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Hoi Chung Suy Tap Trung va Nang Dong.

  1. QUA TRINH LICH SU CUA HOI CHUNG SUY TAP TRUNG VA NANG DONG (STTND):
Die Geschichte vom Zappel-Philipp
The Story of Fidgety Philip

"Ob der Philipp heute still
Wohl bei Tische sitzen will ?"
Also sprach in ernstem Ton
Der Papa zu seinem Sohn,
Und die Mutter blickte stumm
Auf dem ganzen Tisch herum.
Doch der Philipp hörte nicht,
Was zu ihm der Vater spricht.
Er gaukelt
Und schaukelt,
Er trappelt
Und zappelt
Auf dem Stuhle hin und her.
"Philipp, das mißfällt mir sehr !" 		 "Let me see if Philip can 
Be a little gentleman; 
Let me see if he is able 
To sit still for once at table." 
Thus spoke, in earnest tone, 
The father to his son; 
And the mother looked very grave 
To see Philip so misbehave. 
But Philip he did not mind 
His father who was so kind. 
He wriggled 
And giggled, 
And then, I declare, 
Swung backward and forward 
And tilted his chair, 
Just like any rocking horse;- 
"Philip! I am getting cross!" 

Seht, ihr lieben Kinder, seht,
Wie's dem Philipp weiter geht !
Oben steht es auf dem Bild.
Seht ! Er schaukelt gar zu wild,
Bis der Stuhl nach hinten fällt;
Da ist nichts mehr, was ihn hält;
Nach dem Tischtuch greift er, schreit.
Doch was hilfts ? Zu gleicher Zeit
Fallen Teller, Flasch' und Brot.
Vater ist in großer Not,
Und die Mutter blicket stumm
Auf dem ganzen Tisch herum. 		 See the naughty, restless child, 
Growing still more rude and wild , 
Till his chair falls over quite. 
Philip screams with all his might, 
Catches at the cloth, but then 
That makes matters worse again. 
Down upon the ground they fall, 
Glasses, bread, knives forks and all. 
How Mamma did fret and frown, 
When she saw them tumbling down! 
And Papa made such a face! 
Philip is in sad disgrace. 

Nun ist der Philipp ganz versteckt,
und der Tisch ist abgedeckt,
Was der Vater essen wollt',
Unten auf der Erde rollt;
Suppe, Brot und alle Bissen,
Alles ist herabgebissen;
Suppenschüssel ist entzwei,
Und die Eltern stehn dabei.
Beide sind gar zornig sehr,
Haben nichts zu essen mehr. 		 Where is Philip? Where is he?
Fairly cover'd up, you see!
Cloth and ll are lying on him;
He has pull'd down all upon him!
What a terrible to-do!
Dishes, glasses, snapt in two!
Here a knife, and ther fork!
Philip, this is naughty work.
Table all so bare, and ah!
Poor Papa and poor Mamma
Look quite cross, and wonder how
They shall make their dinner now. 

 
 
 

Tren day la bai tho "Zappel Philipp" (Philip nang dong hay Fidgety Philip) cua Heinrich Hooffman, mot y si nguoi Duc, tac gia nhieu tho van cho tre em, da viet vao nam 1846 o Frankfurt. Ong sang tac bai nay de tang nguoi chau moi 3 tuoi cua ong. Day la mot bang chung la con nguoi da biet ro ve Hoi Chung Nang Dong Suy Tap Trung tu rat lau. Hon nua hoi chung nay khong phai la hiem hoi. Tu hon 25 nam nay, Hoi Chung STTND da tro nen mot truong hop benh ly duoc quan sat nhieu nhat o cac phong mach cua cac bac si Nhi Khoa va Than Kinh Tam Tri. Hoi Chung nay duoc goi trong tieng Anh la Attention Deficit Hyperactivity Disorder (ADHD). Nhin vao lich su cua cac xa hoi, ta co the thay rang Hoi Chung nay da hien dien tren trai dat co le tu khi co loai nguoi, it nhat o giai doan ma loai nguoi da to chuc thanh xa hoi co co che, va luat phap ro rang. Do la luc con nguoi, duoi anh huong cua Konrad Lorenz, cha de cua nghanh nghien cuu cac khia canh ve Hanh Vi Tac Phong (Ethology) cua cac loai vat va Con Nguoi, bat dau hinh thanh khai niem ve nhung hanh vi tac phong duoc coi la nam trong trong pham vi "Binh Thuong". Trong qua trinh cua Hoi chung nay, cac nha nghien cuu va cac tac gia da cho no rat nhieu ten khac nhau: The Hyperactive Child Syndrome, Hyperkinesis, Minimal Brain Dysfunction, Minimal Brain Damage. Sau benh dich viem nao nam 1918, nhieu tre em song sot con dich da co nhieu trieu chung  cua STTND khien nhieu nguoi nghi rang hoi chung nay duoc gay ra boi ton thuong nao bo. Ve sau nay, danh tu Attention Deficit Hyperactivity Disorder da duoc Hiep Hoi Than Kinh Tam Tri Hoa Ky (The American Psychiatric Association, Task Force on DSM) thua nhan nhu la danh xung chinh thuc cua Hoi Chung nay, duoc the hien trong cuon DSM-IV la cuon sach ket hop tat ca cac benh tam tri hien hanh voi cac tieu chuan dinh benh duoc thua nhan. To Chuc Y Te The Gioi cua Lien Hiep Quoc (World Health Organization –WHO) voi cuon ICD-10 (International Classification of Diseases- second edition) cung da ket nap cac tieu chuan dinh benh tuong tu nhu cua My.

