The main clinical manifestations of attention deficit hyperactivity disorder (ADHD) are obvious lack of concentration and short duration of
The main clinical manifestations of attention deficit hyperactivity disorder (ADHD) are obvious lack of concentration and short duration of attention, hyperactivity and impulsivity.
Domestic survey found that the prevalence rate was 1.5%, and the prevalence rate of school-age children in foreign countries was from 3% to 5%, and that of male was more than female, and the sex ratio was 4:1 ~ 9:1 (). Recent epidemiological studies have shown that the prevalence rate is 10% in the primary school students, and the female is about 5%.
(two) etiology and pathogenesis
The etiology and pathogenesis of this disease is not clear, it is considered to be caused by a variety of factors. The related factors are as follows:
1 genetic disease has familial aggregation.
2 neurotransmitters have been proposed in recent years, dopamine, norepinephrine and serotonin (5 - HT) hypothesis. The function of dopamine and norepinephrine in the blood and urine of patients was 5 - HT hyperfunction.
3 neuroanatomical and neurophysiological magnetic resonance imaging revealed abnormalities in frontal lobe development and asymmetry of bilateral caudate nucleus. Positron emission tomography (CT) study showed that the perfusion of the premotor and prefrontal cortex decreased, and the metabolic rate was decreased, which was related to the control of attention and movement. EEG showed slow wave increase, fast decrease in the frontal leads the most obvious.
4 patients with abnormal development had many complications, such as maternal or perinatal complications.
5 family and social psychological factors of parents relationship, family breakdown, improper parenting, parents bad character, mother suffering from depression or hysteria or substance addiction, family economic difficulties, housing problems, separation with parents, childhood abuse, cause the improper of school education and bad environment and other adverse factors as predisposing factors or symptoms persist. In addition, some patients were found to have elevated blood lead levels, lower serum zinc levels, but higher zinc levels in their hair.
(three) clinical manifestations
1 attention deficit disorder is the most important symptom. Performance in lectures, homework or other activities, attention is difficult to endure, easily distracted by external stimuli, or often from one activity to another activity. Patients in the event can not pay attention to details, often because of careless mistakes. Absent in conversation with an adult, as if to listen. Often avoid or do not want to take a long time to focus on the tasks, such as classroom assignments or homework, can not be completed on time or other tasks assigned. Patients usually easily absent-minded, often lost toys, appliances or other belongings, forget the daily activities.
2 too many activities and impulse patients often seem very quiet, small foot action, sitting to squirm, without leaving the seat in the classroom or other quiet places, running around or climbing, to engage in quiet activities or games, seemed especially vigorous. In the absence of action before the lack of thinking, regardless of the consequences, with a temporary interest in acting, for this reason often with a partner to fight or dispute, resulting in adverse consequences. Speak more on any occasion, interrupt or interrupt a conversation when someone is talking, the teacher in question has not yet been finished when they get the first answer, will jump to disrupt the companion game, or not queuing patiently. Emotional instability, easy to over excited, but also prone to frustration and emotional depression or resistance and aggressive behavior. Requirements must be met immediately, otherwise the crying, tantrums.
3 learning difficulties, because the attention deficit and hyperactivity affect the patient in the classroom listening effect, the speed and quality of the completion of the work, resulting in poor academic performance, lower than their intelligence should be achieved academic performance.
4 patients with abnormal development of nervous and mental development, such as fine movement, coordinated movement, spatial location, and so on. Such as hand, turn to finger motion and shoelaces and buttons are not flexible, so it is difficult to distinguish. A small number of patients with language development delay, poor language skills, mental retardation and other issues. The intelligence test showed that some patients had low IQ, verbal IQ was higher than that of IQ, and the score was lower.
5 conduct disorder, attention deficit hyperactivity disorder and conduct disorder comorbidity rate as high as 30%~50%. Conduct disorder showed aggressive behavior, such as beatings, abuse, assault, abuse and destruction of goods, animal, sexual assault, robbery, or is not consistent with the moral standards and social norms, such as lying, truancy, wandering, arson, theft, fraud, sexual indecency etc..
(four) course of disease and prognosis
Nearly half of the patients had an onset before the age of 4, but many of the patients had difficulty in learning because of a lack of attention after entering elementary school, or because of serious behavioral problems. About 30% of the patients in puberty symptoms gradually disappear, but most patients will continue into adolescence, adulthood at 40% to 50% of patients still have clinical symptoms, 20%~30% patients not only have clinical symptoms, with antisocial behavior, substance abuse, alcohol dependence and other issues. The factors that lead to poor prognosis include the combination of conduct disorder, reading difficulties, emotional disorders, bad family and social psychological factors, low intelligence and so on.
