教授:今天我们要讨论的是 Prof: So, today we're gonna to talk about
上周一阅读的内容 what we were reading for Monday
这个章节讲的是发展精神病理学 The chapter is on developmental psycho-pathology
也就是情感上的东西 What that means is emotional
也就是所谓的情绪障碍 what are termed emotional disorders
一些儿童患有此类疾病 得跟这类疾病打交道 that children, some children have and deal with
今天我们要讲到的是注意力缺陷障碍(ADD) Today, we're going to talk about Attention Deficit Disorder
这种情况其实是相当普遍的 which is a very fairly common... well, common in terms of....
首先 它的媒体关注度很高 it gets a lot press for sure, and something
然后 我相信很多人都会有感同身受的经历说 that a lot of people I think can relate to in terms of feeling
天啦 我也无法集中精力 我是不是也患上了 oh, I have problems with attention
注意力缺陷障碍或者注意力缺陷多动障碍 Maybe I have ADD or ADHD
今天我们就要讲到它 So, we're gonna talk about; we're gonna look at
首先它到底是一类什么样的疾病 Well, what is it first of all?
在孩子身上有哪些表现 What does it look like in kids?
其次 这类疾病的病因为何 Second of all, where does come from?
会带来一些什么样的后果 What are some of the consequences?
患上它们的孩子要面临哪些困难 What are some of the difficulties kids with ADD and ADHD face?
最后时间允许的话 我们讲讲有哪些治疗方法 And then – time permitting – what are the treatments?
就处理这类疾病而言 What do we know about what's effective
有哪些有效的手段和方法 in terms of dealing with treatments?
目前利他林以及其它一些兴奋药物 Certainly Ritalin and other kind of stimulant medications
在临床上被广泛运用 are widely used
但是这还是有争议的...... But that controversial...
让孩子服用药物 这会让人们 You know, people feel that putting kids on drugs, just kind of naturally
自然地产生抵触情绪 most of us are kind of against it
这类治疗手段到底是好是坏呢 But, so, is that a good or a bad thing?
或者可能不是一个好坏的问题 or is it maybe not a good/bad thing?
可能提这个问题本就不合适 Maybe that's not the right question
好了 首先我要给你们...... Ok, let me start by giving you...
总的来说在谈论ADHD时 and just one thing in general as we talk about ADHD
有一点我希望大家能牢记于心 that I want to have you keep in mind
其实之前我们就间接地提到过ADHD We kind of talked about ADHD before, not directly
当我们读到婴孩时期的自律能力那一章节时 but in terms of when we read about self-regulation in toddlerhood–
也就是孩子控制冲动的能力 kids' abilities to have impulse control
可能有很多不同的术语 There are probably different terms
我不能一一记住 书上用了很多不同的术语 I forget the terms, all the different terms the book you use
好像是行为抑制 或者自我控制 自我调节 but, kind of behavioral inhibition or self-control, self-regulation
这些术语都和ADD以及ADHD有关系 Those are all terms related to ADD and ADHD
心理学家和精神病医生认为 the people that – psychologists, and psychiatrists
要正确地对待注意力缺陷障碍疾病 the way to think about ADD is not...
尽管的确情绪障碍是一个术语 而且 even though that's a term and we have this term emotional disorders
一些孩子患有一些孩子没有 that some kids have and other kids don't
但是要想当然的认为一个孩子 It's not really fair to think of it as something
要么患有这类疾病 要么完全没有 就不恰当了 that a kid either has or doesn't have
我的意思是仅从疾病分类层面来讲 I mean, it is fair to think of that
这种想法无可厚非 in terms of that label
但是要弄清疾病在深层含义上的原理 but in terms of the underlying kind of ‘what's going on with it?
这个层面上我们要用整体的观点来思考 it's more fair to think of it as a continuum
比如很多十岁左右的孩子 like all kids, let's say, all ten-year-old kids
或者说我们大家 在专注于某些特定事情上 You know, we can all relate to the ability and the inability
都可能存在注意力无法集中的问题 to pay attention to certain things
我们在读教科书时 We all read our text book and find ourselves
看完了一段 然后意识到 looking over the paragraph and then we realize
怎么 我刚刚扫过的那一段 wait a second; my eyes just went over the paragraph
怎么什么也没记住 but nothing registered
又不得不倒回去重读一遍 So, you go back and read the paragraph
其实从某种程度上来说 So, we all, to some extent...
