生的技能，帮助他们在生活中应对挑战。药物治疗无法做到这一点，因此我们绝不认为药物是治疗ADHD的唯一解决方案。” (Added "应对挑战" to "help them in life" to make it sound natural in Chinese, or just "帮助他们的生活". Let's stick closer to the text: "对他们的生活有所帮助".) -> "帮助他们在生活中应对" or just "对他们的生活有帮助". Let's go with: "帮助他们在生活中受用". Actually, "long-term skills that will help them in life" -> "受用终生的技能，将对他们的生活有所帮助". * *Revised Draft:* 班内特表示：“对于6岁及以上的儿童，建议两种疗法并用，因为行为疗法能教会孩子和家庭受用终生的技能，对他们的生活有所帮助。药物治疗无法做到这一点，所以我们绝不认为药物是治疗ADHD的唯一解决方案。” * *Paragraph 4 (Institutions):* * Check for duplicates. The source text lists "Children's Hospital of Philadelphia" twice. I will translate it exactly as the source lists it to maintain fidelity, even if it looks like a typo in the original. * *Refinement:* 参