What Are the Symptoms of ODD?

Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder in childhood, with a prevalence of 1% to 10%. It is manifested in the activities of cognitive participation, lack of concentration, lack of persistence of attention, a large amount of activity and frequently changing content, behavioral impulses, abruptness, and disregard for consequences. It usually starts before the age of 6 and has preschool symptoms that gradually improve with age, and some cases can continue into adulthood [1]. In recent years, research on ADHD has become a hot spot. In order to increase people's understanding of the nature of this behavioral disorder, this article summarizes the results of ADHD research in recent years as follows.

Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder in childhood, with a prevalence of 1% to 10%. It is manifested in the activities of cognitive participation, lack of concentration, lack of persistence of attention, a large amount of activity and frequently changing content, behavioral impulses, abruptness, and disregard for consequences. It usually starts before the age of 6 and has preschool symptoms that gradually improve with age, and some cases can continue into adulthood [1]. In recent years, research on ADHD has become a hot spot. In order to increase people's understanding of the nature of this behavioral disorder, this article summarizes the results of ADHD research in recent years as follows.

Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder

Introduction to Attention Deficit Disorders

It usually starts before the age of 5 and is characterized by a lack of persistence in activities that require cognitive participation, and it is easy to change from one activity to another, but neither can be completed, accompanied by confusion, poor control and activities over. Children are often careless and impulsive, prone to accidents, and violate discipline, but not because of deliberate contempt for discipline, but because of lack of consideration. Patients and adults often show de-inhibition when interacting with each other, lacking normal caution and restraint. Specific delays in cognition, motor, and speech development are common. May be secondary to social disorders and inferiority.

Theoretical model of attention deficit hyperactivity disorder

The purpose of establishing a theoretical model of neuropsychology is to explore the etiology and pathological mechanism of ADHD, and then guide clinical diagnosis, treatment and rehabilitation. At present, there are five theoretical models of ADHD, namely delayed transfer model, behavior inhibition / promotion model, inhibition model, cognitive energy model, and executive function model.

Attention deficit hyperactivity disorder

The reported incidence in foreign countries accounts for about 3% -10% of school-age children, and the domestic report is 1.5% -12%. The disparity in the current prevalence survey results is related to the inconsistency of the diagnostic methods and scales used in the survey, in addition to differences in actual prevalence between countries and regions. According to the DSM-IV-R diagnostic criteria, the prevalence rate in school-age children is 3% -5%. The ratio of male to female incidence is 9: 1 to 4: 1. This is related to the boy's hyperactive symptoms, which are associated with more impulsive, aggressive behavior and behavior problems. This disease has attracted the attention of the society because of its high prevalence and children often accompanied by learning difficulties. Psychological and behavioral corrections and medications have been effective in some children.

Harvard University research found that Ritalin (the most commonly used prescription drug) can increase ADHD activity in places with low cerebellar activity. We also know that ADHD does not occur alone, and often merges like dyslexia , developmental coordination difficulties, and even autism . This suggests that multi-region or single-region dysfunction in the brain may affect multi-region integration and connection. There are some independent studies that support these diagnoses, which are actually caused by cerebellar function. We know that there are more and more children with ADHD. What is the prevalence of ADHD? With the gradual unification of ADHD diagnostic standards in the world, the prevalence of ADHD reported by scholars at home and abroad is now close, such as the United States 3.4-4.7%, Germany 3.9% -9.0%, Japan 4%, Australia 7.5% -11% , New Zealand 3.0%, Brazil 5.8%. In recent years, the prevalence of ADHD reported in various parts of China is about 1.3% -13.4%, such as Beijing 8.6%, Shanghai 4.0%, Tianjin 3.8%, Henan 10.2%, Harbin 6.9%, Jilin 10.8%, Hefei 10.6%, and Hunan 7.3 %, Guangzhou 1.3%. According to 7 large domestic surveys, the prevalence of ADHD in China is 4.31% -5.83%. At present, foreign scholars generally believe that the prevalence of ADHD is about 3% -6%. A rough estimate is that there are approximately 1,461-17.9 million children with ADHD in China!

Causes of attention deficit hyperactivity disorder

Overview of attention deficit hyperactivity disorder

The etiology and pathogenesis of attention deficit hyperactivity disorder is uncertain. This disease is currently considered to be a syndrome caused by a variety of biological, psychological and social factors.

It was first discussed in the early 20th century. In 1902, an article by Dr. George Still, who was interested in childhood diseases, was published in London. He found that some children seemed to be unable to stop, their emotions were ups and downs, and they often caused trouble. The main characteristics of ADHD are inattention, overactivity, and impulsivity, but these symptoms often make it difficult for them to follow regular behaviors or maintain fixed performance. Dr. Steele believes that these children "have abnormalities in motion control." He wrote an article on the subject and published it in the British Medical Journal. The Diagnostic and Statistical Manual (DSM), published by the American Psychological Association, first described hyperactivity disorder in 1980 and called it "childhood hyperactivity abnormalities." After several revisions by related scholars, the term "attention deficit hyperactivity disorder" finally came into being, and its symptoms and diagnostic criteria have become increasingly clear. The fourth edition of the latest Diagnostic Manual for Mental Illness (DSM-IV) divides ADHD into three different types: "attention deficit", "overactive", and "attention deficit combined with overactive". In DSM-, attention deficit and hyperactivity / impulsivity each have 9 symptoms, and the diagnosis can be confirmed by meeting 6 or more symptoms. At the same time, every symptom must occur in more than one environment, such as at school and at home. Other conditions include that symptoms must be observed before the age of 7 and that no other psychological factors are responsible. The use of magnetic resonance imaging (MRI) and functional scanning (FMRI, which analyzes blood flow in the brain) can help us understand the differences between ADHD patients and the general structure and functionality of the brain. At present, the most consistent data is the reduction in the size of the middle cerebellum (the cerebellar vermiform, located at the lower back of the brain) and the middle brain region (including part of the brain stem). We used to think that ADHD is related to the prefrontal lobe of the brain. However, in fact, most people who suffer from ADHD are due to the cerebellum not functioning properly. Studies over the past 20 years have found that people with cerebellar dysplasia also have symptoms of ADHD. Functional scans also revealed low cerebellar activity in ADHD patients.

