Deficit-Hyperactivity Disorder, also known as ADHD, is a common mental disorder in childhood. Inattention and short attention spans, hyperactivity, and impulsivity disproportionate to age and developmental level, often accompanied by learning difficulties, conduct disorders, and maladaptation. The disease begins before school and presents a chronic course. The disorder not only affects children’s school, home, and out-of-school life, but can easily lead to persistent learning difficulties, behavioral problems, and low self-esteem in children, who have difficulty getting along with others at home and at school. If not treated in time, some children will still have symptoms in adulthood, which will obviously affect the patients’ academic, physical and mental health, as well as their family life and social skills in adulthood.
The etiology of attention deficit hyperactivity disorder is unclear. At present, attention deficit hyperactivity disorder is considered to be a syndrome caused by a variety of biological factors, psychological factors, and social factors alone or in synergy.
- Attention deficit is one of the main manifestations of the disease. The child’s active attention is reduced, and the passive attention is enhanced. It is manifested as inattention, inattentiveness in class, easily distracted by the interference of the environment, and the object of attention frequently changes from one to another. The activity moves to another activity. Can’t concentrate on homework, play, and play, careless and sloppy. There is a beginning and no end in doing things, and things are lost, often giving up halfway. Procrastinating homework, interrupting constantly for reasons such as drinking water, eating, urinating, etc., the time for homework is significantly prolonged. Mild attention deficit can focus on activities that interest you, such as watching TV, playing computer games, etc.
2. Excessive activity is mainly manifested as excessive restlessness and/or many small movements, the child’s behavior is naive, not in line with his age, often running back and forth or constantly making small movements, unable to sit still in the classroom, often twisting or standing on the seat, and in severe cases. Leaving the seat to walk around, or leaving the classroom without authorization, talking too much, making noise, interrupting, causing trouble, and affecting classroom discipline. There are two types of hyperactivity:
Hyperactive behavior in children with persistent hyperactivity occurs in any setting, such as at school or at home, and is often severe.
Situational hyperactivity, hyperactive behavior occur only in certain situations (mostly at school), but not in other situations (at home), and the impairment of various functions is mild.
- Emotionally unstable, irritable, self-willed, poor self-control, unable to restrain their behavior even though they know it will lead to adverse consequences. Often accompanied by fast, imprecise behaviors without a clear purpose, naive, easily overexcited by external stimuli, and easily frustrated. Behaving abruptly, recklessly, without considering the consequences.
- Children with poor academic performance have normal or basically normal intelligence, and the reasons for their learning difficulties are related to inattention and hyperactivity. The time when learning difficulties appear depends on the level of intelligence and the severity of ADHD. Children with severe ADHD who have moderate or low intelligence levels may have learning difficulties in the early school age. Those with higher intelligence levels and milder symptoms of hyperactivity may have learning difficulties only in the junior high school stage.
- Nervous System Abnormalities About half of the children have the neurological soft disease, which is manifested as clumsy rapid alternating movements, uncoordinated mutual aid activities, inability to walk in a straight line, eyes closed, difficulty standing, positive finger-nose test, inflexible fine motor movements, and some patients with neurological disorders. Children may have visual-motor disorders, spatial position perception disorders, and so on.
Common treatments for ADHD
1. Medical treatment
Central stimulant methylphenidate
Methylphenidate is currently the main drug for the treatment of attention deficit hyperactivity disorder, and methylphenidate is contraindicated in children with epilepsy, a history of epilepsy, or abnormal EEG with epileptiform discharges. Side effects can occur early in treatment and are usually mild and short-lived. The most common side effects were decreased appetite, stomach pain or headache, delayed sleep onset, nervousness, or social withdrawal. Most of these symptoms can be successfully controlled by adjusting the dosing regimen.
Central norepinephrine modulating drug clonidine
Clonidine is a centrally acting antihypertensive drug. The only therapeutic indication approved by the U.S. Food and Drug Administration in the treatment of hypertension in adults and older adolescents. The safety and efficacy of use in children have not been proven.
- Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulate (TMS) is a magnetic stimulation technique that uses a time-varying magnetic field to act on the cerebral cortex to generate induced currents to change the action potential of cortical nerve cells, thereby affecting the metabolism and neural activity in the brain. Painless, non-invasive, safe, and reliable stimulation of the central and peripheral nerves.
Application in Attention Deficit Hyperactivity Disorder
TMS neurophysiology may provide particularly new insights into common neuropsychiatric disorders such as ADHD, which, unlike other neurological disorders in children with well-defined anatomical or injury features, are characterized by complex dysfunction at the cellular level.
- Application in Evaluation
A case-control study of 49 8-12-year-olds with attention deficit hyperactivity disorder (ADHD) found that short-interval intracortical inhibition (SICI, a form of GABAA-mediated inhibition in the motor cortex) was reduced in the primary motor cortex Moreover, this reduction is related to the severity of ADHD. The authors believe that TMS-induced sICI is related to the severity of ADHD and the development of motor skills. Possible mechanisms suggest that surround inhibition mediated by GABAergic interneurons and mediated by dopamine may play an important role in ensuring that ADHD extracts signals from the cortex for accurate movement selection and control. Transcallosal suppression was also assessed for ADHD. Buchmann et al” used TMS to study the physiology of the motor cortex and corpus callosum in 13 children with ADHD and compared them with controls and found that the short-term iSP in ADHD may reflect cortical (location of motor cortex fibers projecting through the corpus callosum) and V (cones of the corpus callosum) The origin of the body tract) is the imbalance of inhibition and excitation in the interneural network, and the prolonged latency of iSP may reflect the difference in the myelinization of rapidly conducting fibers through the corpus callosum in ADHD, suggesting that iSP may be a powerful tool to distinguish ADHD children from normal children This is also supported by a study of iSP in children with ADHD aged 7-13 years by Garvey et al. Based on the above studies on the relationship between ADHD clinical symptoms and neurobiology, it has been suggested that Ritalin can partially reverse the abnormality of subcortical motor circuits.
- Application in therapy
A recent clinical trial attempts to explain new insights into the neurobiological aspects of ADHD”. A randomized, sham-controlled crossover study of 9 patients with ADHD aged 15-20 years with rTMS stimulation in the right prefrontal lobe Cortex, the frequency is 10Hz (100% motor threshold), 2000 pulses each time, 5 times a week, a total of 2 weeks. The results show that TMS is safe. No serious adverse reactions, TMS stimulation group and sham stimulation group in the overall clinical impression The scores of ADHD-IV and ADHD-IV were significantly improved, but no significant difference was found between the two groups.