On the morning of August 16, the seats outside the "Learning Difficulty Clinic" of Nanjing Children's Hospital were filled with parents and children.
This clinic is only open on Tuesdays and Saturdays. 40 numbers are placed on time at 1:00 pm one week in advance. Parents need to wait for them, otherwise they will be gone in seconds.
Some parents never got the account, so they simply hung up the "Children's Health Clinic" account next to it, and some parents heard this novel name for the first time from a hot search on the Internet. Aren't we all naughty when we were young?" He greeted the child to the consultation room, "If you don't want that much, just give your child a comprehensive physical examination before school starts."
According to incomplete statistics, in the past two years, hospitals in Shanghai, Nanjing, Wuhan, Changsha, Nanchang, Tianjin and other places have opened "learning difficulties clinics", and almost every clinic is "hard to find".
Behind the tight "learning difficulty clinic", there are serious medical problems, such as the neglect and misunderstanding of related diseases, such as the lack of professional child psychiatrists; on the other hand, it also points to education, children from family After coming from the society, we will return to the family and society. Medical means can only improve the symptoms. The intervention of schools and social forces is also an important part.
"Learning Difficulty Clinic" is named after the most perceptible chief complaint of parents, "Learning Difficulty". It is like a thread on the water, gently pulling out the stories of families that are difficult for outsiders, as well as the huge number of unforgettable stories that cannot be ignored. Education Anxiety.
Outpatient clinic
"Frequently interrupting other people's conversations or forcing others to accept his language and games?"
"right."
"Often switch to another thing before one thing is done, can't do things exactly as required?"
"Yes."
...
On the morning of August 16, Zhang Yu and his 10-year-old son Taotao were consulting in the outpatient room for learning difficulties in Nanjing Children's Hospital.
Doctor Huang Yizhen asked questions one by one according to the scale, and Zhang Yu gave a positive answer to almost every question.
She touched the back of her son's head and half-jokingly said, "Look at how well the doctor and aunt understand you."
About 20 minutes later, Zhang Yu got a preliminary diagnosis opinion and examination report-suspected ADHD (attention deficit and hyperactivity disorder, commonly known as ADHD) and Asperger's syndrome.
She wasn't surprised by the ADHD findings, but what about Asperger's?
She didn't get it.
Next, Taotao will have to draw blood, do an electroencephalogram, and conduct a series of assessments including an intelligence test and an evaluation of the social life ability scale to make the final diagnosis.
Zhang Yu felt that something was wrong with the child very early on.
In the first semester of the first grade, Taotao did not do well in school, but it was still worry-free.
After the outbreak of the epidemic in 2020, Taotao took online classes at home. Zhang Yu was pregnant with her second child and couldn't separate too much energy. Taotao was led by her grandparents. "At this time, all the good habits developed before are gone."
Taotao's grades plummeted. Zhang Yu said that his son used to read books by himself, but he never read books again.
Taotao is addicted to short videos on mobile phones and playing games.
What's worse, Zhang Yu found that Taotao's attention is almost measured in minutes, even if it is playing a favorite game, Taotao's patience is difficult to exceed five minutes.
After Zhang Yu checked the information on the Internet, he suspected that his son had ADHD.
She took Taotao to a hospital in her hometown of Liyang, Jiangsu. After a simple and quick evaluation, the doctor told her that Taotao was just at a playful and active age, not enough to be diagnosed with ADHD.
Zhang Yu felt that it was not that simple. She wanted to take her son to see a doctor in a more professional hospital in Nanjing. The husband and wife had differences of opinion.
The husband insisted that there was nothing wrong with his son. The so-called ADHD was a "scam" and an "IQ tax", but Zhang Yu didn't listen to him. After she grabbed the account a week in advance, the couple took a day off and drove from Liyang to Nanjing. .
At first, Zhang Yu didn't tell his son the real purpose of coming to Nanjing. Taotao always thought it was because he came to the hospital for rhinitis. He didn't understand what was going on until he got to the door of the consultation room.