Harvard University research found that Ritalin (the most commonly used prescription drug) can increase ADHD activity in places with low cerebellar activity. We also know that ADHD does not occur alone, and often merges like dyslexia, developmental coordination difficulties, and even autism. This suggests that multi-region or single-region dysfunction in the brain may affect multi-region integration and connection. There are some independent studies that support these diagnoses, which are actually caused by cerebellar function.

Genetic and neurochemical factors in attention deficit hyperactivity disorder

Monozygotic twins have almost 100% ADHD, while dizygotic twins have only 10% -20%. The phenomenon of familial aggregation in close relatives also suggests that ADHD is related to genetic factors. Recent studies have shown that the gene variants associated with ADHD mainly have a 48 bp repeat polymorphism on the third exon of the dopamine D4 receptor (DRD4) gene. Dopamine transporter (DAT1) gene 480bp repeat polymorphism. Polymorphism on codon 158 of catecholamine methyltransferase (COMT) gene. Polymorphisms of synaptophysin-retaining protein-25 (SNAP-25) gene on the DXS7 locus on the X chromosome. The genetic mutation rate of ADHD children is higher than that of normal children. DRD4 mutations make it less sensitive to dopamine, while DAT1 mutations accelerate dopamine elimination, allowing dopamine to be cleared before it binds to receptors on neurons, causing the brain's output-input loop The exception. That is, the lack of central nervous transmission media such as dopamine can easily lead to abnormal behaviors such as children's activity, alertness, mood, and cognition. Ritalin has the effect of inhibiting the dopamine transporter, prolonging the time required for dopamine to bind to the receptor, thereby playing a therapeutic role.

Factors of mild brain injury and brain retardation in attention deficit hyperactivity disorder

Maternal malnutrition, disease, X-ray exposure, premature delivery during delivery, dystocia, hypoxia and asphyxia. Postnatal craniocerebral trauma, inflammation, febrile convulsions, poisoning, etc. can cause brain damage, especially ADHD symptoms in frontal cortex damage. But many children have no history of brain injury and no neurological abnormalities. It is considered to be mild brain dysfunction. But there is still no sufficient basis. During the development of the brain, the frontal lobe evolves late and is most vulnerable to damage. Some scholars believe that ADHD is related to the retardation of the frontal lobe of the brain. All factors affecting the development of the frontal lobe can cause disease. 3-1 / 4 of children with ADHD tend to improve their symptoms into adolescence. Recent studies have suggested that attention should be regarded as a development area just like language and motor function. People with attention problems actually have this function weakened or stunted.

We used to think that ADHD is related to the prefrontal lobe of the brain. However, in fact, most people who suffer from ADHD are due to the cerebellum not functioning properly. Studies over the past 20 years have found that people with cerebellar dysplasia also have symptoms of ADHD. Functional scans also revealed low cerebellar activity in ADHD patients.

Sociopsychological factors of attention deficit hyperactivity disorder

It has been reported that parents of children with ADHD are mostly junior and middle level, and only 7.6% of parents have higher education, which is significantly lower than that of the control group. Children with single-parent families or parents who suffer from mental illness, alcohol abuse, and misbehavior, and who are "warmly deprived" are prone to develop ADHD symptoms. Failure to develop good living and learning habits since childhood, family too much doting, children will have symptoms such as freewheeling, poor self-control, hyperactivity and other symptoms. For example, parents and teachers are too demanding of children's learning and living behaviors, children's psychological and emotional depression, tension, prone to excessive behavior, distracted, impulsive and other behavioral abnormalities. Parents and teachers who fail to educate their children carefully due to busy work, or lack of education methods and the responsibility to cultivate the next generation, can also easily aggravate ADHD symptoms. Although many of the above social and psychological factors are not necessarily the direct cause of ADHD. But it certainly has an impact on the development and prognosis of the disease.

Abnormal brain electrophysiological function of attention deficit hyperactivity disorder

Electroencephalogram q-wave activity increased in children with ADHD. Q-waves appear more frequently during sleep, which suggests that ADHD children have insufficient awakening, which leads to the release of subcortical activity and hyperactivity. Central stimulants improve the excitability of the cerebral cortex and eliminate the phenomenon of insufficient awakening to play a role in the treatment of ADHD. The decrease in the amplitude of the late component of brain evoked potentials in ADHD children also indicates that there are abnormalities in the electrophysiological functions of the brain in ADHD children. (5) The effects of lead and other chemicals on postnatal mice were fed with lead acetate solution. After 40-60 days, it was found that the mouse activity was significantly increased compared with the control group. There are also reports that blood lead concentration is positively related to pediatric hyperactivity and ADHD children have higher blood lead levels than the normal control group. Therefore, many scholars believe that ADHD is related to excessive lead intake. The sources of children's lead and other chemical pollution are: air pollution (industrial exhaust, leaded gasoline, etc.). Study environment and school supplies (paint layers for desks and chairs, pencils, crayons, etc.), plastics and paint toys, food and water pollution (food additives, canned food, popcorn, leaded preserved eggs, etc.), home decor chemical products are widely used As well as pediatric finger sucking and pica, but the exact mechanism of these pollution factors and the pathogenesis of ADHD is not clear.

Clinical manifestations of attention deficit hyperactivity disorder

Overview of attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder are mainly manifested as attention deficit and hyperactivity, often accompanied by learning difficulties and emotional behavior abnormalities.

Attention deficit hyperactivity disorder attention deficit

There are two types of people's attention. One is active attention, that is, focusing on something according to subjective will to achieve a certain purpose and complete a certain task. Active attention requires will and perseverance, which is often called "struggling." The other is passive attention, in which objective things attract people's attention by their own characteristics, so they can turn and focus on these things at will and effortlessly.

