併存障害を有する成人期ADHD患者に対する訪問作業療法の意義—家事や育児の困難により入退院を繰り返していた事例を通して

Importance of home-visit occupational therapy for an adult with ADHD and comorbid disorders: A case of a patient frequently hospitalized due to difficulties with housework and childrearing

要旨：併存障害を有する成人期ADHD患者に訪問作業療法を実施した．症例は40歳代の女性で，家事や育児を遂行できず入退院を繰り返していた．訪問作業療法では，注意の持続困難を考慮した片づけの工程の簡素化，視覚優位の特性を活かした視覚的手掛かりの設置などを行い，症例の遂行能力に適合するように環境を調整した．同時に，同居家族に心理教育を行い，多職種連携を行った．結果，症例は家事と育児を遂行できるようになり，介入後2年間入院しなかった．以上から，成人期ADHD患者の訪問作業療法の意義は，作業療法士が障害特性に関する医学的知識と作業の専門的知識を活用して，患者の生活を再建することであると考えられた．

　This article examined the importance of home-visit occupational therapy for an adult with ADHD and comorbid disorders. The patient was in her 40s, and was frequently admitted to the hospital due to difficulties with housework and childrearing. During home-visit occupational therapy, the OTR intervened in daily occupations and adjusted the environment accordingly, while considering characteristics of disabilities associated with ADHD, for example, simplifying the cleaning process by taking into account attention deficit and enhancing visual cues. In addition, family psychoeducation and multidisciplinary support was provided. Consequently, the patient became able to perform housework and raise her children. She continued to live at home without admission for two years since this OT intervention. Therefore, the significance of occupational therapy for adult ADHD patients suggests that occupational therapists rebuild patients' life by utilizing medical knowledge of disability characteristics and expert knowledge of their occupation.