OBJECTIVE: To explore a new model of combining medical rehabilitation in hospital with educational rehabilitation in school and family rehabilitation. Methods Inter-related professionals were organized to evaluate and observe 57 children with ADHD, and a comprehensive rehabilitation program including medical rehabilitation, educational rehabilitation, family rehabilitation, and daily dietary considerations was developed and implemented. Results Most of the children who received rehabilitation treatment showed a significant reduction in hyperactivity index, as well as a significant improvement in attention and academic performance, and showed more cooperation in medical rehabilitation. Conclusion The combination of in-hospital medical rehabilitation with in-school educational rehabilitation and family rehabilitation is a new model and effective method for treating ADHD in children.
ADHD in children, also known as juvenile hyperactivity disorder, mild brain dysfunction, and attention deficit disorder, is a behavioral disorder characterized by age-inappropriate hyperactivity, inattention, capriciousness, and impulsivity, with basically normal intelligence, but with learning difficulties, uncoordinated motor functions, and psychological abnormalities. The prevalence is 3% to 10%, with boys more than three times that of girls, and the incidence of boys is significantly higher than that of girls. One of the reasons for this may be related to the fact that boys are more prone to impulsive and aggressive behaviors and are more likely to be accompanied by behavioral problems, which are more noticed.
1. Data and methods
(1) Clinical data: A total of 57 cases were observed, which were outpatients and inpatients of our pediatric encephalopathy rehabilitation department from February 2010 to June 2012. Among them, 42 cases were boys and 15 cases were girls, with a male to female ratio of 2.8:1; the youngest was 3 years old and the oldest was 14 years old; 36 cases were of preschool age and 21 cases were of school age; the duration of the disease ranged from 6 months to 3 years; 28 cases were accompanied by EEG abnormalities and 37 were accompanied by cerebral blood supply deficiency.
(2) Diagnosis and inclusion criteria: refer to the diagnostic criteria of ADHD in children in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) of the American Psychiatric Association.
(3) Exclusion criteria.
(1) Other disorders affecting hyperactivity in children;
(2) Those who did not follow the treatment protocol;
(3) Those who have not completed 3 months of treatment.
(4) Method: 3 months of treatment using a combination of medical rehabilitation such as acupuncture, auricular acupuncture, sensory integration and guided education, combined with school (kindergarten, primary and secondary school) education and family rehabilitation.
(5) Criteria for determining the efficacy The efficacy was evaluated by referring to the clinical efficacy criteria formulated in the “Latest Diagnostic Criteria for Domestic and Foreign Diseases” and the subtraction rate of Conners’ Scale before and after 3 months of treatment as observation points. Cured: the main symptoms disappeared, the hyperactivity index score decreased by >80%, and the academic performance improved significantly; Effective: the main symptoms improved, the hyperactivity index score decreased by >50%, and the academic performance improved to varying degrees; Effective: the main symptoms improved, the hyperactivity index score decreased by >30%, and the academic performance improved but was not stable; Ineffective: the above symptoms or indexes did not improve or deteriorated.
2. Results
Among the 57 patients treated, 20 cases (35.09%) were cured, 14 cases (24.74%) were effective, 18 cases (31.58%) were effective, and 5 cases (8.59%) were ineffective, with an overall effective rate of (91.41%).
3. Discussion
(1) Conducting routine medical treatment: holding health lectures and popularizing basic knowledge The inattentive, hyperactive, and impulsive behaviors of children with ADHD are manifested as disruptive behaviors and learning backwardness at school, and teachers may mistakenly believe that the impulsive behaviors that the children themselves cannot control are their intentional actions and intentionally or unintentionally alienate these children. Parents who are outside of school do not see this, creating a conflict between parents and teachers, both believing they are right. Parents believe that teachers are too sensitive, uncaring, incapable of bettering their children, and stereotyping them; teachers, however, believe that parents are too scatterbrained, indifferent to their children, and poorly home-schooled.
