If you had ADHD, you would have had trouble reading that first paragraph without getting distracted. You would have thought of other things to do. You would have looked around the room, focusing on things other than the computer screen. You might have even gotten up and wandered off. No wonder children with ADHD have trouble being in school and focusing on school work.

美国约有150万至350万名学龄儿童有注意力不足过动障碍症 (Attention Deficit Hyperactivity Disorder，简称为过动症，或ADHD)；据估计，男孩过动症的发生率是5 %， 而女孩则是2 %。为何男孩比女孩容易得到过动症？这仍是个未解的谜。有超过60%以上的孩子长大后还是有过动的症状。根据美国国家卫生研究院的统计，超过百万的孩童服用医师所开立的处方药以控制过动的行为。依估计，教育当局得为此花上３兆美元。

如果你得了过动症，你大概很难毫不分心的读完上面第一段文章。你会想着其它要做的事。你会朝着房间里其它地方东看看西看看，把注意力放在其它事情上，但就是不看计算机屏幕上的文章。你甚至可能起身开始走来走去。难怪过动儿没办法乖乖在学校上课，或是专注在学校指定的功课上。

Signs to Look For

Almost all people at some point exhibit some of the symptoms of ADHD. We all get distracted at times; we all have had trouble finishing work or tasks. However, children with ADHD are, in general, less able to care for themselves, less able to recognize appropriate social behavior, and less able to communicate than non-ADHD children of the same age. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association has a very specific listing of behaviors that must be observed before a diagnosis of ADHD is made.

There are many reasons other than ADHD why children may have these behaviors. Infections, learning disabilities, or educational issues may result in symptoms similar to ADHD.

Some days, for some reason, these symptoms may be absent, leading others to think that the person with ADHD can control the behaviors. A definite diagnosis is difficult because there are no tests that consistently detect ADHD. A physician can only observe behaviors and guess whether the child has ADHD. Many children have trouble concentrating, or may not be in a mood to cooperate on the day they see the doctor. This could lead to an incorrect diagnosis. ADHD must be diagnosed by a health care professional who specializes in these types of disorders in cooperation with parents and teachers.

寻找过动症的征兆

几乎所有的人在某些时候都曾有过动症的症状。我们会不时分心；会没办法如期完成工作或是学校的作业。然而，普遍而言过动儿比较没办法照顾自己，没办法辨识出在什么场合该做什么事，也没办法跟同年纪的小朋友沟通。根据美国精神科医学会所出版的精神疾病诊断与统计手册（The Diagnostic and Statistical Manual of Mental Disorders ，简称DSM-IV），要确定孩子是不是过动儿，得先检视孩子的行为是否符合DSM-IV的临床诊断标准。

当然有很多其它的原因也让孩子有像过动症一样的行为。受到生物性病原的感染，学习上遇到困难，或老师上课的内容方式，都有可能造成与过动症相似的症状。

诡异的是，某些时候，不晓得什么原因，这些症状会突然消失无踪，让人们误以为过动儿其实是可以控制自己行为的。这一点使得要很肯定的诊断出一个孩子是不是过动儿变得困难重重，因为没有一个测验能够对同一个受试者在不同时间点，前后非常有一致性的检验出过动症的存在。医师也只能借着观察孩子的行为，来猜测这孩子是不是过动儿。许多小孩都有注意力不集中的问题，或者只是看医生的那天心情不好，懒得跟医师叔叔阿姨合作。这些原因都可能导致误诊。因此，过动儿的诊断需要专精于此的医疗人员和家长老师一同合作，才能减少误诊的情形。

Examining the Cause

Evidence shows that children who were born weighing less than 1500 grams (3.3 pounds) or who had birth complications may be more prone to ADHD. Additionally, studies have linked resistance to thyroid hormones to hyperactivity and lack of impulse control, but it is unclear how this impacts ADHD.

Other factors which are being investigated to see what role they may play in ADHD are exposure during pregnancy to:

• Toxins (such as lead)
• Drugs (such as alcohol or cocaine)

According to the National Institutes on Health, ADHD is not usually caused by:

• Too much TV
• Food allergies
• Excess sugar
• Poor home life
• Poor schools

Increasing evidence suggests that ADHD is an inherited condition. If one identical twin has symptoms of ADHD, the other twin has a 75-91% chance of sharing the same trait. Children who have ADHD are likely to have one close relative who also has ADHD. One-third of all fathers who had ADHD when they were young have children who have ADHD.

Adoption studies provide more evidence of a genetic link to ADHD: biological relatives of children with ADHD have a higher chance of having ADHD than adoptive relatives of children with ADHD.

