What is ADHD?

ADHD in children, also known as attention deficit hyperactivity disorder (ADHD). Is a common child behavioral abnormalities. These children have normal or near-normal intelligence, but have deficiencies in learning, behaviors, and emotions. They are mainly characterized by difficulty in concentrating attention, narrowing attention span, short attention span, and activities regardless of occasion. Excessive, emotional and impulsive, and often accompanied by cognitive impairment and learning difficulties. It develops pre-school and is a chronic process. The disease not only affects children's school, family and off-campus life, but also easily leads to persistent learning difficulties, behavioral problems and low self-esteem in children, and it is difficult for such children to get along with each other at home and school. Without timely treatment, some children will still have symptoms after adulthood, which will obviously affect their academic, physical and mental health, and family life and social ability in adulthood. Investigations at home and abroad have found that the prevalence of the disease is 3% to 10%, and the male to female ratio is 4 to 9: 1. Premature children suffer from this disease more.

Basic Information

nickname

Attention deficit hyperactivity disorder

English name

hyperkinetic syndrome of childhood

English alias

minimal brain dysfunction

Visiting department

Pediatrics

Multiple groups

child

Common causes

Genetic, neurological factors; environmental factors; social, family, psychological factors

Common symptoms

Disproportionate attention disproportionate to age, reduced attention span, excessive activity regardless of occasion, emotional impulses with cognitive impairment and learning difficulties

Causes of ADHD in children

The etiology of this disease is unknown so far, and it is currently thought that it is caused by the interaction of multiple factors.

1. Genetic and neural factors

(1) Genetic factors Parents with ADHD and family history of mental and behavioral disorders ADHD children have a history of ADHD in childhood. The prevalence of siblings of ADHD children is 3 times higher than that of the control group, and emotional psychosis is also more common . In addition, fathers of children with ADHD have antisocial personality traits or alcohol dependence, and mothers have more rickets. Adult relatives of hyperactive children with a disorder of conduct have personality disorders, higher rates of alcohol addiction and rickets. Research on adoptive children The anti-social personality, alcohol dependence and rickets of the biological parents of ADHD children are significantly higher than those of the healthy parents or the children of the control group. The parents have a history of hyperactivity and disorder in childhood, and there are more mental disorders . Study of twins The incidence of ADHD in monozygotic twins is higher than that of twins, and the incidence of siblings is about five times that of half-siblings. Research on heritability Heritability of hyperactivity is 0.75, and heritability of attention deficit is 0.76. Molecular genetics studies indicate that ADHD is related to polymorphisms in dopamine genes (D2, D4 receptor genes, etc.).

(2) Neurotransmitter Neurochemical and psychopharmacological studies have found that neurochemical transmitter imbalances in the brain, such as low blood and urine dopamine and norepinephrine function, and 5-HT function decline. Some scholars have proposed the dopamine, norepinephrine, and serotonin (5-HT) hypotheses of ADHD, but no hypothesis can fully explain the cause and mechanism of ADHD.

(3) Neuroanatomy and neurophysiological PET show that children with ADHD have lower brain function than normal children, especially in the forehead area. MRI revealed abnormalities in the corpus callosum and caudate nucleus. The abnormalities in the corpus callosum were mainly anterior, posterior, or both. Functional MRI revealed changes in the metabolism of the caudate nucleus, frontal zone, and anterior cingulate gyrus in ADHD patients, mainly due to reduced metabolism.

2. Environmental factors

Including prenatal, perinatal and postnatal factors. Among the risk factors related to pregnancy and childbirth include smoking and drinking in mothers with ADHD, premature delivery of the child, postpartum ischemic hypoxic encephalopathy, and thyroid dysfunction. Childhood diseases associated with ADHD include viral infections, meningitis, encephalitis, head injuries, epilepsy, toxins and drugs. More controversial factors include malnutrition, diet-related sensitization reactions, excessive consumption of beverages or foods containing food additives, iron deficiency in children, increased blood lead levels, and lower blood zinc levels, which are related to the occurrence of ADHD, However, the evidence is insufficient.

