User:It's gonna be awesome/ADHD management
注意力不足過動症(ADHD) Attention Deficit Hyperactivity Disorder | |
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同义词 | 注意力缺失症(Attention deficit disorder)、過度活躍症=Hyperkinetic disorder (ICD-10) |
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待在圖書館、餐館、上課、聽演講、開會等需要長時間保持靜態的場合,對患者來說可能不太容易。[1][2] 圖片為冰島教室內的學生Stofa i hradbraut | |
症状 | 容易分心(難以把專注力放對地方)、過度的活動、 難以控制行為和衝動[3][4] |
起病年龄 | 6 - 12 歲 左右[5][6] |
病程 | 多於6個月 [5] |
病因 | 尚不明確[7] |
診斷方法 | 根據症狀並排除其他可能的致病原因。[3] |
鑑別診斷 | 品行障碍、對立反抗症、學習障礙、躁鬱症[8] |
治療 | 心理治療(Counseling)、改變生活方式(lifestyle changes)、藥物[3] |
患病率 | 5,110萬(2015年)[9] |
分类和外部资源 | |
醫學專科 | 精神病学 |
「ADHD」的各地常用譯名 | |
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中国大陸 | 注意力缺陷多动障碍 |
臺灣 | 注意力不足過動症 |
香港 | 專注力失調/過度活躍症 |
澳門 | 專注力失調/過度活躍症 |
日本 | 注意欠陥・多動性障害 |
大韓民國 | 注意力缺乏過多行動障礙 |
越南 | 𦇒亂增動減注意 |
注意力不足過動症(ADHD)是一個經過適度治療可有效管理的慢性疾病。由於注意力不足過動症(ADHD)的症狀表現十分多元,容易讓人誤以為是其他疾病引起的,因此本條目旨在詳列ADHD的症狀表現形式,協助讀者釐清。
ADHD典型症狀包括忘東忘西、粗心大意、寫作業很久、吃飯很久、常恍神、家長交代的事一下就忘、東西不會收、今天念的書明天就忘掉大半、怎麼教都沒用。且/或有明顯的焦慮症狀。[10]
ADHD在腦部發育尚平均比同一年紀的人慢了三年,因此有較慢發展的認知功能(包括注意,記憶,結構,組織,學習,反應及解決事情能力),及自我動作及情緒控制能力表現,表現出來被簡要描述的症狀就是注意力不足,衝動及過動表現。[10]
2014年時,基思·康納斯醫師(是早期推動美國大眾認知注意力不足過動症的人士之一),在《纽约时报》提出他認為注意力不足過動症在美國有過度診斷的情形[11],不過同年有一篇經過同儕審查(peer-reviewed)的醫學回顧性文獻表明ADHD在美國成人族群中的診斷率低於實際的盛行率。 [a] [12]
台大醫院精神部教授高淑芬指出,國際的ADHD盛行率約7%,但根據台灣的健保資料庫統計,無論兒少或成人在台的就醫率均不到2%。[13]治療的目的是為了與「注意力不足過動症」做朋友以發揚優點,避免缺點;而不是為了抹掉這一切,父母的觀念應該與時俱進。[14][15]
症狀表現
编辑ADHD symptoms by age.
兒童(6-12歲)Children (6-12 Years) | 青年(13-17歲)Teenagers (13-17 Years) | 成人(18歲以上)Adult |
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容易分心 (Easily distracted) |
內在的不安寧 (Displays inner restlessness) |
專注力上的問題 (Inattention/concentration problems) |
難以井然有序地完成家庭作業,常導致遲交,且作業內夾雜粗心的錯誤 (Homework poorly organized, contains careless errors, often not completed) |
難以在各項學校/學習事務中保持有計畫性、秩序性的。常常有始無終。 (Schoolwork disorganized, shows poor follow-through) |
生活缺乏秩序與組織且難以在行動前事先做計劃 (Disorganized and fails to plan ahead) |
在問題尚未結束時搶答 (Blurts out answers in class before the question is completed) |
肢體上的過動可能轉變為內心的不安寧 (Hyperactivity may become less visible) |
錯誤判斷剩餘時間以及完成一件事所需的時間 (Misjudges available time) |
難以完成家務事 (Fails to complete chores at home) |
健忘(容易忘記目標、動機、……) Forgetful; easily forget the goal, motivation, reason, etc. |
難以開始即完成一個計畫 (Difficulty initiating and completing projects) |
難以在遊戲中輪流 (Has difficulty awaiting turn in games) |
一件事情還沒做到一個階段就轉移注意力到另一件事情 (Shifts activities prematurely) | |
常常離開座位 (Often out of seat) |
健忘,常常遺失東西 (Forgetful; often loses things) | |
常在不適當的時機點找人說話、常不自覺闖入他人的空間 (Often interrupts or intrudes on others) | 做出衝動的決定 (Makes impulsive decisions) |
ADHD患者往往缺乏自我管理能力(Self-control/self-regulation)、自我動機(/自我激勵/self-motivation),進而形成以下的特質,例如:分心、拖延、和缺乏規劃。ADHD患者常被其他人認為嘈雜且偏好追求高度刺激好讓自己比較不會分心且變得比較有效率。 其實ADHD患者的學習潛力及整體資質與常人無異。
Sluggish cognitive tempo (SCT) is a cluster of symptoms that potentially comprises another attention disorder. It may occur in 30–50% of ADHD cases, regardless of the subtype.[18]
SCT symptoms (Summary) | ||
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Life Period | Examples of Observed Symptoms |
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Children | Failing to pay close attention to details or making careless mistakes when doing school-work or other activities |
Trouble keeping attention focused during play or tasks | |
Appearing not to listen when spoken to (often being accused of "daydreaming") | |
Failing to follow instructions or finish tasks | |