ADHD children have the following characteristics:

1 Passive attention is dominant and active attention is insufficient. This is manifested by a lack of concentration and often open thinking during class. Ignoring the teacher's questions or answering questions that are not answered, and doing homework is easily distracted by irrelevant external stimuli. I usually forget to do things (inadequate attention). For interesting TV shows, books, novel games, etc., you will be fully absorbed or relatively concentrated (passive attention is dominant). In severe ADHD children, there may be a significant lack of active or passive attention.

2 Note that the strength is weak, the maintenance time is short, and the stability is poor. In addition to taking the initiative to pay attention to complete a certain task, you also need to pay attention to the intensity and time. Children with ADHD can't be highly focused and have short attention spans. For example, 10-12 year old students should be able to maintain 40 minutes of intensive listening time. Children with ADHD have difficulty doing so, and are prone to fatigue and distraction.

3 The attention range is narrow and not good at assigning attention. Normal children can clearly grasp the objects and quantity of attention at the same time. This is indispensable for accomplishing a certain task. For example, when doing homework, the brain should consider the question, the eyes should read the content of the book, the hand should write the answer, and the words should be written in the prescribed size. Just like the driver of a car must grasp the steering wheel, control the speed of his feet, keep his eyes on the front, and listen to the surrounding sounds. Be smart enough to distribute your attention. And ADHD children are not good at grasping the points and points of attention. Note the narrow range. If you do homework, it is easy to miss questions, write strings, sloppy, and make unexpected low-level errors. Difficulty completing assignments on time, etc.

Hyperactivity of attention disorder

ADHD children are distracted due to self-control deficit (SCD), and their behaviors tend to be moving with the scene and appear hyperactive.

Its hyperactivity has the following characteristics :

1 Too much activity that is not commensurate with age.

It occurs in infancy and preschool. Infant performance is crying, irritable, dancing constantly, excited and sleepless, difficult to develop a regular diet and defecation habits. After walking, the activity was significantly increased compared with normal age children. It is difficult for children to have quiet moments other than sleep time. After entering the kindergarten, he did not observe discipline, was so noisy and troublesome, and had no intention of playing. A toy was changed after a while.

2 Hyperactivity symptoms have no clear purpose.

The action is chaotic and constantly changing patterns. Therefore, their behaviors are often fragmented due to lack of integrity. For example, in the classroom, you can play with toys and use a pen or a knife to scribble on a textbook or desk. Or make funny faces to make the students around laugh and provoke right and wrong. Or even knock on the table, whistle, leave the seat and run around in the classroom. Absolutely disregarding the discipline and interference it causes. Doing everything in life is difficult and difficult.

3 Impulsive waywardness.

Hyperactivity is often irrespective of the occasion, reckless, and difficult to control. Therefore, its behavior is often destructive and dangerous. Prone to accidents. Such as turning over the pot at home, arbitrarily dismantling and losing toys and stationery. The criticisms of teachers and parents have been ignored and repeatedly taught. You ca nt wait patiently for a rotation in a game event, or you have to jump in line first, or you just give up and do nt do it. I like climbing high, over the railings, suddenly crossing the road in front of a moving vehicle, being able to get into the water without swimming, whimping, doing whatever I want.

Attention deficit hyperactivity disorder and behavioral abnormalities

ADHD children are often criticized by teachers, ridiculed by classmates, despised, and reprimanded by their parents because of impaired attention, excessive activity, impulse, and decline in academic performance. Their self-esteem is hurt, their emotions are more fragile, and they are prone to the following symptoms.

1 Withdraw and avoid.

"Experiences of failure and frustration" will make ADHD children "defend themselves" in a way of withdrawal and avoidance in an attempt to change the situation of blame everywhere. As a result, there are situations such as fear of class, irregular assignments, evasion of exams, and even truancy. Although some children go to school, they will complain of chest tightness, headache, chest pain and other discomfort as soon as they arrive at the school, and ask for treatment. The examinations to the hospital were normal. At this time, it is easy to be diagnosed as "school phobia". ADHD children will resolutely correct teachers 'criticisms and parents' persuasion education. However, due to lack of self-discipline and control, they will often repeat their crimes soon after. This makes it easy for teachers and parents to consider it as "intentional confrontation", and resentment and anger arise. This will lead to more severe criticism and punishment. A vicious cycle of "withdrawal avoidance aggravated punishment withdrawal from withdrawal" appears, which makes ADHD symptoms continue and aggravate.

2 Fantasy and loneliness

ADHD children do not get the care, attention, and fun they deserve in school and at home. They will seek a "quiet and happy" environment for spiritual comfort and satisfaction. Symptoms of fantasy and loneliness gradually develop. Some will be melancholy and silent, pessimistic and disappointed, and do not play with their classmates. There is also very little speech at home with loved ones. Others lower their actual age and prefer to play with young children or young children and play games with young children in order to avoid the "higher requirements" of their peers. Fantasy and lonely behavior will inevitably affect academics, leading to learning difficulties, long-term adaptation disorders, and autism.

3 Overcompensation

Some ADHD children try to counteract inferiority and compensate for the damage to their self-esteem. They will rely on their strong advantages in organizational skills, physical strength, etc. to organize small groups in schools or classes, lead regulation, manipulate or force other students to participate, coax inside and outside the classroom, bully criticism, despise their classmates, and treat their teachers Playing pranks with classmates, or even teaming up with Europe, using this aggressive behavior to show their abilities, deny their own shortcomings, and compensate for their own shortcomings, such impulsive behaviors can easily cause behavioral disorders in children, and even constitute juvenile crime.

4 Concealment and denial

Some children with ADHD, when they are criticized by teachers or parents, in order to avoid blame and punishment, they will preemptively control the situation by joking, playing clowns, making faces, coaxing, lying, etc. to attract the attention of critics. Or mock yourself first to stop criticism. Others completely deny their bad performance and blame their behavioral faults on the criticisms of teachers and classmates and parents' reproach. Some parents also think that their children are clever and lively. Their bad behavior is caused by the fault of the teacher and the surrounding classmates. Concealment and denial will increase the confrontation between the teacher and the classmates and the child, which will hinder the treatment of the disease.

