Concept: Childhood hyperactivity syndrome is a common behavioral abnormality in children, mainly manifested as normal or basically normal intelligence, with hyperactive and restless behavior disorder, attention disorder, good impulsivity, fidgeting, and backward academic performance, which makes parents and teachers feel difficult in daily life and study. Some people compare this disorder to a symphony losing its coordination and harmony.
Morbidity: The prevalence rate is reported to be 1.5-10% of school-age children in China. The prevalence is significantly higher in boys than in girls (80% in males). The onset of the disease is less than 6 years old, and most of the symptoms become apparent during elementary school and are seen in the hospital. The disease is more frequent in children born prematurely.
Etiology.
This disease is not a disease caused by a single factor, but a syndrome caused by a variety of biological, psychological and social factors, either alone or in concert.
1. Genetic factors: In a family survey, the number of siblings with ADHD was three times higher than that of other children, and the rate of monozygotic twins was significantly higher than that of dizygotic twins. The rate of homozygosity was significantly higher in monozygotic twins than in dizygotic twins. There were also significantly more alcoholics, antisocial personalities, and hysterics among the affected children’s blood relatives.
2, dietary factors: Some people believe that food additives (such as food coloring, etc.) is the cause of hyperactivity, while others believe that eating more sugar-rich sweets, beverages and fried high-protein foods, etc., is also a causative factor.
3.Other factors: environmental pollution, mild lead poisoning, iron deficiency anemia, poor social environment, single-parent family, too poor family economy, overcrowded housing, poor parental character or other psychological disorders, over-indulgence, long-term foster care elsewhere, etc., can constitute the causative factors of this disease. It is believed that excessive lead in the body is an important cause of ADHD. Because low doses of lead can inhibit enzyme activity in the brain, interfere with neurotransmitter metabolism, affect the intelligence, memory, visual, auditory and motor functions of the child, and make the child unable to control his or her behavior.
Clinical manifestations.
1, excessive activity manifested as a marked increase in activity, excessive non-tranquility, often running back and forth, can not sit still in the classroom, often wriggling in the seat or stand up, excessive noise, talk a lot, do not discipline, do not listen to orders, the more the need to maintain quiet and discipline in the environment, hyperactivity more prominent, like to play dangerous games.
2. Inattentiveness Inability to listen carefully to the teacher in class, often easily distracted by subtle outside distractions, such as being attracted by the sound of footsteps, conversations or cars outside the classroom. Does homework slowly, carelessly and hastily, and makes many calculation errors and typos. Inability to stay on task and to make up one’s mind. In general, the fluctuation of clinical symptoms is sometimes related to the different situations and activities in which the child is engaged. Children have the most difficulty maintaining their attention when doing homework, engaging in repetitive or demanding activities, and doing things that are not new. The symptoms of ADHD can be reduced in attractive, novel or unfamiliar environments.
3. Impulsive behavior Unstable emotion, easily agitated, lack of self-control, capricious, easily overexcited and easily fighting with classmates. Sometimes they do not avoid danger and are stubborn, disobedient, impulsive and rude in front of parents.
4. Learning difficulties Although their intelligence is normal or close to normal, they lack the necessary attention in the learning process and do not pay attention to their homework, thus lagging behind in their academic performance (especially in the upper grades). Some children with ADHD have perceptual activity disorders, for example, when copying pictures, they often cannot distinguish the relationship between the subject and the background, cannot analyze the combination of graphics, and cannot synthesize the parts of the graphics into a whole. Some children with ADHD read “6” as “9”, or “d” as “b”, and cannot even distinguish between left and The former is a general analysis disorder. The former is a comprehensive analysis ability disorder, and the latter is a spatial orientation ability disorder.
5, neurodevelopmental disorders Children with persistent hyperactivity often have this performance, such as clumsy fine coordination movements, inflexible shoelace tying, buttoning, difficulty in distinguishing left and right, sometimes accompanied by delayed language development. Children with hyperactivity often show some fixed neurological soft symptoms, such as positive palm-turning and finger-testing.
