教授:现在我们看一段视频 Prof: We're gonna play a video now
讲述:詹姆斯11岁了 Narrator: James is 11 years old
和很多其他同龄男孩一样 Like many boys his age
很容易被视频游戏迷住 he's easily captivated by video games
视频游戏可以让他的注意力保持很长一段时间 which may hold his attention for long periods of time
玛西:这道题道理是一样的 很好 Marcy: It's gonna be same thing, it's nice
你能解答出来吗 OK, can you do that
詹姆斯:要是我不会算呢？ James: What if I can't do the math, did I?
玛西:逃是逃不掉的 Marcy: You do it in the next spot
詹姆斯:嗯... James: Mmm mm
同样的 和很多其他同龄男孩一样 Also, like many children his age, he finds everyday tasks
他发现像家庭作业这样的日常任务不够刺激 like homework, are not nearly as stimulating
但是詹姆斯无法集中注意力完成诸如家庭作业 But James' inability to focus on activities likes homework
这样的情况 要比其他很多孩子严重得多 is much more serious than it is for most other children
他还易冲动 James is also impulsive
难以控制自己的情绪和行为 He has a hard time controlling his emotions and his behavior
这给他自身以及家庭都带来了一些问题 and that has led to problems for him and his family
玛西:这是你的家庭作业 不是我的 Marcy: It's not my homework what to do
詹姆斯:我知道 James: I know
玛西:你把这些都擦掉了 Marcy: You erased the whole thing
詹姆斯:我知道 James: I know
玛西:拜托了 重新来 把后面的都做了 Marcy: No, come on. Go back and do the rest
玛西:他才九个月大的时候 Marcy: When he was at nine months old
我们去拜访别的小孩 we went to see his friend
他不像其他孩子那样老老实实的坐在沙发上 and rather than sit on the couch like...
或是我们膝盖上 or, sit in our laps like some of the other children
他居然爬到椅背上 He was climbing up the back of the chair
拽出一根吊灯的电线 and pulling a cord that hung your lamp on the wall
把它扯下来然后把灯弄坏了 He pulled that down and it broke
还有很多类似这样的调皮捣蛋 Just lots of busy activities
多年来都是这样 他刚生下来的头几个月 and, throughout the years, the early months
儿科医生还一直告诉我们詹姆斯 头脑灵活 the pediatrician kept telling us that he was quick-minded
詹姆斯:看看这个新的章节... James: Look at... look at the new chapters. Like...
讲述:在最近这五年 Narrator: Over the next five years
詹姆斯的 头脑灵活 以及 攻击行为 James' quick-minded and aggressive behaviors
不断继续并且愈演愈烈了 continued and intensified
在家里以及幼稚园里都麻烦不断 He had trouble at home and in preschool
他无法做到遵守规则 也很难交到朋友 It was hard for him to follow instructions and to make friends
孩子的这些问题让父母迷惑而苦恼 These problems were puzzling, as well as painful, for his parents
玛西:终于在他一年级的时候 Marcy: Finally, in first grade
他的老师向我道出了了心声 the teacher confided in me and said
我本来不打算告诉你这些的 you know I'm really not supposed to tell you this
但是...我们的确需要研究一下孩子的培育计划 because this is... we really have to go through the Ed-plan
这是必经的步骤 and do the formalities of this
我的侄儿患有注意力缺陷障碍 but my nephew has Attention Deficit Disorder
我认为你的孩子也患上了 and I think that's what your son has too
讲述:有大约百分之三的孩子 Narrator: Some three percent of children
会患上注意力缺陷多动障碍(ADHD) may have Attention Deficit Hyperactivity Disorder
患者会呈现一系列的症状 characterized by a number of symptoms
男: 当我们谈论ADHD时 Man: When we talk about ADHD
我们指的就是一种障碍 we're talking about a disorder
患儿会展现出大量极为明显的症状 where children exhibit a number of very distinct symptoms
其中一个就是与发育不符合的注意力涣散 One of which is developmentally inappropriate inattention
孩子不完成任务 The child doesn't attend to tasks
不听老师的话 the child doesn't attend to teacher
不遵守规矩 等等 the child doesn't follow instructions, etc.