II. TIEU CHUAN DINH BENH THEO DSM-IV:

DSM-IV dinh benh Hoi Chung STTND (ADHD) nhu sau:

    1. Phai co (1) hoac (2)
      1. Sau (6) hay nhieu hon cac trieu chung sau day duoc coi nhu bieu hieu cua suy tap trung. Cac trieu trung nay phai tiep dien 6 thang hay lau hon toi mot muc gay xao tron trong kha nang sinh hoat hang ngay, gay rac roi, nhieu loan moi truong chung quanh cua tre khi so voi muc do sinh hoat cua tre cung tuoi.

        2.  

         
         
         

        Suy Tap Trung:

        1. Thuong hay thieu kha nang tap trung tu tuong vao cac chi tiet hoac pham cac loi lam rat cau tha trong khi lam bai o truong hoc, hoac o trong cac sinh hoat hang ngay khac.
        2. Thuong hay co kho khan duy tri chu tam de hoan thanh trach vu hay trong cac cuoc choi voi ban be.
        3. Thuong khong co ve chu tam de nghe khi co nguoi noi voi minh.
        4. Thuong khong tuan theo loi chi dan hoac menh lenh, va khong hoan tat cac trach vu, bai vo o truong hay o nha. Dieu nay khong phai do khuynh huong chong doi, uong nghanh hay khong hieu menh lenh.
        5. Thuong co kho khan trong viec to chuc cach lam viec hay sinh hoat hang ngay.
        6. Thuong tranh ne, ghet, hay mien cuong lien he vao cac nhiem vu thuong doi hoi su co gang ve tri oc.
        7. Thuong hay de lac hoac mat cac do dac, trang cu can cho viec sinh hoat hang ngay (chia khoa, but, sach, dung cu).
        8. Thuong bi gay chenh mang boi cac kich thich ben ngoai nhu tieng dong.
        9. Thuong hay quen lam cac cong viec hang ngay cua minh.
      2. Sau (6) hay nhieu hon cac trieu chung nang dong hoac cuong dong da duoc tiep dien 6 thang hay lau hon gay xao tron trong kha nang sinh hoat hang ngay mot cach binh thuong va khong phu hop voi hanh dong cua tre cung lua tuoi.

        3.  

         
         
         

        Nang Dong:

        1. Thuong di dong chan tay hoac khong the ngoi yen.
        2. Thuong hay di dong trong lop hoc, khong co phep, hoac di dong trong truong hop ca nhan duoc coi nhu la phai ngoi tai cho.
        3. Thuong hay chay lang xang, leo treo qua dang trong cac truong hop ma hanh dong nhu vay duoc coi la qua dang.
        4. Thuong co kho khan trong su tham gia tro choi hay sinh hoat mot cach im lang (thuong rat on ao).
        5. Thuong hay chay lang xang suot ngay chu co bo may trong nguoi khong the ngung duoc.
        6. Thuong noi huyen thuyen, suot ngay.

          7.  

           
           
           

          Cuong Dong:

        7. Thuong tra loi mau chong truoc khi nguoi hoi noi xong.
        8. Thuong co kho khan cho doi toi phien minh.
        9. Thuong hay noi chen, noi ngang vao cau chuyen cua nguoi khac.
B. Mot so cac trieu chung tren xay ra truoc khi tre em dat toi 7 tuoi. C. Mot so cac trieu chung tren phai xay ra o it nhat hai moi truong khac

nhau, vi du nhu o nha va truong hoc.