我们没人能够百分百 none of us are 100 percent perfectly able to pay attention
高度集中注意力 you know, to sustain attention
持续关注某件事情 all what we want to sustain attention on
我们会告诉自己 必须持续集中注意力 Or what we tell ourselves we need to sustain attention on
因为明天会有一个小测试或者一场考试 because we got a quiz tomorrow or a test tomorrow
那些最终被诊断出ADD So, it's just that, the kids that get ended up with labels of ADD
即注意力缺陷障碍 Attention Deficit Disorder or ADHD
或ADHD 即注意力缺陷多动症的孩子 Attention Deficit Hyperactivity Disorder
都是一些表现比较极端的孩子 you know, are at the extreme of that
但其实我们身上都会或多或少有类似的表现 but we're all kind of on this continuum
所以我们不能简单的把它理解为 So, it's not something that some kids have
某些孩子会因为生物或化学原因患上这类疾病 this one thing, biologically or chemically
而别人都不存在这类问题 that the rest of us don't have
只不过是这些孩子症状更明显或者问题更突出 but they have more of it
这里我并不是说 And now, that's not to say that
伴随ADD疾病的就没有生物学上的条件 there aren't biological conditions that go along with ADD
我们待会儿会讲到的 we're gonna talk about that some
而是说某种程度上 我们每个人都有ADD but it's to say that we all kind of can relate to it to some extent
当我们在讨论ADD疾病 so when we're talking about ADD
也就是在讨论自律能力时 were also talking about self-regulation
可能我们并不仅仅是说 we maybe weren't just talking about
某个孩子拥有的注意能力名列前茅 百里挑一 this kid's at the top five percent of the ability to pay attention
而是一个总体趋势 一种综合素质 but we're talking about the general trends in
对于我们某些冲动行为的自控能力 you know, being able to pay attention to have control
等等其它事件的掌控能力 over our impulses behaviorally, and things like that
我们以三个案例开始 Let me start off by just reading three examples
让你们对ADD ADHD患儿的表现有大致的印象 to give you a sense of what kids with ADD, or ADHD, look like
比如他们有哪些显露病症 Or how they might present... present is a word that
这个词常被心理学家或精神病医生用到 like, psychologists or psychiatrists use...
有哪些表症和行为 whether they're presenting symptoms, presenting behaviors
丽萨的儿子杰克一直是一个难以管教的小捣乱 Jack, Lisa's son Jack had always been a handful
即使只是一名学前儿童 Even as a preschooler
他也可以把整栋房子弄得天翻地覆 he would tear through the house like a tornado
大喊大叫 室内混战 翻箱倒柜 shouting, roughhousing and climbing the furniture
没有什么玩具或活动能让他安静几分钟 No toy or activity ever held his interest for more than a few minutes
经常毫无征兆的四处乱窜 and he would often dart off without warning
似乎意识不到一条车水马龙的街道 seemingly unaware of the dangers of a busy street
或者拥挤的商场有多么危险 or a crowded mall
管教杰克是一件让人头疼的事 It was exhausting to parent Jack
但是丽莎过去一直没太在意 but Lisa hadn't been too concerned back then
她说到男孩就是这样的 总会长大的 Boys will be boys, she figured. He'll grow out of it
但是一直到他8岁了 杰克依然如此 But here he was now eight, and still no easier to handle
要让他安静下来完成家务和功课 Every day was a struggle to get Jack to settle down
每天都是一场斗争 即使是让他完成一项 long enough to complete even the simplest tasks
最为简单的任务也不容易 from chores to homework
他的老师经常批评他在班上注意力不集中 His teacher commented frequently about his inattention
搞破坏行为 and disruptive behavior in class
好了 第二个例子是马克 Alright, second of all, Mark
马克 14岁 精力比大多数同龄男孩要充沛 Mark, age 14, has more energy than most boys his age
但是他总是过度活跃 But then, he's always been overly active
三岁开始他就是一个捣乱鬼 Starting at age three, he was a human tornado
横冲直撞 所到之处一片狼藉 dashing around and disrupting everything in his path
在家里从不安分 At home
一会儿玩这个一会儿玩那个 he darted from one activity to the next
身后是一大堆他玩过的玩具 leaving a trail of toys behind him
吃饭的时候常把盘子打翻 At meals, he upset dishes
还叽叽喳喳说个不停 and chattered on non-stop
他鲁莽而冲动 He was reckless and impulsive
跑上马路也不管对面正开过来的车子 running into the street with oncoming cars
尽管妈妈很多次告诉他 no matter how many times
这非常危险或者责备他 his mother explained the danger or scolded him
在操场上他看似也不比其他孩子疯多少 On the playground, he seemed no wilder than the other kids
但是他倾向于反应过度 but his tendency to overreact
比如殴打玩伴仅仅因为别人撞了一下他 like socking playmates simply for bumping into him
这样的情况已经几次让他陷入麻烦了 had already gotten him into trouble several times
他的父母也无计可施 His parents don't know what to do
溺爱的祖父母安慰他们 男孩就是男孩 Mark's doting grandparents reassured them, boys will be boys
不要担心会懂事的 但事情并不是这样的 Don't worry; he'll grow out of it. But he didn't
最后一个例子是丽莎 Lisa... Lisa
在她17岁时仍然在努力地让自己规矩一点 At age 17, Lisa still struggles to pay attention and act appropriately
但是这对她来说不是一件容易的事 but this has always been hard for her
回想起那晚她父母带她到一家餐厅 She still gets embarrassed thinking about that night
庆祝她十岁生日时发生的那一幕仍然感到尴尬 her parents took her to a restaurant to celebrate her tenth birthday
当时她被女服务员一头耀眼的红头发分了神 She'd gotten so distracted by the waitress' bright red hair
以至于他父亲叫了她三次 that her father called her name three times
才想起要点菜 before she remembered to order
然后还没来得及阻止自己 Then, before she could stop herself
她脱口而出你的头发染得太糟糕了 she blurted, your hair dye looks awful
在小学和初中阶段丽莎安静而听话 In elementary and junior high school Lisa was quiet and cooperative
但是总是喜欢做白日梦 but often seemed to be daydreaming
她很聪明 但是就是无法提高自己的成绩 She was smart, yet couldn't improve her grades
不管有多努力 no matter how hard she tried
很有几次 即使明知道答案 Several times she failed exams
她还是考砸了 Even though she knew most of the answers
因为她无法把注意力集中在试卷上 she couldn't keep her mind on the test
她的父母对于她成绩差的态度就是 Her parents responded to her low grades
剥夺特权 以及责骂 by taking away privileges and scolding
你就是懒 you're just lazy
成绩不好就是因为你不努力 You could get better grades if you only tried
有一天 丽莎又考砸了 One day, after Lisa had failed yet another exam
老师发现她在呜咽 我到底是怎么啦 the teacher found her sobbing, what's wrong with me?