探寻过动症的成因

目前科学家仍然没有办法很清楚解释过动症的成因。可能是脑中接收神经传导物质多巴胺（dopamine）的接受器秀逗了，没办法正常运作所导致的。另一个很有可能的原因则是脑中的多巴胺含量异常。最近，一项针对成人所做的研究将过动症的成因指向与多巴胺合成有关的酵素 －多巴脱羧酵素（dopa decarboxylase）。或许是掌管注意力以及定力的大脑前额叶皮质区（anterior frontal cortex ）出了问题 －这个区域的神经细胞，它们的多巴脱羧酵素不能正常运作而导致过动症的发生。

一些证据显示，出生于体重不到1500公克（3.3磅）的孩子，或是出生时难产的孩子比较可能发生过动症。再者，过去曾有研究试图将甲状腺素（thyroid hormones）与过动(hyperactivity)以及无法控制冲动扯上关系，但究竟甲状腺素如何对过动症构成影响，这依然是个谜。

另外，在怀孕期间可能会接触到的一些因子也曾被拿来研究是否在过动症的形成过程中扮演某种角色：

• 毒物(例如铅)

• 药物 (例如酒精或是古柯碱)

根据国家卫生院研究结果，过动症通常不是下列原因所引起的：

• 看太多电视

• 食物过敏

• 吃了过多的糖

• 疲乏的家庭生活

• 贫乏的学校环境

有越来越多的证据支持过动症与遗传有关。如果同卵双胞胎中有一个人有过动症的症状，另一个人同时罹患过动症的是75-91%。如果循着过动儿的家族表追踪，很容易发现过动儿的近亲里头也有其它孩子是过动儿。小时候患有过动症的父亲里头，有三分之一的人他们的小孩也会有过动症。

借着研究被领养的过动儿，提供我们更多的证据支持过动症与遗传有关的想法：与过动儿有血缘关系的孩子同时患有过动症的机率高于收养过动儿的家庭里其它小孩也有过动症的机率。

Structural Signs

New evidence demonstrates that not only are some of the structures slightly different, but the brain may use these areas differently. By taking a brain scan, researchers have noticed that boys with ADHD have an abnormal increase of activity in two structures: the frontal lobe and striatal areas below it. These areas work in part to control voluntary action. So the ADHD boys were working harder to control their impulses than non-ADHD boys. Once given Ritalin, this abnormal activity quieted down. This effect was not seen in the non-ADHD boys. So Ritalin may act differently on ADHD brains compared to "normal" brains.

Although the brain scan, called functional magnetic resonance imaging (fMRI), is expensive--about $1500--and may not be covered by insurance, it may provide a more accurate way to diagnose ADHD. As science explores more of the mysteries of the brain, ADHD may be thought of more as a disability or disorder, rather than a behavioral problem.

生理结构上的征兆

过去几年的研究显示有过动症的男孩脑的形状比一般孩子较为对称。过动症男童的脑部有三个区域比同年龄没有过动症的男童小：前额叶皮质区（prefrontal cortex），尾状核（caudate nucleus），和苍白球（globus pallidus）。前额叶皮质是大脑的「命令中枢」，而其它两个部分则是负责将命令转为行动。

                                     新的证据显示过动儿不只是在大脑结构上有些许不同，他们使用这些区域的方式也跟正常孩子不一样。研究人员利用脑部影像扫瞄，发现过动儿的脑部有两个区域活动异常增加：额叶（frontal lobe）以及在它下方的纹状体（striatal areas）。这两个区域与控制肢体的随意动作（voluntary action）有关。因此有过动症的小男孩比没有过动症的小男孩更难控制他们的冲动。一旦给予一种名为利他能（Ritalin）的药物，不正常的好动就会缓和下来。但同样的药物对于没有过动症的小男孩则没有抑制冲动的效果。因此Ritalin作用在过动儿脑部的方式，可能和作用于正常人脑有所不同。

虽然功能性磁振造影系统（fMRI)的脑部扫瞄所费不赀，在美国大约要花上1500美元而且保险并不给付，但是它可能提供了一种更精确的方式来诊断过动症。当人类的科学对于脑部的奥秘有更多的了解时，过动症可能不会再被认定为是某人不肯控制自己行为的问题，而是一种生理上的缺陷或疾病。

Treatment

These medications can be addictive in teenagers and adults, but they have not been found to be addictive in children with ADHD. Nine out of 10 children improve on one of these stimulants, so if one does not work, the others are tried. If these medications do not work, some children respond well to antihistamines, usually prescribed for allergies. Clonidine, a drug normally used to treat hypertension, also alleviates some symptoms of ADHD. With any of these medications, adjusting the dosage for each child is vital for treating the symptoms of ADHD.