第二个症状就是易冲动 Another symptom is impulsivity
比如一个患儿无法完成家庭作业 Here, we have a child who doesn't complete homework
总是从一个任务跳到另一个 for example, who switches from one task to another
总是抢别人的话头 who talks out of turn
还没等问题提完 就抢先答复 who responds before questions are actually finished
这些就是易冲动的表现 in a quality of impulsivity
第三个症状 过度活跃 这也是最为显著的一个 The third symptom, which may be the most notable, is hyperactivity
比如一个孩子老是不停地到处走动 Here, a child is always moving around
无法安分的呆在座位上 a child is unable to stay in a seat
烦躁不安 活跃异常 a child may fidget; a child is always active
讲述:詹姆斯的症状如此严重 Narrator: James' symptoms were so severe
他妈妈只能把他带到这儿来了 that his mother brought him here
马萨诸塞大学医疗中心的 to the Center for Attention Deficit Hyperactivity Disorder
注意力缺陷多动障碍(ADHD)中心 at The University of Massachusetts Medical Center
但是要对ADHD确诊还存在一些问题 But making a finding of ADHD poses some problems
拉塞尔A·巴克利医生是这家中心的创始人 Doctor Russell A. Barkley is the Center's founder
拉塞尔A·巴克利: 可能最大的难题在于 Russell A. Barkley: Probably the greatest difficulty is trying to
分清哪些是正常儿童的特征 尤其是正常男孩 distinguish between what is typical of normal children
以及哪些是ADHD患儿具备的典型特征 particularly normal boys, and what is typical of these children
很多研究都显示 百分之四十到五十的正常男孩 Many studies indicate that up to 40 to 50% of normal boys
都有坐立不安 注意力涣散以及易冲动的表现 are described as restless and inattentive and impulsive
这里我们用到的判断孩子是否患有ADHD The best way we have of determining
或者是否异常的最好的办法 whether this child is ADHD, or deviant
就是通过父母和老师的反映 is using the reports of parents and teachers
比如行为打分量表和问卷调查 进行判断 such as on a behavior rating scale and questionnaire
然后对比老师们 and comparing that to what teachers say
对同龄正常孩子的反映 about normal children of that age
通过对行为评分 来评估一个孩子 that gives us a measure of just how far from normal this child falls
到底和正常孩子偏离了多远 in his ratings of behavior by these people
讲述:还有一个问题是很多ADHD患儿 Narrator: One problem with diagnosis is that many children with ADHD
把临床评估当作是一个表现的机会 see the clinical evaluation as an opportunity to perform
他们努力集中注意力 They pay greater attention, and score better
因此得分要比他们在平常环境下的好 than they would under normal circumstances
医生亚瑟·阿纳斯托普洛斯为是该中心的主任 Doctor Arthur Anastopoulos is the Center's director
亚瑟·阿纳斯托普洛斯:值得我们注意的是 Arthur Anastopoulos: We need to keep in mind that
当我们在对孩子进行临床评估的时候 when we evaluate children in a clinic
一对一的形式越新颖 the more novel one-to-one it is
就越不容易对ADHD有一个正确的判断 the less likely to see ADHD
所以我的工作就是给这些孩子 So my job with them is to create situations
创造一个不那么刺激的 比较枯燥的环境 that are relatively uninteresting – boring
如果时间够长 if you will – of long enough duration
他们就更易于表现出ADHD症状 that have a chance of eliciting ADHD symptomatology
讲述:有一个评估技巧 Narrator: One of the evaluation techniques
