Childhood hyperactivity disorder (ADHD for short), also known as attention deficit hyperactivity disorder (ADHD). It is a common abnormal behavior problem in children. These children have normal or near-normal intelligence, but have deficits in learning, behavior and emotion, mainly in the form of difficulty concentrating, reduced attention span, short attention span, excessive activity regardless of the occasion, and emotional impulsivity that are incompatible with their age and developmental level. The disorder starts in preschool and has a chronic course. The disorder not only affects the child’s school, family and out-of-school life, but also leads to lasting learning difficulties, behavioral problems and low self-esteem, making it difficult for the child to get along with others at home and at school. If not treated in a timely manner, some children will continue to have symptoms into adulthood, significantly affecting their schooling, physical and mental health, as well as their family life and social skills as adults. Surveys at home and abroad have found that the prevalence of this disorder ranges from 3% to 10%, with a male to female ratio of 4 to 9:1, with more children born prematurely suffering from this disorder.
Clinical manifestations
The symptoms of ADHD are diverse and often vary according to age, environment and attitude of the surrounding people.
1. Excessive activity
Most of the symptoms begin in early childhood and become more pronounced after entering elementary school. Some children start to be hyperactive in infancy, showing extra activity, crawling outward in a crib or cart, and often running instead of walking when they start to walk. When the child grows older, he or she may not be able to read a few pages of a small book before changing to another one or simply tearing it up; sometimes he or she may go through a box and make a mess. After starting school, the child often has trouble sitting still. In class, they move a lot, can’t sit quietly, squirm around in their seats, talk a lot, run around, jump around, climb up and down, and don’t know the danger. They like to provoke people and often fight with their classmates.
2. Difficulty in concentration
The core symptom of this disorder is the difficulty in paying attention and short attention span, which is incompatible with the age. Patients often have difficulty sustaining attention during lectures, homework or other activities, and are easily distracted by external stimuli. They are unable to pay attention to details during learning or activities and often make mistakes due to carelessness. Difficulty maintaining attention, often intentionally avoiding or being reluctant to engage in tasks that require longer periods of sustained concentration, such as classroom work or homework. Procrastination and inability to complete assignments or assigned tasks on time. Patients usually tend to lose things, often losing toys and learning tools, forgetting the daily schedule of activities, and even forgetting homework assigned by the teacher.
3.Emotional instability, impulsive and capricious
The child has poor self-control, unstable emotions, excitement, anger, crying, impulsiveness, and frequent temper tantrums. They are stubborn, stubborn, impatient, childish, lacking a sense of honor, not distinguishing right from wrong, lying, truanting, cheating, not returning from school, or even taking up bad habits. Reacts quickly and without sufficient information. Do things without considering the consequences and act on the spur of the moment, which often leads to fights or disputes with peers, resulting in negative consequences. Interrupts or interrupts others when they are talking, is eager to answer before the teacher finishes a question, and cannot wait patiently in line.
Attention deficit, excessive activity and impulsive behavior are the core symptoms of ADHD and have diagnostic value.
4. Learning difficulties
Although the children have normal intelligence, they show learning difficulties, poor memory discrimination, often write “b” as “d” or “6” as “9 “b” as “d” or “6” as “9”, etc., and low academic performance. Some of them have good intelligence, but their academic performance is not satisfactory, and they show up and down, fluctuate a lot, and their performance changes like a springboard, and their performance goes up if they catch it, and goes down if they don’t catch it, and even cause repeating a grade.
5.Abnormal development of the nervous system
Patients have poor development of fine motor, coordinated motor and spatial position sense. For example, hand turning, finger movement, shoelace tying and buttoning are all incompetent, and left-right discrimination is difficult. A small number of patients have delayed language development, poor language expression and low intelligence.
6.Character disorder
The co-morbidity rate of attention deficit hyperactivity disorder and conduct disorder is as high as 30% to 58%. Conduct disorder is characterized by aggressive behaviors, such as verbal abuse, hitting classmates, destroying objects, abusing others and animals, sexual assault, robbery, etc., or some behaviors that do not conform to moral and social norms, such as lying, truancy, running away from home, arson, theft, 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 meet the diagnostic criteria of adult ADHD. The clinical manifestation of adult ADHD differs from that of childhood ADHD, with “attention deficit” as the main manifestation and “hyperactivity” reduced. Due to the impulsiveness of the patient, he/she acts recklessly and rashly, easily gets into conflicts with colleagues, changes jobs frequently due to impulsiveness, drives impulsively and does not follow traffic rules causing traffic accidents. The assessment of symptoms in adults with ADHD is usually done with the help of a spouse, parent, colleague or supervisor who is close to the patient.
Diagnostic criteria
At present, it is still mainly based on the medical history, clinical manifestations, physical examination and psychiatric examination provided by the parents and teachers of the affected children.
1. Symptom criteria and typing Compared with most children of the same age and gender, the following symptoms are more common.
Group A symptoms
(1) Often failing to pay careful attention to details and making inattentive mistakes in doing homework or other activities.
(2) Often fails to maintain attention when completing tasks or playing games and tends to start but not finish.
(3) Often appears not to be listening when others speak to him.
(4) often fails to follow instructions consistently (not due to disobedient behavior or failure to understand) and fails to complete homework on time
(5) Often has difficulty organizing his or her daily studies and life.
(6) Frequently avoids or has a strong aversion to homework.
(7) Often loses necessities such as workbooks, books, pens, toys, etc.
(8) Is easily attracted to external stimuli.
(9) Frequent forgetfulness (e.g., dropping things at school, forgetting assigned tasks).
Group B symptoms
(1) Constantly moving hands or feet or writhing in the sitting position. (Older children or adolescents are limited to subjective feelings of fidgeting).
(2) Frequently leaves the seat in the classroom or other places where sitting is required (including doing homework at home, etc.).
(3) Running and crawling in situations where he or she should not move (adolescents may exhibit only a subjective feeling of inability to sit)
(4) Difficulty playing quietly.
(5) Being constantly busy or driven like an engine
(6) often talk too much and talk endlessly
(7) Often rushes to answer questions before they are finished.
(8) Is unable to wait patiently in line for his turn in a game or group activity.
(9) Often interrupts others or forces others to accept him (e.g., interjects into conversations or games).
Typology: (1) mixed type with attention deficit symptoms and hyperactivity-impulsivity symptoms ≥ 6; (2) attention deficit-oriented type with only attention deficit symptoms ≥ 6; (3) hyperactivity-oriented type with only hyperactivity-impulsivity symptoms ≥ 6.
2.Course of disease criteria
The disease usually starts before 7 years old and lasts for more than 6 months.
3.Exclusion criteria
Not due to pervasive developmental disorder, mental retardation, childhood psychiatric disorder, organic psychiatric disorder. Neuropsychiatric diseases and drug side effects.
4.Severity classification
(1) Mild symptoms meet or slightly exceed the symptoms required for diagnostic criteria, with only minor or no impairment of school and social functioning.
(2) Moderate symptoms and impairment between mild and severe.
(3) Severe exceeds the symptoms required by the diagnostic criteria by a large margin, with significant and extensive impairment of school, family, and partnership social functioning.