3. Social, family, psychological factors

Such as poor social environment or family conditions (parental disagreement, family breakdown, improper parenting styles, childhood separation from parents, abuse, economic poverty, overcrowded housing, poor parental personality, alcohol, drug abuse, mental illness, school education methods Improper factors, such as improper factors), can become the inducement of disease, and affect the development and prognosis of the disease course.

Clinical manifestations of ADHD in children

The symptoms of ADHD are diverse and often vary depending on age, environment, and attitudes towards others.

1. Excessive activity

Most of them begin in early childhood and are more pronounced after entering elementary school. Some children start to be overactive during infancy, appearing to be particularly active, crawling out of the cradle or cart, and often start running instead of walking. The child is a little older, and after reading a few pages of the villain's book, change to a new one, or simply tore the book; sometimes turning the box over and over, messing up. After starting school, children often have no hands and feet. There are many small movements in class. You can't sit quietly and twist around the seat. There are too many words, running around, jumping around, climbing up and down, and I don't know the danger. Likes to provoke people, often quarrels with classmates and so on.

2. Attention difficulty concentration

It is manifested that the difficulty of concentration and the short duration of attention are not suitable for the age, which are the core symptoms of this disease. Patients often have difficulty paying attention during lectures, homework or other activities, and are easily distracted by external stimuli. Details can not be noticed during learning or activities, often mistakes are made due to carelessness. Pay attention to maintenance difficulties, often deliberately avoiding or unwilling to perform tasks that require a longer period of concentration, such as classroom work or homework. Procrastination can not complete assignments or assigned tasks on time. Patients are prone to lose things, and often lose toys, learning tools, forget daily activities, and even forget homework assigned by teachers.

3. Emotional instability, impulse

Children have poor self-control, emotional instability, irritability, irritability, crying, impulse, and often lose their temper. Stubborn personality, stubbornness, irritability, naivety, lack of honor, right and wrong, some lying, truancy, deceit, some going out of business, or even getting into bad habits. Act quickly when there is insufficient information. Doing things irrespective of the consequences, acting on the basis of temporary interests, for this reason often fights or disputes with companions, resulting in adverse consequences. Intervening or interrupting other people's conversation while others are talking, can't wait to answer before the teacher's question is finished, and can't wait patiently in line.

Attention deficits, excessive activity, and behavioral impulses are core symptoms of ADHD and have diagnostic value.

4. Learning difficulties

Although the children were normal in intelligence, they all showed learning difficulties, poor memory discrimination, often writing "b" as "d" or "6" as "9", etc., and their academic performance was low. Some have good intelligence, but their academic performance is not ideal, showing up and down, performance fluctuating greatly, and the performance changes like a springboard. Grasping the results as soon as you catch them, dropping without catching them, and even causing repetition.

5. Nervous system development abnormalities

The patient's fine movements, coordinated movements, and spatial position perception were poorly developed. Such as turning hands, finger movements, tying shoelaces and buttons are inconvenient, it is difficult to distinguish left and right. A few patients have problems with delayed language development, poor language expression ability, and low intelligence.

6. Disorders of conduct

The comorbidity rate of attention deficit hyperactivity disorder and conduct disorder is as high as 30% to 58%. Disorders of conduct are manifested as offensive behaviors, such as abusive, hurting classmates, destroying objects, torturing others and animals, sexual assault, robbery, etc., or behaviors that do not conform to ethical and social norms, such as lying, truancy, running away from home, Arson, stealing, etc.

7. Adult ADHD

Regardless of whether children with ADHD are treated or not, 60% to 70% of them still have symptoms in adults, and some of them can reach adult ADHD diagnostic criteria. The clinical manifestations of ADHD in adults are different from ADHD in children. The main manifestation is "attention deficit", and "excessive activity" will decrease. Patients are impulsive, act recklessly, easily conflict with colleagues, change jobs frequently due to impulses, drive impulsively, and fail to follow traffic rules to cause traffic accidents. Symptom evaluation in adults with ADHD generally requires assistance to a patient, such as a spouse, parent, colleague, or supervisor.

