attention deficit disorder
Introduction
Introduction to attention deficit disorder Attention deficit disorder, also known as hyperkinetic syndrome (hyperkineticsyndrome), referred to as ADHD. It is especially prevalent in children's pre-school period. The activity is mostly obvious symptoms. The attention deficit disorder is a group of syndromes with hyperactivity, inattention, poor participation ability, cognitive impairment and learning difficulties, and basic intelligence. basic knowledge The proportion of illness: 0.001% Susceptible people: special in children Mode of infection: non-infectious Complications: autism
Cause
Attention to the cause of defects
Genetic factors (20%):
In the family research survey, it was found that the disease has family aggregation. Children with ADHD have childhood ADHD, adult snoring, social morbidity and alcoholism more than normal parents, and the child's parents have a prevalence rate of 20%. The prevalence rate of first-degree relatives was 10.9%, the prevalence rate of second-degree relatives was 4.5%, the incidence rate of single-oval twins was 5l%-64%, and the rate of twin-child twins was 33%.
Neurotransmitter system (20%):
Studies have shown that this disease may be related to central neurotransmitter metabolism defects. In recent years, DA, NE and 5-HT hypothesis have been proposed. The metabolites of DA and NE in children's blood and urine are lower than normal children, suggesting 5-HT Dysfunction, another study found that increased dopamine beta hydroxylase activity is related to the search for novel behaviors and actions. The activity of catecholamine O-methyltransferase (COMT) is associated with attention deficits and hostility, norepinephrine, dopamine and 5 -Serotonin (5-HT) three neurotransmitters play an important role in the development of hyperactivity disorder. Gray believes that there are behavioral promotion systems (BFS) and behavioral inhibition systems (BIS) in individuals. BFS is a broad behavioral system. Its function is to promote extroverted behavior, sexual behavior and aggressive behavior to actively adapt to the environment, its biochemical basis is the midbrain dopamine system, BIS function is to "compare" the real environment and expected behavior, "suppress" the inappropriate behavior of BFS, by Norepinephrine and 5-HT in the septal hippocampal system are completed together. In general, the relative intensity of BFS/BIS, ie, dopamine/norepinephrine plus 5-HT, affects behavior at a certain point in time. BIS Children showed good attention span and the ability to distinguish the environment; on the contrary, when BFS is relatively strong, it is difficult to maintain attention, more externalizing behavior similar to ADHD clinical performance.
Delay in development (20%):
Clinical observations have found that children with ADHD often have clumsy and cooperative movements, clumsy, distinguishable, visual, auditory and difficult, spatial positional abnormalities and other neurological soft signs, often accompanied by open speech, delayed language development, abnormal speech function, stuttering Problems such as functional enuresis or residual feces, many studies suggest that this may be due to delayed central nervous system maturation or due to insufficient arousal in the cerebral cortex.
Psychosocial factors (10%):
The persistence of environmental, social and family factors is the key to inducing and promoting ADHD. Some scholars believe that poor society, family and school environment have a direct causal relationship with situational hyperactivity, and pervasive hyperactivity. It is mainly an inducement, but it has a great impact on the prognosis of both. These factors include: bad social atmosphere and peer influence, family economic difficulties, housing overcrowding, family disharmony, parental disharmony or divorce, improper parenting style, Excessive love or indulgence, poor parental status, mother suffering from snoring or depression, parental antisocial behavior or material dependence, physical or psychological abuse of children by family members, lack of attention to children's needs, childhood separation from parents, teacher education methods Improper factors can contribute to the occurrence and persistence of ADHD.
Other factors (10%):
Mild brain damage caused by various causes, affecting the function of the nervous system, may lead to inattention and hyperactivity, vitamin deficiency, food allergy, food flavoring, additives, elevated blood lead levels, blood zinc levels Lowering, etc. may also contribute to ADHD.
Many scholars have studied the etiology and pathogenesis of ADHD in children. However, it is still unclear. Some people speculate that it may be a complex disease. The literature reports are summarized as follows:
Biological factors
(1) Minor brain injury: Since ADHD has been pointed out, there is a hypothesis of brain damage, but recent studies have shown that the proportion of significant brain damage is not too high.
(2) Genetic factors:
1 Control study of hyperactive children and normal children: anti-social personality characteristics or alcohol dependence of children with ADHD, mothers have more snoring, and children with ADHD have more psychopathological problems.
