Can the learning difficulties clinic help children to turn things around? Parents have cognitive misunderstandings
2024-08-14
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Hyperactivity and lack of concentration in class, depression and anxiety when talking about learning, stomachache as soon as going to school... For some children, learning difficulties are like a difficult problem that stands between parents and children, causing pain to the children and anxiety to the parents. As summer vacation approaches, many parents take their children to seek medical treatment during the extra-long vacation, and the learning difficulties clinics launched by many hospitals in the city have also ushered in a peak in summer visits. Is it really a disease for children to have poor grades? What are the influencing factors behind it? What should I do if I find that my child has learning difficulties? Why are there more children with learning difficulties... With these questions, a Beijing Youth Daily reporter went to the psychiatry department of Beijing Children's Hospital to find out.
Phenomenon
The summer learning difficulties clinic is fully booked
During the summer vacation in Beijing, the whole city was enveloped in a rolling heat wave. As hot as the city, some students and parents were also anxious. Outside the psychiatric department of Beijing Children's Hospital, it was crowded with students and parents who came to see the learning difficulties clinic.
On the afternoon of July 24, Kunkun (pseudonym) and his mother walked out of the consulting room of psychiatrist Tang Xinzhou of Beijing Children's Hospital after a follow-up visit. Previously, Kunkun's mother had received "complaint calls" from school teachers every now and then, reporting that Kunkun could not sit still during class, moved around, and liked to pick things with his hands. He sat by the window and the wall on one side was torn to pieces by him. The child also always affected others, liked to talk to others, and constantly disrupted the order of the class, which made the teacher very distressed and unable to complete homework independently.
Faced with such an unusual situation, Kunkun's mother took her child to Beijing Children's Hospital for a concentration test at the teacher's suggestion. It was found that Kunkun's concentration was very poor, which was a typical learning difficulty caused by attention deficit hyperactivity disorder. After a period of drug treatment, Kunkun's condition was greatly relieved. This time when Kunkun came to the hospital for a follow-up visit, the child's mother said that in the last month of the semester, the teacher did not call once, and he could complete his homework independently. When they walked out of the clinic, the two were in much better condition than when they first came.
Among the children who come to the learning difficulties clinic for treatment, some cannot sit still in the classroom, whisper to each other, make frequent small movements, and even affect classroom discipline, and are always called by the teacher to call their parents; some are slow in doing homework, and it takes them several times longer than their peers to complete the same amount of homework; some children become irritable and even hit others when they mention going to school; some children are taciturn and even show symptoms of depression and anxiety, and their parent-child relationship is strained... Tang Xinzhou said that every summer vacation, the department is fully booked and the overall number of outpatient visits is 10%-20% higher than usual.
"We have a total of 17 doctors in the child psychiatry department. They start seeing patients at 8 a.m., get off work at 12 p.m., and see patients from 1 p.m. to 4:30 p.m. The learning difficulties clinic is open on Tuesdays, Wednesdays, and Fridays, but even at other times, the psychiatry department is crowded with children who want to see a doctor for learning difficulties. Although the number of outpatient appointments is fixed every day, some parents come from other places, and there will inevitably be some patients who add appointments on the spot, so we rarely get off work on time." said Tang Xinzhou.
Causes
Attention-deficit/hyperactivity disorder is most common
In fact, learning difficulties are not a disease diagnosis in themselves, and there may be various potential reasons behind them. These children usually show that their academic performance does not match their intelligence level. Some of them show obvious difficulties in listening, speaking, reading, writing, reasoning and calculation skills. Some are not interested in learning and school, are unwilling to go to school or even completely refuse to go to school.
In clinical practice, Tang Xinzhou has seen many unusual symptoms of learning difficulties: some children will have unexplained fever, stomachache, or blood pressure fluctuations as soon as they go to school. There is also a child whose vision turns black and white as soon as he goes to school. "Behind this conversion disorder is actually anxiety and depression. When children hear about going to school, they may not be able to express it verbally, so they express it through various physical symptoms. Just like some adults feel bad and have "work anxiety" when they think about working overtime, this kind of imagination can also be regarded as children's "learning anxiety."
Learning difficulties are just a superficial phenomenon. There are multiple factors behind it. There are serious medical problems, such as related diseases being ignored and misunderstood, and lack of medical resources in the field of child psychiatry. On the other hand, there may be hidden educational anxiety of "wanting sons to become successful" and "wanting daughters to become outstanding".
When visiting the hospital, the doctor will conduct professional tests on the child to find out the problem and treat it accordingly. Tang Xinzhou said that learning difficulties are generally caused by three situations, including learning difficulties caused by attention deficit hyperactivity disorder, learning difficulties caused by intellectual disabilities, and learning difficulties caused by learning environment and family upbringing problems.
