Clinical manifestations of ADHD: The main manifestations are attention deficit and hyperactivity, often accompanied by learning difficulties and abnormal emotional behavior.
I. Attention deficit
There are two types of attention, one is active attention, that is, the subjective will to focus on something in order to achieve a certain purpose, to complete a certain task. Active attention requires will and perseverance, which is usually called “effort”. The other type of passive attention is when objective things attract one’s attention by their own characteristics, so one can turn and focus on them at will and without effort. Luo Qiuyan, Department of Rehabilitation, Yuexiu District Children’s Hospital, Guangzhou
Attention deficits in children with ADHD have the following characteristics.
1. Passive attention is dominant and active attention is insufficient.
This is reflected in the lack of concentration in class and the frequent desertion of thoughts. The child is often distracted by irrelevant external stimuli, and is often confused by the teacher’s questions or answers. Usually, they forget everything they do (lack of active attention). On the other hand, children with ADHD pay attention to interesting TV programs, books and magazines, and novel games (passive attention dominates). In children with severe ADHD, both active and passive attention can be significantly deficient.
2. Weak, short-lived, and unstable attention.
In addition to active attention, children with ADHD need to pay attention with the appropriate intensity and duration to accomplish a task. In children with ADHD, attention is not highly focused and is short-lived. For example, 10-12 year old students should be able to maintain a 40-minute attention span. Children with ADHD have difficulty doing this and are easily fatigued and distracted.
3. Narrow attention span and poor distribution of attention.
Normal children can clearly grasp the object and amount of attention at the same time. This is indispensable for accomplishing a certain task. For example, when doing homework, the brain has to consider the problem, the eyes have to read the book, the hand has to write out the answer, and the word has to be written in the prescribed size. Just as a car driver’s hands need to take the wheel, his feet need to control the speed, his eyes need to look ahead, and his ears need to listen to the sounds around him. It is important to distribute one’s attention appropriately. Children with ADHD are not good at grasping the main points and focus of the object of attention. The scope of attention is narrow. For example, they tend to miss questions, write in series, scribble sloppily, and make undesirable low-level errors in calculations. It is difficult to finish homework on time, etc.
Excessive activity
Children with ADHD are hyperactive due to their lack of self-control (SCD), distraction, and tendency to “migrate with the scene”.
Their hyperactivity has the following characteristics.
1 Excessive activity incompatible with age development.
It occurs in infancy and preschool. In infancy, it is characterized by crying, irritability, incessant dancing of hands and feet, excitement and sleeplessness, and difficulty in developing regular eating and defecation habits. After walking, there is a marked increase in activity compared to normal children of the same age. Children have difficulty in having quiet moments except for sleep time. After entering kindergarten, they are undisciplined, noisy and disruptive, and have no desire to play, changing toys after a while.
2 Hyperactivity has no clear purpose.
The movements are disorganized and change constantly. As a result, their behavioral actions are fragmented and lack integrity. For example, in the classroom, the child may play with toys, or use a pen or knife to make drawings on the textbook or desk. They may make faces to make the students around them laugh and cause trouble. You may even knock on the table, whistle, or leave your seat and run around the classroom. You do not care about the discipline and the disturbance caused to the surroundings. They do everything in life in a sloppy manner and have difficulty in finishing well.
3 Impulsive and capricious.
Hyperactive behavior often regardless of the occasion, regardless of the consequences, difficult to control. Therefore, their behavior is often destructive and dangerous. Accidents are likely to happen. For example, they may turn over jars at home, dismantle and lose toys and stationery at will, without care or concern. They ignore the criticism of teachers and parents and repeatedly violate the law. Can’t wait patiently for the turn to participate in game activities, either jumping the queue first or abandoning them. They like to climb high, jump over the railing, suddenly cross the road in front of a moving vehicle, do not know how to swim, go into the water at will, do whatever they want on a whim, etc.