D. Cac trieu chung tren phai gay xao tron ve doi song, hoc hanh, cong

viec.
    1. Cac trieu chung tren khong xay ra cung luc voi cac nhieu loan da duoc dinh benh o tre vi du nhu Tam Ben Tram Cam hay Hung Tram Cam (Depressive Disorder or Bipolar disorder) Tam Than Phan Liet
 
(Schizophrenia), Tam Benh Lo Au (Anxiety Disorder) IV. CAC THE LOAI HOI CHUNG STTND:
    1. Hoi chung STTND, loai PHOI HOP bao gom ca ba hoi chung: Suy Tap Trung, Nang Dong va Cuong Dong
 
2. Hoi chung STTND, loai chinh yeu Suy Tap Trung. Loai nay thi khong co nang dong hay cuong dong, chi bi lo denh, thieu tap trung.

Phan lon tim thay o con gai, rat kho dinh benh vi it gay chu y cho nguoi khac.

3. Hoi chung STTND, loai chinh yeu nang dong, cuong dong. O loai nay khong co van de suy tap trung.

 V. DICH HOC:

Thuong thi kho dinh benh khi tre con nho hon 4 hay 5 tuoi. Cac thong ke da lau cho la benh chiem vao khoang 4 toi 5 % so tre o tuoi di hoc. Cac nghien cuu gan day cho thay hoi chung nay co the chiem toi 10 % so tre em o tuoi di hoc. O the phoi hop la the thuong gap nhat, thi con trai nhieu hon con gai tu 4 toi 9 lan hon. Tru the loai chu yeu suy tap trung thi con gai co ve nhieu hon con trai. Hoi chung nay co tinh chat gia dinh (khong dung chu di truyen vi chua chung minh bang phuong phap khoa hoc duoc). Thuong thi ty le nguoi bi hoi chung nay cao hon giua cac nguoi trong cung gia dinh cua tre co hoi chung, so voi dan so ben ngoai.

VI. NHU VAY HOI CHUNG STTND LA GI?

Noi mot cach nom na, tre bi hoi chung STTND la tre rat la lo denh, khong the duy tri tap trung, nen khong the cham chi lam bai trong lop hay o nha, khong hoan thanh duoc nhiem vu cua minh.Tre cung hay bo do cong viec, bat dau lam nhieu thu, nhung chang co cai nao xong. De chan nan, bo roi cong viec dang lam neu gap kho khan. Tre neu o khong, hay thao go do dac trong nha roi rap lai khong duoc. Tre cung hay bay bua o trong nha, thieu oc to chuc, nen bua bon lam. Cung hay de do lung tung roi tim khong duoc Tre rat la nang dong va cuong dong. O trong lop di chuyen moi noi, khong co phep cua thay, noi chuyen on ao, di chuyen ban ghe, leo treo moi noi. O nha nhay len ban ghe, leo treo, lam viec thieu suy nghi, nhu bang qua duong ma chang nhin gi ca, tho ngon tay vao o dien, v.v… Vi vay tre hay de bi tai nan (accident prone), dut, hay gay tay, chan, bi tray trua. Thuong phai duoc nguoi lon giam sat nhieu hon. Tre thuong gap kho khan o truong hoc, vi lam thay giao buc boi, co thanh kien voi tre. Nhung phai nho la tre thuong rat la thong minh, mac du diem cac bai hoc thi khong cao, vi khong tap trung duoc. Vi vay tre thuong hoat dong rat thap hon la kha nang thuc su cua minh. Day la dieu rat bat cong cho tre, neu khong duoc dieu tri. Vi tre khong phat huy het kha nang cua minh, ma hay bi buoc cho toi la luoi bieng, hu don.

VII. STTND O NGUOI LON:

Mot nua tre em bi hoi chung STTND se lan lan khoi khi den tuoi truong thanh. Mot nua kia se tiep tuc co trieu trung voi mot so bien dang. Thuong nhung nguoi nay cung nang dong, khong the doi toi phien minh duoc, hay bo do cong viec nen cu di het tu cong viec (job) nay den cong viec khac. Ho cung nong tinh, de nan long, de gian du, di nhanh, an nhanh, rat la bua bon. Lam viec thieu suy nghi nen de bi tai tieng.

