金學堂英語的部落格

【By ALAN SCHWARZ／聯合報／陳世欽譯】

With millions of children having received a diagnosis of attention deficit hyperactivity disorder, there is concern that the condition is overtreated with prescription medications.

Yet now some in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing.

Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment.

The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the illness, with the lead paper claiming the question of its existence “seems to be laid to rest as of this issue.” The psychologist Russell Barkley of the Medical University of South Carolina has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.”

Keith McBurnett, a professor of psychiatry at the University of California, San Francisco, said: “When you start talking about things like daydreaming, mind-wandering, those types of behaviors, someone who has a son or daughter who does this excessively says, ‘I know about this from my own experience.’ They know what you’re talking about.”

Yet some experts, including Dr. McBurnett , say there is no consensus on the new disorder’s symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications.

“We’re seeing a fad in evolution: Just as A.D.H.D. has been the diagnosis du jour for 15 years or so, this is the beginning of another,” said Dr. Allen Frances of Duke University in North Carolina. “This is a public health experiment on millions of kids.”

Though the concept of sluggish cognitive tempo, or S.C.T., has been researched since the 1980s, it has not been recognized in the Diagnostic and Statistical Manual of Mental Disorders, used by the American Psychiatric Association.

Steve S. Lee, an associate professor of psychology at the University of California, Los Angeles, said he was conflicted over the psychology journal’s emphasis on sluggish cognitive tempo. He expressed concern that A.D.H.D. had already grown to encompass too many children with common youthful behavior, or whose problems are derived from inadequate sleep, a different learning disability or other sources.

About two-thirds of children with an A.D.H.D. diagnosis take medication that quells impulsiveness and inattention but carries risks for insomnia, appetite suppression and, for teenagers and adults, abuse.

“The scientist part of me says we need to pursue knowledge, but we know that people will start saying their kids have it, and doctors will start diagnosing it and prescribing for it long before we know whether it’s real,” Dr. Lee said. “A.D.H.D. has become a public health, societal question, and it’s a fair question to ask of S.C.T. We better pump the brakes more diligently.”

中譯

已有數百萬兒童經診斷罹患注意力不足過動症（ADHD）。有人擔心，這種症狀有以處方藥物過度治療之虞。

然而精神醫學界有些人說，他們發現了另一種新疾病，可能使需要接受注意力問題治療的年輕人大幅增加 。它名為「遲鈍認知步調」（SCT），症狀包括沒有活力、做白日夢與心智處理過程緩慢。

主張對SCT進行更多研究的專家說，SCT已經逐漸累積列為法定疾病，以及必須接受藥理治療的分量。

「兒童異常心理學」期刊一月號以136頁刊載多篇描述這種疾病的研究報告。主要的報告說，這個疾病的存在似乎已經隨著這些報告的發表而「毋庸置疑」。南卡羅來納醫科大學心理學家巴克萊在多項研究報告與演講中指出，SCT已經成為「新的注意力疾病」。

舊金山加州大學精神病學教授麥柏尼特說：「你開始談論做白日夢、心思遊移等行為的話題時，兒子或女兒也有相同問題的某人會說，『我因為自己的經驗而對此頗有瞭解』。他們知道你在說什麼。」

然而包括麥伯尼特在內的部分專家說，醫學界尚未就這種新疾病的各種症狀取得共識，遑論科學上的有效性。他們並警告，如果未經更嚴謹的科學研究就逕行宣傳這個觀念，可能導致孩子們接受沒有根據的診斷與處方藥治療。

北卡羅來納州杜克大學的法蘭西斯教授說：「一種一時流行的觀念正在演進中。就像過去15年，ADHD是主流診斷項目，這是另一種趨勢的開始。這是針對數百萬孩子展開的公衛實驗。」

醫學界早自1980年代即已開始研究SCT的概念，然而它迄未獲得美國精神醫學學會的「精神疾病診斷與統計手冊」承認。

洛杉磯加大心理學副教授史帝夫李表示，「兒童異常心理學」期刊對SCT的強調令他感到矛盾。他擔心的是，ADHD已經納入太多青少年時期行為相同的孩子，或者問題肇因於睡眠不足、有不同的學習障礙或其他原因的孩子。

經診斷患有ADHD的孩子大約2/3服用可紓解衝動或注意力不集中等狀況的藥物，但同時承擔失眠、食慾不振，以及青少年、成人都可能濫用等風險。

史帝夫李說：「我科學的那一面說，我們必須追求知識。不過我們也知道，人們會開始說自己的孩子有這種問題。遠在我們確定是否真有其事之前，醫師就會開始診斷並開立處方藥。ADHD已經成為一個公衛與社會問題。對SCT也該有這方面的量。我們最好多踩踩煞車。」