ADHD in children

Some children have abnormal EEG and brain evoked potentials, but they have no specific diagnostic significance.

ADHD in children

At present, it is still mainly based on the medical history, clinical manifestations, physical examination and mental examination provided by the parents and teachers of the children.

1. Symptom criteria and classification Compared with most children of the same age and gender, the following symptoms are more common:

Group A symptoms

(1) often fail to pay close attention to details, and careless mistakes in homework or other activities;

(2) Often unable to maintain focus when completing tasks or playing games, often beginning and ending;

(3) People often don't seem to listen to him when they speak to him;

(4) Often unable to follow the instructions all the time (not due to defiant behavior or failure to understand) and unable to complete homework on time;

(5) It is often difficult to arrange daily study and life;

(6) often avoids or extremely dislikes homework;

(7) Often lose necessities, such as workbooks, books, pens, toys, etc .;

(8) Easily attracted by external stimuli;

(9) Often forget things (such as throwing away at school and forgetting the assigned tasks).

Group B symptoms

(1) Often move hands or feet or twist in the sitting position. (Older children or adolescents are limited to subjectively feeling uneasy);

(2) Frequently leave the seat (including doing homework at home, etc.) in the classroom or other places that need to be seated;

(3) Running around and crawling in some places that shouldn't be moved (youth may only show the feeling of being unable to sit on subjectively)

(4) Difficult to play quietly;

(5) Frequently busy or driven like an engine;

(6) often talk too much, endless talking;

(7) often rush to answer before the question is finished;

(8) Can't wait patiently for his turn in the game or group activities;

(9) Interrupting or forcing others to accept him often (for example, inserting conversations or games).

Classification: mixed type of attention deficit symptoms and hyperactivity-impulsive symptoms are 6; attention deficiency-based type only pay attention to symptoms of symptoms 6; hyperactivity-based type only hyperactivity-impulsive symptoms 6 Entrants.

2. Course standard

It usually starts before the age of 7 and lasts for more than 6 months.

3. Exclusion criteria

Not due to generalized developmental disorders, mental retardation, childhood mental disorders, or organic mental disorders. Caused by neuropsychiatric diseases and drug side effects.

4. Severity classification

(1) Mild symptoms meet or slightly exceed the diagnostic criteria, with little or no impairment of school and social functioning.

(2) Moderate symptoms and damage are between mild and severe.

(3) Severe symptoms beyond the diagnostic criteria are many, and there is a significant and widespread impairment of the social functioning of schools, families, and partnerships.

ADHD in children

Develop comprehensive intervention programs based on the characteristics of patients and their families. Drug treatment can alleviate some symptoms in a short period of time, and a series of adverse effects of the disease on patients and their families rely more on non-drug treatment methods.

Cognitive behavioral therapy

Effective for controlling hyperactivity, impulsive control, and aggressive behavior. There are two main types of behavioral therapy and cognitive behavioral therapy. Behavioral therapy uses the principle of operational conditioning to strengthen patients' positive or negative behaviors in a timely manner, so that patients learn appropriate social skills and replace inappropriate behavioral patterns with new and effective behaviors. Cognitive-behavioral therapy mainly solves impulsive problems of patients, allows patients to learn how to solve problems, recognizes whether their behavior is appropriate, and chooses the appropriate behavior mode.

2. Drug treatment

Drugs can improve attention deficits, reduce activity levels, improve academic performance to a certain extent, and improve the relationship between patients and family members in the short term.