2 The study of adoptive sons: The proportion of children with ADHD who are diagnosed with ADHD is higher. The parents of children with ADHD have antisocial personality, alcohol dependence and snoring are more than parents of adoptive parents or control children, and childhood of biological parents. There are more history of hyperactivity and conduct disorders and more people with mental disorders.
3 twin studies: the incidence of ADHD in monozygotic twins is more than 5 times higher than that of twins, and the consistency of symptoms of hyperactivity and attention disorder in single-oval twins is much higher than that of twins. Recently, the Gemini study also reported attention deficit disorder, the main variables of hyperactivity and impulsive symptoms (70% to 80%) were related to genetic factors (average about 80%) (Faraone 1996; Gjone 1996), and some scholars reported single egg double The same prevalence rate of children with ADHD is about 80%, while the same rate of double-oval twins is only 29%.
4 Heritability study: Stevenson analyzed 91 pairs of female twins and 105 pairs of twins of the same sex by multiple regression. The heritability of hyperactivity was 0.75%, and the heritability of attention deficit was 0.76%. The impact of the disease, Levy studied 1938 families with twins, according to the DSM-IV standard, the consistency of the proband, the single and double egg twins, the heritability of the siblings was calculated, the result is 0.75% ~ 0.91% .
5 Molecular genetics research: Several research groups have used several large families to conduct molecular genetic studies on children with ADHD and their family members. Biederman et al. conducted quantitative genetic analysis of large families in Boston to prove single genes. It may explain the performance of the disease, and other scholars believe that it is polygenic inheritance. The earliest molecular genetic study of ADHD in children pointed out that ADHD is related to the polymorphism of dopamine receptor gene, and the focus is on the D2 receptor gene. Some scholars believe that it The increase is also related to alcohol dependence, tic disorder, pathological gambling, etc. Some scholars call this kind of problem a reward-deficiency syndrome. Lahoste (1996) reported that the proportion of 7 repeat alleles of D4 receptor in children with ADHD is higher than that of the control group. Bailey et al (1997), Swanson (1998) repeated this result, Sunohahara et al (1997), Faraone (1999) also obtained similar results in adult ADHD, Comings DE et al (1996) reported that ADHD is polygenic, and DH, The DT1 gene is associated with the D2 receptor gene, and of course some inconsistent results may be related to the different ADHD phenotypes selected, Barkley RA (1998) to predict the next 10 years in an area of the human genome is completed at the same time or later, molecular genetic studies of children with ADHD may be fruitful.
(3) Metabolism of catecholamines: Animal experiments and studies on humans suggest that children with ADHD are mainly abnormal in the pathway of catecholamines, and the concentrations of adrenaline and dopamine in urine, serum and cerebrospinal fluid support the reduction of dopamine and adrenaline turnover. The hypothesis that cerebrospinal fluid in children with ADHD results in a decrease in dopamine turnover or an increase in dopamine sensitivity, confirms the hypothesis of low dopamine status in ADHD, and that Tourette's syndrome is associated with excessive renewal of dopamine.
Animal experiments suggest that hyperactive children may have dopamine metabolism disorder. Some people use 6-hydroxydopa to inject new mice, and selectively destroy the dopa pathway. These mice have obvious hyperactivity and difficulty in walking. After that, the ability to complete the learning task is improved, the activity level is reduced, and the activity can be reduced as the age of the mouse increases, but learning defects still exist, and the dog with high activity level and aggressive behavior also has hereditary learning difficulties. Animals respond better to dextroamphetamine (dextroamphetamine), which can improve their learning deficits, hyperactivity and aggressive behavior. Children with ADHD can also observe similar phenomena. Functional MRI finds the frontal striatum, striatum and net. The morphological structure is regulated by catecholamines affected by central stimulants, and studies of methylphenidate (Ritalin) suggest that dopamine is the main mediator involved, and serotonin is also involved.
(4) Research on neurobiochemistry: There are also comparisons between dopa -hydroxylase, monoamine oxidase, catecholamine oxygen methyltransferase in children with ADHD and normal children, no difference, norepinephrine and dopamine The results of the metabolites high vanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were inconsistent, while in children with ADHD there was a significant reduction in 3-methoxy-4-hydroxyphenylethylene glycol (MHPG). The views are more consistent.
(5) Neuroanatomy: Some scholars have examined the hyperactive children and their siblings. They found that after the use of Ritalin in hyperactive children, the blood flow in the basal ganglia and the midbrain increased, but the blood flow in the anterior cortex decreased, especially In the motor area of the cerebral cortex, brain imaging techniques have also shown that young people with a history of ADHD have atrophy of the cortex. Although the previous CT study did not find any difference between hyperactive children and normal children, new imaging techniques such as PET are more consistent. The findings are characterized by low brain function changes, especially in the forehead area. These findings are important because the function of the forehead and cortical motor areas is important to maintain attention, control impulses, and regulate attack and motor activity.