那么这三个孩子有什么共同点吗 So, what are the similarities do you see between these three kids?
学生:冲动 Student: Impulsive
教授:什么 Prof: What's that?
学生:非常冲动 丽莎 那个红头发事件 Student: Very impulsive. Lisa with the hair dye. Before she could...
她能想也没想就脱口而出 she blurted it out before she could even really think about it
教授:好 冲动 这是三个主要特征中的一个 Prof: Yeah, ok. Impulsivity. And that's one of three main traits
ADD患者倾向于具有三类临床表现 three categories of behaviors that the kids with ADD tend to have
你们还注意到其它方面吗 Other things you noticed about the three kids?
他们三个孩子行为表现中的共同点 Commonalities... in their behaviors?
黛布拉 Debra?
黛布拉: 他们其实知道对错 Debra: They know the difference between right and the wrong
他们只是不能控制自己的行为 They're just unable to control their actions
教授:这个视角很好 Prof: Yeah, well, that's a good point
我不知道...... I don't know if that's... let me see
我不知道是不是所有例子都能证明这点 I don't know if all the examples kind of showed that
但是可以肯定的是患有ADD的孩子 But, yeah, that it's not necessarily that kids with ADD
并不都是是非不分的孩子 don't know right and wrong
事实上就这一点我和其他老师也常谈论到 In fact, this is a conversation I have with teachers a lot is that
因为他们易于冲动或者容易走神 but they... because they act impulsively or kind of get distracted
他们往往会形成错误的行为 they often form behaviors that
但其实他们也知道这些行为是不对的 you know, they kind of otherwise they know are wrong
我和其他老师也经常讨论 And so, it's... you know, I talk to teachers a lot
就像有些老师说的 他们知道孰是孰非 like teachers are saying, well they know what's right and wrong
他们只是缺乏行动力 you know they just need to do it
关于ADD有一点需要我们注意的是 But one thing about ADD
对于ADD人们普遍有的一点误解是 in kind of a general understanding people have about ADD
让我们看看最后一句引用父母说的那句话 and this goes back to this last quote, where the parents say
你就是懒 you're just lazy
成绩不好就是因为你不努力 You could get better grades if you only tried
然后是丽莎对自己再次考砸了的自责 And then Lisa's concerned about herself
我到底是怎么啦 failed another exam, what's wrong with me?
拉塞尔 巴克雷是心理学的一位领军人物 Well, Russell Barkley who's kind of one of the leading psych ologists
多年来在马萨诸塞州 He's been researching and dealing with kids with ADHD
他一直致力于研究和诊治ADHD患儿 for many years now up in Massachusetts
他认为ADD的核心 在于缺乏动机 He describes what the core of ADD is, is a motivational deficiency
缺乏动机 不是指孩子们懒 and, by motivation, it's not that kids are lazy
并不是丽莎父母认为的那样 你就是懒 like her parents, Lisa's parents tell her, you're just lazy
相反这里拉塞尔 巴克雷认为 Rather, what he means by that is that
ADD ADHD患儿大脑的化学组成稍异于一般人 the chemistry of the brain is a little bit different
他们的神经网络和其他人比起来也稍有不同 The wiring is a little bit different in kids with ADD and ADHD
这样一来 大脑的奖惩机制 that, such that rewards, positive rewards and negative rewards
就异于常人 act a little differently
他们需要比别人更高的 积极的肯定 That they need a higher level of positive reinforcement
才能做好一件事或者保持注意力 just to kind of do the right thing, or to sustain attention
这主要是由于我们刚讲的 And that's related, we think, back to
和这些孩子大脑化学组成差异有关 like I said, chemistry differences in these children
这并不是他们故意如此 So, it's not unwillful
只是因为他们的神经网络有点不同罢了 It's just that their wiring is a little bit different
再次强调 要用联系统一的观点看待这个问题 And again, like I said, it's a continuum
我们每个人的大脑化学结构 we're all in a continuum of the brain chemicals
都跟奖惩机制有关 related to reward
只是ADD患儿的奖惩机制稍有不同罢了 and punishment are a little bit different in kids with ADD
所以看似他们不认真 不努力 So that they look like they're not trying
其实只是他们的某些生物机制有点不同 but it's just that they're, you know, a little different
待会儿我们要看一个视频 And we're gonna see a video in a little while
你们会看到巴克雷会提到这点 You'll see Barkley talking a little bit about this
ADD三个主要症状是 注意力涣散 自制力弱 While the three main symptoms of ADD are inattention, impulsivity
就像刚才凯莉说的 过度活跃 and as Kelly said, and hyperactivity
ADD ADHD患者可以是注意力缺陷主导型 You can have ADD and ADHD primarily inattentive type