ADHD learning difficulties

What is Attention Deficit Hyperactivity Disorder ?

According to medical statistics in Europe and the United States, one in six of us is affected by learning difficulties of varying degrees. What are the learning difficulties? The National Institutes of Health (NIH) defines that learning difficulties are attributed to the nervous system, which is characterized by difficulties in recognizing the correctness and fluency of words, and inability to spell, and difficulty in forming the pinyin of the language. What we mean by "learning difficulties" generally refers to specific manifestations of poor learning ability, inattention, poor physical coordination, and lack of social skills due to dyslexia, ADHD, and Asperger's symptoms. .

Causes of attention deficit hyperactivity disorder

Scientific research in recent years shows that learning difficulties are caused by slow development of the cerebellum. If the cerebellar function cannot be effectively exerted, it will lead to various types of learning difficulties. Because each person's cerebellar development is different, the symptoms of learning difficulties in each person will not be completely similar, and the symptoms often overlap each other.

Since the cerebellum is an important information processing center in the learning process, it can "automate" our capabilities. With the automation function, many things and skills in daily life can be made directly after we learn without thinking. Once the cerebellum cannot operate effectively and automatically, and you have to relearn everything you do, it is likely that reading and writing, coordination of movements, interpersonal relationships, etc .... the life skills that ordinary people can easily learn will become troubles, even disaster Struggling with nightmares, no matter how hard they struggle, they are always stuck in a difficult position.

Effects of attention deficit hyperactivity disorder

Generally speaking, the IQ of people with learning difficulties is normal, and sometimes even surpasses ordinary people, but some ordinary people think it is a simple thing, but they still have to make great efforts to achieve it. When it is generally believed that simple things become difficult, they can have profound negative effects on patients. Their self-confidence will be greatly reduced, and frustration will make them lonely or outlier and cause trouble and depression. These will further develop into serious behavior problems, which will affect the development of life's path.

If the child suffers from these problems, parents will be even more distressed. How sad it is when the expectations of Wang Zicheng become disillusioned and the child changes from lively and lovely to lonely and depressed. Therefore, learning difficulties not only cause a serious blow to my personal study and work, but also affect the normal life of their family and friends.

Children with ADHD can have learning difficulties, but their learning difficulties are not caused by mental retardation (mental retardation). In contrast, ADHD children have the same level of intelligence as normal children, but their IQs are mostly in the normal range (except those with combined mental retardation). The learning difficulties of children with ADHD are mainly due to distraction and failure to concentrate on the knowledge that should be fully learned and learned. Therefore, their learning difficulties have the following characteristics. 1 Fluctuation in academic performance Children with ADHD can improve their performance with the strict help of their parents. But a little relaxation, due to the existence of ADHD symptoms, academic performance will decline significantly, performance is very unstable, and the difference between good and bad. 2 Learning gradually declines as they progress to the upper grades. Children with ADHD in the lower grades have shallow learning content and are easy to master. After entering the upper grades, the learning content becomes more difficult, and due to the persistent existence of ADHD symptoms, it is difficult to receive good learning results. Grades will gradually decline. It covers all subjects. 3 There should be low-level errors that should not occur during the study or examination as described above.

Nerve signs

Most of the neurological examinations in children with ADHD are completely normal, and some children may have the following signs.

1 Minor ataxia

Some children walk in an S-shape and are prone to wrestling. Practice lacks a sense of rhythm. Incorrect movements and postures are difficult to correct. Buttons, laces, and other fine movements are slow and inflexible. Circles and scissors are awkward. Some still have mirror-like movements. For example, when one hand is doing a certain action, the other hand will involuntarily make similar movements.

2 soft nerve signs

When the child makes some coordinated and fine movements, they often seem awkward and uncoordinated. These positive signs lack the localization and qualitative significance of the nervous system. It may also appear in some normal children and will gradually disappear with age. This is different from the signs of hard nervous system such as paralysis and paralysis, so it is called "soft neurosis". There are 20-30 kinds of soft neurosis . Commonly used are finger-to-nose, hand turning, and finger-to-finger tests. About 67.5% of children with ADHD can be positive for one or two soft neurological signs. It can be used as a diagnostic reference for ADHD.

3 Other anomalies

The incidence of nail biting is high, and finger sucking, stuttering, slurred speech, and enuresis are also common. There are also congenital defects such as low auricles, epiphyseal skin, high arched hard jaw, strabismus, penetrating hands, flat feet, short little fingers, and foot inversion. At this time, attention should be paid to the identification of mental retardation caused by various reasons.

Attention deficit hyperactivity examination

1 EEG

The abnormal rate of EEG in ADHD children is higher than that in normal children, which is mainly manifested by the increase of slow wave, etc. But it does not reflect changes in advanced mental activities such as attention and cognition. It cannot be used as a basis for diagnosis.

2 Brain evoked potential research found that mental activity has a certain regularity on the effect of brain evoked potential late components. When concentration is high, the volatility increases significantly. Otherwise it decreases. Due to inattention in children with ADHD, the difference in this change in amplitude decreases. Can assist in diagnosis.

3 Smart test

Most of the children with ADHD are normal. Some children may be better than normal children on certain items. But because of its learning difficulties and other reasons. Its intelligence level is mostly in the lower limit of the normal range, and some children may have cognitive impairment. Mainly manifested in comprehensive analysis and visual spatial disorientation.

4 Imaging examination

CT and magnetic resonance imaging of the brain revealed some minor abnormal changes in children with ADHD. Such as the right anterior lobe of the brain is slightly smaller than normal children, the right is smaller than the left and so on. However, these changes lack specificity and cannot be used as a basis for diagnosis, which is helpful for differential diagnosis.