Seidman LA (1999) concluded that MRI examinations of 13 studies (202 boys and 14 girls) found that common abnormal sites were corpus callosum and caudate nucleus, and corpus callosum abnormalities were mainly anterior (top sheath) and posterior (pressure) Or both of them decrease in size, and the caudate nucleus volume decreases to one side or both sides. Only one study reported that the volume is increased, and the globus pallidus and the right anterior volume are also reduced. One study found that the entire volume is reduced (4.7%). It is 5.2% reduction on the right side. These findings are consistent with earlier theoretical models.
Functional MRI results were inconsistent, from the caudate nucleus of adults and family-borne ADHD children, the changes in the frontal zone and anterior cingulate gyrus, mainly due to decreased metabolism.
2. Environmental factors: Some studies have suggested that ADHD may also be caused by various environmental factors. In 1975, some scholars suggested that food allergies may cause hyperactivity and attention disorders in children, and some people have proposed food additives and salicylates. It can cause children to be overactive, impulsive and learning problems, but there is still some debate.
3. Pathological mechanism: Recently, PET studies have found that the density of dopamine receptors is related to children's development. The specific change of dopamine receptor density is not mature until adolescence. The area in which hyperactive children are easily affected is considered to be the anterior lobe. Pathway, neuropsychological research suggests that the anterior leaf function of hyperactive children is immature. The researchers believe that the anterior cortex is related to children's impulse and aggression behavior. Local cerebral blood flow studies have found that the frontal and caudate nucleus are mainly involved. Some studies have shown that medications increase blood flow in the basal ganglia and midbrain, and reduce blood flow in the motor area. These findings may explain why methylphenidate (Ritalin) can increase the attention of hyperactive children, exercise. Behavior is reduced, impulsive behavior is controlled, and fine movements and gross movements can be coordinated. Other studies focus on the thalamus, reticular activation system and anterior midbrain bundle. Compared with normal controls, neuroendocrine is also somewhat different. Hyperactive children's growth hormone response to amphetamine or methylphenidate is different, further illustrating that hyperactive and normal children have organisms The difference, whether it is skin electric or evoked potential research, found that children with ADHD generally show a lack of arousal level of stimulation. Previous studies have also found that insufficient levels of arousal are related to antisocial behavior and conduct disorder, because of insufficient awakening, reward and punishment behavior In general psychological level can not work, children with ADHD are difficult to learn from the previous lessons, and their behavior problems are difficult to correct.
Psychology research also found that children with ADHD have elevated social thresholds, whether positive or negative, and hyperactive children are not easy to accept. Generally, rewards and punishments are not easy to constrain and correct behavioral problems of such children. Some studies have shown that methylphenidate or other drugs are used. Neuro-stimulants, hyperactive children's social thresholds are reduced, positive or negative reinforcement levels are adjusted, which lays the foundation for behavioral correction. These psychological, physiological and pharmacological studies provide a theoretical framework to explain hyperactive children. Why can't we learn from life events, so it is difficult for such children to follow social norms, and they are prone to academic difficulties and interpersonal tensions and social adaptation obstacles.
4. Neuropsychological and neurobiological hypothesis: Viginia Douglas (1972) emphasized attention shift and impulsive control, leading to the concept of attention deficit disorder. Jeffrey Matter (1980) suggested that the symptoms of hyperactivity in children are related to dysfunction of the anterior lobes. Paul Wender (1971) proposed the hypothesis that catecholamine activity was reduced in the caudate nucleus and the happy center. Satter and Cantwell (1974) proposed the hypothesis of insufficient cortical arousal, all of which still affect imaging, functional imaging thinking, Some of the current contributions are mainly focused on cognition and brain.
Barkley (1997) proposed that the key defects of ADHD are executive function, including working memory, inhibition and planned damage, executive function dependent on the reticular structure regulated by the forebrain cortex, Voller (1991) and Heilman (1991) proposed right side defect (Note that defects have a hemispherical advantage) involve the prefrontal cortex and basal ganglia. Molecular genetic studies indicate that ADHD is associated with polymorphism in the dopamine gene, and may also be involved in the interaction between genes and genes, between genes and the environment. a complex disease.