6, secondary manifestations The above behavioral characteristics can lead to a series of secondary consequences. For example, learning difficulties, i.e., their academic performance is often lower than expected by their intellectual ability; low self-esteem, due to poor academic performance, discrimination by teachers, rejection by classmates, or beatings for not meeting parents’ expectations; and conduct problems, often caused by failure to get satisfaction from parents and teachers, and frequent reprimand for impulsive behavior. Some children even experience truancy, running away from home and attacking others.
Diagnosis.
So far, there are no clear pathological changes as a basis for diagnosis. The diagnosis is mainly based on the performance of the affected children at school and at home provided by parents and teachers, combined with birth history, growth and development history, family history, necessary neurological examination, intelligence examination, etc.
1. Attention disorders (at least 6 of the following, lasting for at least 6 months, reaching maladaptive levels and inconsistent with the child’s developmental level)
(1) Often fail to pay careful attention to details or make inattentive errors in doing homework or other activities.
(2) Often fails to maintain attention while completing tasks or playing games.
(3) Often appears to be listening when others speak to him/her.
(4) Often fails to consistently follow instructions and to complete homework, daily chores, or obligations at work (not because of disobedient behavior or failure to understand instructions).
(5) The ability to organize tasks and activities is often impaired.
(6) Often avoids or has an extreme aversion to tasks that require maintaining attention in an effort to complete them, such as homework.
(7) Often loses objects such as workbooks, pencils, books, toys, or tools.
(8) Is often easily drawn to external stimuli.
(9) Often forgets things in the course of daily activities.
2. Hyperactivity (at least 3 of the following, lasting for at least 6 months, reaching maladaptive levels and not consistent with the child’s developmental level)
(1) The hands or feet are often unsteady, or the body squirms when sitting.
(2) Leaves the seat in the classroom or other situations that require remaining seated.
(3) Often runs or climbs high ladders in inappropriate situations (in adolescents or adults there may be only a sense of restlessness).
(4) Often makes inappropriate noise during play or has difficulty participating quietly in recreational activities.
(5) Demonstrates persistent hyperkinesia, where the social environment or the demands of others do not cause the child to change significantly.
3. Impulsivity (at least 1 of the following, lasting at least 6 months, reaching maladaptive levels, and inconsistent with the child’s developmental level)
(1) The child often blurts out answers before the question is finished.
(2) Often fails to line up or wait in order in games or organized situations.
(3) Often interrupts or interferes with others (e.g., by interrupting conversations or games).
(4) Often talks too much and fails to respond appropriately to social planning.
In applying the above diagnostic criteria, the following two points should be noted.
1.On the occasions when activity is allowed, such as after class or school, there is no diagnostic significance no matter how active the activity is; only on the occasions when activity is not allowed, such as during class or doing homework, and still cannot restrain oneself and keep moving, there is diagnostic significance.
2, only excessive activity, but no inattention, can not be diagnosed as ADHD. On the contrary, if inattentiveness is obvious, but not excessive activity, ADHD can also be considered. In the United States, since 1979, according to the most common and prominent symptom of ADHD is difficulty in concentration, “ADHD” has been renamed “attention deficit disorder”, and divided into “attention deficit with hyperactivity “The latter is also known as “hyperactivity without hyperactivity”.
Differential diagnosis: 1.
1, normal naughty children: although sometimes inattentive, but most of the time can still focus, in order to play, often hastily and quickly complete homework, and do not drag. They can still observe discipline and can self-regulate.
2.Autism: often have too much activity and concentration difficulties, and can not establish emotional connection with the surrounding people, and the behavior is repetitive and single.
3.Low intelligence: often have hyperactivity, inattentiveness and learning difficulties, but low IQ.
4, tic – obscene syndrome: at the beginning of the disease, see facial muscle twitch-like movements, such as blinking, pouting, crooked neck, shaking head, making a face, gradually developed to the proximal muscles of the limbs and appear shrugging shoulders, thigh bending and abduction, finger paddling, and even suddenly clenched fist pounding chest, disappeared during sleep. It is often accompanied by shouting, barking and cursing-like obscenities in the throat.