Children begin to pay attention to defects and activity was too much trouble all these clinical manifestations in schools, families and other occasions in the past 7 years, lasting more than 6 months, the social function (such as learning achievement, interpersonal relationship etc.) produce adverse effects, can be diagnosed with adhd. Learning disabilities, neurological and mental disorders and other clinical manifestations are not the basis for diagnosis, but help to clarify the diagnosis. If the patient is accompanied by clinical manifestations of conduct disorder, and to achieve the degree of diagnosis of behavioral disorders, the diagnosis of attention deficit hyperactivity disorder and conduct disorder.
(six) differential diagnosis
1 patients with mental retardation is associated with attention deficit and hyperactivity, patients with mild mental retardation in primary school at the beginning, before clear mental retardation diagnosis, can easily be mistaken for adhd. However, attention deficit and hyperactivity disorder patients through treatment, attention to improvement, academic performance can be improved to achieve the same level of intelligence. The mental retardation of academic achievement is always consistent with the level of intelligence, but also the language and motor retardation, judgment ability, understanding ability and social adaptability are generally low.
2, conduct disorder
3 children with emotional disorder in anxiety, depression or manic cases will show too much activity, inattention. Attention deficit hyperactivity disorder (ADHD) may also be subject to criticism from teachers and parents, or anxiety and depression due to lack of satisfaction. The area of the two is the first and main symptoms of patients with mood disorders is emotional problems, the onset of the disease duration, shorter duration. Attention deficit hyperactivity disorder (ADHD) is characterized by long-term persistent attention deficit and hyperactivity.
4 patients with tic disorder mainly for tic head and face, limbs or trunk muscles are fast, short, irregular, such as wink, shrug, crooked neck, waved, pedal foot and twist, can also be accompanied by involuntary vocal tics, may be mistaken for hyperactivity or naughty. It is easy to find out the characteristics of tic symptoms by careful mental examination, and it can be distinguished from attention deficit and hyperactivity disorder. However, attention should be paid to about 20% of patients with tic disorder and attention deficit hyperactivity disorder.
5 schizophrenia in early schizophrenia patients may exhibit does not abide by the school discipline, hyperactivity, inattention, class grades, easily confused with adhd. But the symptoms of schizophrenia will gradually appear schizophrenia, such as hallucinations, delusions, apathy, introversion, strange behavior, but not attention deficit hyperactivity disorder symptoms, according to phase identification.
6 autistic children with autism were mostly accompanied by hyperactivity, impulsivity and attention deficit disorder. However, autistic patients also show difficulties in interpersonal communication and communication, speech disorders, interests and activities, such as the limitations of the content, which is associated with attention deficit and hyperactivity disorder.
According to the characteristics of patients and their families to develop a comprehensive treatment plan. Drug treatment can alleviate some of the symptoms in the short term, and a series of adverse effects to the patients and their families is more dependent on non drug treatment.
1 there are mainly two kinds of psychotherapy: behavior therapy and cognitive behavior therapy. Patients often lack adequate social skills, such as how to initiate, maintain and end the process of communication between people, poor peer relationship, offensive language and behavior of others, poor self-control etc.. Behavioral therapy using the principle of operant conditioning in a timely manner to be positive or negative reinforcement on the behavior of the patients, so that patients learn proper social skills, with new and effective behavior to replace inappropriate behavior patterns. Cognitive behavioral therapy mainly solves the problem of impulsive patients, the main contents are: let the patient learn how to solve the problems, bring their own behavior to pre estimate the consequences of impulsive behavior restrain their own behavior, to identify whether it is appropriate to choose the appropriate behavior. Forms of psychotherapy are treated individually or in groups. Group therapy is more beneficial for patients to learn appropriate social skills.
2 special education patients should be included in the object of special education. Teachers should carry out education according to the characteristics of patients, avoid discrimination, corporal punishment or other rude education methods, the proper use of praise and encouragement ways to enhance the patient's self-confidence and consciousness, through language activities, or interruption of the bad behavior of patients with negative, the curriculum should be considered to provide patients with sufficient time.
3 drug therapy can improve the attention deficit, reduce the level of activity, to a certain extent, improve academic performance, improve the relationship between patients and family members in the short term.
Under the guidance of a doctor with a small dose of central stimulants, small doses of antidepressants, small doses of antipsychotic drugs, brain cell function rehabilitation drugs.
4 education and training for parents is suitable for patients with behavioral disorders or other psychological problems, parents do not agree to accept medication or inappropriate parental education. Education and training can take the form of a single family or group, is the main content: to provide a good supporting environment for parents, let them learn how to solve the family problem skills, learn together with the child to develop a clear incentive agreement, effectively avoid the contradictions and conflicts between children and the correct use of positive reinforcement to encourage good behavior the child, use punishment to eliminate child's bad behavior.
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