Avoiding tasks that require a high amount of longer-term mental effort and organization, such as school projects | |
Frequently losing items required to facilitate tasks or activities, such as school supplies | |
Excessive distractibility | |
Forgetfulness | |
Procrastination, inability to begin an activity, such as completing homework |
Life Period | Examples of Observed Symptoms |
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Teens/Adults | Procrastination; delaying or avoiding starting projects that require vigilant mental effort |
Difficulty sustaining concentration on conversations or briefly losing attention on someone speaking | |
Hesitation to sustain concentration in planning and organizing for the completion of tasks | |
Hesitative responses, doubt, and delayed execution due to inattention remembering information | |
Difficulty finishing projects or completing assignments because many tasks simultaneously on the go | |
Forgetting to complete tasks and details after temporarily switching to more stimulating tasks | |
Difficulty finding misplaced tools after task switching due to bypassing adequate memory storage | |
Sustained information processing is slower than others causing information gaps that inhibit execution | |
Problems remembering appointments, obligations, or instructions | |
Difficulty learning new projects when concentration deficits cause desire to multitask or daydream | |
Distracted from persevering during work; difficulty holding onto a job for a significant amount of time | |
Change plans to the inconvenience of others due to forgetting or not fully aware of the bigger scenario | |
Maintaining excessive personal items such as storing old items of diminished usefulness | |
Obsessive behavior as compensation or coping mechanism for a perseverance deficit | |
Difficulty transitioning to new task or activity due to obsessive behavior | |
Higher rate of vigilant concentration fatigue after inhibiting many distractions from greater effort required |
情境
编辑「一名媽媽因洗碗時想著擦地,跑去擦地時又想到家裡沒有衛生紙,想到什麼做什麼,結果每件事都只做一半、沒完成。」[13]
成人注意力不足過動症(Adult ADHD, Adult with ADHD, ADHD in Adult)\其實是注意力不足過動症的症狀從幼年延續到成年期,並不是成年後才出現的疾病。其症狀基本上仍未脫離分心、過動-衝動的核心概念,只是表現方式有很多(比起幼年期更為多樣),一般大眾不一定能將這些多樣的表現型式與ADHD的核心症狀相連結。
研究發現,兒童青少年時期的ADHD症狀若未經治療,約有六成進入成年期後仍有明顯症狀。
有鑑於目前臺灣社會對於成人ADHD的認識有限,不少成人ADHD患者在生活中經歷了可能比別人更多的困難和挫折且在迷糊和混亂中度過了不少歲月,卻不知其問題的根源,於是只能不斷的自我批判欲藉此改善現況,然而卻反而使自己變得更負面以及精神狀況每況愈下。因此下表主要乃根據國立臺灣大學醫學院附設醫院精神醫學部、基因醫學部主任高淑芬醫師之著作摘要整理出成人ADHD的特徵,幫助疑似患者自我察覺。[19]
- 經常天馬行空地想東想西,腦海中不斷迸發出新的點子,興致勃勃地告訴別人後卻鮮少具體實踐,讓美麗的夢想成真。即便興沖沖開始執行,通常也只是三分鐘熱度。
- 喜歡熱心主動的幫助別人或提供別人各式各樣的建議,不過與此同時,對自己的事卻顯得吊兒啷噹,拖拖拉拉,好像沒有作完的一天。
- 喜歡說話,無論是在會議中或是上課的場合中,仍會忍不住一直跟旁邊的人聊天。經常吵到人而不自知。
- 對注意力不足過動症患者來說,跟別人好好聊天可能不是一件容易的事,因為不耐於傾聽,經常插嘴或岔(離)題。
- 對於時間這個東西沒什麼概念,常常無法準時赴約,不是遲到,就是根本把這件事拋到九雲通宵外,把這件事情給忘了。(缺乏時間觀念)
- 粗心、忽略細節、因為不耐煩而便宜行事。只想求快的結果就是做事的品質令人不敢恭維。
- 因為注意力不足過動症的緣故,患者顯得容易衝動又沒耐心,例如:開快車,搶黃燈或闖紅燈、插嘴、插隊、搶話、發生交通事故、收到罰單或與人起衝突。
- 注意力不足過動症患者常挨批評像長不大的人、迷迷糊糊、懶懶散散、不用心、說說哥、說說姊、不負責任、白目、生活習慣不好、以自己為中心等。
- 患者每當遭受到類似的批判,往往覺得無奈又委屈並為此而焦慮。因為患者本身也不想這樣,但就是心有餘而力不足,無法自我控制。
- ADHD患者的言行舉止往往令周遭的親友感到納悶,一來是他們的表現有時候很不錯、學習力也不差,但為何就是需要旁人再三提醒專心把事情做好,還需周遭親友們不時替患者操心。
- 一心只講求快速、效率,卻未顧及到做事的品質,以至於語焉不詳、字跡潦草、漏洞百出。像是剛拿到一樣新東西,連看說明書都不耐煩,便直接動手安裝或使用,導致事倍功半,或是不小心就把東西給弄壞了。
- 對於金錢和財務不太有概念、粗心大意,因此在收支上維持平衡對於成人ADHD患者來說,可能不是一件輕鬆的事情。
- 對於ADHD-患者來說,時間通常只有『現在』沒有『未來』,所以常會把很多事情都擠在同一個時間。ADHD患者的空間能力也不太好,家中的桌子、地上、床鋪、和櫃子經常堆滿東西。書桌上的東西堆積成了一座小山坡,沒有歸類,然而其抽屜可能空空的,只裝了點小紙屑。