冲动控制障碍主导型 primarily impulsive type
患者可以是部分表现 So, you can have some
并不一定三种症状都有 you don't have to have all three of these
我们这就一一讲到这些不同的症状 We're gonna go through what these different symptoms are
以及它们在孩子身上有哪些典型的表现 and how they typically manifest themselves in kids
首先是注意力涣散 First of all, well, inattention, obviously
很明显就是难以保持注意力 Difficulty sustaining attention
但不是对任何事情都这样 But that's not just to anything
ADD患儿极善于连续几小时打视频游戏 ADD kids are very good at playing video games for hours at a time
事实上这又回到之前我们说过的奖赏机制 In fact, video games... and it gets back to this kind of reward
这类孩子大脑神经化学里的奖赏机制不同 differences in rewards in kids' brains
ADD患儿的问题在于 Its difficulty sustaining attention to boring and dull tasks
难以在枯燥乏味的任务中保持注意力 that's the problem for ADD kids
而视频游戏非常有利于让人保持注意力 So, for example, video games are very good at sustaining attention
因为这里有太多的环境刺激 because there's so much, like, going on noises
持续的音效 画面上不断跳出的物体等等 and things blowing up and, like, things popping on the screen
这个小方盒提供了很多刺激 There's a lot of stimulation that comes at you in this little box
它们可以帮助维持注意力 that helps you sustain attention
而且等级会越来越高 And they have higher and higher levels, you know
慢慢积累 很有挑战性 是不间断的 it's kind of cumulating like challenging. So, that's just non-stop
而要在日常单调或枯燥的任务中 Well... so, sustaining attention to kind of boring or kind of dull
保持注意力 everyday tasks
尤其是学校这样一个环境 you see this particularly in school
毫无疑问 学校是挺枯燥的 对吗 and not surprisingly, cuz school is boring, right?
我的意思是 如果把一个需要额外刺激 I mean, if you were to take a kid who needs extra kind of stimulation
以保持注意力的孩子放到学校里的话...... to keep him sustaining their attention... like
我听到有人这样认为说 I've heard people argue, like
最糟糕的情形就是把患儿放到这样的环境里 the worst situation you could put them in is
让他安静的坐在板凳上 we'll have him sit still at a desk and listen to somebody
听某人在教室的前面喋喋不休的讲课 chatter up at the front of the room all day
偶尔可能在黑板上写几个字 and maybe occasionally write something on the board
一切都通过话语交流...... It's all kind of, like, you know, like, verbal
大家想想我们小学 Anyway, but if you think about our primary schools
以及初中的那种环境 our elementary schools, in like
首先就保持注意力的能力而言 you know, a kid who is maybe a half step down
一个可能还处于坐立不安阶段的孩子 in terms of able to pay attention in the first place
你把他放到这样一个环境 and then you put him in this context
逼着他不得不安静的坐着听别人讲课 where they have to sit and listen
整个过程还不能做其它活动 and they're maybe not doing motor things along with that
可以想象这对他们来说 You can see how it might be difficult
是一件多么艰难而富有挑战的事情 and challenging for that kid
潘克西普是中西部某处的一名心理学家 他认为 Panksepp is a psychologist out in Mid-west somewhere
大多数被诊断为ADHD的孩子 Most youngsters diagnosed with ADHD
可能根本就是正常的 may simply be normal
这些是非常顽皮的孩子难以调适 highly playful children who have difficulty adjusting to
达到体制的预期这里指学校或其它机构...... certain institutional expectations, meaning a school or other things
可能他们的这种脾性更适合 Perhaps such temperaments were more adaptive
生存在原始而古老的环境中 in primitive ancestral environments
在那里 打猎和采集是生活的主要职责 when hunting and gathering were the main pursuits of life
所以患有......的孩子 You know, so kids who have...
不仅仅是患有ADHD的孩子 and not just like I said, not just kids with ADHD
还有那些具有注意力障碍 but people who are on this end of the continuum
处于这个整体的极端情况的人们 of having difficulty paying attention
义务教育制度是19世纪末期兴盛起来的 Well, we've made schooling mandatory back in the late 1800s
那么 ADHD这类疾病在这之前存在吗 and so, did ADHD exist before we did that?
人们对此有过争议 这之前存在吗 I mean, you know, people have argued this; did it exist?
其实并不是因为化学...... Well, you know, not that the chemistry
某些潜在的化学结构的变化 the underlying chemistry change
这类疾病的出现很好的说明了 情绪障碍 but it kind of was a good example of how emotional disorders...