5, habitual twitching: hyperactivity phenomenon fixed in a certain muscle group, often with a trigger, attention is not affected.
Treatment.
1.Western medical treatment
Central nervous excitatory drugs: Ritalin, dextroamphetamine, methamphetamine, pemoline, etc. can be used optionally. Another effective class of drugs: tricyclic antidepressants (promethazine, chlorpromazine and amitriptyline), can be started in small doses and gradually increased to an effective dose and then changed to maintenance therapy.
The main change after taking the medication is the improvement of attention, especially active attention, when children can sit quietly in their seats during class, concentrate on the teacher’s lecture and are not easily influenced by external stimuli. Secondly, the amount of activity and small movements can be reduced, the irrelevant activities that were carried out in the classroom disappear, the effective listening time is increased, and therefore, the academic performance is improved. In addition, due to the improvement of academic performance and classroom discipline, the child’s good behavior will be recognized by the teacher and classmates, and there will be a change from a passive teacher-student relationship of being rejected to an active teacher-student relationship of being accepted, and the child’s mood will be further stabilized and behavior will be further improved. At this time, parents will also hear news of their child’s improved behavior from the teacher, see their child’s improved behavior at home, and their words and actions in the process of interacting with their child will also prompt and encourage the further development of acceptable behavior, and this sense of acceptance will in turn improve the affected child’s self-confidence and self-esteem, thus improving the relationship with the parents.
2.TCM treatment
According to TCM, the etiology of ADHD in children is a deficiency in the root cause and a disorder in the balance of yin and yang, and the principle of treatment is to harmonize yin and yang. According to the different clinical manifestations of the child, combined with the tongue and pulse, it is mostly divided into three types of evidence.
(1) Liver and kidney yin deficiency
Treatment: Nourish the liver and kidney, submerge the yang and calm the will.
Qiju Dihuang Wan plus or minus. Commonly used drugs: Shu Di, Shan Yu Pei, Shan Yao, Wolfberry nourish the kidney and nourish the liver; Chrysanthemum, Dan Pi, Tribulus terrestris pacify the liver and subdue Yang; Green Dragon’s tooth, Yuan Zhi, Turtle Board nourish the mind and calm the will.
(2) Heart and spleen deficiency
Treatment Tonify the heart and spleen, nourish blood and calm the mind.
Radix Rehmanniae Spleen Soup with Gan Mai Da Zao Tang plus or minus. Commonly used herbs: roasted licorice, Radix Codonopsis, Rhizoma Atractylodis Macrocephalae, Radix Astragali to benefit Qi and strengthen the spleen; Radix Angelicae Sinensis, Jujube, Longan Pulp, Huai Mai to nourish the heart and blood; Fu Shen, Sour Jujube, Yuan Zhi to tranquilize and calm the mind.
(3) Internal disturbance of phlegm and fire
Treatment Clear heat and eliminate phlegm, calm the mind and calm the will.
Radicals: Huang Lian Wen Bile Tang with addition and subtraction. Commonly used herbs: Semen, Chen Pi, Citrus aurantium, Poria to dissolve phlegm and move Qi; Bile South Star, Tian Zhu Huang, Bamboo Roo to clear phlegm and heat; Huang Lian, Dan Pi, Lian Qiao to clear heat and remove fire; Calamus, Yu Jin, Mother of Pearl to tranquilize the mind and calm the will.
Acupuncture therapy
1.Body acupuncture: Neiguan, Taichong, Dazhi, Quchi.
2, ear acupuncture kidney, subcortical, brainstem, excitement point. Also can be used Wang Bu Liuxing Zi pressure points, operation method: auricular local sterilization with 75% alcohol, Wang Bu Liuxing Zi 1 grain, stick in 0.5 ~ 0.6 cm size square tape, and then the tape on the required points, finger pressure on the tape each time 1 ~ 2 minutes, so that there is a significant local swelling, heat, pain and other sensations. Parents are instructed to press the tape no less than 3 times a day, alternating between the left and right ears, and to change Wang Bu Liu Xing Zi 2 times a week. 15 times is a course of treatment, with a 2-week break between courses.