I asked Taotao, "Do you have any thoughts on visiting the Learning Difficulty Clinic?" Taotao lowered his head and did not answer.
Outside the clinic, the children's attitudes toward the "learning difficulty clinic" varied widely.
Some children don’t take it seriously, but in more families, this topic is sensitive. When I was talking to a father, he saw his son approaching and immediately lowered his voice, “Don’t talk, don’t talk, we usually don’t show up in front of children. Say this."
Zou Yan is the only parent outside the outpatient clinic without a child.
She was carrying a backpack, carrying her son's brain CT film and medical records, and knocked on the outpatient room several times, hoping that the doctor would add a number for her.
Zou Yan said that she had been squatting for several weeks without being able to get the number. This time she was prompted to go directly to the hospital to try her luck because just two days ago, her 11-year-old son took a math test and his score suddenly dropped to In the end, Zou Yan panicked, "He doesn't seem to understand, so I just want to come over and see if he has a problem with his IQ."
But Zou Yan didn't dare to talk to her son about seeing a doctor at all.
A few months ago, she wanted to trick her son into going to a traditional Chinese medicine hospital for acupuncture and moxibustion to treat his attention deficit problem. As soon as his son saw the word "brain department", he understood. The mother and son had a fierce quarrel. In the end, Zou Yan persuaded her son to do it. With ordinary acupuncture, this is the past.
"He (son) won't come with me." Zou Yan couldn't hide her loss.
As soon as school starts, it is time for her son to enter the sixth grade. This is the critical sprint stage. In addition to studying cultural classes this summer, she also enrolled her son in extracurricular classes in programming and table tennis, which are fully arranged every day.
"Finally diagnosed"
"'Learning difficulty' is of course not a disease, but a chief complaint," explained Huang Yizhen from the Learning Difficulty Clinic of Nanjing Children's Hospital.
In Nanjing Children's Hospital, the predecessor of "Learning Difficulty Clinic" is "Psychological and Behavioral Clinic". The most common complaints of parents are "learning difficulties" and "difficulty in concentrating". Like the "Insomnia Clinic" and "Pain Clinic", the main complaints are Named clinics are becoming more common.
Huang Yizhen said that the reason why the name "learning difficulties" was decided is precisely in the hope that the pathological reasons behind "learning difficulties" could be popularized for parents, and that children with problems could be intervened as soon as possible, so as not to miss the best treatment period.
The "Learning Difficulty Clinic" of Nanjing Children's Hospital opened in February 2021 and has treated more than 4,000 children so far.
Huang Yizhen introduced that ADHD is the most common in "learning difficulty clinics", accounting for about 80%. In addition, learning skills development disorders (such as dyslexia), Asperger's syndrome, emotional problems, etc. are also the main reasons for being diagnosed.
There are also children with borderline intelligence and mental retardation.
Mental illnesses are often accompanied by comorbidities, and many children may have two or several illnesses.
These names are a bit unfamiliar to parents, who realize that "learning difficulties" and mental retardation don't directly equate.
For example, ADHD commonly known as ADHD actually includes three types: attention deficit, hyperactivity-impulsive and mixed. Attention deficit is more common, and a child who looks quiet may also have ADHD.
Learning skills development includes dyslexia, spelling difficulties, dyscalculia, etc., which is a slight disorder of brain function caused by an inborn gene.
Asperger's syndrome is a syndrome in Pervasive Developmental Disorders (PDD) that has certain characteristics similar to autism, such as interpersonal difficulties, stereotyped, repetitive interests and behavior patterns.
On the online social platform, children diagnosed with ADHD have a unified name - "Awa", and parents share their children's medical treatment, medication and intervention.
Like depression, anxiety, etc., ADHD is a spectrum disorder. There may be mild or moderate symptoms, but they are not enough to make a diagnosis. Only when the symptoms reach a certain level and cause serious functional impairment can it be Diagnosed.