并不仅只关乎个人 或者个体情况 you know, it's not just the person, or what's in the person
而是一场人 与人所处的环境的需求 It's the match between the person
之间的竞争结果 and the demands of the environment that the kid is in
竞争目的在于两者是否能够成功地相互适应 in terms of whether they are going to be successful and adaptive
因此当ADD患儿还处于学徒期的时候 Such that, kids with ADD, you know, when they were apprentices
每天可以获得很多运动和触觉上的刺激 and could get a lot of motor and tactile stimulation everyday
这个时候可能还没有多大的问题 you know, maybe it wasn't such a problem
随着他们渐渐长大 And that's, you know, as you see kids grow with ADD
如果能进入一个他们可以胜任的职业 you find them getting into occupations where they can
获得他们所需要的刺激 而不是单调的重复 kind of, get the stimulation they need and do fine
这样他们也并没有多大问题 without having, kind of, doing repetitive, boring type things
游戏持续时间较短...... Shorter duration of play...
如果把一堆玩具放在地板上...... so, if you put a bunch of toys out on the floor...
事实上我们在特拉华州做过这个实验 and in fact, research we did up in Delaware, we did this
把所有不同的玩具放在地板上 put a whole bunch of different toys on a floor
然后让孩子们玩一会儿 and watch a kid play for a while
会观察到 他们(患儿)更换玩具更为频繁 You'll see them jumping from toy to toy more often
一个正常的孩子可能 You know, whereas one kid might
找到一个玩具玩上5分钟 you know, find a toy and play with it for five minutes
而ADD患儿则会很快失去注意力 a kid with ADD will, kind of, lose attention
会不断更换手中的玩具 and jump to another toy, playing with that
这是一些 These are just some of the things
父母和教师经常会说的话 that parents and teachers will typically say
我相信ADD全部或者很大一部分 and I believe all these are, like, from questionnaires...
都是通过问卷调查诊断出来的 the way that ADD is diagnosed or a big part of it
就是让老师和父母填写问卷 is having teachers and parents fill out questionnaires
问卷上面有一个列表 列的都是这样的句子 where there's a list of terms like this, phrases
答案范围是一到五的量表 and on a scale from, like, one to five, they would say, you know
比如 从不 偶尔 几乎总是 总是 like, never , sometimes , almost always , always
通过这样的调差 You know, with these kind of things
来评估一个孩子具有这些问题的严重程度 rating how severely the kid has difficulty with these thing
这就是其中一个样本 and these are just a sample of it
现下有很多不同种类的问卷调查 And there are different kinds of questionnaires out there
然后把不同的注意力测试分数 But then you add up across different ways of paying attention
或者ADD通常表现症状的分数加起来 or different kind of ways in which ADD usually presents itself
看孩子的总分数是多少 You know, what's the kid's total score?
然后就能 就集中注意力的能力而言 And you can figure out, alright then, what percentile is this kid at
计算出在同龄孩子中 for all kids his age or her age
孩子位于哪个百分比段 in terms of being able to pay attention?
第二个易冲动 Second, is impulsivity
这里有两点...... There's, kind of, two things that...
思维涣散更易于被认为是 Inattention is more of what you would call
认知方面的因素 the cognitive side of things
但是就行为方面而言 But then on the behavioral side of things
冲动和过度活跃可归为这一类 there's impulsivity and hyperactivity
关联构思 冲动 Related constructs, impulsivity
刚才三个案例中我们都看到了 we saw in these examples
缺陷和抑制行为 deficiency and inhibiting behaviors
跟我做 这个游戏 Simon Says
对于思考ADD是一个很好的范例 is a kind of a good prototype of thinking about of ADD
跟我做 游戏要求你怎样做呢 What does Simon Says require you to do?
这个游戏包含了一种竞争冲动 You've got, kind of, competing impulses
大脑正在向你发送信号 Well, the brain is sending a signal
让你这么干 for most of you to actually do that
你的大脑发出了竞争的信号 So you have competing signals going on in your brain
这个游戏实际上是测试你是否有 And so, what Simon Says is testing the ability for you
把注意力集中到最高目标上的能力 to sustain your attention to the overarching goal
要求你完成以 西蒙要你怎么样 开头的指令 which is only to do things that I said Simon Says does
别的则不需执行 and not the other thing
但是这也不是说冲动在这里就不起作用 But that doesn't mean that one impulse to do it isn't there
这就是ADD患儿所面临的困难 And so, that's part of the struggle that's some ADD kids have
他们很难把注意力放在最高目标上 is sustaining that, kind of, overarching goal
在大脑的前半部分 我们之前讲过 There's something called the front part of the brain
有一个叫前额叶的部位 which we've talked about, the frontal lobe
它被称为执行中心 is called the executive center
它负责组织规划目标 where you organize goals and planning
也是这里 可以产生抑制冲动的能力 And that's, kind of, where that ability to inhibit the one impulse
因为在这种情况下 because you're trying to sustain this greater goal
你要努力维持一个更大的目标 where that occurs
这对于ADD患儿来说是一个难点 And so, that's a more difficult thing for kids with ADD
实际上这个研究我们在特拉华州也做过 We also did a... we actually did a research I did up in Delaware
我们让孩子们做 跟我做 这个游戏 进行测量 We had kids play Simon Says as a measure of this
我们发现 他们在游戏中表现的好坏 and found it to predict, like, the ability to do well on Simon Says
可以预测他们在日常生活中的表现 predict who's... not perfectly
当然不完美 但那些在游戏中更易出错的孩子 but kids who made more errors in Simon Says
在实际生活中更易发脾气 were the same kinds who more often threw temper tantrums
在学校也跟其他孩子相处困难 这一点并不奇怪 and had struggles with other kids in school, not surprisingly
这里没有白板笔 I don't have a marker here
有的话我会...... but if I did...