叫做限时教学情景任务 is called the Restricted Academic Situations Task
比如要求一个孩子在15分钟内 Here, a child is asked to work on math problems
解答一些数学问题 over a period of 15 minutes
医生乔治·杜普尔一边对整个过程进行解释 Doctor George DuPaul explains the procedure
一边通过一面单向镜观察詹姆斯 while observing James through a one-way mirror
乔治·杜普尔:我们想知道 George DuPaul: What we're looking for is
詹姆斯在这个过程中 how well Jamie pays attention to this work
集中注意力的程度 and also how fidgety and restless he might be
以及坐立不安的程度 during the time he's working on this
离开座位的频率 how often he might get out of his seat
或者和房间里那些 or play with objects in the room
与任务本身毫无干系的物体玩耍的频率 that have nothing to do with the task itself
15分钟的观察内积累起来的时间 So, what we end up with during this 15-minute observation
也就是詹姆斯能集中注意力的百分比时间 is a percentage of time that Jamie is paying attention to his work
其中也包括他焦躁不安的百分比时间 as well as a percentage of the time that he's fidgety or restless
离开座位的时间 and out of his seat
以及做其他事的时候 这些都可能跟ADD相关 and doing things that might be related to Attention Deficit Disorder
讲述:不到五分钟 Narrator: In less than five minutes
詹姆斯开始表现出一些ADHD行为 James begins to exhibit some ADHD behaviors
包括一些明显的沮丧和愤怒 including some apparent frustration and anger
每当这些行为出现 杜普尔医生就 As Doctor DuPaul tracks the number of incidents
进行跟踪计数 and when they occur
詹姆斯很快就达到了他能集中注意力的极限 James quickly reaches the limits of his attention span
乔治·杜普尔:可以看到詹姆斯 George DuPaul: You notice too that Jamie was fairly able to
在实验一开始时还可以较好地集中注意力 pay attention during an earlier part of this observation
现在当实验观察进行到八分钟 and now, as we're closer to eight
至九分钟时 or nine-minutes mark of this observation
他的注意力明显下降了 his attention has really diminished significantly
阿瑟·阿纳斯托普洛斯: 很明显 Arthur Anastopoulos: Well, certainly the behavior that we observed
在这个限时任务里我们观察到的行为 during that restrictive task
是在反常范围内的 would be in the abnormal range
詹姆斯可能有轻度到中度的异常行为 and probably in the mild to moderate end of the abnormal range
有些孩子被送到诊所后 Some of the children come into the clinic when, in fact
就座时表现甚至更为焦躁 they're even more restless while in their seat
可能会比詹姆斯完成的任务更少 maybe complete even fewer problems than he did
我相信詹姆斯至少完成了五分之三 he was at least able to complete three of the five pages, I believe
而且他完成得也相当正确 And those were done fairly accurately
所以他的问题里 正确性的问题并不大 so, in his case, accuracy is not as much of a problem
他的问题在于他完成任务的比例 for what was the problem was the total productivity, if you will
讲述:如果你患上了注意力缺陷障碍 Narrator: If you have an attention deficit
那么当需要集中注意力的时候 then you ought to be having trouble with any time
你可能随时都会遇到麻烦 you're asked to pay attention to something
但是他们很擅长玩电脑游戏 And yet, they're good with Nintendo
家庭作业就很糟糕了 they're lousy at homework
如何解释这种情况呢？ What explains those differences?