- 當ADHD患者想要或需要某些人、事、物時,他們可能會立馬插嘴或打斷別人,無論別人是不是正在忙、談話中。ADHD可能就會要對方放下正在做的事,立即回應他們。ADHD患者之所以會急性子,除了是肇因於衝動的核心症狀外,他們也擔心如果不現在說出來,未來可能就會忘記啦。
- 為了找東西而浪費很多寶貴的時間,甚至為此進出家門多次而遲到。
- 分辨事情緩急輕重的能力不好。例如:明明人家急著要一份資料,ADHD患者卻因為別人的一句話或一個動作而分心,轉而關注其他的人事時地物,於是原本正在進行的事情全拋諸腦後。對於ADHD來說,一旦應該做的事被打斷,就很難再回來持續做完。
- 常常會從ADHD患者身上觀察到一些好似不安、不安穩的小動作,例如:摸東摸西、拉扯衣服、碰碰文具、在椅子上旋轉、剝指甲、在紙上塗鴉等。
- 常覺得靜不下來。
- 丟三落四的,不是找不到手機、錢包、鑰匙、帳單就是忘了帶應該記得帶的重要東西。
- 說話的時候常常更換主題,使得別人不易釐清重點。
- 因為衝動的特質,ADHD患者經常不假思索就脫口而出不得體的話。(常講錯話)
- 不耐於傾聽他人,往往對方的話還沒講完,他們就插嘴或急著接話:「我知道,我知道,我告訴你⋯⋯」。但別人要說的並不一定與ADHD患者預測的相同。
- 可能會藉由超車、闖紅燈來擺脫等待停等紅燈、堵車時的不耐煩。因此容易出車禍和吃罰單。
- 排隊、等待火車對於ADHD來說可能是件非常煩人的事情。
- 可能因為肢體容易碰撞到別人而引起人際衝突。(肢體協調性可能不足)
- 遇到稍微比較複雜的指令,就容易亂掉。即便是每天的例行公事,也需要不斷地叮嚀。
- 倘若沒有明確嚴格的時間限制,ADHD可能會把他應該做的事、應該繳交的作業、......,無限期的延後,沒有完成的一天。
- 經常從一件事情切換至另一件事情的結果可能是每一件事情都沒做完或花很長的時間才能做完。
- 做事欠缺規劃、分辨事情緩急輕重的能力有待加強、缺乏時間觀念可能帶給人不可靠、不守信的感覺。
- ADHD患者們也不太容易與別人維持長時間的對話和互動、或者看電視(鎖定同一個節目)。總之就是很難持續,還沒有到一個段落,就中斷離開了。
- 是一個熱心的人,點子很多也很好動,但就是常常恍神、糊裡糊塗、少根筋似的。
- 做事情容易拖拖拉拉,拖延到最後一刻。
- 思考或者做事情上常看起來心不在焉、虎頭蛇尾,講不聽。
- 不耐久坐、才剛坐下看東西、看資料,不到幾分鐘就想站起來找人聊天。
- 各種坐姿,有時候會把腳擱在桌上,或者一直扭動,旁若無人似的。
- 手上的書已經翻開超過半小時,卻因為一直無法專心閱讀,所以書還停留在剛翻開時的那一頁。
- 不擅於整理東西、打理生活,不論是隨身攜帶的包包裡、家裡的房間、抑或是桌子上,基本上都塞著或堆著各種東西。隨著時間的流轉,這些小平原、小丘陵會變成亂亂的大台地和大山坡。
- 忘東忘西的,經常忘記答應別人的事情、東西放在哪裡、安排好的行程規劃、證件、約會的時間地點、資料、應該做到的事、......。注意力不足過動症患者腦部的記憶功能並無缺損,但就是太健忘了,讓自己和周邊的人都感到十分的無奈。
- 易粗心犯錯、工作效率不足、不易與人建立並維持良好的溝通、常常換工作、換老闆、虎頭蛇尾、有始無終、恍神、處事亂無章法、坦率直接、沒有心機、天真、興趣廣泛、少根筋的樂天派、活潑好動、熱心助人、講義氣、喜歡打抱不平、愛講話所以很容易交朋友、創意十足、熱情洋溢、活力充沛、開朗活潑、單純、時間管理能力有待加強、三思而後行的能力不足。
同為注意力不足過動症患者之哈洛威爾醫師對於成人注意力不足過動症的觀察:[20]
“ | 雖然『注意力不足過動症』常認為是好發於兒童青少年時期,然而到目前為止,我們已經知道,成人『注意力不足過動症』的數量遠多於我們原本的預測。即便有些幼年『注意力不足過動症』患者會在其成年時期擺脫『注意力不足過動症』,但我們已經了解到,其實絕大多數的幼年『注意力不足過動症』患者之症狀會持續至成年時期。 | ” |
——哈洛威爾 |
“ | 以下表列之特徵為我們歷經數年臨床經驗所得之成人注意力不足過動症患者的特徵:
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——哈洛威爾 |
“ |
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——哈洛威爾 |
哈洛威爾:「治療成人ADHD患者與治療兒童青少年ADHD患者,兩者是同等重要的。因為ADHD對於一位成人的衝擊相當廣泛,例如:生涯、婚姻與家庭、......等。」 [20]
注:為使疑似患者早日察覺症狀,因此條列了許多對於ADHD偏負面的描述。事實上,ADHD的核心症狀不多,條列的內容大多為核心症狀的表現型。ADHD患者litterally(其實)也有很多優點(可參看相關書籍)。
治療
编辑“ | 「行為治療」簡單來說,就是利用「刺激—反應」的原理,以外在的具體增強物,如酬賞、獎品的給予;或內在的情感增強物,如讚美、榮譽感等,雙管齊下,增強孩子的合宜行為,修正不恰當的行為反應。
另外,還有「認知行為治療」,是以改變認知的方式,讓孩子們學會以不同的、新的正向想法,來取代原先錯誤的、舊有的負面想法。當孩子的觀念和態度重新建立之後,就比較願意以正確態度去克服困難、面對挑戰。認知行為治療可以幫助孩子學會自我調整、增強解決問題的能力、能彈性去處理憤怒與挫折感。 研究發現,行為治療搭配藥物治療的效果最好。藥物從生理上提升孩子的穩定性、專注力、自我控制、認知思考能力、減少衝動,讓父母和師長可以更順利展開行為治療的訓練。 |
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——高淑芬 Susan Shur-Feng Gau,《家有過動兒:幫助ADHD孩子快樂成長》 |
家中的行為治療
编辑用「愛」來溝通
编辑傾聽與陪伴
编辑父母教育訓練 (Parent Management Training)
编辑Raising a child with ADHD is not easy. Family life is often dominated by conflicts and sometimes there is additional pressure from other people too. Teachers, friends, family members or other parents often assume that the child’s behavior is a result of the wrong kind of parenting. But many parents of children with ADHD gradually develop strategies to help them cope better in everyday life.
Raising a child with ADHD can be very challenging. It demands a lot of attention from parents. The child’s behavior often leads to tension within the family or trouble at school. Children with ADHD are abnormally impulsive and restless. They don’t follow rules or instructions and are sometimes aggressive. So it is perfectly normal for parents to sometimes feel helpless, annoyed or even furious, as well as worrying about their child. But it is important to remember that the child is not behaving that way on purpose and that their behavior has nothing to do with their character.