我会画一个星形图......两个星形 I would draw a picture of a star, two stars...
可能这里有 well, maybe there's some over here
先画一个星形图 Draw a picture of a star
然后在紧贴着其内部再画一个小点的 and then a star just slightly smaller right inside of it
这是我们在特拉华州做的另一个实验 And this is another thing we did up in Delaware
当时我在那里读研究生 when I was in grad school up in Delaware
我们让孩子们画一个星星套一个星星 But have kids try to draw inside those lines
但画的星星不能碰着第一个星星的线条 like, draw the star without touching the lines themselves
如果他们的线条越界了就告诉他们 So, they go across and then you'd say
好 现在你们最好尽量慢慢画 well, now do it as slowly as you can
一边做一边给他们计时 And you're timing while they do this
然后 下面是最为关键的时候了 But then, and this is the one that's most critical
好了现在我希望你们加快速度 越快越好 alright, now I want you to do it as quickly as you can
同样的 规则是不能碰到第一个星星的线条 Again, the rule still is, you can't touch the lines
这又回到了 跟我做 这个游戏上面 And this goes back to the kind of Simon Says thing
那就是当在完成其它任务时 of keeping that overarching goal in mind
还要照顾到最高目标 while you're doing this other task
你会看到这些孩子就慌神了 And, what you'll see is kids that just, kind of, lose...
乱了方寸 画得很快 this inhibit thing, they go really fast
但是都越过了原有的线条 and they're all over these lines
可以看到他们大多数都不具备 And, you know, so they've, lost the ability
同时维持两个目标的能力 to sustain two goals at the same time
同样的 我们发现他们完成任务时犯错的次数 And again, we found, kind of errors on this task
就是说 总共越过了多少次线 like numbers of times they crossed the line on these stars
我们也用圆做过同样的实验 and we did the same thing with
比如说让孩子们画圆环套圆环 like, two circles that they can stay inside the circle
但是星星那个效果更好 因为结构更复杂一点 But the star was better, because it's more difficult
同样地 可预测出谁在日常生活中更易发脾气 Again, predicting temper tantrums
哪些孩子在学校和同学相处困难 having difficulty with other kids in school
还有他们倾向于迅速作出反应 Tendency to respond quickly
不会等待拿到所有指示才做事情 without waiting for all the instructions to do something
你们有多少人还记得...... How many of you remember...
我记得是在二年级的时候 I remember in second grade
我相信你们中有些人也做过同样的测试 I'm sure some of you passed this same test
在这个测试中会有一名老师 where you had a teacher who did this with you
给你们一张试卷 They give you a sheet
然后老师会说 Your teacher gives you a sheet and says...
试卷上面 比如有20条指令 从1到20 it's got a list on it and, let's say, 20 instructions, like one to 20
你会觉得 这不是一份作业吗 做吧 You think it's an assignment, and she says, ok ...
事实上 第一条指令就是 and in fact, but the very first direction says, you need to...
开始答题之前 before you do any of these answers
请读完整张试卷 you need to read through the whole sheet
再下笔作答 and then you can go back and start completing them
而最后第20条说 Well, number 20 says
无需作答任何一题 you don't actually have to do any of these numbers
只要在顶端写上名字 you just have to write your name on the top
交还给老师就行了 and turn it back into your teacher
有多少人做过这个测试 How many of you did that at some point?
我是在二年级的时候做的 I think I did that in second grade
记得当时就只有一个人 and I think there was one person
把问卷从头到尾读完了 who read them all...
按照预期 交了答卷 and did it right and turned it in, you know
这不是ADD测试 And so, that's not a test of ADD
因为大多数儿童因为太年幼都做不到这一点 cuz most people fail at an early age to do this
但这本质是一样的 也是让人按指令做事 But that's the kind of a thing too, is like, following directions
很明显 这也不光是冲动 Now that's not just about impulsivity, obviously
也有遵守指令 It's about following directions
但这跟ADD患儿遇到的困难很相似 But it's similar to, kind of, difficulties ADD kids would have
读完这些题目对他们来说是相当枯燥的 They just... reading through something is so monotonous to them
这对他们很困难 所以他们拿到手就开始做了 that it's difficult for them. So, they just start doing
因为他们想要的是刺激 because they want that stimulation
接下来 不计后果 Failure to consider consequences
患有ADD的孩子 青少年 以及成人 so you see more risk-taking behaviors
更易于有冒险行为 kids, adolescents, adults with ADD
我记得有一次和一个成年人谈话 I remember talking to an adult
为了评估他是否患有ADD that I was assessing to see whether he had ADD or not
他当时讲到自己如何从自家屋顶上跳下来 He was talking about how he jumped off the roof of his house
当时他还是个孩子 As a kid, that was something that he did
这里有谁小时候这么干过吗 Anybody here did that, like, as a kid?