As a result, many families with suspected ADHD have had more than one medical visit.
Zeng Ying's daughter Niuniu was diagnosed with ADHD in February this year. "10 years old, fourth grade, finally diagnosed." She emphasized again, "Yes, finally."
Unlike many "A-babies" who were found to be "complaints" by teachers to their parents, Niuniu's kindergarten teacher spoke highly of her, and only one foreign teacher reminded Zeng Ying that Niuniu had some unusual behaviors, such as walking around in class as if no one else was there. .
Zeng Ying also noticed something strange. When Niu Niu was in middle school, she developed an unexplained pica. When she was older, Niu Niu's attention was difficult to concentrate, and her literacy mirrors were reversed, such as "b" and "d". If you can't tell the difference, write "warm" as "warm".
Zeng Ying took her daughter to the expert account in Shanghai, but the doctor believed that Niuniu was only a normal child with poor attention span. Zeng Ying suspected that her daughter had dyslexia and was denied by experts, "Look, she can read on her own before she went to primary school. How can there be dyslexia?"
But Zeng Ying always felt that her daughter was different from other children.
Before going to primary school, Niu Niu mastered 1000-1500 Chinese characters and addition and subtraction within 100. Zeng Ying said that the energy spent in this process is several times that of other peers.
After going to primary school, despite having the foundation of these pre-preparations, Niuniu's grades were barely average.
In addition, Niuniu is impulsive and irritable, and is very inattentive.
A few years ago, Niuniu was not diagnosed, and the whole family still raised Niuniu as an "A baby".
Zeng Ying opened a company in Shanghai. She doesn't need to work at ordinary times, and has plenty of time to accompany and tutor Niuniu at home.
Even though she is aware that her daughter may have ADHD and needs to be more patient and tolerant with her, she still has occasional outbursts during homework help.
"A baby costs her mother," Zeng Ying said, "A baby family, first of all, the mother can't be depressed, and neither the family relationship nor the parent-child relationship can collapse nor dare to collapse."
After her daughter was promoted to the fourth grade, Zeng Ying felt more and more struggling, "I and she (Niuniu) are too tired." Instead, the diagnosis meant a relief to her.
In May 2021, China's first epidemiological report on the prevalence of mental disorders in children and adolescents was released. The survey results showed that among school students aged 6 to 16, the total prevalence of mental disorders in Chinese children and adolescents was 17.5%. Among them, the most prevalent mental disorder is attention deficit hyperactivity disorder, accounting for 6.4%, and tic disorder accounting for 2.5%.
A widely cited public data is that there are about 23 million ADHD children and adolescents in China.
"It's hard to say what the diagnosis rate is." Liu Huaqing, director of the Clinical Psychology Department of Beijing Huilongguan Hospital and member of the Chinese Medical Association's Child and Adolescent Psychiatry Professional Committee, said, "Many rural counties or third- and fourth-tier cities do not have professional diagnostic institutions, and parents' awareness rate Not high, they don't think it's a disease, and they don't see it in professional institutions. Secondly, there is still a shortage of professional pediatric psychiatrists." In 2019, data published by "The Lancet" showed that my country's child psychiatry professionals The number of doctors does not exceed 500, compared with 8,000 in the US.
Facing the parents who kept pushing the door and asking for a plus sign, Huang Yizhen was a little helpless.
There are only two doctors in the "Learning Difficulty Clinic" and Huang Yizheng, and they also have to attend the "psychological and behavioral clinic" on Thursday and Friday. , it is difficult to open clinics every day in the short term.”
Liu Huaqing has pointed out more than once, "early screening intervention for ADHD is really necessary." He explained that ADHD children can be found at the age of two or three years old. If early screening can be popularized, the pressure will not be completely transferred. For parents, children can also get better development.
The constraints of reality are also obvious.