Prevention
Attention deficit prevention
1. It is necessary to promote pre-marital examination to avoid marriage of close relatives; when choosing a spouse, it is necessary to pay attention to whether the other person has epilepsy or schizophrenia and other mental disorders.
2. Age-appropriate marriage, do not marry early, early pregnancy, do not be too late marriage, late pregnancy, to avoid the congenital deficiency of the baby, there are plans to prenatal and postnatal care.
3. In order to avoid birth injury and reduce the chance of brain damage, it should be natural, because the proportion of cesarean section in children with ADHD is higher.
4. Pregnant women should pay attention to temperament, maintain a happy mood, peace of mind, avoid cold and heat, prevent disease, use drugs with caution, ban tobacco and alcohol, and avoid the effects of poisoning, trauma and physical factors.
5. Create a warm and harmonious living environment, so that children can spend their childhood in a relaxed and pleasant environment, and teach students in accordance with their aptitude.
6. Pay attention to reasonable nutrition, so that children can develop good eating habits, not partial eclipse, not picky eaters, and ensure adequate sleep time.
7. Try to avoid children playing with lead-painted paint toys, especially if they are not included in the mouth.
Complication
Attention deficit complication Complications autism
Often accompanied by learning difficulties and psychological abnormalities, some children can not complete formal school education, and often have anti-social awareness in adolescence.
Symptom
Attention deficit symptoms symptoms common symptoms irritating attention disorder anxiety anxiety inattention attention deficit hyperactivity disorder conduct disorder
Pay attention to defects
Active attention to keep the time up to the child's age and IQ level is one of the core symptoms of ADHD. The attention of this child is very easy to be dispersed by the environment, and the time of concentration is short. Therefore, they When playing blocks or class, they often seem unfocused and distracted by environmental disturbances. Pay attention to the frequent shift of objects from one activity to another, as if they were lost to the original because they noticed new things. Interests, when doing homework, you can't concentrate on yourself, while doing and playing, constantly changing the content of the work, constantly interrupting the work with reasons such as drinking water, eating, etc., carelessly, arbitrarily altered, lost, and the operation time is significantly extended due to the drag of the action. I almost responded to the stimuli from all sides. I couldn't filter the irrelevant stimuli, so the attention was difficult to concentrate. A few children showed a gaze in a daze, sitting in the classroom and looking at the teacher, and the inner activity had already flown out. When you pay attention to defects, you can pay attention to activities that you are interested in, such as watching TV, listening to stories, etc. No attention can be paid to any activity.
2. Too many activities
Most children have been particularly active since childhood. In a relatively quiet environment, the amount of activity and activity has increased significantly. It is particularly prominent in situations where self-discipline or order is needed. It is another core symptom of hyperactivity disorder. Excessively, most of them begin in early childhood. After entering primary school, they are more constrained by various restrictions. Some children begin to have excessive activities during their infancy. They are extraordinarily active and will climb from the cradle or car. When they start to learn, they often take the run, the children are a little bigger, see the little book can not read a few pages, just change one, or simply tear the book, sometimes rummaging the cabinet, messed up, after entering the primary school, performance In order to be too restless and/or small in the classroom, there is obviously more, you can't sit still, twist and twist in your seat, look around, look around, shake the table and swivel chair, talk loudly, can't stop, often provoke others, who can meet The things always have to touch, deliberately make a sound to attract attention, often quarrel or fight with classmates; often because of good mouth and interference, easy to cause teachers annoyance Failure to comply with classroom discipline and order, like a dangerous game, climb down low, mischievous.
Persistent hyperactivity refers to a type of school, family and clinic that occurs frequently, with early onset, long duration, severe symptoms, cognitive deficits or low IQ, and academic and interpersonal relationships are affected. Large, situational hyperactivity refers to hyperactivity that occurs only on certain occasions (such as schools), while in other situations (such as the family) does not appear in a type, the degree of impairment of various functions is more persistent than sustained.
Impulsive
Due to the lack of restraint ability, hyperactive children often react excessively to some unpleasant stimuli, often make unthinking behaviors, irritate, ignore the consequences, destroy things, behave as naive, self-willed, self-restraint, easy to stimulate Impulsive, prone to external excitement and excitement, strong sense of frustration, behavioral abruptness, rashness; lack of careful consideration beforehand, behavior regardless of the consequences, resulting in dangerous actions to hurt or destroy behavior under impulsive; afterwards will not learn the lesson, they want What must be met immediately, otherwise crying, losing temper, often causing trouble, their emotions are unstable, they will be screaming or noisy for no reason, and they have no patience, and everything is rushing, impulsive and capricious is the prominent and often appearing of ADHD. Symptoms, for this reason, some scholars regard it as a core symptom.
