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Hoi Chung Suy Tap Trung va Nang Dong.
QUA TRINH LICH SU CUA HOI CHUNG SUY TAP TRUNG VA
NANG DONG (STTND):
Die Geschichte vom Zappel-Philipp
The Story of Fidgety Philip
"Let me see if Philip canBe a little gentleman; "Philipp, das mißfällt mir sehr !" Just like any rocking horse;-"Philip! I am getting cross!" Hoi Chung Suy Tap Trung, Nang Dong
Nach dem Tischtuch greift er, schreit.
Glasses, bread, knives forks and all.
Hoi Chung Suy Tap Trung, Nang Dong
Look quite cross, and wonder howThey shall make their dinner now.
Tren day la bai tho “Zappel Philipp” (Philip nang dong hay Fidgety Philip) cua HeinrichHooffman, mot y si nguoi Duc, tac gia nhieu tho van cho tre em, da viet vao nam 1846 oFrankfurt. Ong sang tac bai nay de tang nguoi chau moi 3 tuoi cua ong. Day la mot bangchung la con nguoi da biet ro ve Hoi Chung Nang Dong Suy Tap Trung tu rat lau. Honnua hoi chung nay khong phai la hiem hoi. Tu hon 25 nam nay, Hoi Chung STTND datro nen mot truong hop benh ly duoc quan sat nhieu nhat o cac phong mach cua cac bac siNhi Khoa va Than Kinh Tam Tri. Hoi Chung nay duoc goi trong tieng Anh la AttentionDeficit Hyperactivity Disorder (ADHD). Nhin vao lich su cua cac xa hoi, ta co the thayrang Hoi Chung nay da hien dien tren trai dat co le tu khi co loai nguoi, it nhat o giaidoan ma loai nguoi da to chuc thanh xa hoi co co che, va luat phap ro rang. Do la luc connguoi, duoi anh huong cua Konrad Lorenz, cha de cua nghanh nghien cuu cac khia canhve Hanh Vi Tac Phong (Ethology) cua cac loai vat va Con Nguoi, bat dau hinh thanhkhai niem ve nhung hanh vi tac phong duoc coi la nam trong trong pham vi “BinhThuong”. Trong qua trinh cua Hoi chung nay, cac nha nghien cuu va cac tac gia da chono rat nhieu ten khac nhau: The Hyperactive Child Syndrome, Hyperkinesis, MinimalBrain Dysfunction, Minimal Brain Damage. Sau benh dich viem nao nam 1918, nhieutre em song sot con dich da co nhieu trieu chung Hoi Chung Suy Tap Trung, Nang Dong
cua STTND khien nhieu nguoi nghi rang hoi chung nay duoc gay ra boi ton thuong naobo. Ve sau nay, danh tu Attention Deficit Hyperactivity Disorder da duoc Hiep Hoi ThanKinh 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 cuonDSM-IV la cuon sach ket hop tat ca cac benh tam tri hien hanh voi cac tieu chuan dinhbenh duoc thua nhan. To Chuc Y Te The Gioi cua Lien Hiep Quoc (World HealthOrganization –WHO) voi cuon ICD-10 (International Classification of Diseases- secondedition) 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) 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.
Suy Tap Trung:
(a) 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 otruong hoc, hoac o trong cac sinh hoat hang ngay khac.
(b) Thuong hay co kho khan duy tri chu tam de hoan thanh trach
vu hay trong cac cuoc choi voi ban be.
(c) Thuong khong co ve chu tam de nghe khi co nguoi noi voi
(d) Thuong khong tuan theo loi chi dan hoac menh lenh, va
khong hoan tat cac trach vu, bai vo o truong hay o nha. Dieunay khong phai do khuynh huong chong doi, uong nghanhhay khong hieu menh lenh.
(e) Thuong co kho khan trong viec to chuc cach lam viec hay
(f) Thuong tranh ne, ghet, hay mien cuong lien he vao cac
nhiem vu thuong doi hoi su co gang ve tri oc.
(g) Thuong hay de lac hoac mat cac do dac, trang cu can cho
viec sinh hoat hang ngay (chia khoa, but, sach, dung cu).
(h) Thuong bi gay chenh mang boi cac kich thich ben ngoai nhu
(i) 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 nangsinh hoat hang ngay mot cach binh thuong va khong phu hop voi hanhdong cua tre cung lua tuoi.
Nang Dong:
Hoi Chung Suy Tap Trung, Nang Dong
(a) Thuong di dong chan tay hoac khong the ngoi yen.