Diet therapy
1, should eat more zinc-rich food. Because zinc is a trace no element in the human body, and the human body is closely related to the growth and development. Zinc deficiency often causes children to lose appetite, developmental delay and mental retardation. Studies have found that most students with good academic performance have high zinc content in their hair. Therefore, often eat zinc-rich food, such as eggs, liver, beans, peanuts, etc. to improve intelligence will help.
2, should eat more iron-rich food. Because iron is the raw material of blood production, iron deficiency will make the brain’s function disorder, affect children’s emotions and aggravate hyperactivity symptoms. Therefore, children with ADHD should eat more iron-rich foods, such as liver, poultry blood, lean blood, etc.
3, should eat less food containing lead. Because the increase of lead content in the body interferes with the normal metabolism of the neural mediators acetylcholine and catecholamines in the central nervous system, resulting in brain dysfunction, making children’s visual movement, memory and sensation, image thinking, behavior and other changes, hyperactivity, so children with ADHD should eat less lead-containing eggs, shellfish, lettuce, sunflower seeds and other foods.
4, should eat less food containing aluminum. Because aluminum is a kind of metal that threatens human health. Eating too much aluminum can cause mental retardation, memory loss, loss of appetite, indigestion. ADHD children should eat less doughnuts, because the production of doughnuts need to add alum in the flour, and the chemical composition of alum is potassium aluminum sulfate. Therefore, eating doughnuts is detrimental to the intellectual development of children.
5, eat less food containing tyrosine or tryptophan. Australian scholars found that the occurrence of pediatric ADHD is related to diet, that is, when the diet of children contain more tyrosine or tryptophan, can appear hyperactivity. Other scholars believe that this disease is related to children eating too much sugar, such as eating more starchy foods (steamed buns, snacks, bread) for breakfast, and then drinking some high-sugar orange water, which makes the affected children prone to a variety of hyperactive behaviors.
Psychotherapy
1.Positive reinforcement method: The purpose is to sustain correct behavior through rewards and encouragement. Before applying the positive reinforcement method, we should determine what behavior we want the child to change (determine the target behavior) and determine what the direct consequences of this behavior are; design a new behavioral outcome to replace the original behavioral outcome; and give positive reinforcement, such as rewards and encouragement, to the child immediately when the appropriate behavior occurs. Rewards play an important role in the treatment of children’s behavior. When a child shows good behavior that meets the rules and requirements, the child is immediately rewarded so that the child feels happy and satisfied, thus forming good habits. Alternatively, the child’s attention can be fostered by shaping and adding a new behavior, such as rewarding the child when he or she completes the prescribed behavior, on a consistent basis. This can be used in conjunction with self-control methods, where the child is instructed to learn to control his or her behavior using self-monitoring and self-reinforcement. The child keeps a daily record of his or her behavior and after 1 week, compares the number of times inappropriate behavior occurs and rewards progress in behavior. The purpose of encouragement is to motivate the child to voluntarily and actively learn to repeat certain good behaviors. The type of encouragement is generally based on mental or verbal stimulation and can be done at any time.
2. Punishment: Punitive measures are taken to reduce or eliminate certain undesirable behaviors of children. Generally can be used to temporarily isolate the method, so that he understands the bad behavior, so as to eliminate the bad behavior, but punishment should not be taken to intimidate, scolding and other rough ways, so as not to cause children’s rebellious psychology.
3, abatement method: is a method to reduce or eliminate the occurrence of bad behavior of children. The first step is to understand what factors play a reinforcing role in undesirable behavior, and after finding the reinforcing factors, to eliminate them. For example, a child’s tantrum may be reinforced by excessive parental attention and occur repeatedly. If parents take a dismissive approach to the situation, the tantrum behavior may gradually subside.
Environmental Treatment
Treatment is achieved by improving the environment by changing the attitudes of parents, teachers and society toward the patient. This includes the following points.