Key points in the diagnosis of ADHD

Correct diagnosis depends on a detailed medical history, including information obtained from parents and teachers; physical examination is then performed, and the neurological signs examined have a positive significance in excluding certain neurological diseases; mental state examinations focus on language development, intelligence Check to exclude the corresponding development problems.

Key diagnostic points include:

(1) Onset before 6 years of age, symptoms persist for more than 6 months.

(2) Attention deficits and excessive activity must coexist, and perform prominently in more than one occasion at home, kindergarten, school, or clinic. (3) Impulsivity, reckless behavior, learning difficulties, and conduct problems can exist, but they are not necessary for diagnosis.

(4) The characteristics of both hyperactivity and conduct disorder exist. If hyperactivity is extensive and severe, it is diagnosed as "hyperactivity disorder".

(5) When co-existing with other behavioral disorders, emotional disorders or mental retardation, priority should be given to such diseases, rather than the first diagnosis of ADHD. The fourth edition of the US Manual of Diagnosis and Statistics of Mental Disorders (DSM-IV) divides ADHD into three main subtypes based on the symptoms dimension:

(1) Attention deficit-based (ADHD-I), which is mainly manifested in the difficulty of maintaining concentration, easy distraction, and the beginning and end of things;

(2) Hyperactive-impulsive (ADHD-HI), mainly manifested as excessive activity, noise, etc .;

(3) Mixed type (ADHD-C). Attention deficit symptoms and hyperactive impulses are more prominent. DSM-IV's diagnostic criteria for ADHD has two advantages: one is the ability to type ADHD; the other is the ability to classify the severity of ADHD based on symptoms.

Attention deficit hyperactivity disorder

(LD) Attention deficit hyperactivity disorder with learning disability (LD)

LD refers to a state in which children do not have mental retardation, lack of perceptual deficits and educational deprivation, such as defects in listening, speaking, reading, writing, and calculation. Barkley [4] reported that ADHD has dyslexia from 8% to 39%, dyslexia from 12% to 30%, dyslexia from 12% to 27%, and the total consolidation rate between 30% to 50%, which is significantly higher than normal Children, that is, at least 1 of 3 children with ADHD diagnosed with LD [4, 6]. Neuropsychological studies have found that due to the short duration of ADHD attention, it is difficult to register signals and show short-term memory impairment. At the perceptual level, children with ADHD often have difficulty in tactile discrimination, impaired executive function, and poor working memory and continuous operation. As a result, children with ADHD often lack planned and predictive behaviors, and they seem to have difficulty in learning and interpersonal communication. In many cases, children with ADHD often have better visual abilities than auditory functions [7]. There is also a difference in behavior and intelligence between ADHD and LD. The average intelligence of the combined is lower than normal, while the intelligence of children with ADHD is more normal. ADHD children with LD often have more serious behavioral problems, such as poor behavior, truancy, depression, suicide, drug abuse, absenteeism (work), etc. [4, 8].

Attention deficit hyperactivity disorder with behavioral disorders

The behavioral disorder associated with ADHD is called comorbidity, and about 65% of children with ADHD are associated with one or more comorbidities.

ADHD ADHD with destructive behavior disorder

Includes two subtypes of Oppositional Defiant Disorder (ODD) and Disorder of Conduct (CD). The symptoms of ODD are grouped into 3 categories: (1) defiant and provocative behaviors, such as actively defying or refusing to obey the requirements of adults; Behaviors, such as anger, irritability, irritability, hatred, and revenge; (3) hostility, such as pointing at others when making mistakes [10]. CD refers to repeated and persistent offensive and antisocial sexual behaviors during childhood and adolescence, including theft, running away from home, cruelty to animals, sexual abuse and so on. ODD is the precursor of CD, and CD is also the precursor of antisocial personality disorder in adults.

ADHD ADHD with mood disorders

Mood disorders are also known as affective mental disorders, including depressive disorder (DD) and bipolar disorder. Depression is the core symptom of depression, and the prevalence of ADHD and DD is 15% to 75%. Some children experience depression for several hours a day for several hours in long-term ADHD. During this time, they have unresponsiveness, drowsiness, and difficulty concentrating, resulting in abandoning learning. Bipolar disorder (BPD) is characterized by recurrent or alternating manic and depressive episodes. It can occur in childhood and adolescence, but it is not typical.

ADHD ADHD with mood disorder

Children's emotional disorders (ED) are manifested as inferiority complexes, shyness, social withdrawal, anxiety, crying, allergies, depression, and chronic sadness. Children with ADHD with ED have more fetal problems and developmental delays than those without ED, and have more stressful events in their lives. Parents have higher rates of separation and divorce. ADHD combined with ED has fewer behavioral problems than ADHD alone, but has more attention deficits. ADHD and ED also share common family susceptibility factors and are also affected by environmental factors.

ADHD ADHD with tic disorder

Tic Disorder (TD) refers to sudden, rapid, involuntary, repetitive contraction movements or involuntary vocalization of a certain part of the body's muscles or muscle groups, which can have a short or chronic course. There are more men than women, and there is a certain Genetic predisposition. Hyperactivity and attention deficit symptoms of ADHD usually appear before tics, which are 2 to 3 years earlier than TD's motor tics and vocal tics, and are common in children with severe tics. ADHD and TD overlap with a wide range of behavioral problems. A variety of behavioral problems such as violations of discipline, aggressiveness, and extraversion shown by ADHD + TD may be caused by ADHD [13].

ADHD ADHD with speech impairment

Language developmental disorder (LDD) manifests as delays in speech, difficulty in expressing and / or understanding language, and inarticulation. LDD is similar to ADHD in the pathogenesis, which is mainly related to delayed brain function development and neurological dysfunction. About 50% of children with ADHD are associated with LDD. These problems are not caused by language difficulties, but are more likely to be caused by difficulties in the implementation process. Early language and language correction training can help prevent learning difficulties in the future [12].

Self-assessment of attention deficit hyperactivity disorder

Parents or teachers can use the self-assessment form (derived from the clinical diagnostic standards of the American Psychiatric Association) to observe the child. If the two types of symptoms are combined, if there are 6 or more characteristics, they should seek a professional clinician as soon as possible. Assistance.