(b) Thuong hay di dong trong lop hoc, khong co phep, hoac di
dong trong truong hop ca nhan duoc coi nhu la phai ngoi taicho.
(c) Thuong hay chay lang xang, leo treo qua dang trong cac
truong hop ma hanh dong nhu vay duoc coi la qua dang.
(d) Thuong co kho khan trong su tham gia tro choi hay sinh hoat
mot cach im lang (thuong rat on ao).
(e) Thuong hay chay lang xang suot ngay chu co bo may trong
(f) Thuong noi huyen thuyen, suot ngay.
Cuong Dong:
(g) Thuong tra loi mau chong truoc khi nguoi hoi noi xong.
(h) Thuong co kho khan cho doi toi phien minh.
(i) Thuong hay noi chen, noi ngang vao cau chuyen cua nguoi
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 E. 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 chola benh chiem vao khoang 4 toi 5 % so tre o tuoi di hoc. Cac nghien cuu gan day cho thayhoi chung nay co the chiem toi 10 % so tre em o tuoi di hoc. O the phoi hop la the thuonggap nhat, thi con trai nhieu hon con gai tu 4 toi 9 lan hon. Tru the loai chu yeu suy taptrung thi con gai co ve nhieu hon con trai. Hoi chung nay co tinh chat gia dinh (khong Hoi Chung Suy Tap Trung, Nang Dong
dung chu di truyen vi chua chung minh bang phuong phap khoa hoc duoc). Thuong thi tyle nguoi bi hoi chung nay cao hon giua cac nguoi trong cung gia dinh cua tre co hoichung, 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 duocnhiem vu cua minh.Tre cung hay bo do cong viec, bat dau lam nhieu thu, nhung chang cocai nao xong. De chan nan, bo roi cong viec dang lam neu gap kho khan. Tre neu okhong, hay thao go do dac trong nha roi rap lai khong duoc. Tre cung hay bay bua o trongnha, thieu oc to chuc, nen bua bon lam. Cung hay de do lung tung roi tim khong duoc Trerat 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 odien, v.v… Vi vay tre hay de bi tai nan (accident prone), dut, hay gay tay, chan, bi traytrua. Thuong phai duoc nguoi lon giam sat nhieu hon. Tre thuong gap kho khan o truonghoc, vi lam thay giao buc boi, co thanh kien voi tre. Nhung phai nho la tre thuong rat lathong minh, mac du diem cac bai hoc thi khong cao, vi khong tap trung duoc. Vi vay trethuong hoat dong rat thap hon la kha nang thuc su cua minh. Day la dieu rat bat cong chotre, neu khong duoc dieu tri. Vi tre khong phat huy het kha nang cua minh, ma hay bibuoc 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 naycung nang dong, khong the doi toi phien minh duoc, hay bo do cong viec nen cu di het tucong viec (job) nay den cong viec khac. Ho cung nong tinh, de nan long, de gian du, dinhanh, 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.
Hoi Chung Suy Tap Trung, Nang Dong
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 nhancu lam tieng dong nhu khai cuong hong, khac nho, hat hoi, hoac tao cactieng 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’snang 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 xactruoc khi dieu tri. Vi cac ban nen nho la khong phai tre em nao nang dong hay lo denhcung 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 nhomAmphetamines hoac co tac dung giong vay. Amphetamines la mot loai ma tuy, co loaituong duong la methamphetamine hay duoc dan xi ke ma tuy dung. Nen thuoc phai duocgiu gin that ky luong de khong bi lam dung hay trom cap. Va cung rat than trong khidung. Co dieu tat ca cac tre em bi STTND khi dung amphetamine deu to ra KHONG cogia tang hiem hoa ghien xi ke ma tuy khi lon len. Nguoc lai, o tre em duoc chua tri, khanang ghien ma tuy khi truong thanh phan nhieu duoc GIAM XUONG. Co thuoc co tacdung giong nhu amphetamine, do la methylphenidate (Ritalin) Hau het cac thuoc dangban tren thi truong deu la mot hinh thuc bao che cua hai loai duoc lieu nay. Cac loai naydeu thuoc loai thuoc duoi su kiem soat cua chinh phu (controlled substances).Co mot loaithuoc khong phai loai stimulant la atomoxetine (Strattera), nhung co kha nang lam haigan. 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 chungSTTND 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 nentranh an nhieu duong hoac cac do an co mau. Thuong tre bi Hoi chung STTND hay bi cacban 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- Texas Tech. University- The Texas College of Osteopathic Medicine He was also Medical Director of several psychiatric hospitals in Texas Hoi Chung Suy Tap Trung, Nang Dong

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