Impulsiveness has been included in the DSM-IV diagnostic criteria as one of the three characteristic symptoms of ADHD. ICD-10 has not yet used this symptom as a prerequisite for the diagnosis of hyperactivity disorder. One of the reasons is the current measurement of impulsivity. And how to recognize and assess the lack of consistent standards.
4. Learning difficulties
The intelligence level of children with ADHD is mostly normal or close to normal. However, due to defects and hyperactivity, it still brings some difficulties to learning, affecting the classroom learning effect and the speed and quality of homework, resulting in poor academic performance and academic achievement. Inconsistent with the level of intelligence, some children have cognitive function defects, such as visual-spatial position disorder, can not distinguish the relationship between the subject and the background, can not analyze the combination of graphics, can not integrate the various parts of the graph into a whole, left and right Can't, so that the reverse word is written, the "department" is written as "accompanying", the "6" is read as "9", the "b" is regarded as "d", and even the left or right cannot be distinguished. The change of the former is a comprehensive analysis. Obstacles, the latter are obstacles to spatial positioning. They also have difficulty in reading, pinyin, writing or language expression. Children with ADHD respond without serious thinking, and understanding is not complete. It is also one of the reasons for learning difficulties.
In addition, about 30% to 60% of children with ADHD are associated with confrontational disorders, 20% to 30% of children with conduct disorder, 20% to 30% of children with anxiety disorders, and 20% to 60% of children Accompanied by school skills barriers.
In general, the clinical symptoms of hyperactive children are sometimes different from those of children, and the activities involved are different. Children with ADHD are paying attention when they are doing homework, doing repetitive activities or doing great efforts, and doing something new. The maintenance of force is the most difficult, attractive, and the symptoms of ADHD can be alleviated in new or unfamiliar environments. Under continuous and direct reinforcement procedures, attention is maintained better than local and delayed enhancement procedures. When the instruction is repeated, the child's ADHD completes the task, and the maintenance of attention is not a problem. In the place where there is no strict strict regulation and strict discipline requirements, the hyperactive child is almost indistinguishable from the normal child. The phenomenon of fluctuations with the situation indicates that the severity of symptoms manifested by hyperactive children is affected by the environment and has a high degree of interaction with them.
5. abnormal nervous system
Half of the children have fine movements, coordinated movements, spatial positional dysfunction, and clumsy movement skills, such as turning hands, pointing movements, laces and button buttons, etc. With the development of the nervous system, it will gradually improve. A few children with abnormal neuropsychiatric development have delayed language development and poor language expression. Neuropsychological tests have shown developmental disorders in attention, memory, visual motion and generalization, and reasoning ability.
A certain number of children have EEG abnormalities, mainly characterized by slow wave, poor amplitude modulation, irregularity, less frequent spikes and spikes, and mild diffuse rhythm abnormalities, but EEG abnormalities are only useful for diagnosis. There was no significant relationship between disease genetics, etiology, treatment response, and prognosis.
Female children are less active, with less problems with conduct, more emotional problems, lower incidence of externalization (attacks, violations), but more serious intellectual damage, resulting in this difference To a large extent, it is affected by the source of the child, that is to say, in the sample that has not been visited by the hospital, the female has less attention and has more internalized behavior. She is not welcomed by her peers or attacked by her peers. The sample of the visit did not show the above difference.
The main manifestations of adult ADHD are attention deficit, hyperactivity or restlessness, emotional impulse or instability, impaired learning or social function, clinical features similar to childhood ADHD, due to inconsistent diagnostic criteria used in follow-up studies. The prevalence of adult ADHD is 8% to 80% of those with a history of ADHD in children, and the difference is very large. The American Children and Adolescent Epidemiology Study (MECA) scores <70 for the general assessment scale (GAS). By definition, the prevalence rate is 3.3%. Shaffer believes that if 10% of children with hyperactivity symptoms in the Mannuzza study sample can continue into adulthood and can promote MECA results, the annual prevalence of adult ADHD is estimated to be about 0.3%. Other mental disorders in adults are significantly lower. In adult patients, in addition to core symptoms such as inattention, hyperactivity or restlessness, and emotional impulses, there are other behavioral and/or emotional problems in multiple age groups. Class manifestations of conduct disorder or confrontational disorder, antisocial personality, substance abuse, such as Mannuzza et al (1993) follow-up only 8% of hyperactivity symptoms persist to adults The incidence of substance abuse and antisocial personality in these patients is extremely high. It is unclear whether the behavioral problem is the result of attention deficit and hyperactivity or the accompanying problem. Therefore, it is unclear which factors lead to the ultimate social function impairment. The outcome is difficult, and the other is the combined emotional disorder, such as generalized anxiety and poor mood. Because of the inability to classify these diseases in the DSM system, it is difficult to classify and diagnose adult ADHD.