有几个 A couple of you
我猜想那应该是平房 I assumed it was just a one-story house
但是这里可以看出他的不计后果 But, you know, kind of, failure to consider consequences, again
做事的时候 没有考虑到行为的长远后果 like the doing the behavior without the long-term planning of what is
比如我们刚才也看到了 往马路上乱跑 you know, running into the street... we read that
其中一个例子 我们读到过的 往马路上跑 One of the examples I read about, running into the street
其实也就是他们不能把注意力放在 You know, kind of, not being able to sustain attention
保持安全 免受伤害这个最高目标上 to that overarching goal of safety and being hurt
这样的 or something like that
毫无疑问 排队对他们也很困难 Not surprisingly, waiting in line is difficult
在工作中倾向于走捷径 Tendency to take shortcuts in work
联系我们刚讨论过的那个实验 relates back to that exercise we just talked about
无法推迟满足 Inability to delay gratification
我可能在某个时候做过这个实验 Did I...? I probably did at some point
就是棉花糖实验 我之前有讲过吗 The marshmallow task, did I talk about that in here?
这是针对学前儿童的一个很经典的心理研究 That's the one that's classic psychology study with preschoolers
在60年代末做的实验 是斯坦福做的吗 like done in the 60s, late 60s, out at Stanford?
当时的实验者 They... experimenters... they bring kids in
把孩子单独带进实验室 one kid at a time, into the lab
然后拿出一块棉花糖然后说 put a marshmallow out there and say, oh, I've got...
整个过程是被监控的 镜子后面装了一台摄像机 and it's all rigged, of course. There's a video camera behind a mirror
实验者会说 我要到另一个房间 and the experimenter says, oh, I've got to go into the other room
去拿一些东西 马上回来 to get some materials and I'll be back in a minute
如果你能等到我回来 你会得到两块糖 And if you can wait till I get back you'll get two marshmallows
如果你想要两块糖 就不要吃掉这一块 So, don't touch the marshmallow, if you want two
实验者离开 Well, and then they leave
然后从视频上观察孩子们的行为 and then they see they're videotaping what the kid does
他们发现那些能够忍住 And they found that kids that were able to sustain
不去碰棉花糖的孩子 like, not touch the marshmallow...
他们观察这个有一些方式 比如说 they had different ways of coding this
孩子们盯着棉花糖看的时间长短 like, how much the kid was like, kinda' looking at it
是否真的碰到了糖块 and then whether did they really touch it
最后是否吃了糖块 and then, in fact, did they eat it
他们发现孩子在那几分钟表现出来的抑制能力的 And so, they found, like, the different levels of being able to
不同水平 inhibit themselves for that minute
能够预测 他们高考学术能力测试中 you know, predicted, I think it was 270-point differences
SAT中270分的差距 in S.A.T. scores in high school
还有其它的像学前儿童表现出的抑制能力 and other things like, a kid's able to inhibit themselves in preschool
就和睦相处而言 you know, in terms of getting along better
在高中更被其他孩子喜欢 being more liked in high school by other kids
更不易惹是生非 being in less fights than other kids in high school
可以看到......这些都是互相联系的 So, you can see... and of course, that's all correlational
并不奇怪 but it's not surprising
这种是否能控制冲动的能力 I don't think, that this inability, disability to impulse control
对孩子之间如何相处是有很广泛的影响力的 you know, is pervasive in terms of how kids get along
如果你不推伙伴 他们就会更喜欢你 You know, kids are going to like you more if you don't push them
类似这样的事情 and things like that
所以控制冲动很重要...... So, impulse control is important
另外一点 关于普遍的诊断问题的 And the other thing about diagnoses in general is that
至关重要的一点 a real critical thing is
就是它是否会导致适应问题 it causing problems in their adaptation
如果你想这样称呼的话 if you want to call it that
也就是会给他们的学校表现带来问题吗 Meaning, is it causing problems in school
以及他们的分数 with their... for their grades?
冲动控制力 Is it causing problems in terms of impulse control
这会给他们与其他孩子相处带来问题吗 getting along with other kids?
如果你是注意力涣散型的 You know, if you're inattentive... a lot of us are inattentive
大多数人都有这类问题 but we get along fine, and we're able to
但是我们能够多花点时间学习 刻苦一点 study a little bit longer or harder
争取在学校有一个好的表现 and do fine in school
事实上ADD患儿 注意力涣散主导型的 So, in fact, ADD, you know, like, primarily inattentive type
儿童和青少年 可能存在诊断不足的情况 is probably under-diagnosed among children and adolescents
因为它不会过多地干扰到教学 cuz it doesn't cause disruption in the classroom as much
或同龄孩子 or in peer groups
因此考虑是否是情绪障碍时 这一点很关键 So, that's a critical part too, what's considered an emotional disorder
就是看它是否会干扰患者能力 Does it cause a disruption or to your ability
或者与人相处会带来困难等等...... to get along for whatever that means
无论是二年级还是高中生还是别的... whether you're second grade or high school, or whatever
嗯 Yeah?