"One is the level of attention of everyone, and the other is that there is no policy implementation." An Jing, a psychotherapist, deputy director of the Psychiatry Department of Huilongguan Hospital, said.
To take medicine or not to take medicine
In the consultation room, a parent tried to negotiate with Huang Yizhen, "She (daughter) is too young, can she not take medicine?" Huang Yizhen explained that the doctor will adjust the dosage according to the child's actual situation to minimize side effects.
This is a problem that Huang Yizhen often faces. Many parents feel that they need to take medicine unless their children have a cold, fever, and physical symptoms. Like spectacle correction, you can’t see clearly not because you’re not trying hard enough, but because the structure of the eyeball has changed.”
When a child is diagnosed with ADHD, what he/she faces is: if he/she is under 6 years old, he/she is advised to undergo intervention training, and if he/she is over 6 years old, a doctor will usually prescribe medication.
At present, there are usually two kinds of drugs available in China - Focused and Zestar.
Drugs have stirred the most sensitive nerves of parents.
In the learning difficulties clinic, you will find that parents are quite active in taking their children to see a doctor, but they are generally hesitant when facing medication.
Whether it is Focused or Zestar, there are certain side effects, mainly in gastrointestinal problems and sleep disorders, and some people show depression.
In addition, taking the drug for at least one year, whether it will become addictive or not is also a concern for parents.
There are also parents rushing to the outpatient clinic for medicine.
As a red prescription drug that is strictly controlled, parents can only prescribe it with a doctor's order.
They expect this "smart drug" to bring about qualitative changes and improve the parent-child relationship in the process of tutoring and education.
When the doctor informed a father of his child's condition, the father cut in bluntly and said, "Prescribe the medicine, I have to live first."
In some families, doctors suggest that children can use non-drug interventions for sensory integration training, but they are unable to cope with both money and energy.
Many people are from other places, and there is no decent sensory training center in their hometown. Both husband and wife have jobs and cannot spend much time with their children. Taking medicine has become the most worry-free and convenient means.
After Niu Niu was diagnosed, Zeng Ying chose to have her daughter take medicine almost without hesitation.
Zeng Ying carefully protects Niuniu's self-esteem. In her opinion, many A-babies are getting worse and worse because they are unable to achieve their goals. After long-term setbacks, they have learned helplessness. If there is always a lack of positive results incentives, A-babies Maybe she would indulge herself "rotten", she was afraid that her daughter would give up on herself first.
Fortunately, Niuniu's symptoms were mild, and she took the lowest dose. After half a year, there were no obvious adverse reactions, and her study time was shortened by 30% to 40%.
But what made Zeng Ying sad was that her daughter seemed to be psychologically dependent on the drug. She told Zeng Ying that the drug was her "crystal slipper" and she didn't want to go back to her original state.
"In fact, children themselves also hope to be a good child. Just like adults want to be successful, it is very good to feel recognized and affirmed." Jing Jing said that children of this age have received feedback from the outside world. It comes from studies, and the second is from interpersonal communication. If there is no treatment intervention, they will continue to be frustrated in these two aspects, and the mental pressure will be even greater. In the long-term, they will have a feeling of dislike of school, interpersonal communication disorder, and even induce depression, obsessive-compulsive disorder, bipolar disorder. Affective disorders, etc.
changed family
"A baby" affects the whole family.
After Shen Yi's daughter Coco was diagnosed with ADHD, she stopped taking the medicine for only two months.
Shen Yi described that Coco before taking the medicine was like a happy bird every day.
After taking the medicine, Coco was quiet all day and was not interested in things.
Shen Yi decided to rely on non-drug means to improve, "even if it's slower."
In November last year, Shen Yi signed Coco for a sensory integration training class, twice a week. The price of the course is not cheap, 3,200 yuan a month.
Shen Yi and her husband both have to go to work, and their parents from their hometown in Anhui specially came to Beijing to take care of their children.
The training class lasted for four months. Since the outbreak of the epidemic in Beijing in March this year, Coco has never participated in training again.