Over time, many families come up with strategies to help them cope with everyday situations. There are various strategies to help plan the day and avoid surprises, or to at least be ready for them. Some parents are reluctant to lay down clear rules because they don’t want to be too authoritarian or strict. But the aim of these strategies is to help create an environment in which the child can cope better.
Routines, clear instructions and rules
编辑Many parents say it is helpful to plan and structure the day carefully. Clear routines can help children to know what to expect and be better prepared for things. A lot of parents say that telling their child about any changes to the routine as soon as possible helps too.
It is also a good idea to give your child very specific instructions. Then they will know what exactly needs to be done and you will also have the opportunity to offer praise or a reward when the task has been completed. For instance, instead of saying “Please clean up your room,” it would be better to say something like “Please put your toys in the box and make your bed.” Whenever your child does what you ask them to do, it is important to praise them for that specific task. For example: “Thank you for washing the dishes so nicely.”
Parents often say that it helps to establish clear rules for behavior and to reward their child when those rules are followed. One example of a reward is a certain amount of TV time. If the child breaks the rule, this privilege is taken away again. For this system to work, everyone needs to be aware of what kind of behavior is expected from the child and what the reward will be. It is also important to follow through on these agreements as much as possible.
Setting realistic goals
编辑Children and teenagers with ADHD may have problems that touch many different areas of their lives. As a result, some parents might want to try to change everything all at once – for instance, improve their child’s relationships with siblings, classmates and teachers and also improve their performance at school.
It is very important to make realistic goals so the child doesn’t feel overwhelmed or frustrated. Goals should be approached in small steps that the child is capable of completing. An example of a specific goal might be playing with other children at recess without getting into a fight. The goals and achievements can be noted on a list or somewhere else, and then checked later on.
Watching for signs of overstimulation
编辑If you notice early on that a given situation is too much for your child to handle, and that they are overstimulated or agitated and about to lose control, you can respond right away and, for instance, have them take a time-out in another room.
Watching for these signs in everyday life can also help you recognize what kinds of situations or other things may trigger the problematic behavior. It is important to talk with your child. For instance, you could wait for a quiet moment and then ask how they are feeling and why they think they “exploded.”
Children may find it easier to focus on a task or fall asleep if they are in a room that is calm and free of distractions. So it might help to keep things like televisions or computers out of the room where your child does their homework or sleeps. It might also be a good idea for their desk to face the wall instead of a window, so that they have fewer distractions.
Sports and hobbies
编辑Many parents and children find that sports and exercise help to blow off some steam and get rid of excess energy. But it is also important to make sure that physical activities are guided by an adult because some children tend to become overexcited when they get too much exercise. Injuries resulting from inattentiveness are more common amongst children and teenagers with ADHD, so not all types of sports are equally suitable.
Sports and exercise are best scheduled for the afternoon: Things need to quiet down towards the evening to avoid problems falling asleep.
Having other hobbies can also make things a little easier. It is important for a child to find an activity that is captivating and enjoyable, and which offers opportunities to experience success. Feeling appreciated and knowing that they have done something well often helps children to focus better when doing other activities they are less enthusiastic about.
Praise is key
编辑It is important to give children honest praise when they have succeeded at something and to encourage a healthy self-esteem despite all of the problems. Children who have ADHD often don’t get enough positive feedback because they cause trouble at home and in school, and have difficulties finding friends.
It’s not always easy to show affection and understanding when your daily life together is often so difficult. But taking some time to give your child caring attention, do things together, have fun and enjoy shared experiences can make it easier to take the stressful moments more in your stride.
Pay attention to your own needs and accept help
编辑It is important for parents to pay attention to their own needs in order to balance out the stresses of daily life and help them stay calm when dealing with their child. This means getting help – for instance from friends or family who can give them a break, or in the form of professional support to assist them in parenting.
It is worth involving close friends or relatives who get along well with the child and can occasionally spend an afternoon or evening with them – without being caught up in the everyday problems. That way both parents could have regular breaks to recharge their batteries.
Participating in education programs for parents, seeking advice and establishing good relationships with specialists who treat ADHD in children is a great help for many parents. It can help you be more patient, calm and tolerant when dealing with the problems in everyday life. But it also helps not to ask too much of yourself.
Sharing experiences in a self-help group with other parents who have children with ADHD is sometimes helpful. Regardless of the kind of support you choose, letting others help you out and actively addressing problems can make everyday family life much easier. It allows you to take a step back and clear your head so you can support your child as best you can.[23]
Psychological treatments
编辑Children with ADHD who have psychological treatment will usually have a type of therapy known as cognitive behavioral therapy. “Cognitive” approaches focus on things related to your memory, thoughts and mental abilities. Parents can learn behavioral therapy techniques in parent education programs. They will first use them under the supervision of their child’s therapist. Behavioral therapy typically combines several interventions that focus on changing different aspects of the child’s behavior.
One approach aims to encourage good behavior in children using reward systems or negative consequences. Here it is important to clearly describe the desired behavior, and it should also be possible to check whether the child behaves in the desired way. In order to give the “behavior plan” a chance to work, you have to stick to it consistently for several weeks. You should therefore make sure it isn’t too much for your child to handle, and avoid trying to change too many types of behavior at the same time.
Another approach involves the use of “time-outs” when children misbehave. In time-outs, children spend a short amount of time in a different room.
Cognitive approaches help children and teenagers to plan and complete tasks more effectively. One example is the use of “When-then sentences.” These are instructions that children come up with themselves in order to practice completing certain tasks. For instance, “When I finish my homework I will look at my timetable and pack my backpack for the next day.” This is an example of a kind of technique known as self-instructional training.
A different technique is known as self-management training. Here children learn how to be better organized. For instance, they may learn to break tasks down into smaller steps, and check how successful they have been by asking themselves questions such as:
What do I have to do?
What do I need in order to do it?
How can I do it?
Did I succeed?
Research on the effectiveness of cognitive and behavioral therapy approaches in children and teenagers with ADHD has produced conflicting results. This does not mean that these approaches do not help. But more research is necessary.