People who do NOT have ADHD may also respond to stimulants and may find that their attention and ability to focus will improve. This reaction does not mean that they have ADHD. It is not recommended for people without a diagnosis of ADHD to use these drugs. No one knows if stimulants have the long-term effects.

Ritalin is the best known drug used to treat ADHD. It was first used in the 1950s to treat narcolepsy, an illness where people suddenly fall asleep at irregular times. It works by making more dopamine available in the brain by reducing dopamine reuptake. Therefore, dopamine can stay in the synapse for a longer time. Ritalin curbs symptoms such as hyperactivity and other behavioral problems, but it does not improve IQ.

Ritalin is being prescribed at an astonishing rate. Statistics mentioned in a 1998 TIME magazine article are telling: Ritalin production in the US has increased more than sevenfold in the past eight years. Ninety-percent of it is consumed by people in the US.

Why have the prescriptions skyrocketed? Part of the reason may be pressure--pressure from teachers for children to behave, pressure from parents for their children to do well in school and to succeed in other pursuits, and pressure from society for children to do more and better, at a younger age.

Ritalin has side effects that include irritability, decreased appetite, inability to sleep, depression, and personality changes. With the increase in information about where dopamine may be deficient, medication could be designed to target those deficient areas instead of increasing dopamine production in the entire brain. This may reduce the side effects associated with Ritalin and other drug medications.

药物治疗

有三种兴奋剂被拿来控制过动症的症状。

这些药物可以用来治疗青少年或是成人，但还没有被用来治疗小孩。十个小孩里有九个会因使用这些药物治疗而获得改善，要是某一种药物治疗效果不好，那就再试试别的。如果这些药物都没效的话，可以试试通常拿来治疗过敏症（allergies）的抗组织胺剂（antihistamines），某些过动儿对这一类药物的反应还不错。另一种通常拿来治疗高血压的药物Clonidine，同样地能缓和某些过动症症状。不论使用任何一种药物来治疗过动症，医师依着每个孩子调整药物的剂量是极为重要的事。

没有过动症的人如果服用这些药物，可能也会对这些药物有反应，并且发现自己的注意力已及定力变好了。这样的反应并不表示这些人患有过动症。没有被诊断为过动症的人最好不要服用这些药物。因为没有人知道这些药物会有什么长期性的影响。

利他能是最为人所知的过动症治疗药物。它首次于1950年代被用来治疗嗜睡症，那是一种使人突然陷入沈睡状态的疾病。这种药物借着减少多巴胺的再吸收，延长多巴胺在突触的作用时间，而达到治疗的目标。Ritalin可以控制住过动或是过动症其它行为上的症状，但是它并不能提高智能。

医师开立利他能作为处方用药的成长速度很快。据1998年时代杂志的统计，过去八年，利他能在美国的制造量成长了七倍。其中有90%的使用者是美国人。

为什么利他能的用量会有那么戏剧化的攀升？有部分原因可能是来自于压力－压力来自于师长对孩子们行为举止的要求，来自于父母亲望子成龙成凤的心态，希望孩子能在学校或是在其它活动上有杰出表现，以及整个社会风气倾向希望孩子能在小小年纪就青出于蓝而胜于蓝。

利他能所带来的副作用包括易怒，没有胃口，失眠，忧郁，以及性格改变。当我们对于过动儿脑部哪些区域多巴胺含量有异了解的越透彻，越有可能可以设计出专门作用于这些特定区域的药物，更精准的控制局部区域多巴胺的含量，以改进现有的处方药没有选择性的增加整个脑部多巴胺生成量的缺点。盼能因此减少利他能和其它药物的副作用。

Controversy

Ritalin is one of the most commonly prescribed drugs for children, but there are worries about its long-term effects. There are no studies on children who have taken Ritalin for more than 14 months. Ritalin affects the brain in a way very similar to cocaine, one of the most addictive substances known. Are children who take Ritalin more likely to use illegal drugs in the future? Are they more likely to smoke as adults?

There is reason for this concern. Rats who were exposed to stimulants were more likely to help themselves to cocaine, suggesting that early exposure to some drugs may "prime" a person for future drug use. Data on the link between Ritalin and later substance abuse are controversial. Some studies show that Ritalin makes people more prone to addiction to certain substances. Other researchers insist that ADHD children are not more likely to use drugs of any type later in life.