Attention symptoms

1. Failure to notice small details or make careless mistakes in school homework, work or other activities.

2. Unable to sustain attention at work or play.

3. I don't seem to listen when talking to others.

4. Unable to complete the tasks explained by the teacher or parents.

5. Lack of organizational ability.

6. Often avoid, dislike or refuse to participate in tasks that require continuous brain power, such as school work or homework.

7. Lost or forgotten what you need for work or play.

8. Easily attracted by external stimuli.

9. It is easy to forget daily routine activities, and adults need to be reminded from time to time.

Overactive or impulsive symptoms

1. I can't sit quietly in my seat, my body twists and turns.

2. Leaving seats frequently in class, unable to sit still.

3. Unsuitable for running, jumping and climbing in classrooms or activities.

4. Can't participate quietly in games and leisure activities.

5. Keep moving (much like a motor).

6. Talking a lot (often speaking continuously without interruption).

7. Answer the questions before they are finished.

8. Can't wait in turns (where you need to wait, you can't wait patiently).

9. Often interrupt or interfere with other people, such as: interrupt or interrupt others' games.

Main manifestations of attention deficit hyperactivity disorder

Distracted:

Not attentive and easily distracted;

often make careless mistakes;

Do not understand or listen to others;

Cannot complete homework, daily housework or work as instructed;

Not willing to do things that require energy concentration (such as homework or housework);

often lose three forget four.

Overactivity:

Keep your hands and feet moving, or wriggle around your seat; (Poor class discipline, often affecting other students)

Running around or climbing up and down at inappropriate times and occasions;

often cannot play or activities quietly;

It is always active at any moment, it seems that a machine is driving him;

There are many regular words.

Poor control force:

Patience is poor and can't wait.

often interrupt or interfere with others.

Unbearable setbacks, intense mood swings and impulsive behaviors.

Without proper treatment, ADHD can lead to an overall decline in quality of life.

Parents of children are often under pressure, feeling depressed and depressed, and marriage is prone to distress; parents and children are often emotionally opposed; sibling brothers and sisters are tense.

Due to the lack of attention, children are unable to develop their own abilities, resulting in poor academic performance; this leads to a vicious circle with inferiority, anxiety, depression or suicide.

Children are more difficult to get along with others, are prone to disputes, and have accidents (either themselves or others).

Children are prone to behavior problems such as lying, theft, and disruption of order. Adolescents may have inappropriate behaviors such as weak bullying; substance abuse, smoking, and even drug use.

In fact, attention deficit hyperactivity disorder is not a child s personality or parental discipline, but a disease that allows its development to cause many adverse consequences. Early treatment can greatly reduce the problems faced by children and parents.

Most ADHD have comorbidities, and ADHD with comorbidities has more severe social impairment than ADHD alone and is more difficult to treat. Common comorbidities are: antagonism, dysfunction, writing, expression, depression, anxiety, dyslexia, etc.

Attention deficit hyperactivity disorder is characterized by "attention":

1. Often unable to pay attention to details, making careless mistakes in homework, work or other activities;

2. It is difficult to maintain concentration in doing things or activities;

3. When others talk to him, they often show that they are not listening;

4. It is often difficult to complete things according to instructions, unable to complete homework, housework or work (not because of opposite behavior or inability to understand instructions);

5. Frequent difficulties with organizational work or planning activities;

6. Frequently evades or dislikes activities or work that require thought;

7. Often forget things (such as books or things needed for work);

8. It is easy to be disturbed;

9. Often forget what to do every day.

Attention deficit hyperactivity disorder is characterized by "overactivity":

1. When sitting, I often feel embarrassed, playing with hands or feet, or constantly twisting my body;

2. Standing up often when you need to sit, or leaving a chair in class;

3. Running around or being overactive in inappropriate situations (if you are a teenager or an adult, you feel restless) 4. It is difficult to play or work quietly;

5. Always can't calm down, always doing something, or moving constantly;

6. Extremely loves speaking.

Attention deficit hyperactivity disorder is characterized by "impulsiveness":

1. Before someone else asks the question, rush to say the answer;

2. Can't wait for his turn;

3. Often interrupts things / conversations in inappropriate situations.

Clinical classification of attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder

1 It is often difficult to focus on details or make careless mistakes in study, work or other activities.

2 Difficulty staying focused while studying, working or playing.

3 When talking to others, they often seem absent-minded and seem non-listening.

4 Do not complete homework, housework, and work tasks as required (not because of resistance or incomprehension).

5 It is often difficult to conceive and plan assignments and work.

6 Often reluctant or avoiding energy-intensive tasks such as classroom or homework.

7 Necessities for learning and activities such as textbooks, homework supplies, and tools are often lost.

8 Often distracted by external stimuli.

9 Very forgetful in everyday life.

ADHD hyperactivity and impulsivity

1 Sitting constantly twisting hands and feet often seems irritable.

2 In the classroom or other situations where you should not walk around, you often leave the seat without permission.

3 It often runs up and down on unsuitable occasions, and it is only a subjective feeling of restlessness among teenagers or adults.

4 It is difficult to participate quietly in games or after-school activities.

5 It is always active, as if driven by a machine.

6 Speeches are often chattering and impulsive.

7 Often rush to answer before the question is asked.

8 It is difficult to wait in line patiently.

9 Often interrupts or interferes with other people's speech and games.

(1) Mixed type

6 conditions in both A and B symptoms.

(2) Distracted type

6 diagnostic conditions for only A and not B symptoms.

(3) Hyperactive Impulse

6 diagnostic conditions in patients with B but not in Category A symptoms.

Identification of disorders of attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder

According to the different occasions where children are hyperactive, the activities that are shown in schools, homes, hospitals, clinics, and other places are called excessive hyperactivity. Symptoms of hyperactivity are only found in the school or home environment. Situational hyperactivity often has socio-psychological factors such as family discord, divorce of parents, death of a loved one, overburdening of learning, crowded classrooms and improper education methods. The onset of time is more extensive and hyperactive late, and there are many problems with character. The therapeutic effect of central stimulants is not as good as that of generalized hyperactivity, and it is necessary to pay attention to the removal of the cause, and the prognosis is worse than that of generalized hyperactivity.