拉塞尔A·巴克利:曾经有几个理论认为 Russell A.Barkley: There've been a few theories around that
这可能纯粹是因为 have suggested that
社会环境发展形成的疾病 this could develop out of purely social circumstances
主要是因为 要么是不恰当的家教 those primarily pertain to either bad parenting
要么是压力的增加 或者社会的变迁 or to the degree of stress and change in our society
所谓的 现代生活的节奏 what you might call "the tempo of modern life"
而现在我们知道 这种疾病并不是因为 we now know that this disorder is not due to
父母的养育方式 how your parents are raising you
玛西:这里要用哪个来除? Marcy: What are you going to use to divide
詹姆斯:50 James:, 50
玛西:好 50 Marcy: 50 Ok
讲述:50多年里 Narrator: For more than 50 years
引起ADHD疾病的具体原因 the precise cause of Attention Deficit Hyperactivity Disorder
仍然还不为人知 has remained unknown
尽管也提出过几个关于ADHD病因的理论 Although several theories have been offered
有的认为 ADHD的相关行为 some have suggested that the behaviors related to ADHD
根源在于大脑中的一个特殊部位—脑前额叶 have their roots in a specific part of the brain, the frontal lobe
拉塞尔A·巴克利: 它是大脑的动机控制中心 Russell A. Barkley: The centers of the brain that control motivation
它决定了你对这个世界的敏感度 how sensitive you are to your world
尤其是对形成整体行为结果尤为重要 and especially the consequences that happen to you
可能ADHD患儿大脑的这个部位运行不良 seems to be not working well in these children
从而导致他们对于那些 It makes them less sensitive than the things
足以促使一般孩子良好表现的事件敏感度较低 that would motivate a normal child to behave
我们正尝试把ADHD看做一种生物上的缺陷 So, we are now coming around to looking at ADHD as a deficit
动机的缺陷 a biological deficit, in motivation
这似乎就可以解释患儿在哪些方面表现得好 and that seems to explain where they'll do well
哪些方面又表现得不好 and where they won't
这样就可以预测 如果在一个高刺激的环境下 You can now predict that under a highly motivating situation
患儿们很喜欢他们正在做的事情 where they enjoy what they're doing
如果规定说在时间内完成任务的话 where there is some immediate consequence
承诺给他们一定的奖金 筹码或者玩具 such as the promise of money or chips or toys
这样一些立竿见影的后果 for getting that work done
这些孩子的表现就不会有什么问题 these children will have no trouble with that
但是同时也可以预测相反的情况 But it also predicts the opposite
那就是 如果所做的事情没有产生结果 where there is no consequence for doing your work
要求他们做的事情是枯燥的 where the work you're asked to do is boring
而且持续时间较长的话 and protracted over long periods of time, for instance
或者说事情的结果要在将来 长远才能看到 And the consequences for what you do in the future
这些孩子就会出现很多问题 in the long run, these children will have substantial problems
讲述:刺激类药物 比如右旋苯丙胺和利他林 Narrator: Stimulant drugs, such as Dexedrine and Ritalin
经常被用来改善ADHD症状和相关行为 are often prescribed to help manage the symptoms and related behaviors
近几年来越来越多的人开始疑问 But one might question, as many have in recent years
为什么要给像詹姆斯 why a stimulant is being prescribed
这样的孩子开刺激类药物呢？ for a child like James
他们本来就过度活跃 who's already over-active
医生巴克利就此提出了一个理论 Doctor Barkley has a theory on why this works
拉塞尔A·巴克利:几十年来一些专家认为 Russell A. Barkley: For many decades, professionals thought that
这可能听起来很矛盾 these drugs did something opposite to these children
这些药物对正常孩子有提神醒脑的作用 paradoxically you might say
而对ADHD患儿则有相反的镇静安神的作用 than they did to normal children
因为大家相信如果正常孩子服用这类刺激药物 and the belief was, that if you gave a normal a stimulant
会让他们变得兴奋且过度活跃 you would excite him and make him hyperactive
如果是一个本就过度活跃的孩子服用 and if you give a hyperactive child this drug
似乎会让他安静下来且注意力集中 it seemed to calm him down and make him concentrate
现在我们知道其实两种情况都纯属臆想和误解 we now know that both of those are completely myths, misconception
首先在国家心理健康研究所进行的一些实验里 First of all, we have given these drugs to normal children