(1) Central stimulants are mainly methylphenidate, dexamphetamine, methamphetamine, and pimoline. Low doses of methylphenidate can help improve attention, and high doses can improve hyperactivity, impulsivity, and reduce behavior problems. Central stimulants are restricted to patients over 6 years of age. Due to the central excitatory effect, it should not be used at night. Side effects of the drug include decreased appetite, insomnia, headache, irritability, and irritability. It is not yet determined whether it affects growth and development. Central stimulants may induce or exacerbate tics in patients and are not recommended for patients with tics. Substance abuse must also be considered when using central stimulants for long periods of time.

(2) Tricyclic antidepressants mainly include imipramine, chlorpromazine, and amitriptyline, which can be started in small doses and gradually increased to an effective dose and switched to maintenance treatment.

(3) Selective norepinephrine reuptake inhibitor , tomoxetine, which is equivalent to methylphenidate, has few adverse reactions, and is well tolerated. It has been listed as a first-line treatment for ADHD. . Features: once a day, the effect can last for 24 hours; long-term use, no addiction; the onset time of the drug is slower than the central stimulant, generally only after 1 to 2 weeks after starting the drug, the effect is not applicable Patients with ADHD who need acute treatment. The most common adverse reaction is a gastrointestinal reaction that requires medication after a meal.

3. Behavior Management and Education

Teachers and parents need to conduct effective behavior management and psychological education according to the characteristics of patients, avoid discrimination, corporal punishment or other crude education methods, and use praise and encouragement methods to improve patients' self-confidence and consciousness. When the parents and school of a child with ADHD determine that the child's condition or behavior has affected the child's ability to participate in learning, the child can receive intervention at school. The child's seat can be arranged near the teacher to reduce the child's distraction during class. The course should be arranged in consideration of giving the patient sufficient activity time.

4. Education and training for parents

It is suitable for patients with a disorder of conduct or other psychological problems, parents who do not agree with medications, or improper parental education. Education and training can take the form of a single family or group. The main contents are: provide a good supportive environment for parents, let them learn skills to solve family problems, learn to work with children to formulate clear reward and punishment agreements, and effectively avoid Contradictions and conflicts, master the correct use of positive reinforcement to encourage children's good behavior, and use punishment to eliminate children's bad behavior.

5. Social skills training

Under conditions that allow children with ADHD to have more contact with sympathetic partners, such as joining certain sports teams, they are not only required to complete certain sports, but provide an environment for social activities for children with ADHD .

6. Physical training programs

It is an individual movement that can guide them to control impulsive and aggressive behaviors, make them follow the guidance, and enhance self-esteem and self-confidence. Including boxing, judo, weightlifting, fitness, track and field, swimming, tennis and other items, the team assessment method is not used.

7. Other treatments

For example, some children are effective in the selective removal of additives in food; some are effective in small amounts of coffee; children with allergic ADHD have a better effect when combined with anti-allergic drugs; and it is helpful for vocational counseling and training of older children. EEG biofeedback treatment has also been reported to be satisfactory.

Childhood ADHD Prognosis

Without treatment for children with ADHD, the prognosis is mostly poor, and some of the symptoms in more than half of children with ADHD, such as inattention and impulse, last long. In terms of learning, it is somewhat difficult to complete compulsory education, resulting in a decline in academic performance. In terms of personality, he often balances his mentality with lying, bragging, strange actions, and confrontation. When they are adults, they are not highly educated, lack skills, are not serious about study and work, willful impulses, bad interpersonal relationships, and have some bad habits that are difficult to adapt to society and are not welcomed by society. They cannot become a useful person. Personality Twisted, easy to go astray.

ADHD prevention in children

Early prenatal identification of the environmental factors that cause the cause of ADHD, necessary laboratory tests, and then prevention and treatment. Early screening of children with ADHD in kindergarten and elementary schools, strengthening the promotion and training of ADHD-related knowledge in key groups of communities and school teams, improving the early recognition of ADHD symptoms by parents, teachers, and primary care doctors, and early diagnosis and treatment of patients Improve the early recognition and diagnosis of ADHD, and reduce the harm of the disease to itself, family and society.