Lectures were held in schools to introduce the etiology, clinical manifestations, diagnosis and clinical interventions of ADHD in children, so that teachers and students in schools, parents and relevant authorities would have a basic understanding of the disease. The teachers will be made aware of the special context in which this disease arises, not to blame the parents for the hyperactive behavior and learning difficulties of the affected children, to understand the hyperactive behavior of the affected children, and to cooperate with the medical staff in an organized, regular, direct and specific way to guide the treatment of such children, so that the hyperactive children will receive appropriate education for their healthy physical and mental development and rehabilitation.
(2) Change the stereotype of parents that “the end of medicine is the beginning of education”, and provide medical treatment and education at the same time. If parents only focus on medical rehabilitation in the process of seeking medical treatment, but neglect the development of good character and behavioral habits, these non-intellectual factors play a vital role in the social adaptability of hyperactive children, and will also bring obstacles to medical rehabilitation. Guided education can be used to deal with abnormal behavior problems such as self-injury, destructive behavior, and screaming by gradually reducing the frequency of abnormal behavior until it disappears by diverting attention.
(3) Educational rehabilitation in schools
As the main place where students with disabilities live, school is the link between all parties. By strengthening the cooperation between hospitals, families and primary and secondary schools and establishing a support network, a treatment system based on doctors, supplemented by parents and primary and secondary school teachers, this cooperative approach provides a broader platform for the application of this treatment model, while driving medical research. Hyperactive children lack self-control and frequently display aggressive behavior when in conflict with teachers and classmates, and their impulsive behavior and unthinking actions can cause problems for teachers and classmates. Therefore, they are easily rejected by others and have difficulty in establishing good interpersonal relationships.
Teachers should take a step-by-step approach, to know and understand the affected child, to be his friend, to implement highly targeted repetitive visual education; to affirm and enhance what is beneficial to the child’s development, to pay high attention to his academic progress; to prohibit doing discriminatory interventions, for example, sitting alone and criticizing him in front of his parents; to use rules and simple game methods, to make language and cognitive learning as interesting and lively as possible; to strengthen the The attention and encouragement of children with ADHD, prompting the children to establish a reasonable work and rest system, creating an excellent learning environment for them, and enhancing their ability to overcome the psychological barriers of low self-esteem and timidity have a very good effect.
Family rehabilitation
Developmental pediatrics believes that a poor family environment and improper parenting style can easily make children develop ADHD symptoms or aggravate the existing symptoms, and that a tense family relationship and noisy activity environment can not only aggravate their low self-esteem, anxiety, isolation or rebellion but also affect the occurrence, development and prognosis of the disease. Parents are the primary educators of their children and are the first important people they meet in their lives. By participating in the treatment of their children with hospitals and schools, they can build a harmonious educational environment for the development of their children, promote their positive and healthy development, and maintain and consolidate the rehabilitation effect of their children. Creating a peaceful and harmonious activity environment for the child is a prerequisite for the treatment of children with ADHD. This requires parents to have good psychological qualities, to be patient and careful, to work with the child psychologically on an individual basis, to integrate training into games in a way that is easily accepted by the child, to develop the child’s interest in training, and not to force training.
Parents should also set aside a fixed amount of time every day to do games with their children, the content and rules are set by the child; more positive live with the child, without affecting the premise of the game, you can also use body language to express goodwill. However, when the child has obvious aggressive behavior, give a clear response and turn your back to the child, and tell the child in a calm and firm tone that the game is over; minor misbehavior can be ignored. Help the child to develop good habits and a proper routine of work and rest time, and arrange a certain amount of time for outdoor exercise every day to both strengthen the body and expend excess energy, avoid too much activity in the family and classroom that is difficult to control, so that hyperactive behavior and sleep can be improved and compliance and imitation can be increased. Avoid foods containing glutamate, salicylates, food condiments, artificial colors and foods contaminated with lead and aluminum to avoid triggering or aggravating the disease.