Psychological treatments have long been tested and proven to be effective in the treatment of many other kinds of mental disorders. Children and teenagers with ADHD who also have other mental health problems, such as anxiety disorders and depression, may benefit from other psychological treatments too.
Families who would like to have psychological treatment often have to be patient. It can take several weeks or months to get an appointment in a psychotherapy practice.[24]
Neurofeedback
编辑Another treatment option for ADHD is known as neurofeedback. This is a special kind of biofeedback. It involves measuring electrical activity in the brain (brain waves) using electrodes placed on your scalp, and then displaying the readings on a screen. By observing their own brain waves, children can learn to consciously control their thoughts and concentrate better as a result. Nowadays there are also devices with which you can learn to complete certain tasks, such as moving an object on the screen, using your brain waves.
Whereas some studies have suggested that neurofeedback could be helpful, others have not found any effect. So more research is needed in this area too.[24]
Support at school
编辑ADHD affects many areas of life, usually at school too. For treatment to be successful, parents and therapists should therefore also involve the child’s school or kindergarten. If a child has learned self-management skills, for instance, it would be helpful if their teachers were aware of this.
It is also possible for teachers to adjust the learning environment so that it is easier for children with ADHD to follow in class. This could include rearranging the classroom. For example, the child could sit at a desk that allows the teacher to keep an eye on them and react if they stop paying attention. They should also sit somewhere where they are exposed to as few distractions as possible. It can therefore be better to put desks in rows rather than group them. Objects that are not needed can be hidden from view in cupboards. When the class writes a test, the child with ADHD could take their test in a separate room, away from distractions.
There are various other things that teachers can do at school, such as
introduce short “physical exercise breaks” during lessons, or attend a training course to find out more about ADHD and how to better deal with children who have ADHD, as well as learn education techniques that aim to encourage children to behave well.
There is very little research on interventions at school, so it is not possible to say much about how effective they may be. They are often only carried out as part of small projects, or by individual teachers who are interested in helping children with ADHD.[24]
對於治療方式的不同論點(灰框內容無醫學實證支持)
编辑請注意:以下有部份內容(灰色框線內)並非出自Wikipedia:可靠來源 (醫學)
中華民國(台灣)有社會學學者從新聞媒體資料庫-聯合知識庫蒐集2001年起有關注意力不足過動症的新聞報導,並從記者的報導中,利用內容分析方法分析出「兒童的過動問題一開始就以生物醫學模式來解釋,在處遇建議上則呈現從行為治療轉向藥物治療的明確趨勢」的結論[25][26]。 |
然而透過歸納單一新聞資料庫所記載的新聞報導所得出的醫學結論,其信度與效度是非常具有爭議的。(參見:注意力不足過動症 § 治療)
美國有社會學家認為注意力不足過動症(ADHD)的治療是一個把「不常見且不被廣泛接受的行為」(deviant[b] behavior)醫療化的例子。抱持這種想法的社會學家認為ADHD的治療是把早期不屬於醫療範疇的學生在學表現的問題給醫療化(另有一說是指這是「特教醫療化」)[c]。[28][29]在中華民國,也有兩位學者附和這樣的論點。[30] |
在美國,絕大多數的醫療人員(healthcare providers)相信ADHD是一個真實存在的「症」(genuine disorder)[29],至少在症狀較明顯的人身上是這樣沒錯。 [31][32]美國醫療人員之間的爭議主要是圍繞在那些症狀輕微的病患的診斷及治療方式[31][32][29][33][34][31][32][29][註 1]。(美國的ADHD流行率高於世界平均,詳見:注意力不足過動症 § 流行病學)
英國官方機構-英國傑出國家健康照護機構(National Institute for Health and Care Excellence)在2009年發表聲明,聲明中有提及目前存在的爭議,但表示:當前的治療策略與診斷方法都是基於大量學術文獻所形成的學術界共識而得[d]。 [35]
中華民國一位中央研究院歷史語言研究所的學者分析指出,台灣關於「西藥」的文化信念或成見在注意力不足過動症的治療方式的爭議之中,扮演著一個催化劑的角色。[36]
該學者建議精神醫學界「必須更認真思考大眾科學與衛教等議題」、全面向的介紹一個疾病以避免見樹不見林,從而化解相關爭議[36]。 這位學者的結論是注意力在當代社會扮演的腳色日益重要[38]並預期精神科在未來的人類社會中,將有更為多元的職能。[39] 這位學者在提出個人觀點後列出幾個提醒事項:
|
注释
编辑- ^ 原文:A 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.
- ^ deviant\ is used to describe a person or behaviour that is not usual and is generally considered unacceptable [27]
- ^ 原文:Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one.
- ^ 原文:In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.
備註
编辑- ^ 60 分 與 59 分的差別。
- ^ 參見 注意力不足過動症 § 醫病關係
參考文獻
编辑書目
编辑- Edward M. Hallowell; Peter S. Jensen. 分心就該這樣教 從優勢能力出發,找出學習新方向. 遠流出版. 1 November 2009: 24–. ISBN 978-957-32-6544-3.
參考資料
编辑- ^ 高淑芬. 找回專注力:成人ADHD全方位自助手冊. 台北: 心靈工坊. 2016-05-09 [2016-12-12]. ISBN 9789863570592.
- ^ 高淑芬. 家有過動兒:幫助ADHD孩子快樂成長. 台北: 心靈工坊. 2013-08-28 [2016-12-09]. ISBN 9789866112805.
- ^ 3.0 3.1 3.2 Attention Deficit Hyperactivity Disorder. National Institute of Mental Health. March 2016 [5 March 2016].
ADHD management recommendations vary by country and usually involve some combination of counseling, lifestyle changes, and medications.
- ^ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th. Arlington: American Psychiatric Publishing. 2013: 59–65. ISBN 978-0-89042-555-8.
- ^ 5.0 5.1 Symptoms and Diagnosis. Attention-Deficit / Hyperactivity Disorder (ADHD). Division of Human Development, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. 29 September 2014 [3 November 2014].
