ADHD was first described by george steel in 1902. In recent 100 years, there have been more than 25 names about ADHD, including mild brain injury, mild brain dysfunction and ADHD in children. In 1970s, scholars discovered the central role of attention deficit disorder in this disease, and named it attention deficit disorder. For people with ADHD symptoms, they named it attention deficit disorder with ADHD. It is worth noting that in recent years, with the research progress of modern cognitive psychology, scholars have also questioned the core role of attention deficit, thinking that the core defect of this disease may exist in the process of information processing or transmission (reaction) of the body, or it may be that the body's comprehensive information ability is defective, resulting in poor selective inhibition of motor response.
The treatment of ADHD includes educational intervention, parental consultation and drug therapy.
(A), educational intervention
Education plays an important role in the development of ADHD children. All children with or without learning disabilities should receive personalized special education. Teaching students in accordance with their aptitude means teaching students in accordance with their aptitude in personality factors such as temperament, personality and intelligence, and making special arrangements for ADHD children in terms of homework assignment, after-school counseling, extracurricular activities and classroom questioning. Because most children have experienced many failures and setbacks in their study and life, it is the key to education for teachers and parents to use behavior correction skills such as positive reinforcement, regression, negative reinforcement and punishment to help children build their self-confidence and self-esteem through encouragement (positive reinforcement) and achieve continuous success or progress. Appropriate and gentle punishment can sometimes have a good effect, but corporal punishment and scolding must be strictly prohibited. The cooperation mode of family, school and professional institutions can play the best role in educational intervention.
(2) Family counseling
Family members' comprehensive understanding of ADHD is the key to treatment. After diagnosis, professionals and parents must have a comprehensive communication about the disorder itself, behavior correction, emotional support, drug treatment and prognosis. Children themselves need support, and families also need support. Removing the disharmonious factors in the family and improving the parent-child relationship can play a good role in the treatment of ADHD, especially in preventing secondary disorders. Parents participate in children's activities, so that children can combine static and dynamic. Purposeful and planned activities can cultivate children's good study and life habits, help reduce ADHD and improve attention.
(3) drug therapy
The drug treatment of ADHD has long been controversial. The central issues of controversy include the validity of the above diagnosis and the side effects of drugs. Judging from the current trend, most scholars in the United States advocate drug therapy. According to literature reports, about1300,380,000 5- 14-year-old children in the United States are taking methylphenidate (ritalin) to treat ADHD. The amount of ritalin produced and consumed in the United States is five times that of other countries in the world. On the other hand, Britain does not advocate drug treatment. Based on the results of various studies, the current view is that (1) after decades of clinical application, methylphenidate can be considered as a relatively safe and very effective therapeutic drug; (2) Use medication on the basis of strict diagnosis, and at the same time use other means including educational intervention, behavior correction, family counseling, and pay attention to monitoring the side effects of drugs.
At present, drug therapy mainly includes two types, namely psychoactive drug therapy and non-psychoactive drug therapy.
1. Exciting drugs
There are mainly methylphenidate (ritalin), phenytoin (pimoline) and dextroamphetamine. There is no dispute about the short-term effect of this drug on improving attention. Since Bradley first used the drug to treat ADHD in 1937, a large number of studies have confirmed the good efficacy of the drug. In addition to improving attention, the drug can also improve academic performance, promote parent-child relationship and reduce aggressive behavior.
Methylmethylphenidate is the most commonly used refreshing drug, which is effective for about 70%-80% ADHD children. The medicine has good curative effect and quick response, and can improve children's attention on the day of taking it. Teachers use Connor's questionnaire to record the improvement of children's behavior after taking the medicine, which usually has obvious effect in the first few weeks after taking the medicine. It is very important to take this opportunity to implement other educational measures. For school-age children, the initial dose is usually 5mg- 10mg each time, 1-2 times a day, mostly in the morning and noon. If the treatment fails after one week, the dosage can be increased, and the total amount can not exceed 40mg each time. In addition, due to the short half-life, it is often necessary to give it twice a day. At present, there is a sustained-release dosage form of methylphenidate abroad, once a day, which has good clinical compliance for children. Usually do not take medicine on weekends, whether to take medicine in winter and summer vacation depends on the family's concern for children, but children who take medicine to lose weight can not take medicine. The duration of medication varies from several months to several years. Preschool children generally don't use it. There are few studies on the long-term efficacy of methylphenidate. A study found that the drug could not improve children's academic performance in the end, but critics believed that the choice of subjects in the study was biased, and the children in the drug group were more seriously ill than those in the placebo group.
The main side effects of methylphenidate are loss of appetite and difficulty sleeping. This side effect mainly occurs in children who take medicine three times a day and may lead to weight loss. About 25%-35% of children complain of headache and stomachache, most of which appear at the initial stage of taking medicine, and the symptoms can disappear after continuing taking medicine or reducing the amount. In addition, it has been reported that the drug has the risk of addiction and drug abuse, but it usually exceeds the therapeutic dose, so parents should strengthen the management of the drug.
Phenytoin (Pimoline) can be used when the curative effect of methylphenidate is not obvious, and the effective rate is 65-70%. The drug takes effect slowly and takes effect about a week after taking it, but the half-life of phenytoin is long, reaching 12 hours, so it only needs to be taken once a day, with an initial dose of 5-20mg/ day, and the dose can be gradually increased according to the curative effect, and the maximum dose is 100mg/ day. The main side effects are liver function damage, insomnia, depression and loss of appetite.
2. Other drugs: About 20%-30% of children are not sensitive to psychostimulants. At this time, α receptor antagonists can be selected, mainly clonidine and guanfacine. Clonidine is the most commonly used drug, which has obvious effect on reducing ADHD and is the first choice for children with ADHD complicated with TIC disorder. At the same time, it can reduce impulsive and aggressive behavior. Although it is a antihypertensive drug, it has little effect on children's blood pressure. Blood pressure should still be monitored during use. Especially in the process of drug withdrawal or reduction, we should pay attention to the rebound of blood pressure. Another alternative drug is antidepressant, such as desipramine or imipramine.
(D) sensory integration training
Sensory integration therapy was founded by Els in the United States to treat ADHD and learning disabilities in children. This therapy mainly uses skateboards, swings, balance beams and other game facilities to train children. According to reports and observations, it has a good effect on reducing children's hyperactivity.
(5) Other treatments mainly include high-dose vitamin therapy, mineral supplementation and lead excretion therapy.