Children's Wechsler Intelligence test shows that children with ADHD have more intelligence at normal levels or at the level of marginal intelligence (70-90 total IQ), and 35% of children with ADHD develop speech IQ and operational IQ. Unbalanced, operating IQ is better than verbal IQ. So far, there is no clear pathological change as a basis for diagnosis. Therefore, the current diagnosis is still based on the medical history, clinical manifestations, and physique provided by the parents and teachers of the child. Examination (including neurological examination), mental examination as the main basis, clinical assessment scale is not only helpful for diagnosis, but also to understand the severity of the disease and to evaluate the treatment effect. Commonly used Conners Child Behavior Scale, including parental questionnaire, concise symptoms Scale and teacher rating scales; Achenbach Child Behavior Scale (CBCL); attention measurement, children with ADHD can not be persistent, easy to disperse; intelligence test to rule out mental retardation.
Examine
Attention to the inspection of defects
There is no specific laboratory test for this disease. When other symptoms such as infections occur, laboratory tests show positive results of other diseases. The following general examinations can be performed:
1. Regular hematuria examination, biochemical electrolyte examination.
2. Serum immunological examination.
3. CT scan of CT hyperactivity disorder found no abnormalities.
4.MRI
The area of the corpus callosum (upper anterior motion zone) and the corpus callosum (pre-motion zone and auxiliary exercise zone) was significantly larger in the ADHD group than in the control group, and the increase in these areas was evident in the hyperkinetic-impact factor of the Conners scale. A positive correlation suggests that some of the clinical features of ADHD can be expressed in terms of differences in the number of brain morphologies. On the other hand, Wise reviews the function of the primate premotor region and concludes that the premotor region is some Stimulation in the inhibition of autonomic response plays a key role. For example, the cortical damage of the anterior motor zone of the macaque can not inhibit the behavior of taking bananas through a transparent plastic disk, but it is still repeated, impulsively attempting to pass the plastic disk before the damage. The same macaque quickly got bananas. This defect is similar to human defect inhibition and is called the ADHD core defect by Barkley.
5. Computerized EEG (CEEG)
The bilateral frontal lobe is found in a group of children with dyslexia. The left and left posterior areas are mainly characterized by increased alpha wave activity, suggesting insufficient cortical arousal, attention deficit hyperactivity disorder and Tourette syndrome. No specific changes were found in the CEEG examination. The study found that the conventional EEG abnormality rate was higher in the attention deficit hyperactivity disorder than in the normal children's control group. The slow wave activity increased, the fast wave decreased, the occipital region, and the right axillary region rhythm. Significantly lower than normal control children, due to the study population, standard, electrode placement, test conditions, interpretation of attention deficit hyperactivity disorder CEEG is very difficult, most consistent studies believe that the intensity is lower in 8 ~ 10Hz, and The findings in normal children are inconsistent. In children with attention deficit hyperactivity disorder, there is almost no change in peak and latency after giving ordinary and novel stimuli, indicating that children with attention deficit hyperactivity disorder have difficulty in correct selection and evaluation of given stimuli. .
6. Positron emission tomography (PET)
Previous studies of ADHD children and control children found that children with ADHD had decreased brain cerebral glucose metabolism. The most different brain regions were the anterior motor area and the frontal gyrus. Some scholars believe that the therapeutic effect of psychostimulants is through the increase of the caudate nucleus. Blood flow to improve symptoms, Matochik et al (1994) hypothesized that psychotropic stimulants with better efficacy for ADHD can increase or normalize the local glucose metabolism rate in ADHD patients, and further use PET scans in 18 adult ADHD patients. 18F (deoxyglucose) was used as a tracer to measure the changes of glucose metabolism before and after stimulant treatment. The results showed that glucose metabolism was changed in only 2 brain regions in 60 brain regions of interest, and the anterior side of the right caudate nucleus was descending. The area increased, and in the therapeutically effective group, the patient's glucose metabolism increased, but whether the increase in local glucose metabolism depends on the action of stimulants remains to be further studied.
