Most children are excitable, cry a lot, sleep poorly, have difficulty feeding, and do not easily develop regular bowel habits since infancy. As the child grows older, in addition to increased activity, he or she has uncoordinated movements, poor concentration or short attention span, emotional impulsiveness and lack of control, indiscipline in class and learning difficulties. The child has normal intelligence, but lower than average learning ability due to poor mental concentration, poor auditory discrimination and poor language skills.
Clinical symptoms are more prominent in school-aged children.
They talk a lot in class, make small movements, get agitated, and quarrel with others; their behavior has unclear purposes, such as taking people’s things and sometimes not avoiding danger; they do not fit in with others in group activities; they are stubborn, disobedient, impulsive and impolite in front of their parents; some children adopt an attitude of avoiding difficulties and become passive and withdrawn. As they grow older, many children develop learning difficulties. Although most children with ADHD have normal or near-normal intelligence levels, they still have difficulty learning due to the above symptoms. 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 figures, and cannot integrate the parts of the figure into a whole. Some children with ADHD read “6” as “9”, or “d” as “b”, and cannot even distinguish between left or right. The former change is a general analysis disorder, while the latter is a spatial orientation disorder. They also have difficulties with dictation, phonics, writing, or language expression. Children with ADHD answer without careful thought and have incomplete understanding, which is also a cause of learning difficulties.
Diagnosis of this disease requires an exhaustive history of ADHD, a family history of similar disorders or other neuropsychiatric disorders, maternal pregnancy of the affected child and a history of growth and developmental disorders in early childhood.
I. Summarize its clinical features as follows.
1. Excessive activity: Most of them start in early childhood and show significant performance after entering elementary school, with incessant small movements in class, tearing books, scribbling books out of shape, touching anything that can be touched, teasing, and often fighting with classmates.
2, inattentiveness: inattentive when studying, short attention span in class, react to stimuli from all sides.
3. Emotional instability: impulsive and capricious, shouting for no reason, impatient and in a hurry.
4. Learning difficulties: The child has normal intelligence, but hyperactivity brings learning difficulties. Some children have cognitive activity disorder and comprehensive analysis disorder. The course of the disease usually starts before the age of 7 and lasts for more than 6 months.
Second, the diagnosis of pediatric ADHD and differential diagnosis points.
It needs to be differentiated from pervasive developmental disorder, mental retardation, childhood psychiatric disorder, organic psychiatric disorder, neuropsychiatric disorders and drug side effects. Since there is no clear pathological change as the basis for diagnosis so far, the main basis is still the medical history, clinical features, physical examination and psychiatric examination provided by the parents and teachers of the children.
1. Symptom criteria.
The following symptoms are more common than most children of the same age. Eight of the following behaviors must be present.
(1) Often moving hands or feet or writhing in the sitting position.
(2) Difficulty sitting quietly when asked to do so.
(3) Easily distracted by external stimuli.
(4) Cannot wait patiently in line for a turn in a game or group activity.
(5) Often rushes to answer questions before they are finished.
(6) Difficulty in doing things as instructed, such as not finishing chores.
(7) Has difficulty staying focused during homework or games.
(8) Often does not finish one thing and changes to another.
(9) Has difficulty playing quietly.
(10) Often talks too much.
(11) Frequently interrupts or disrupts the activities of others, such as interfering with other children’s play.
(12) Often seems to listen when others talk to him/her.
(13) Often loses items needed for school and activities at school or at home.
(14) Often participates in activities that are physically dangerous without considering the possible consequences.
2. Disease duration criteria.
The disease usually starts before 7 years old and lasts for more than 6 months.
3.Severity classification.
(1) Mild: symptoms meet or slightly exceed the symptoms required by the diagnostic criteria, with only minor or no impairment of school and social functioning.
(2) Moderate: symptoms and impairment between mild and severe.
(3) Severe: symptoms that exceed the diagnostic criteria by a large margin, with significant and widespread impairment of school, family, and partnership social functioning.