What Are the Benefits of Cognitive Behavioral Therapy for ADHD?

Attention deficit hyperactivity disorder (ADHD) is called ADHD in China, and it is a common psychological disorder in childhood. It is manifested as inattention and short attention span, excessive activity, and impulsivity that are not commensurate with age and developmental level, often accompanied by learning difficulties, conduct disorders, and maladjustment. Investigations at home and abroad found that the prevalence was 3% to 7%, and the male to female ratio was 4 to 9: 1. Some children still have symptoms after adulthood, which obviously affects their academic, physical and mental health, and family life and social ability in adulthood.

Basic Information

nickname

Attention deficit disorder with ADHD and ADHD

English name

attention deficit hyperactivity disorder, ADHD

English alias

Attention Deficit Disorder with Hyperactivity

Visiting department

Department of Psychological Medicine

Multiple groups

child

Common causes

Genetics, imbalance of neurochemical transmitters in the brain, abnormal development of the frontal lobe, prenatal, perinatal and postnatal factors, family, social and psychological factors, etc.

Common symptoms

Attention deficits, excessive activity, behavioral impulses, learning difficulties, abnormal nervous system development, and behavioral disorders

Causes of attention deficit hyperactivity disorder

The etiology and pathogenesis of this disease are unclear and are currently thought to be caused by the interaction of multiple factors.

Heredity

Pedigree studies, twins and fosters support genetic factors as an important cause of ADHD, with an average heritability of about 76%.

2. Neurotransmitters

Neurobiochemical and psychopharmacological studies have found that neurochemical transmitter imbalances in the brain, such as patients with low levels of dopamine and norepinephrine in blood and urine, and reduced 5-HT function. 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 Neurophysiology

Structural magnetic resonance imaging (MRI) revealed abnormalities in the frontal lobe and asymmetry of the bilateral caudate nucleus. Functional MRI also found defects in brain function in patients with ADHD, such as hypofrontal function, and abnormal activation of functions in the frontal lobe, especially the prefrontal lobe, basal ganglia, anterior cingulate cortex, and cerebellum.

4. 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, elevated blood lead levels, and decreased blood zinc levels associated with ADHD, but The evidence is insufficient.

5. Family and psychosocial factors

Parental disagreement, family breakdown, improper parenting style, poor parental personality, mother suffering depression, impulsive, anti-social behavior or material addiction to father, family financial difficulties, overcrowded housing, childhood separation from parents, abuse, school Adverse factors such as improper education methods may be the cause of the onset of the disease or the persistent symptoms.

Clinical manifestations of attention deficit hyperactivity disorder

Pay attention to defects

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.

2. Too much activity

It is manifested that patients often feel restless, have small hands and feet, and cannot sit quietly, twisting around in the seat. Leaving your seat without permission in the classroom or other quiet places, running around or climbing. Difficult to engage in quiet activities or games, busy all day.

3. Behavioural impulses

Act quickly when there is insufficient information. Acting impulsively, doing things regardless of the consequences, acting on the basis of temporary interests, often fighting or disputes with peers, 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

Attention disorders and hyperactivity affect the patient's attendance in the classroom, the speed and quality of homework, resulting in poor academic performance, which is often lower than what his intelligence should achieve.

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.

Attention deficit hyperactivity disorder treatment

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.

In terms of treatment, a comprehensive intervention plan is formulated based on the characteristics of the patient and his family. 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.

Psychotherapy

There are two main types of behavioral therapy and cognitive behavioral therapy. Patients have poor peer relationships, aggressive language and behavior towards others, and poor self-control. 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 First-line treatment drugs. At present, mainly domestic methylphenidate and its controlled-release tablets.

Methylphenidate, trade name Ritalin. Low doses help improve concentration, 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 tic symptoms in patients, and comorbid tic disorders are not recommended. Substance abuse must also be considered when using central stimulants for long periods of time.

(2) Selective norepinephrine reuptake inhibitor , tomoxetine, which is equivalent to methylphenidate, has few adverse reactions, and is well tolerated. . 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.