- ^ Dulcan, Mina K.; Lake, MaryBeth. Axis I Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence: Attention-Deficit and Disruptive Behavior Disorders. Concise Guide to Child and Adolescent Psychiatry 4th illustrated. American Psychiatric Publishing. 2011: 34. ISBN 978-1-58562-416-4 –通过Google Books.
- ^ NIMH » Attention-Deficit/Hyperactivity Disorder (ADHD): The Basics. NIMH » Home. [2017-07-26].
- ^ Ferri, Fred F. Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders 2nd ed. Philadelphia, PA: Elsevier/Mosby. 2010: Chapter A. ISBN 0323076998.
- ^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.. Lancet. 8 October 2016, 388 (10053): 1545–1602. PMC 5055577 . PMID 27733282. doi:10.1016/S0140-6736(16)31678-6.
- ^ 10.0 10.1 嘉義長庚精神科副教授級主治醫師、教育部部定副教授 陳錦宏 醫師. 心動家族:注意力不足過動症ADHD的第三條路. 台灣心動家族兒童青少年關懷協會. Tc-adhd.com. 2016-12-13 [February 2017] (中文(臺灣)).
- ^ Schwarz, Alan. The Selling of Attention Deficit Disorder. The New York Times (14 December 2013). 14 December 2013 [26 February 2015].
- ^ Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014, 16 (3). PMC 4195639 . PMID 25317367. doi:10.4088/PCC.13r01600.
Reports indicate that ADHD affects 2.5%–5% of adults in the general population,5–8 compared with 5%–7% of children.9,10 ... However, fewer than 20% of adults with ADHD are currently diagnosed and/or treated by psychiatrists.7,15,16
- ^ 13.0 13.1 孩子常上課分心、撒謊...真的不是故意搗蛋 - 即時新聞 - 20170326. 蘋果日報. 2017-03-26 [2017-06-26] (中文).
- ^ 洪蘭. 洪蘭:「不專心」也是上天的祝福|專欄|洪蘭|2015-05-12|天下雜誌第572期. 天下雜誌. 2015-05-12 [2017-06-26] (中文).
- ^ 撰文者jiabin. 找出孩子的長處!西北大學研究:容易分心的孩子,可能擁有較高的創造力 (容易分心,...) - 教育 - in媽咪育兒新知 - 商周.com. 商業周刊 - 商周.com. 2017-05-24 [2017-06-26] (中文).
- ^ Fayyad, J.; De Graaf, R.; Kessler, R.; Alonso, J.; Angermeyer, M.; Demyttenaere, K.; De Girolamo, G.; Haro, J. M.; Karam, E. G.; Lara, C.; Lepine, J.-P.; Ormel, J.; Posada-Villa, J.; Zaslavsky, A. M.; Jin, R. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. The British Journal of Psychiatry (Royal College of Psychiatrists). 2007-05-01, 190 (5): 402–409. ISSN 0007-1250. doi:10.1192/bjp.bp.106.034389.
- ^ ADHD and You. ADHD: What Do Symptoms Look Like at Different Ages?. [2017-03-09].
- ^ Barkley, R. A. Sluggish Cognitive Tempo (Concentration Deficit Disorder?): Current Status, Future Directions, and a Plea to Change the Name (PDF). Journal of Abnormal Child Psychology. 2014, 42: 117–125. PMID 24234590. doi:10.1007/s10802-013-9824-y.
- ^
高淑芬. 找回專注力:成人ADHD全方位自助手冊. 台北: 心靈工坊. 2016-05-09 [2016-12-12]. ISBN 9789863570592 (中文(臺灣)).
from section of 成人ADHD的診斷
- ^ 20.0 20.1 Dr. Hallowell on the Today show discussing Adult ADD. Drhallowell.com. 2014-10-16 [2016-12-09].
Dr. Hallowell on the Today show discussing Adult ADHD\ While ADHD tends to be associated with childhood, we’ve learned that it is far more widespread among adults than previously understood. While there are some children with ADHD who will outgrow it, we now know that the vast majority will not. Listed below are criteria for adult ADHD that we developed from our clinical experience: A sense of underachievement, of not meeting one’s goals , regardless of how much one has actually accomplished. Difficulty getting organized. Chronic procrastination or trouble getting started. Many projects going simultaneously; trouble with follow through. A tendency toward addictive behavior. Chronic problems with self-esteem. Inaccurate self-observation. Family history of ADHD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.Recognizing and treating ADHD is just as important for adults as it is for children, as it has a wide ranging impact in careers, marriages and families.
- ^ 高淑芬. 家有過動兒:幫助ADHD孩子快樂成長. 台北: 心靈工坊. 2013-08-28 [2016-12-09]. ISBN 9789866112805.
- ^ TVBS. 父母陪伴少品質差 孩子心理健康亮紅燈│TVBS新聞網. TVBS. 2017-05-12 [2017-07-17] (中文).
- ^ pmhdev. Attention deficit hyperactivity disorder (ADHD): Coping with ADHD in everyday life: Information for parents. PubMed Health. 2015-09-09 [2017-06-28].
- ^ 24.0 24.1 24.2 pmhdev. Attention deficit hyperactivity disorder (ADHD): What can help children and teenagers who have ADHD?. PubMed Health. 2015-09-09 [2017-06-28].
- ^ 曾凡慈、劉毓翔. 建構童年異常:新聞媒體中的兒童過動症及其轉變 The Construction of ADHD and Its Transformation in the News. 社會分析 (東吳大學社會系;輔仁大學社會系;世新大學社會心理學系). 2017-02, 201702 (14). doi:10.3966/221866892017020014003.
- ^ 曾凡慈. 兒童過動症的在地興起與專業技能網絡的變遷. 《科技、醫療與社會》 Taiwanese Journal for Studies of Science, Technology and Medicine: 15–76. 2015年10月 [2017-06-23] (中文). 参数
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被忽略 (帮助) - ^ deviant. Cambridge Dictionary. [2017-06-24].
- ^ Parrillo VN. Encyclopedia of Social Problems. SAGE. 2008: 63 [2 May 2009]. ISBN 9781412941655.
- ^ 29.0 29.1 29.2 29.3 Mayes R, Bagwell C, Erkulwater JL. Medicating Children: ADHD and Pediatric Mental Health illustrated. Harvard University Press. 2009: 4–24. ISBN 978-0-674-03163-0.
