Diagnosing ADHD in Kids

We are seeing an increase in requests for kids to be evaluated for ADHD. I'm getting asked about diagnosing a child about once a week or more, and they're usually requests by parents and they're usually at well-visits.

Limitations of Well-visits for ADHD Evaluations

首先，需要说明的是我不能在就诊时做ADHD评估. 这是一个完全不同的预约，需要提前完成大量的文书工作.

Some parents think I can just tell them right then and start treatment. 不. Although I've reviewed medical records where some other providers do, that's not ideal or in the best interests of the child.

The Complexity of ADHD Diagnosis in Children

There's actually a lot that goes into evaluating a patient for ADHD. ADHD isn't a simple diagnosis, especially in kids, because many things present like hyperactivity or focus issues in kids, but they don't actually meet the criteria for ADHD.

例如，有两岁和三岁孩子的父母想让我诊断他们的孩子是否患有多动症. 所有 toddlers and preschoolers seem to have ADHD. 这是因为他们的大脑还在发育，他们一开始就是非常忙碌的小人物.

Diagnostic Criteria for ADHD in Children

真正的ADHD诊断需要症状在6岁以后出现至少6个月. 大发娱乐让家长和老师填写的问卷是针对7岁及以上儿童的标准化问卷. There is no way that a child aged 2 or 3 should be diagnosed with ADHD. 他们可以被贴上多动症的标签，但这个年龄的孩子多动症有很多原因.

家长们经常会说老师要求他们对孩子进行ADHD评估. 再一次。, there are specific criteria, and one of those is that symptoms need to be present in more than one setting, usually both at home and at school.

我有很多病人来看病，他们在家里表现得很好，但在学校却表现得很糟糕. 经常, 我发现这是更多的对立行为，因为他们不喜欢他们的老师, or they could be getting bullied, or they have a learning disorder that's not been diagnosed. And so instead of trying to get the work done, 他们偷懒是因为他们不理解信息，他们不想尝试，因为他们知道他们不会得到它, and that causes other behavior issues.

我遇到过一些孩子，老师担心他们注意力不集中，因为孩子们总是走神. 其中一些实际上被证明是癫痫性疾病，有些最终被证明是焦虑.

类似的, I have a lot of patients who are angels and great students at school, but Tasmanian devils at home. My boys, for example. Home is their safe place and they let loose there, 但他们没有多动症，因为他们的行为问题只存在于一个环境中.

我在做多动症评估的过程中了解到的一件事是，有很多孩子不符合多动症的标准，但却符合焦虑和对立违抗性障碍的标准. Those two go together a lot actually, and they're best managed by therapy.

所以当父母甚至老师质疑我为什么不给孩子治疗多动症的药物时, 我解释为什么那些药物对孩子的行为没有大发娱乐. 它们对大脑中不同的神经递质起作用，我不适合在这种情况下开药.

Influence of Electronic Devices on Children's Behavior

另一个有趣的发现是，实际上有些东西正变得越来越普遍，这是由于电子设备，即使是婴儿也接触到电子设备. 有研究表明，孩子们正习惯于对一种行为做出立即的反应.

想想看. 我有9个月大的孩子在我的办公室里开始哭，他们的父母怎么办? They pull out their phones and they put on a video for the baby to watch.

The babies then develop connections in their brains that say, “嘿, 当我哭泣, I get a reward of watching a video," and their brains start to rewire so that when they do a certain behavior, they want that reward. When they don't get it, they ramp up their behavior.

孩子们会大发脾气，因为他们想要得到奖励，不得到奖励他们是不会罢休的.

Executive Function Disorder

也有新的证据表明存在一种叫做执行功能障碍的疾病. It's not a full diagnosis yet, 但这是孩子和成年人无法计划活动和调节情绪的许多问题的一个组成部分.

基本上, 在儿童时期, even starting in the first year of life, kids learn how to work towards goals, adapt to new situations, and ultimately develop the ability to do abstract thinking and planning. These executive functions aren't fully developed until early adulthood, but the foundations are laid in early childhood.

患有执行功能障碍的孩子很难组织自己的想法，并坚持完成他们已经开始的活动, and this also causes issues with hyperactivity and distractibility.

现在有一些理论认为，孩子们从电子游戏和电子时间中获得的所有即时反馈会导致这种执行功能障碍的增加.