Hyperactivity in children with normal attention deficit hyperactivity disorder

It is more common in preschool boys aged 3-6. Lively and active is the nature of children. Normal children are also often playful, curious, active, naughty, and distracted. Therefore, it is easy to be confused with ADHD, and its behavior characteristics need to be carefully observed for identification.

1 ADHD children are more hyperactive than their age and are termed "hyperactive." In addition to sleeping time, some children have almost no quiet moments. The hyperactivity of normal children is consistent with their age and development, or slightly active.

2 ADHD children's hyperactivity often does not have a clear purpose, and behavior often has beginnings and ends and is disorderly. The hyperactivity of normal children is often driven by a certain motivation and desire to achieve a certain purpose. Therefore, its behavior is complete and systematic. For example, if you can borrow the stationery from classmates and return it in time, you will whisper "Thank you". In order to show their abilities, they often answer the teacher's questions first without raising their hands.

3 The hyperactive symptoms of normal children can be self-constrained and controlled under certain environmental conditions. If they are criticized and educated by parents and teachers, their shortcomings can be corrected in time, and it will take a long time to repeat the crime. However, ADHD children often turn a deaf ear to criticism education and repeatedly teach and repeat crimes, with little effect. Another example is when a foreign school teacher observes and listens to a class, normal children can keep quiet and discipline, and even if they are assigned to "special seats", ADHD children still have to twist their bodies constantly.

4 In addition to hyperactive symptoms, normal children are generally not accompanied by or have impulse willful, emotional and other behavioral abnormalities. ADHD children often have abnormal behaviors such as nail biting, enuresis, lying and even fighting.

Attention deficit hyperactivity disorder mental retardation mental retardation

It is caused by mental and social adaptability, cognitive impairment and other symptoms such as excessive activity, inattention and learning difficulties. It needs to be identified with ADHD. The distinction between moderate and severe MR and ADHD is not difficult, and the clinical need to pay attention to the distinction between ADHD and mild MR.

1 Growth and development history ADHD children's growth and development are mostly normal. Children with MR have a history of language, motor, and sensory developmental delay during growth and development.

2 Learning difficulties The characteristics of learning difficulties in children with ADHD are described in Clinical manifestations. The learning difficulties of MR are mainly caused by cognitive impairment, and their ability to accept and understand and analyze and judge are significantly low. Therefore, despite strict "strenuous" education and help, it is difficult to improve or improve academic performance.

3 Social adaptability ADHD children may be good at social, gaming, shopping, labor, etc. However, children with MR are often accompanied by deficits in social adaptability. They will not be or are not good at interacting with classmates, dull and naive, reckless, and accompanied by language and emotional obstacles. 4 Intelligence test The IQ of children with ADHD is mostly normal, and some of them are low, while the IQ of children with MR is mostly less than 70. 5 Treatment response After taking Ritalin and other psychostimulants, the symptoms of ADHD children improved and their academic performance improved. The symptoms of hyperactivity and inattention in children with MR can be improved. However, it is difficult to improve academic performance in a short time.

ADHD

Children with multiple tics have rapid repetitive movements, arrhythmic movements, and purposeless vocal tics, which can be regarded as "hyperactivity". In addition, they may be accompanied by inattention and impulsive behaviors that are easily mistaken for ADHD. However, the characteristics of tics such as multiple tics, fluctuations and recurrence of seizures, and haloperidol treatment can effectively control symptoms, which are different from ADHD. However, clinical ADHD and multiple tics can co-exist.

ADHD in children with schizophrenia

Children with schizophrenia often have apathy, spontaneous mood swings, thinking disorders, and some children may still have delusions and hallucinations. About 36% -60% of families have a history of mental illness. Therefore, it is not difficult to identify with ADHD.

Attention deficit hyperactivity disorder

ADHD children are susceptible to behavioral disorders due to behavioral problems such as lying, truancy, and fighting. However, the behavioral problems of children with ADHD can effectively control and improve symptoms after psychological behavior correction and drug treatment. However, ADHD and conduct disorders can often coexist. A double diagnosis can be made when a problem of conduct has developed as the main symptom in children with ADHD. About 68% of children with conduct disorders also develop ADHD. And 13.8% of children with ADHD may be associated with a disorder of conduct. ADHD still needs to be distinguished from children with autism, adaptation disorders, and hyperactivity and attention deficits caused by hearing and vision deficits.

Attention deficit hyperactivity disorder prevention

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Schools and teachers should improve teaching and management methods, explore teaching methods suitable for children with ADHD, and enhance the fun and artistry of teaching to attract children's attention. Some countries will arrange some ADHD children to receive special education for 1-2 years, but this is not a "low-energy school" but tries to make their educational environment and methods more suitable for ADHD children. Such as slowing down the teaching process, changing the difficulty of homework, appropriately reducing the amount of homework, students can choose their favorite seats. It is not advisable for children who are not mentally retarded to be transferred to a school with low energy disability.

ADHD Social Skills and Physical Training Program

ADHD children often have interpersonal relationship problems. Encourage them to participate in group activities, make them contact with compassionate partners as much as possible, provide them with a suitable social living environment, and allow children to do something useful and planned Training, games and physical activities that help develop active attention. Such as daily and quantitative daily homework tests, sketches, and suitable physical activities, etc., through these activities, they can enhance their self-control ability, coordinate movement, and initiative attention ability. And help them rebuild their self-esteem. The sensory integration training carried out in recent years also helps to strengthen the self-control ability of ADHD children.

Attention Deficit Drug Therapy

When the symptoms of ADHD children are obvious, leading to a decline in children's learning difficulties, or obvious behavioral abnormalities, medication should be given at the same time as psychological and behavioral correction. There are several types of drugs currently used to treat ADHD.