Since 2015, Tang Xinzhou has been engaged in research and clinical work on child mental illness. In the past nine years, she has come into contact with countless patients with child mental illnesses, including ADHD, tics, autism, depression, anxiety, learning difficulties, etc. Among them, the most common learning difficulties in the outpatient clinic are those caused by attention deficit and hyperactivity.
Tang Xinzhou said that among the outpatients at Beijing Children's Hospital, 30% to 40% of the children have learning difficulties caused by attention deficit hyperactivity disorder, especially those who are in the transition from kindergarten to primary school. "When entering the first grade of primary school from kindergarten, many children cannot adapt to the change of environment. After entering primary school, the rules around them have changed. The school requires children to abide by classroom discipline, not to walk around or whisper in class, and the teaching method is obviously different from that of kindergarten. Most hyperactive children will show it at this time."
A Beijing Youth Daily reporter found that most of the patients who came to the clinic were boys. Tang Xinzhou admitted, "It is true that boys have a higher incidence rate. Affected by genes, boys develop their nervous systems more slowly than girls. Neurodevelopmental diseases such as autism are more common in boys than girls."
Learning difficulties may be related to family education model
In addition to the child's own physiological factors, external factors are also an important cause of children's learning difficulties, which are often closely related to the family. Tang Xinzhou said that the way parents educate their children, excessive care or indifference, and the degree of participation and role played by parents in their children's growth process may affect the child's psychology. The relationship and behavior between parents will have an impact on the child's physical and mental development, shaping the child's worldview and values.
In the outpatient clinic, Tang Xinzhou has seen many parents with "rough" educational methods. Some children are addicted to mobile phones and disobey discipline, so parents force their children by beating or scolding them, which makes it easier for children to develop a dislike for learning. Under the intimidation of their parents, some children are more likely to hide their emotions, and finally develop symptoms such as depression and anxiety. For such families, the parent-child relationship is a key issue. In this regard, doctors often adopt follow-up treatment, urge children to return to the hospital for follow-up in time, and carry out psychological counseling. At the same time, relevant psychological knowledge is also popularized to parents, and parents are advised to learn family education knowledge, handle parent-child relationships well, and slowly help children rebuild their confidence in learning and develop good study habits.
In addition to family factors, some children may develop resistance to learning due to other factors such as school environment and social interaction. For example, some children are always caught as "typical" by teachers or punished by standing, some are bullied or isolated by classmates, and some are born with sensitive personalities. Once they fail to handle the relationship with the people around them, these invisible pressures can easily affect the children's psychology.
Tang Xinzhou said: "This kind of learning difficulty is more likely to occur in older children, such as those in junior high school and high school. It is necessary to conduct case analysis on each child so that the school, teachers and parents can work together to help the child out of the predicament."
Myth
Parents want doctors to help discipline their children
In the process of communicating with parents, Tang Xinzhou also found that parents have various misunderstandings about their children's learning difficulties. Some parents think that their children's hyperactivity, emotionality, and disobedience are all their own problems. In fact, at this time, parents have subconsciously put themselves in a position of authority and natural correctness, which leads to their view that their children's behavior is wrong. Some parents only focus on their children's grades. They think that their children scored 80 points in the exam, but parents expect their children to score 90 points. If the children do not meet their expectations, they will bring their children to the clinic and try to ask the doctor to help "strengthen" their grades. In fact, the children do not have serious diseases, but simply have not mastered the learning methods.
Dr. Tang explained: "Many parents come to the clinic and ask the doctor to help them discipline their children, but they ignore the root cause of their children's behavior. Some children do not deliberately want to go against their parents. At this time, parents need to be more patient and caring to understand the real reason behind their children's behavior, whether it is a physiological problem or a problem with the education method."
In the clinic, doctors often feel helpless when faced with parents' doubts and misunderstandings. Although they bring their children to see the doctor, some parents subconsciously do not believe the doctor's diagnosis, especially for children who only have learning difficulties in junior high and high school. "When we tell parents that their children have depression tendencies, some parents directly say that I am talking nonsense, call me a 'quack doctor', and slam the door and leave angrily. This is not uncommon."
"In fact, I understand the feelings of parents very well," said Tang Xinzhou. "After all, raising a child is very difficult. It is not easy to make parents accept that their children's poor performance may be due to illness. All we doctors can do is to persuade them earnestly and try our best to make parents understand and cooperate with their children's treatment in time. But to be honest, the initiative and decision-making power are still in the hands of parents, and doctors are often powerless."
In the face of this situation, she hopes that more and more parents can recognize the phenomenon of learning difficulties and pay attention to their children's mental health. If there are problems, timely adjustment of the mentality can help children better overcome difficulties.