- ^ 張如杏、林幸台. 特教醫療化現象之探討 (PDF). 特殊教育與復健學報. 2009, (21): 1∼17.
- ^ 31.0 31.1 31.2 Silver LB. Attention-deficit/hyperactivity disorder 3rd. American Psychiatric Publishing. 2004: 4–7. ISBN 978-1-58562-131-6.
- ^ 32.0 32.1 32.2 Schonwald A, Lechner E. Attention deficit/hyperactivity disorder: complexities and controversies. Curr. Opin. Pediatr. April 2006, 18 (2): 189–195. PMID 16601502. doi:10.1097/01.mop.0000193302.70882.70.
- ^ Merten, EC; Cwik, JC; Margraf, J; Schneider, S. Overdiagnosis of mental disorders in children and adolescents (in developed countries).. Child and adolescent psychiatry and mental health. 2017, 11: 5. PMC 5240230 . PMID 28105068.
- ^ Taylor, E. Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed?. Archives of disease in childhood. April 2017, 102 (4): 376–379. PMID 27821518. doi:10.1136/archdischild-2016-310487.
- ^ National Collaborating Centre for Mental Health. Diagnosis. Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE Clinical Guidelines 72. Leicester: British Psychological Society. 2009: 116–7, 119. ISBN 978-1-85433-471-8 –通过NCBI Bookshelf.
- ^ 36.0 36.1 巫毓荃(中央研究院歷史語言研究所助研究員). 注意力不足過動症爭議的十個話題. 歷史學柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
關於藥物的社會文化,也在此爭議中起到一定作用。反對者對於過動症藥物的質疑,其實反映了台灣關於「西藥」的文化信念或成見。這些仍廣泛存在的信念,認為西藥不同於取材自天然物質的中草藥,而是人工化學製劑,而且西藥乃藉「以毒攻毒」來達到療效,因此具有較強毒性,且西藥多有依賴性或成癮性,一旦開始使用藥物,就無法停藥而必須長期服用。此外,西藥是治標不治本,它只針對特定症狀或疾病誘因治療,無法根除病因,也無助於調理強化甚至可能弱化體質。長期以來,台灣醫師經常哀嘆這些成見使不少病患,特別是慢性病患者拒絕或中斷必要治療,轉而尋求療效未經證實、副作用不明且無品質管制的中草藥,以致損害健康。事實上,雖然程度不同,但這些可能是跨文化甚至是普世的文化信念。其根源部份在於現代科學醫學本身令人疏離的性質,因此即便如何衛教啟蒙,還是難以完全根除。……化解關鍵可能在於精神科醫師必須更認真思考大眾科學與衛教等議題,並且創新臨床實作的方式。
- ^ 巫毓荃(中央研究院歷史語言研究所助研究員). 注意力不足過動症爭議的十個話題. 歷史學柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
参数
八、其他精神衛生專業、心理學家與教育專業的立場?
到目前為止,兒童精神科醫師的結盟工作似乎進行得非常順利。積極轉介問題學生的老師與特教老師,樂於在過動症醫療中扮演輔助角色的臨床及諮商心理師與社工師,以及大多維持緘默的兒童心理學家,他們主動或被動地加入精神科醫師主導成立的同盟,扮演好被期待的角色,或至少未加入敵對陣營。這些專業的配合,使精神科醫師可以在短時間內建立起一個過動症醫療網絡,過動症醫療的普及並不是精神科醫師孤軍奮戰,而是一個團隊努力的成果。與這些專業的同盟,也讓精神科醫師不管實際醫療情境如何,仍可以宣稱過動症醫療並未只重視生物面向,而是生物、心理與社會並重。更重要的是,這些是在每天工作中實際面對過動兒童的專業人員,他們既有專業,也能與家長一樣真正體會過動兒童所造成的問題與所需要的幫助。他們對於過動症醫療的認可,不但凸顯部分反對團體反智、反科學與反專業的愚昧不明,也與在象牙塔內,不了解真實問題只憑浪漫空想的學界與文化界反對人士,構成鮮明對比。
然而,這樣的同盟關係能維持多久呢?事實上,這些專業固有對於精神疾病的觀點,與強調精神疾病是生物性疾病的精神醫學,有著重大且本質性的差異。關注心理病理與心理發展的心理學,關注家庭社會病理與社會支持的社會工作專業,以及以教育矯正為職能及宗旨的教育與特教專業,基本上並不認同在正常與異常之間畫出明確界線的醫學觀點。在過去,它們時常就如何理解與改變精神病理與精神醫學有所爭辯。近年來,在不同國家地區,在整體精神健康或特定精神病理上,精神醫學的理念以及其所主導的團隊工作模式,也受到來自這些專業的質疑與挑戰。在過動症問題上,這些專業理應要有與精神醫學不同的觀點。目前較少聽到這類聲音,反倒顯得特別。這可能有許多歷史性與當代的內外在因素。但無論如何,即使不是正面地批判,這些專業勢必將會更明確地表達不同於主流精神醫學的意見。目前建立起的網絡未必能持續發揮功能,目前的結盟也將有所變化。即使擁有最先進的科學武器,精神科醫師若不想陷入孤軍奮戰的困境,可能在論述與策略上還必須有所調整。
十、充滿國際視野的爭論:全球化與本土視野
……即使相信過動症的生物性本質,在目前的臨床實作上,從其症狀表現、發現認定、診斷到評估治療成效的指標,都還是以實際情境中的行為為基礎,而各種非藥物治療模式的施行,也需要多方面配合及參與。因此,在評估過動症的各種流行病學數據與藥物療效,以及要引入某種治療模式時,必然需要考慮在地的家庭、教育、社會環境與文化。……我們應該可以期待將聽到更多加入本土視野的研究與觀點。|quote=
值左起第6位存在換行符 (帮助) - ^ 巫毓荃(中央研究院歷史語言研究所助研究員). 注意力不足過動症爭議的十個話題. 歷史學柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
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十一、注意(力)與快樂