7. Single photon emission tomography (SPECT)
In the study of attention deficit hyperactivity disorder, Lou et al. (1990) found in ADHD that the amount of perfusion in the new striatum and frontal area was relatively decreased and the amount of perfusion in the primary sensory area was relatively increased. This perfusion pattern was obtained after methylphenidate treatment. Reversal, it is believed that prefrontal and neocortical dysfunction plays an important role in attention deficit hyperactivity disorder. The same research group also emphasized that the blood flow in the striatum is low, indicating that the inhibition of striatum activity is inhibited by various sensory activities. Lack of attention is a feature of attention deficit hyperactivity disorder. Hamdan-Allen compared the relationship between mean cerebral blood flow and CBCL behavioral items. No relationship between blood flow and attack, hyperactive score was found, and the prefrontal cortex was considered to be impulsive, attacking and In the control of hyperactivity, the regulation of cerebral blood flow should also be considered in connection with catecholamines. Lou et al. (1990) used 133Xe inhalation to measure the insufficiency of regional cerebral blood flow (rCBF). Attention deficit disorder and/or striatum with speech-syntactic speech difficulties, low rCBF around the ventricle, most prominent in the striatum, and speech-syntactic speech difficulties without ADH At the time of D, the left forehead and left central fissures were lower than the right side. Raynaud et al. (1989) found that 9 children with expressive speech disorder had low left hemisphere blood flow, and the study indicated that the left hemisphere was hypofunction.
Amen and Paldi (1993) performed a SPECT scan of 54 children with ADHD who were eligible for DSM-III-R. Sixty-five of children with ADHD showed a decrease in prefrontal activation during cognitive activity, compared with 5% in the normal control group. 35% did not show a decrease in prefrontal activation, and 2/3 of the prefrontal cortex activity decreased significantly at rest. It is considered that SPECT scan has positive significance for the diagnosis and treatment of ADHD.
Du Yasong et al (1997) measured regional cerebral perfusion in 17 children with ADHD and 11 normal children. The results showed that the low perfusion rate was lower in children with ADHD than in normal children. The low perfusion area involved frontal lobe, temporal lobe, and occipital lobe. And the thalamus; semi-quantitative analysis showed that the left basal ganglia was lower than the right side, and the right anterior cingulate gyrus and temporal lobe perfusion were lower than the corresponding part on the left side, suggesting that the frontal basal ganglia loop plays an important role in the pathophysiological mechanism of ADHD. effect.
PET studies found that children with ADHD had reduced perfusion of premotor and prefrontal cortex, suggesting that their metabolic rate was reduced, and these brain regions were involved in the control of attention and movement. MRI found abnormalities in frontal lobe and bilateral caudate nucleus The head end is asymmetrical.
Visual brain evoked potential (VEP) test suggests that the activity-dependent potential (ERP) mutation rate of active-passive attention in children with ADHD is small, and VEP can reflect changes in attention and cognition in children with this disease.
Diagnosis
Attention deficit diagnosis diagnosis
Diagnostic criteria:
Symptom standard
The following symptoms are more common than most people of the same age, and need to have 6 of the following behaviors or attention disorders, or 6 impulsive disorders and hyperactivity.
(1) Note:
1 Often you can't pay close attention to details, or you can make casual mistakes in your homework, work, or other activities.
2 often can not pay attention when completing tasks or playing games.
3 When people talk to him or her, they often don't seem to listen.
4 Often it is not always possible to follow instructions and not be able to complete homework, daily chores or duties at work.
5 The ability to organize tasks or activities is often compromised.
6 often avoid or dislike tasks that require mental effort, such as homework.
7 often loses the necessities of a certain task or activity, such as school work, pencils, toys or tools.
8 is often easily attracted by outside stimuli.
9 often forget things in daily activities.
(2) Hyperactivity:
1 Hands or feet are often unsteady, or wriggle when sitting, leaving the seat in a classroom or other place where a seat is required.
2 often run or climb the ladder in an inappropriate situation.
3 games are often uncomfortable, and it is difficult to participate in entertainment activities quietly.
4 The performance of persistent activities is excessive, and the social environment or the requirements of others cannot make significant changes to the child.
5 often talk too much.
(3) Impulsiveness:
1 often when someone else's question is not completed, the answer is blurted out.
2 In the game or organized occasions often can not line up or wait in order.
3 often disturb or interfere with others.
