Cómo identificar y abordar el Trastorno por Déficit de Atención

Author: Liu Guorui, Specialist Physician in the Department of Medical Psychology at Changzheng Hospital, Shanghai 905 Hospital.

Zhang Yanféi, attending physician in the Department of Medical Psychology at the Second Affiliated Hospital of Naval Medical University.

Wen Jing, therapist in the Department of Medical Psychology of Shanghai First People's Hospital.

Reviewer: Bai Chonghai, Chief Physician of the Department of Medical Psychology at the Second Affiliated Hospital of Naval Medical University (Changzheng Hospital, Shanghai), Professor.

In our environment, there exists a group of 'special children': their brains are innately different, sometimes they find it hard to concentrate, while at other times they possess an inexhaustible energy, like a pendulum in motion. However, if guided correctly, this 'difference' can become their unique advantage. Today, let us together explore this 'difference' known as Attention Deficit Hyperactivity Disorder (ADHD).

1. Revealing the characteristics of ADHD.

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The brains of children with ADHD exhibit a phenomenon known as 'halo of distraction', functioning like a high-sensitivity radar, capable of capturing multiple types of information simultaneously. Unfortunately, this ability sometimes makes it challenging for them to focus on a single task; from birds flying by the window to patterns on their desk, everything can become the focus of their attention.

Children with ADHD are like 'superheroes' filled with energy, always restless and eager to explore the world. They may enjoy constant movement or display great vitality in the classroom.

Children with ADHD tend to express their impulses in ways that their thought speed is almost lightning-fast; they often start responding before others finish speaking or unintentionally interrupt others, with an urgent need to share their own ideas.

2. ADHD in children: where do these 'unique' characteristics come from?

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The genetic coding of ADHD often shows hereditary characteristics; if one of the parents or relatives has similar traits, the likelihood that the child develops ADHD also increases.

Scientific research has discovered that children with ADHD have slower development of the prefrontal cortex, the area of the brain responsible for attention and self-control. Abnormal levels of certain neurotransmitters, such as dopamine, may affect behavior regulation.

Environmental impacts on the mother during pregnancy, such as exposure to nicotine, alcohol, and other adverse factors, as well as an unfavorable environment during the child's early years (such as excessive stress and prolonged sleep deprivation), may also affect the likelihood of developing ADHD.

3. How is ADHD diagnosed?

The doctor conducting the intensive interview will communicate with children suspected of having ADHD, as well as their parents and teachers, to understand their behavioral characteristics in different situations.

(2) Abilities evaluation

The Kahn Child Behavior Scale and the Achenbach Child Behavior Scale (CBCL) can help assess the levels of attention and hyperactivity in children.

The Continuous Performance Test (CPT) evaluates children’s attention through computerized tasks.

Doctors will conduct a thorough examination to rule out other factors that may affect the child's attention, such as hearing problems or thyroid disorders.

4. Proper guidance manual for children with ADHD.

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(1) Super allies (family + school)

Parents, teachers, and others responsible for children with ADHD should provide clear rules and encouragement to help them develop better behavioral habits. Schools can offer personalized support, such as optimizing seating arrangements and providing extra time to complete tasks.

(2) Energy control (pharmacological support)

Central nervous system stimulants, such as methylphenidate, help improve attention in children with ADHD. Non-stimulants, such as atomoxetine, may be suitable in certain special circumstances, such as when children with ADHD are at risk of substance abuse or have comorbidities such as tic disorders or anxiety disorders.

(3) Skill enhancement (behavioral training)

Children with ADHD need to receive scientific training and intervention during their growth. The following behavioral training methods can help them focus better, manage impulsivity, and regulate their emotions, thereby improving their self-regulation abilities.

1) Cognitive-Behavioral Therapy (CBT) - Strengthening thought management.

CBT is a crucial tool for treating ADHD, as it helps children identify and adjust irrational thinking patterns and develop more effective coping strategies. For example, emotional regulation training teaches children to recognize their emotional shifts and alleviate anxiety and impulsivity through techniques such as deep breathing and positive self-talk; self-monitoring of behavior encourages children to keep track of their actions, identify situations where they easily get distracted, and strive to adjust their coping strategies; and goal setting and reward mechanisms help children establish specific and achievable goals, systematically reinforcing positive behaviors through a reward system.

2) Time management training: saying goodbye to procrastination and chaos.

Time management is a significant challenge for children with ADHD, but it can be improved through training. For example, the Pomodoro technique: setting 20 to 30 minutes of focus time, followed by 5 minutes of break, helps reduce distraction caused by prolonged tasks. Another strategy is to use a visual schedule: implementing charts, color codes, or a timer to help children intuitively perceive the passage of time, which improves task efficiency. Additionally, it is helpful to break down tasks and establish priorities: dividing larger tasks into smaller steps, starting with the most important parts, which reduces procrastination and pressure.

3) Social skills training: improving interpersonal interaction abilities.

Children with ADHD may experience issues in social interactions, such as impulsively interrupting, difficulty waiting, and lack of skills to recognize emotions. Social skills training can help them interact better with others. For example, through role-playing exercises, they can learn to express their needs appropriately, listen to others, and manage conflicts; non-verbal communication training can teach them to interpret body language, facial expressions, and tone of voice, thus improving their social understanding; furthermore, practicing self-control through the 'pause-think-act' strategy can reduce impulsive behaviors and improve the quality of their interpersonal relationships.

4) Training in task management and executive functions: improving learning and daily life efficiency.

Executive function is one of the central challenges faced by children with ADHD. The following training methods can help them enhance their executive capacity: 1. Use of to-do lists: noting daily tasks and marking completed ones, which increases the child's sense of achievement. 2. Establishing a fixed routine: a regular schedule (such as specific times for studying, resting, and exercising) helps reduce confusion. 3. Visual tools and reminders: using color labels, reminder software, etc., aids the child in better managing their tasks and time.

5) Sports and outdoor activities: releasing energy and improving concentration.

Studies have discovered that aerobic exercise (such as swimming, running, martial arts, yoga, etc.) can stimulate dopamine secretion in the brain, helping children with ADHD improve their attention and enhance their emotional control capabilities. Team sports (such as basketball, soccer, etc.) can enhance children’s cooperation skills and their awareness of rules. Individual sports (like swimming, taekwondo, etc.) help children develop self-discipline and improve their patience. Being in touch with nature (such as walking in forests and parks) helps alleviate anxiety in children and enhances their attention.

Behavioral training does not happen overnight, but requires long-term perseverance and personalized adjustments. Through training in cognition, time management, social skills, executive functions, and sports activities, children with ADHD can gradually improve their concentration, self-control, and adaptability, thus better leveraging their strengths and becoming the 'superheroes' of their own lives.

Although ADHD may present some challenges, it is not a defect in children but rather a unique way of thinking. Many famous individuals, such as Olympic swimming champion Michael Phelps, diagnosed with ADHD, as well as Leonardo da Vinci and Thomas Edison, who are believed to have certain characteristics of ADHD, have achieved extraordinary feats in their own ways. Therefore, when you encounter a child who jumps from idea to idea and brims with energy, have a little more patience and understanding, and guide them appropriately; you may be witnessing the growth of a future scientist, artist, athlete, or innovator.