学生:我实际上看了下这里的(听不清)标准 student: I'm actually just looking at this (INAUDIBLE) criteria
这里说证据清楚的显示 and it says that evidence is clearly significant
环境以及社会(听不清)职业性起作用 that environment and social (INAUDIBLE) occupational functioning
教授:对 这对所有障碍症都是真实的 Prof: Right. And that's true for all the different disorders
最大的损害 在于你与人的相处 It's like significant impairment in, kind of, getting along
以及做年龄段适应的行为 and doing what you're supposed to do for a person your age
学生:那如何判断ADHD或ADD患者 student: How do you know this ADHD or ADD...
他们的病因不是和那些让他们分心的 how do you know it's not something related to a family issue
家庭因素有关呢 that can distract them?
教授: 很好 这是...... Prof: well it's...
另外一点是 症状需要持续六个月 the other thing is it needs to be sustained for six months
你不能说最近这个人思维涣散 (那他就有病) You can't, just like, say that the person's been inattentive lately
而且 还必须要有 And there has to be evidence before
7岁之前的患病证据 prior to seven years of age for these things
这就是关于这点的两个标准 And those are two kind of criteria
以回答你提的这个问题 that, kind of, get at that question you're asking about
这里还有一些需要排除在外的因素 So, you have what's called a rule-outs
那就是要弄清楚 which is, you know, you have to understand
这个家庭到底发生了什么 what's going on in the family
孩子出现这种情况是因为父母离婚吗 Did this just come up because the parents' divorce?
无论怎样 这潜在地会导致压力 Whatever, it's causing, it's potentially causing stress
也会让儿童难以集中注意力 that makes it harder to pay attention as well
让我们来看一下 过度活跃 过高的活跃度 Let's see. Hyperactivity. Excessive levels of activity
可能会看到一个孩子叽叽喳喳 You might see kids that just talk a lot
停不下来嘴巴 You know, motor mouth. That's not necess...
我要说的是任何一点类似的表现 I should say any one of these things
都不能必然确诊 is not necessarily diagnostic
如果看到一个孩子总是爱说个不停 if you see a kid who's talking a lot
并不意味着他就患有ADD或ADHD It doesn't mean they have ADD or ADHD
只不过是这类疾病的部分表征 but it's, kind of, part of a pattern of things
还有其它的一些部分表征 比如爱动的孩子 if it's part of a pattern of things. Kids who move a lot
坐着的时候或者干其它什么事情的时候 You know, like, kids who shake their leg
喜欢摇晃双腿 when they're sitting, or something like that
这也可能是因为他们感到寒冷 That also could mean cuz' they're cold
或者因为他们是稍微有些焦虑型的人 or because they're slightly more anxious type of a person
但是同样的这也属于部分表症 But again, it's one of the things
曾经有个朋友问过我一个问题 Anyway, so I'm talk... a friend's asked me a question
每一次用余光观察她 as it coming out of the corner of my eye
都会看到她在不断的移动身体 I could see her just like... she just keeps shifting her, like, body
她很难安静的坐下来 You know, like, she's just has a hard time, like, sitting still
这也是一部分......需要...... And it's part of, kind of, needing to ...
可能是需要不断地自我刺激 in a sense there's a self-stimulation that goes on
马上我们就要讲到这点 that we're gonna talk about in a second
它实际上和第二点有关联 And it actually relates to the second point
这不能被认为是多动症 It's not that hyperactivity comes
不是说有某些东西过分活跃 because there's something that's overactive
事实上我们在这一点上的认识是 In fact, what we think and what we know at this point
正因为大脑的某一部分不够活跃 I would say, is that it's parts of the brain that are less active
特定大脑波不够活跃 and certain brain waves that are less active
从而导致他们需要自我创造刺激 that's causing a need to create stimulation
这也是导致ADD或者ADHD的一个因素 that's going on with ADD or ADHD
与之相对的是 大脑某些部位过分活跃 as opposed to, like, some part of the brain that's super-active
这会导致有些孩子更易于兴奋 that's causing the kid to run around more
这里就像是有一个临界点 So, in a sense, there's like a threshold
一个刺激的临界点 a stimulation threshold, that we all, kind of want
ADD患儿某种程度上会努力提升刺激量 and ADD kids to some extent are trying to bump theirs up
因为他们的临界点比一般人要高 because theirs is a little bit higher than the rest of us
这和我之前所讲的 他们遇到的困难 which is also related to what I was saying
联系起来就是 in the beginning about difficulties
同样的事情 with rewards
他们需要比别人有更高水平的奖赏 that they need a higher level of rewards
才能维持同等的行为 for the same kind of thing to sustain the same kind of behavior