2. The course of disease usually begins before the age of 7 and the course lasts for more than 6 months.
3. Exclusion criteria were not due to extensive developmental disorders, mental retardation, childhood mental disorders, organic mental disorders, neuropsychiatric disorders, and drug side effects.
4. Severity classification
(1) Mild: Symptoms meet or slightly exceed the symptoms required for diagnostic criteria, with little or no impairment of school and social function.
(2) Moderate: Symptoms and damage are between mild and severe.
(3) Severe: Many symptoms are required to exceed the diagnostic criteria, and there are obvious and extensive social function impairments in schools, families, and partnerships.
Differential diagnosis
It should be differentiated from the following diseases or disorders with symptoms similar to ADHD:
1 mental retardation.
2 lonely obstacles.
3 depression.
4 caused by chronic social environmental problems.
5 twitching syndrome or multiple tic syndrome.
6 other behavioral disorders.
Many mental retardation have excessive purposeless activities, lack of judgment ability, failure to complete school, often shift from one activity to another, impulsive control is also flawed, and the main difference between mental retardation and hyperactivity syndrome in children The level of intellectual ability of children with mental retardation is lower than normal, and the academic achievement is generally consistent with the level of intellectual ability, while the learning score of children with hyperactivity syndrome is significantly lower than the level of intellectual ability.
Children with autistic disorders also have symptoms such as hyperactivity, impulsivity and attention disorder, but these children with autistic disorders have serious social and interpersonal barriers and language barriers, so children with autism are indeed different from children with ADHD.
Some children with mood disorders also have symptoms such as psychomotor excitement and attention deficit disorder. These children are difficult to distinguish from children with ADHD. Children with ADHD often overlap with children with mood disorders because they have long-term discomfort and depression. From the negative reaction to the relationship between parents, classmates, playmates and teachers, they also expressed irritability in the positive reinforcement of praise, love, etc., the mother's reward can not change the strengthening threshold of these children, children with emotional disorders, their condition The symptoms of seizures and mood disorders are severe, while the duration of children with hyperactivity syndrome is chronic and continuous, which is a mild or moderate disorder.
A long-term chaotic family, whose living environment is difficult to create an environment that allows children to concentrate on completing their homework, whether they are not functioning well by their parents, or because their parents are inconsistent and accused of each other, living in such an environment. Children have many symptoms of ADHD. Before and after symptoms of ADHD, adverse signs of social and family environment may help to identify with ADHD in general children. People with social disorders may have more than one or more children. Mobility, ADHD symptoms may coexist with a ruptured family atmosphere or secondary to adults with alcohol dependence, antisocial personality and families with rickets, once the child is placed in a stable, consistent and complete family and social environment, The symptoms disappear completely, and in this case, the diagnosis of ADHD cannot be easily made.
ADHD and tic disorder may have overlapping symptoms. Many children with tic disorder have a lack of concentration, hyperactivity and impulsive history. About 10% of hyperactive children are accompanied by Tourette syndrome or multiple tic syndrome, tics and tics. Coexistence has certain therapeutic significance. Treatment with cytotoxicity with piperazine and treatment with ADHD with dextroamphetamine (dextroamphetamine) is usually a group of muscle twitching, and some are accompanied by throat and phlegm. Simple tics and slang syndrome are more easily identified with hyperactivity. The last one to be diagnosed is conduct disorder and confrontational behavior. The latter two have more disturbance or destructive behavior to others. The initial symptoms of confrontation disorders are often Children and adolescents who are ruining school rules, disobeying or confronting school leaders and teachers, and who are guilty of violations and conduct disorder often have no other people, accompanied by frequent anti-social and criminal behaviors. As for ADHD children, there is generally no serious anti-social Activities, hyperactive children do not want to have destructive behaviors and behaviors, but because of poor self-control ability can speak impulses and make irrelevant consequences Love, hyperactive children with other disabilities should be actively treated, the prognosis is not good for children because there are two obstacles to overlapping symptoms.
1. Mental retardation: It can be accompanied by attention deficit and excessive activity. It is easy to be misdiagnosed as ADHD, but children with ADHD can improve their academic performance after reaching the level of improvement, and their mental performance is improved. The performance of the delayed person is always consistent with his or her intelligence level. At the same time, there are language and motor development retardation, judgment ability, comprehension ability and social adaptability are generally low.
2. Conduct disorder: These children exhibit behaviors that violate social norms or ethical standards that are compatible with age, damage personal or public interests, have no attention deficit and hyperactive disorder behavior, normal intelligence, no attention deficits, and take excitement The agent is invalid.
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