1. Define the nature of the disease and treat it correctly. Parents should realize that ADHD is a disease and should try to understand the cause and actively seek treatment, rather than taking measures such as roughness, discrimination, coldness, scolding and punishment, which will not only aggravate the disease, but also aggravate the affected child’s low self-esteem, apprehension, withdrawn or defiant psychology.
2, gradually correct hyperactive behavior. The child’s hyperactive behavior should be gradually reduced, and should not set too high a goal, immediately asking them to become quiet and well-behaved children. Excessive requirements will only lead to tension between each other.
3, let children participate in a variety of cultural and sports, social activities, so that they can have the opportunity to exert excess energy.
4, encourage quiet behavior of children, with verbal praise, encouragement and other reinforcement methods to gradually train them to develop the habit of sitting still, can focus on learning and doing.
5.Cultivate children to form good living habits. They should be allowed to develop the habit of living on time, ensuring adequate sleep, and cultivating the good habit of not having two minds from a regular life, for example, not watching TV during meals. Do not accommodate your child’s certain interests, for example, do not allow them to watch TV or movies for a long time without restriction, etc.
6, eliminate the adverse stimuli or mental tension factors in the family that lead to ADHD, coordinate family relations, ease the family atmosphere, and prevent the child from being distracted, anxious and nervous and excited by family factors.
7.The rules are simple and clear. The main point of the requirements for such children is to prevent their reckless behavior damage themselves or endanger others, therefore, the rules set to achieve this goal on the line, it is not appropriate to develop too many rules and regulations.
8, the right treatment. Parents should not discriminate, scold or beat them, nor should they use “illness” as an excuse to be overly accommodating, making them more capricious and aggressive; they should be patient in education and strict in requirements. Parents should take the initiative to maintain regular contact with the school teachers to give feedback to each other and promote the improvement of the child.
Sensory Integration Training
Sensory integration therapy was founded by Ayres in the United States. This method is mainly used to train children with play facilities such as skateboards, swings and balance beams. Other therapies similar to sensory integration include auditory integration training, music therapy, chiropractic therapy, squeeze therapy, hug therapy, and touch therapy.
Comprehensive measures
The treatment of this disease must not be limited to medication alone, but should be a comprehensive approach. The child, parents, teachers and physicians should cooperate with each other and work together in order to achieve better results. It is important to explain to parents and school teachers that hyperactivity syndrome in children is a disease, not simply a child’s naughtiness and playfulness. Do not take a simple and violent attitude towards education, do not scold, punish the child, but also do not overindulge and accommodate, indulge their capriciousness and unrestrained. The child should be sympathetic, caring, a little progress should be given praise and reward in a timely manner. Talk to your child often to help him/her build confidence, sharpen his/her will, and develop interest in learning and hobbies after school.
Prognosis
With the application of various treatment methods, the prognosis of ADHD in children is more optimistic. However, if left untreated, about one-third of children with ADHD will have personality abnormalities by the time they reach adulthood. Many adults with personality disorders have a history of childhood ADHD, disorders of uncontrollable impulsive behavior, a low threshold for tolerating stress, emotional instability and chronic dissatisfaction. Tracking children with untreated or rarely treated ADHD gives us a natural course of the ADHD child. Untreated children with ADHD have been reported to have reduced levels of purposeless hyperactivity with increasing age. However, 30% with delinquent behavior, substance abuse, academic underachievement, impulsivity, and inattention persist in adolescence.
1. residual symptoms of ADHD.
2. antisocial personality disorder.
3. alcohol dependence.
4. dysthymia, anxiety disorders, and some classes of schizophrenia.
Preventive measures
1, the age of childbirth should not exceed 28 years, and participate in more physical exercise.
2, during pregnancy, regular checkups on time. Avoid fetal malposition and caesarean section.
3.Prohibit smoking and alcohol during pregnancy and refrain from taking medication.
4, when the baby goes out, do not use the stroller, because the closer to the ground the more exhaust fumes from cars.
5.Prevent high fever and convulsions in young children.