最後,透過兒童過動症引起的爭議,以及對於成人注意力不足症候群日益增加的重視,我們可以看到注意在當代自我文化中扮演越來越重要的角色。原本,在從十九世紀到二十世紀晚期很長一段時間中,記憶一直是自我文化的核心。一個人是他過去的堆疊;成長經驗決定一個人的人格結構,進而決定其命運;童年創傷是精神疾病的根源,回憶與修通是康復的關鍵;記憶是自我感與自我認同的基礎,自我是敘事的自我,擁有兩套獨立存在的記憶敘事,就是擁有雙重人格;日記與自傳是最重要的自我書寫,它們是引領我們進入自己或他人內在世界的關鍵門戶。在這樣的自我中,注意只是一個上層、被動與被決定的功能。我們注意什麼對象與是否能集中注意力,都是由無意識中真正負有精神能量的記憶所決定,自覺注意集中的自我,只是一種表相,而非真正的自我。然而,近年來,注意似乎有逐漸取代記憶成為自我核心的趨勢。不但注意力不足等精神病理備受關注,注意力也被認為是包括記憶在內等認知學習能力,以及生產力與創造力的基礎。各種傳統或新創訓練操弄注意的身心技術,包括靜坐冥想、內觀、正念減壓、瑜伽、禪修甚或催眠等,如雨後春筍般出現,成為新興或再流行的自我技藝與療癒方法。無論注意集中的對象是身體某部位、某個意念或公案、某件事物、甚或只是一片虛空,注意凝集是這些技術共同重視而想實現的身心經驗。即使部分技術源自追求泯除自我超脫苦樂的宗教修行,但它們的現代版本都強調注意凝集經驗是自我感與快樂等正向情緒的重要來源,也能讓人超越過去自我與現實環境的限制,因此具有良好療癒效果,並能開發增進各種身體與心理能力,而有助於在現世中取得成功。|quote=
值左起第6位存在換行符 (帮助) - ^ 巫毓荃(中央研究院歷史語言研究所助研究員). 注意力不足過動症爭議的十個話題. 歷史學柑仔店(kám-á-tiàm). March 24, 2017 [2017-06-24] (中文).
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因此,精神科醫師關注注意力不足,無論是在成人或兒童患者身上,是否是更廣注意自我文化的一環?他們強調注意力對於學習成長、人際關係與情緒的重要性,治療有助於改善兒童學業成績,在成年患者身上,也可能幫助他們突破原本自以為的成就極限,或至少能獲得原本難達到的注意凝集感受,本身就是一個正向的心理經驗,而有助於改善情緒與自信。雖然在用來改善注意力的方法技術上有歧見,他們其實與批評者共有不少視野、論點與目標。這樣注意文化所形塑的自我,其鮮明特徵在於其更為身體性與情感性,也更仰賴直觀體驗,它由一個又一個的獨立當下鬆散聚集而成,也因此更為斷裂。什麼是它背後的政治經濟學呢?也許我們可以從不少企業嘗試藉由這些身心技術來提高員工生產力,以及政府熱衷舉辦慶典晚會等能帶來短暫快樂感受的大型活動中,找到一些線索。依循這樣的理路,雖然對象仍是精神疾病,精神醫學宗旨其實已有微妙但根本的正向轉變,它不再只是要治療苦痛,還追求創造快樂與提高生產力及創造力。|quote=
值左起第6位存在換行符 (帮助)
參見
编辑- Wikipedia:神經科學專題
- 維基百科主題:思考 Thinking (英文)
- 持續到成人時期之注意力不足過動症(英文)
- 體能鍛鍊
- Rehabilitation_(neuropsychology)#ADHD
- 發展遲緩常見共病列表
- Developmental_disorder#Attention_deficit_hyperactivity_disorder (ADHD)
- Coaching#ADHD
- Homework_coach
- Executive dysfunction
- Disinhibition
- Inhibitory control
- Mood_swing#List_of_conditions_known_to_cause_mood_swings
- Center_for_Research,_Evaluation_and_Awareness_of_Dyslexia
- Treatment_of_Tourette_syndrome
- 大雄·胖虎症候群(無醫學證據證實)
- 哆啦A夢#大雄·胖虎症候群(無醫學證據證實)
- 還珠格格 小燕子 (無醫學證據證實)
Sub-types
编辑Major characteristics
编辑Notable Publications
编辑- Driven to Distraction (1994)
- Delivered from Distraction (2005)
Medications
编辑Stimulants
编辑- Methylphenidate (哌甲酯) (Ritalin, Concerta, and others)
- Dexmethylphenidate (Focalin, Focalin XR)
- Amphetamine (Evekeo, Adderall, Adzenys XR, Dyanavel XR)
- Dextroamphetamine (Dexedrine, Zenzedi, ProCentra, and others)
- Lisdexamfetamine (Vyvanse)
Non-Stimulant
编辑- Atomoxetine (Strattera)
- Guanfacine (Tenex (off-label), Intuniv)
- Clonidine (Catapres (off-label), Kapvay)
Related or Outdated Topics
编辑外部連結
编辑- 家長如何與老師良好溝通?--台灣兒童及青少年精神醫學會 (繁體中文)
- 台灣兒童青少年精神醫學會-相關網站 Link (繁體中文)
- 中華民國衛生福利部
- 中華民國衛生福利部-衛生與口腔心理司
支持團體 (support group)
编辑衛生教育資源(症狀)
编辑- 台灣兒童青少年精神醫學會-精神醫學通訊季刊
- ADHD現代知識專頁
- YouTube上的ADHD: Signs, Symptoms, Research(英文)
- 美國心理衛生中心:ADHD主題(英文)
- 美國心理衛生中心-多媒體 (英文)
- ADHD Child Evaluation ACE半結構式診斷會談工具繁體中文版
工具(症狀管理)
编辑- YouTube上的Outlook行事曆(Training: Outlook 2013 Calendar basics: Create an appointment - Video 1 of 5)
- YouTube上的Google行事曆
- 【ADHD教養原則TIPS】
媒體報導
编辑相關戲劇(無醫學實證支持)
编辑- 衝動的他遇上失魂的她-本港首套有關成人專注力失調及過度活躍症(ADHD)微電影。 (繁體中文)(香港)
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