1 psychostimulants

(1) Methylphenidate (Ritalin)

Its mechanism of action may be to promote the release of neurotransmitters, block the recovery of catecholamine neurotransmitters, and thereby strengthen the exciting process of the cerebral cortex. Each tablet of methylphenidate is 10 mg, which is quickly absorbed within 20 minutes after oral administration, and the blood concentration reaches a peak within 1-2 hours, and the effective blood concentration is 7-10 mg / ml. The half-life is 6h. More than 70% are metabolically degraded or excreted within 24 hours without accumulation or addiction. The commonly used dose is 0.1-0.6mg / kg each time, and it can also be administered by age. It is calculated based on the primary school student's weight of 20-30kg. Children 7 years old, take 5mg at the beginning of breakfast, and increase to 10mg / time after 1 week. If the effect is not obvious, it can be increased by 5mg every week until it is effective. The effective dose varies from person to person, the maximum amount should not exceed 20mg each time, and the total daily amount should not exceed 30mg. Medication alone can be taken at half the amount in the morning. Senior students can take an extra half at noon at 3pm if necessary. It is helpful for completing homework, and medicine should not be taken after 3 pm to avoid affecting sleep. Large doses should be avoided for long periods of time. Common side effects are loss of appetite, dizziness, insomnia, palpitations, and abdominal pain. Continuous medication can be tolerated. In severe cases, it can disappear after reduction or withdrawal. In order to reduce the occurrence of side effects and drug resistance, the drug is discontinued when not studying on weekends, winter and summer vacations, and holidays. Pre-school children and older children after puberty do not require medicine in principle. Children with epilepsy, hypertension, and heart disease should be used with caution or disabled.

(2) Phenoxazole (Pemoline)

The drug can improve symptoms such as inattention and insufficient self-control in children. Can be switched to phenytoin when methylphenidate is not effective. Or combined with methylphenidate. Each tablet has a dose of 20mg and a long half-life of 12h, so the effective blood concentration can be maintained for 8-12h. Only one dose per day is needed to avoid the trouble of bringing the medicine to the school uniform. The starting dose is 10 mg at breakfast, and the effect can be increased to 20 mg after one week. The drug is used once a day, and the maximum dose does not exceed 60 mg. Both drugs should be reduced when combined with Ritalin. The effect of this medicine is slow, and the effect will not appear until 1-2 weeks after taking the medicine. Side effects are milder than that of Ritalin, and those with liver and kidney dysfunction should be used with caution or disabled.

(3) Amphetamine

It is the earliest drug for treating ADHD, and its effect is similar to that of Ritalin. The effect of the drug is longer than that of Ritalin and shorter than that of Pimorin. Due to the obvious side effects of the drug, it has been replaced by the previous two drugs.

Receptor agonist

(1) Clonidine

Originally a drug for the treatment of hypertension. However, it was found to be effective for ADHD, and combination with Ritalin was more suitable for treating refractory ADHD and children with ADHD with tics. The initial dose is 0.05mg / d (half tablet), and then slowly increase the dose to 0.15-0.3mg per day, divided into 3 doses. May have side effects such as hypotension, drowsiness, dizziness, and abdominal pain. Blood pressure needs to be monitored regularly. Long-term medication should not be stopped suddenly to prevent blood pressure from rebounding.

(2) Tricyclic antidepressants

These drugs are imipramine and desipramine. Imipramine is suitable for children with ADHD who have anxiety and depression. The dose is 12.5mg each morning and evening. If the effect is not obvious, it can be gradually increased to 25mg each morning and evening. The total daily dose should not exceed 50mg. Side effects include drowsiness, dry mouth, dizziness, constipation, and tremor. Normipramine has a longer half-life and longer duration than imipramine. The side effects of the two drugs in older children and adults are relatively safer than in children. Children should be cautious because they are prone to cardiovascular side effects. The antidepressant fluoxetine (Nuoxetine) can also be used in older children with symptoms of depression and anxiety.

(3) Other

Newly developed drugs, such as bupropion and notriptyline, also have some effects in treating ADHD. However, the observation time is still short, and further clinical experience is needed.

ADHD Exercise Therapy

The children's guide program is directed at the root cause of learning difficulties-stunting of the cerebellum, and the automatic mechanism of stimulating the cerebellum with exercise to improve the efficiency of brain management of specific areas such as reading, writing, attention, and movement coordination. There will be no regression. This possibility of changes in the physiological characteristics of the brain is called "neuroplasticity of the brain."

Prognosis of attention deficit hyperactivity disorder

The prognosis of ADHD is related to the severity of the disease, whether the treatment is timely and effective, and whether various possible pathogenic factors persist. Most children with ADHD have milder symptoms, increase with age after treatment, increase self-control, and can behave normally in adulthood, or they may show signs of inattention, impulsivity, stubbornness, social adaptability and poor interpersonal relationships. While untreated children with ADHD have improved with age and have no purposeful hyperactivity symptoms, they can still have inattention, low academic performance, impulsiveness, substance abuse, and even behavioral disorders, juvenile delinquency. Therefore, it is believed that the symptoms of ADHD children will disappear naturally with age, and the practice of not treating actively is very detrimental to the prognosis of this disease. It is worth mentioning that we should not only focus on the negative impact of ADHD on children's learning. Due to their vigorous energy and active personality, ADHD patients are more suitable for careers such as sales, software design, stock management, and stylistic arts. This is their advantage.

ADHD is a chronic process with symptoms that persist for many years, and may persist for life. About 70% of children's symptoms will last until adolescence, and 30% of children's symptoms will last for life. What's more, because childhood neglect can cause adults to have troubles in their work performance, daily life, or interpersonal interactions, so that they fall into lack of self-confidence, frustration, depression, unexplained grumpy, and even depression. . In addition, the risk of secondary or comorbid destructive behavior disorder and emotional disorder is also increased, and the risk of adult substance dependence, anti-social personality disorder, and crime may also increase.