Emotional and behavioral abnormalities
Children with ADHD are often criticized by teachers, ridiculed and despised by classmates and reprimanded by parents because of their attention deficit, excessive activity, impulsiveness and declining academic performance, and their self-esteem is hurt and their emotions are more fragile.
1, retreat, avoidance.
Experiences of “failure and frustration” can cause children with ADHD to “defend themselves” by withdrawing and avoiding in an attempt to change their situation of being blamed at every turn. This can lead to fear of attending class, irregular homework, test avoidance, and even truancy. Some children go to school, but once they arrive, they complain of chest tightness, headaches, chest pains, and other discomforts and ask for medical attention. However, all tests at the hospital are normal. This is easily diagnosed as “school phobia”. Children with ADHD are determined to correct their behavior when criticized by teachers and persuaded by parents. However, due to the lack of self-control and self-restraint, the child will often repeat the behavior soon afterwards. This is easily perceived by teachers and parents as “intentional confrontation” and leads to resentment and anger. This can lead to more severe criticism and punishment. This leads to a vicious cycle of “withdrawal and avoidance → increased punishment → withdrawal and avoidance”, making ADHD symptoms persist and worsen.
2. Fantasy and loneliness
Children with ADHD do not get the care, attention and fun they deserve at school and at home. They will seek a “quiet and happy” environment to seek mental comfort and satisfaction. Gradually, fantasy and loneliness symptoms may appear. Some of them are depressed, pessimistic, and do not play with their classmates. They rarely talk to their relatives at home. Some of them lower their actual age and prefer to play with younger children or children in lower grades, playing games that young children play, thus avoiding the “higher demands” of children of the same age. The fantasy and isolation behaviors inevitably affect school, leading to learning difficulties, and in the long run, easy to form adjustment disorders.
3. Overcompensation
Some children with ADHD try to counteract low self-esteem and compensate for the damage to their self-esteem. They will rely on their advantages in such areas as organizational skills, physical strength, etc. to organize small groups in school or class, lead the control, manipulate or force other students to participate, in and out of the classroom, bullying criticism, despise their classmates, pranks on teachers and classmates, and even gang fighting, to this aggressive behavior to show their ability, deny their own deficiencies, to compensate for their own deficiencies, this This impulsive behavior is likely to cause character disorders in children, and even constitute juvenile delinquency.
4. Masking and denial
Some children with ADHD, when criticized by teachers or parents, in order to avoid blame and punishment, will rush to control the situation by joking, acting as a clown, making a face, cajoling, lying, etc., to distract the critic’s attention. Or they mock themselves first to stop others’ criticism. Some are in total denial of their poor performance, blaming their behavioral faults on the criticism of their teachers and classmates and the scolding and scolding of their parents. Some parents also believe that their children are smart and lively, and that their bad behavior is caused by the fault of teachers and classmates around them. Covering up and denying will increase the confrontation between teachers and classmates and the affected children, which hinders the correction of the disease.
Fourth, learning difficulties
Children with ADHD can have learning difficulties, but their learning difficulties are not caused by mental retardation (mental retardation). The learning difficulties of children with ADHD are mainly due to distraction and failure to concentrate on the knowledge that they should be able to learn well. Therefore, their learning difficulties have the following characteristics.
1. Fluctuating academic performance.
Children with ADHD can improve their performance with the strict help of their teachers and parents. However, once relaxed, due to the presence of ADHD symptoms, academic performance will drop significantly, and the results are very unstable, with a wide range of good and bad.
2. Learning gradually declines as they move into higher grades.
ADHD children in the lower grades because of the shallow learning content, easy to grasp, academic performance is still possible, learning difficulties symptoms are not obvious. When they enter higher grades, the learning content becomes more difficult, and it is difficult to receive good learning results due to the persistence of ADHD symptoms. The results will gradually decline. And involve all subjects.
3. “Low-level errors” that should not occur when studying or taking tests as described above often occur.