论战

利他能是用来治疗过动儿最常见的处方用药之一，但是令人担忧的是它的长期影响。并没有任何研究可以告诉我们当孩子服用利他能超过14个月之后会发生什么状况。由于利他能在脑中的作用与瘾君子经常滥用的药物--古柯碱很相似。用过利他能的孩子将来会不会容易染上毒瘾？他们成年之后会不会容易有烟瘾？

这样的忧虑并非空穴来风。根据动物实验显示，如果大鼠在幼年曾经接触过治疗过动症的兴奋剂，之后再让牠们有机会接触古柯碱，这些大鼠自己跑去吃食古柯碱的机率必较高，因此难免令人猜想如果小时候接触过这一类药物，会不会种下日后犯毒瘾的因！关于利他能是否有可能引发后续的药物滥用的问题，相关的研究结果一直备受争议。有些研究显示利他能会使人容易有物质滥用的情形。而其它的研究者则主张过动儿服用这些治疗药物后，日后并不会有药物滥用的倾向。

Combining Therapies

The immediate problem with this is that insurance companies will be more likely to cover the cost of a pill, but may hesitate to cover long-term therapy sessions. Thus, often the treatment for ADHD is focused on the short-term, not on the long-term.

整合性疗法

处方用药可以协助控制过动症的症状，而其它方法像是心理治疗、行为治疗，一样也能帮助对过动儿的症状有所帮助。许多专家正提倡结合药物和其它疗法的整合性疗法。其它对过动儿有帮助的方法包括：创造性的教学方式，利用视觉上的标记提醒孩子他手边正在进行的事，持续对孩子的行为做响应并试着增强适当的行为，对于每日例行的事物给予一些规则或架构，特殊教育，以及其它用来教导学障儿的技巧。

但是这种整合性疗法马上会遭遇的问题是保险公司似乎比较愿意给付药物治疗的费用，但是不大情愿付钱给保户进行长期性的治疗课程。因此，过动症的治疗通常是短期的，而非长期性的。

Coping Strategies

• When necessary, ask for instructions again--don't guess about what you're supposed to do.
• Break large or complex tasks into smaller jobs. Set deadlines for each tasks and reward yourself when you complete each one.
• Each day make a "to do" list. Use a calendar to keep you on track.
• Work in a quiet area. Do one thing at a time. Give yourself short breaks.
• Create a routine. Do the same things in the same order each day.
• Eat a balanced diet, exercise, and get enough sleep each night.

过动症者的生活对策

在美国国卫院为过动症者所编的小册子里条列了一些方法可以帮助过动者在工作或学校能有比较好的表现：
　

• 如果需要的话，在把别人的要求问清楚－不要去猜别人期望你做什么。

• 把大型的，复杂的工作，分割成几个小部分来完成。为每一项作业设定最后完成的期限，奖励你自己当你完成每一样工作。

• 每天都列出「当日工作清单」。

• 在安静的地方工作。一次只做一件事。让自己稍稍休息一下。

• 利用日志帮助自己的工作进度上轨道。

• 创造出生活的规律性。每天以一样的顺序做相同的事。

• 饮食要均衡，适当的运动，每晚让自己有充足的睡眠。

Watch your Head!

The Road Ahead

Although scientists have gained much information in the past few years, ADHD is keeping some of its secrets. Why does it affect more boys than girls? Is ADHD "real" or is society simply labeling children who are having difficulties? And how does dopamine fit into this? Is Ritalin the beginning of a drug dependency or an antidote for needing illegal drugs in order to function? Are the abnormalities in a child with ADHD the same as those seen in adults who have ADHD? Much more work still lies ahead.

小心「头」！

根据医院的纪录过动儿比非过动儿容易发生意外。不只如此，过动儿受伤的程度比同年龄或同性别的非过动儿来的严重多了。这下子又多了一项戴安全帽的理由，当过动儿骑脚踏车，溜冰，玩直排轮，或滑板的时候，记得让他戴上安全帽。

未来的路

虽然科学家在过去几年已经累积了许多关于过动症的知识，但是仍有一些疑团待解。为什么男孩比女孩容易有过动症？ 到底过动症真的是一种生理上的疾病，还是社会为那些「麻烦小顽童」贴上一种简化问题的标签？而多巴胺是如何参与其中？利他能是药物依赖的引子，还是为人们使用非法药品以求正常生活的行径提供一种开脱？过动儿与成人的过动症患者会有相同的异常行为吗？有更多的工作在前方等着科学家一一解答。