Around the child's situation, the family is also making adjustments and changes.
Before that, Shen Yi worked in an Internet company in Beijing, where working overtime was the norm, and her husband was a civil servant in the system, so the job was relatively easy. Coco's studies were mainly tutored by her husband. There was a roar at both ends, and the child cried." Shen Yi couldn't bear it. In June of this year, she quit her job and took care of Coco herself.
The first thing Shen Yi has to do is to control her temper.
She gets along with her daughter 24 hours a day. Because of various small problems, she has to keep an eye on her child's online classes, help her homework, and urge her daughter to skip rope. The doctor advised her to exercise more.
Shen Yi stopped thinking about long-term plans. She planned to hold a family meeting to discuss with her family about the actual situation of Cocoa and the way of education. She understood that this was bound to be a protracted battle.
Liu Huaqing said that as long as the treatment is continued systematically, the effect is still very good. This ideal state means that the child can go to school and socialize normally, which is no different from other children. "Some children are still very smart."
An Jing also believes that more attention should be paid to whether children can perform their social functions normally. "Just like high blood pressure does not mean that you cannot run."
Yin Xiaoyue, 21, has been living with ADHD for more than ten years.
Growing up, ADHD to her, "is like an ant, it is very small, but its existence and damage cannot be completely ignored."
On social platforms, in addition to communicating the experience of treatment and parenting, parents of A baby are more concerned about a child who deviates from the standard, how will they grow up?
What is the future?
Yin Xiaoyue's story may add another perspective.
Yin Xiaoyue in elementary school is not a good student in the traditional sense. Her academic performance is at the bottom, and she has difficulty concentrating. She often starts to get distracted while writing homework, and her thoughts are wild. Those strange fantasies make her mother think she is "not normal".
In school, she always talked back and was often asked by teachers to invite parents.
In fourth grade, she was diagnosed with ADHD at a hospital in Shenyang.
After the diagnosis, Yin Xiaoyue spent a very dark day.
When she went to the doctor that year, she also took an intelligence test, and the score was 121. The intelligence test of ordinary people is between 105 and 115. Yin Xiaoyue is considered to be a smart child, so even though she was diagnosed with ADHD, her symptoms were only regarded by her parents. Is not working hard, "owe to play".
"At that time, my parents suspected that I was a doctor who had a problem with my IQ and took me to see the doctor." Yin Xiaoyue said that when the intelligence test exceeded her parents' expectations, her mother's expectations for her became higher and she was much stricter.
If she was found to be distracted, Yin Xiaoyue would inevitably be beaten and scolded. It was not until she entered junior high school that her symptoms became more serious, and her mother went to prescribe medicine for her.
But she would have retching and no appetite when taking the medicine, so for more than ten years, she only took medicine before exams.
"Drugs can only help me concentrate during exams, but it's useless if I don't learn how to concentrate during exams."
In junior high school, Yin Xiaoyue got rid of the label of "scumbag".
The reason why Yin Xiaoyue's grades are okay in the review is that her intelligence is not bad and she has always been "forced" by her parents and school.
But the process was painful, and she was often mired in depression.
In high school, Yin Xiaoyue studied in a key high school, and the academic competition was under great pressure. Her grades were very unstable, and she was always "fighting" around her attention.
The greater pain is that she has been stigmatized for a long time, and she has to hide secretly every time she takes medicine.
"I used to think that ADHD can only happen to naughty and annoying boys, and I am a girl." Yin Xiaoyue said, "This is a very delicate psychology."
Yin Xiaoyue took two university entrance exams. The first time her grades were 30 points lower than the usual mock exams. Her parents forced her to repeat her studies. The second time her grades increased by 10 points, it was still not ideal, and it was still 10 points lower than the first grade.