However, Tang Xinzhou admitted that the parents who can come to the outpatient clinic for treatment have actually been "screened". They accept the fact that their children have learning difficulties and realize that their children may need the intervention of a doctor before coming to the hospital. Such parents are generally easier to listen to advice and have better compliance. "More parents may see their children's learning problems, but they never thought of taking their children to see a doctor. They don't know the physiological and psychological mechanisms behind learning difficulties. They think that their children are just naughty and don't like to study. They don't realize that they can seek medical help. The children's aversion to learning has not been solved for a long time, and they fall into a vicious circle. This is the problem of parents' attention to children's mental illness. More popular science needs to be done to make more people pay attention to children who need help." Tang Xinzhou said.
extend
There is a contradiction between patients’ actual needs and medical resources
The learning difficulties clinic launched by Beijing Children's Hospital has also attracted many parents from other provinces and cities. They either travel to Beijing during the summer vacation and see a doctor at the same time, or take advantage of the summer vacation to bring their children for treatment. Beijing Youth Daily reporters found that behind this phenomenon is the contradiction between the increasing demand for diagnosis and treatment of children's mental illnesses and the limited supply of medical resources.
"There are very few hospitals with child psychiatry departments in China. There are basically no county-level hospitals, but some municipal hospitals have them. Our clinic receives many students and parents from other provinces and cities. It is very tiring to travel long distances to seek medical treatment, but there are not enough medical resources locally, so parents and children can only travel back and forth. In recent years, the country has been continuously investing in cultivating relevant medical talents, but compared with actual needs, it is indeed too scarce." The number of professional child psychiatrists in my country is very scarce, and the distribution is extremely uneven. Most of the high-quality child psychiatry resources in China are concentrated in tertiary hospitals in first- and second-tier cities. The lack of talent, the uneven distribution of resources, and the increase in the number of children with the disease made Tang Xinzhou feel helpless.
On the one hand, mental illness in children is becoming more and more common, and on the other hand, medical resources are limited. Some parents are inevitably anxious but cannot find professional help, which also gives some social institutions an opportunity to take advantage of it. Some institutions claim that they can solve children's learning difficulties and treat children's hyperactivity, and promote some "new therapies". Tang Xinzhou reminded parents not to blindly believe and suggested that they go to regular and qualified hospitals for treatment. Regarding the qualifications of hospitals, parents can check on the website of the National Health Commission, pay attention to protect themselves and their children, and avoid being deceived.
In recent years, the country has been paying more and more attention to the mental health of children and adolescents. In 2023, the Ministry of Education, the National Health Commission and other 17 departments issued the "Special Action Plan for Comprehensively Strengthening and Improving Students' Mental Health Work in the New Era (2023-2025)", which proposed 22 specific tasks such as strengthening mental health education, standardizing mental health monitoring, and improving psychological early warning intervention to continuously improve students' mental health. By 2025, the proportion of schools equipped with full-time (part-time) mental health education teachers will reach 95%, and the proportion of family education guidance service sites carrying out mental health education will reach 60%.
Li Dachuan, deputy director of the Medical Administration Department of the National Health Commission, said at a press conference held on World Mental Health Day last year that doing a good job in the mental health of children and adolescents requires all departments and even the whole society to attach great importance to and correctly understand it, and incorporate the work into the social governance system, public health system, social security system, etc., to promote it in a coordinated manner and form a joint force. At the same time, for mental health problems of different degrees and stages, a multi-level social psychological service system should be established to provide full-process mental health services in a hierarchical and classified manner.
Mainstream treatment is mainly medication
At present, learning difficulties caused by attention deficit hyperactivity disorder are the most common in outpatient clinics. How to treat them? Tang Xinzhou said that for this kind of situation, clinical treatment mainly focuses on drug treatment and auxiliary training. Doctors will choose the appropriate drugs according to the different tolerance levels and physical conditions of children.
However, some parents believe that the drug is "toxic" to a certain extent and are afraid of side effects so they dare not give it to their children. Tang Xinzhou said that the role of the drug is to increase the excitability of the nervous system and quickly improve symptoms. Different children have different medication cycles, and doctors will scientifically judge the medication process. "Side effects may exist, but there are basically no irreversible side effects. The most common is affecting the child's appetite and sleep. We will observe for a period of time and find that the child has a good tolerance for the medication and there are no obvious side effects. We can continue to give him the medication. If it doesn't work, we will switch to other treatment methods."
Regarding auxiliary training, Tang Xinzhou said that there are two main types that are popular in China. One is digital concentration training, which uses some small games to repeatedly train children's brains. The second is EEG biofeedback, which uses EEG to help children play some small games to train their concentration. However, the current mainstream treatment is still based on medication. (Reporter Jiang Ruojing, intern Zhao Yanqi, Li Jia)
Source: Beijing Youth Daily