VII. CAC BENH PHOI HOP:

Hoi chung STTND thuong co su phoi hop voi cac nhieu loan khac:
1/ Hoi Chung Chong Doi va Uong Nghanh (Oppositional Defiant Disorder -ODD) Day la mot nhieu loan rat hay phoi hop voi STTND toi mot muc do tu 40 toi 50% co thong ke cho la toi 75%. Cac tre nay khong thich nghe loi, rat chong doi, hay cai lai cha me hay nhung nguoi co uy quyen doi voi minh. Bao trang this lam den, to ra rat uong nghanh, ngao man. Khi xin gi ma khong duoc thi tuc gian vo cung. Mot so tre nay lon len se de pham phap va bi tu toi.

2/ Hoi chung pham phap: Cung going nhu truong hop o tren, chi khac la tre hay vi thanh nien co khuynh huong pham phap, chong doi luat phap xa hoi, loai nay co ty le cao vao tu ra kham.

3/ Tam Benh Hung hoac Tram Cam: Cac tam benh ve cam xuc thuong phoi hop toi 20-30% voi tre co hoi chung STTND. Phai nho la STTND co cac trieu chung rat going voi benh Hung Cam (mania). Co the chi bi mot trong hai benh. Nhung co nhieu truong hop, tre bi ca hai benh cung mot luc.

4/ Tam Benh Lo Au (Anxiety Disorder): 30% tre co STTND cung se co tam benh lo au. Cac cha me, than nhan cua tre co STTND cung co ty le cao hon nhieu bi tam benh lo au.

5/ Tourette Syndrome (TS): TS la mot nhieu loan ve co dong goi la tic, nhu nhay mat, giat moi. Rieng Tourette’s thi co vocal tic, tuc la benh nhan cu lam tieng dong nhu khai cuong hong, khac nho, hat hoi, hoac tao cac tieng noi, am thanh co ve rat la tuc tiu (obscene) ma khong kem che duoc. Dieu eo le, la cac thuoc dung de chua STTND thuong lam cho Tourette’s nang hon. Cac tre co Tourette’s thuong cung hay co Tam Benh Am Anh, Cuong Dong (Obsessive Compulsive Disorder).
VIII. DIEU TRI:

Chung toi khong muon di vao chi tiet dieu tri, vi khi ban nghi con em hay nguoi quen cua ban bi STTND thi nen di tim bac si chuyen mon de dinh benh cho chinh xac truoc khi dieu tri. Vi cac ban nen nho la khong phai tre em nao nang dong hay lo denh cung deu bi STTND. Co nhieu tinh trang khac cung co trieu trung tuong tu nhu STTND.

Toi chi muon noi rang phan lon thuoc deu thuoc loai Stimulants thuoc nhom Amphetamines hoac co tac dung giong vay. Amphetamines la mot loai ma tuy, co loai tuong duong la methamphetamine hay duoc dan xi ke ma tuy dung. Nen thuoc phai duoc giu gin that ky luong de khong bi lam dung hay trom cap. Va cung rat than trong khi dung. Co dieu tat ca cac tre em bi STTND khi dung amphetamine deu to ra KHONG co gia tang hiem hoa ghien xi ke ma tuy khi lon len. Nguoc lai, o tre em duoc chua tri, kha nang ghien ma tuy khi truong thanh phan nhieu duoc GIAM XUONG. Co thuoc co tac dung giong nhu amphetamine, do la methylphenidate (Ritalin) Hau het cac thuoc dang ban tren thi truong deu la mot hinh thuc bao che cua hai loai duoc lieu nay. Cac loai nay deu thuoc loai thuoc duoi su kiem soat cua chinh phu (controlled substances).Co mot loai thuoc khong phai loai stimulant la atomoxetine (Strattera), nhung co kha nang lam hai gan. Cac stimulants co the lam mat ngu, mat an, nong nay, cham lon hoac tram cam. Chung co the lam anh huong den he thong tim mach. Co mot so tre em bi trieu chung STTND tram trong hon khi an duong hay cac do an co hoa chat de to mau cho do an (food colorants) dac biet mau do va mau vang. Vi vay tre em bi hoi chung STTND nen tranh an nhieu duong hoac cac do an co mau. Thuong tre bi Hoi chung STTND hay bi cac ban cung lop hat hui, xa lanh nen lau ngay co nhieu mac cam, can co bac si (psychiatrist) hay dieu tri vien tam ly (psychotherapist) de giup do o khia canh nay.

Dr. Son Vi Nguyen was former Assistant Professor of Psychiatry of

- The University of Texas School of Medicine at Houston

He was also Medical Director

of several psychiatric hospitals in Texas