Her mother chose the accounting major for her. She was not interested. "It was very painful to learn."
from family society, back to family society
In the "Learning Difficulty Clinic" consultation room, each child's consultation time is at least 20 minutes. Huang Yizhen will give not only diagnosis, but also suggestions on sensory integration training and family education.
At the end of the clinic that day, Huang Yizhen recommended a book "How to Raise a Child with ADHD" to a parent.
"This is a medical problem, and it's not just a medical problem." Huang Yizhen said, "Children come from the family society, and then they will return to the family society." She hopes that outpatient education can help more people get rid of the disease. Myths, not just families, but schools and society.
According to Huang Yizhen, the hospital opened a popular science course for parents. Later, due to the epidemic, the course was changed to online, with a total of six lessons.
Monday through Friday, the hospital also offers emotional social group training for children with ADHD, psychomotor rehabilitation, biofeedback therapy, and executive function training.
But these seem to be far from enough in the larger environment.
Shen Yi took her daughter to several large hospitals in Beijing. Her original intention was to seek non-drug educational advice, but the consultation time was relatively short, and she felt that she had not gained much.
On the other hand, Shen Yi found that the teachers at her daughter's school did not know anything about ADHD.
It was a decent public elementary school in Beijing. The young teacher asked the senior teacher how to discipline the troublesome naughty child. The latter replied that it would be fine when the child was older.
Over the years, Huang Yizhen has felt that the public's awareness of ADHD and other diseases is improving. In the early years, only children and parents came and went in the outpatient clinic, but now teachers and parents have come together, although this is still rare. See.
Huang Yizhen was most impressed by a female teacher in her thirties.
The female teacher was initially confused and helpless. She found that a child in the class had many behavioral problems at school. After checking the information, she vaguely felt that it might be ADHD, so she found the parents and came to the clinic together.
During the diagnosis, the female teacher provided much of the child's performance at school.
Huang Yizhen also gave her a lot of advice, ranging from how to arrange a seat for the child to changing the way of education. "For example, if you can't punish copying homework multiple times, the child may not be able to solve so many questions."
Raising a baby has forced parents to lower their expectations for their children, but very few people can really make up their minds to let their children completely break away from the current test-oriented education system.
Zeng Ying considered whether to let her children go abroad to receive quality education, but she quickly rejected the idea. She believes that no matter what education system at home and abroad, learning itself requires concentration and cannot really escape.
She plans to plan a suitable path for her daughter in the current education system: she and her husband both studied art, and Niu Niu's artistic talent is also good. She lowered the requirements for Niu Niu's math scores and enrolled her children in painting courses instead. And English - She hopes that Niu Niu University can study art abroad, so English can't be lost, and it must be grabbed from the dolls.
Over the years, as a child, Yin Xiaoyue has tried to reconcile with herself.
After going to college, she learned more about ADHD and realized that "it's not my fault, it's just that the brain is underdeveloped somewhere".
She was relieved.
"My friends around me now know my situation." Yin Xiaoyue plans to study a graduate degree in marketing after graduation. "I will focus a lot on the things I am interested in."
Parents are looking forward to getting some experience from those who have come.
A 25-year-old woman shared her experience of being diagnosed as a child and how she grew up on social platforms. A parent asked her probingly below, "If you go back to your childhood, how would you like to be treated by adults?"
Yin Xiaoyue told me that she hopes that people around her, especially her parents, will realize that this is a disease that cannot be solved by beating and scolding. She hopes to be treated more tolerantly and scientifically.
But in any case, there is no solution from the "learning difficulty clinic" to the pervasive educational anxiety on the Internet.
Anxiety even affected Yin Xiaoyue, who was only 21 years old.
Although she is still in college, she is already "very worried" that her future children will inherit ADHD. From time to time, she will brush up on posts about raising a baby.
However, Yin Xiaoyue is very sure that even if she does have an A baby in the future, "I will definitely do much better than my parents."
(Except Huang Yizhen, Liu Huaqing, and An Jing, the rest are pseudonyms)
Beijing News reporter Li Zhao