我们也给正常孩子用过这类药物 in a few experiments at the National Institute of Mental Health
发现正常孩子的情况也变得更好 for instance, and found that normal children get better too
改变幅度不大 Not as much
因为他们的行为本来没有那么异常 because they weren't as deviant in their behavior
但是正常孩子转变的方向 but the direction of change
也是一样的 is identical to that seen in abnormal children
对比那些没服药的孩子 better concentration, less fidgeting
服药后的孩子注意力集中改善 焦躁程度降低 better impulse control and better work productivity
控制冲动以及工作效率都有所增强 than we would see in the child off medicine
其次我们还发现 The second thing is that we've discovered that
过度活跃的孩子并不是因为大脑过度活跃 hyperactive children do not have a brain that is over-active
因此需要药物来镇定 and therefore the stimulant calms it down
实际上是因为他们大脑的某个部分 They actually have a certain part of their brain
不够活跃 反应迟钝 as I said that is under-active, sleepy, sluggish
这类药物似乎有一种特殊的亲和性 And this drug seems to have a particular affinity
可以进入到大脑的这个部位然后激活它 for going to that part of the brain and activating it
这个部位 Now, that part of the brain
就是负责抑制行为 is the one responsible for inhibiting behavior
集中注意力 以及控制活跃水平 for focusing your concentration, and for suppressing activity level
尤其是控制不必要的活跃水平的部位 especially unwanted activity level
就像一个父母说的 As one parent says, what you're doing
我们要做的就是刺激孩子大脑皮层 is stimulating his brain linings in his brain
进而激活大脑参与抑制 so that you're activating the very part of the brain
和控制行为的这个部位 that's involved in inhibiting and controlling behavior
讲述:有时涉及到家庭内部的一些问题 Narrator: Sometimes problems involved in the family system
也会引起ADHD行为 can contribute to ADHD behavior
所以除了药物治疗 So, in addition to medication, family therapy
家庭治疗或个体化治疗也是必要的 or individual therapy may be necessary
对家长的教导始终是至关重要的 but educating the parents is almost always essential
巴克利: 如果不能完全理解孩子的处境 Russell A. Barkley: You cannot raise one of these children properly
特别是 这是孩子一种能力上的缺陷 if you don't fully understand what this child has
而并不是一个正常孩子的任性淘气 and particularly that the child struggles with a disability...
如果不理解这一点 that this is not willful misbehavior
就不可能正确的抚养这类孩子 of an otherwise normal child
对父母的教育包括跟他们科普 That education involves teaching them
这类障碍有哪些症状 about the symptoms of the disorder
是由什么引起的 what causes it
随着孩子渐渐长大 可能会发生什么 what is likely to happen as these children grow up
以及努力让父母理解 and also tries to work with the parents
这类疾病的出现并不是他们的错 in understanding that it's not their fault either
试着让他们形成这样一个观念 Trying to bring them around to the idea that
即 应对一般孩子 normal things that can be used with typical children
所采用的正常手段 不能用来 are not gonna be as successful at helping them manage
管教和抚养这类孩子 and raise such a child
有的孩子 斥责他一句就能起到效果 Some children just respond to a reprimand
你只需转向他 说 where you can turn to them and you can say
凯瑟林 住手 Catherine, stop doing that
或者 斯蒂夫 或者 肯 随便都好 住手 You know, or "Steve", or "Ken", or whatever, "stop that"
他们就会停下来 And they'll stop
但是对于这类孩子你就是说到天黑 Your kids, you could say that till the cows come home
他们也不会停下手来 and it's not gonna stop what's going on
这时你必须站起来面对... you have to get up and confront...
讲述:用来帮助父母更好管教 Narrator: The methods used to help parents
ADHD患儿的方法 better manage the child with ADHD
通常都基于行为矫正的概念 are typically based on behavior modification concepts
一个很常见的方法叫做 代币制行为矫正法 one common method is called "A Token Economy"
这个方法规定 in which a child receives poker chips
若孩子表现好就可以获得扑克筹码 for good behavior
而这些象征性的筹码可以兑换成 these tokens may be cashed in for
零食 玩具或某些特权 treats, toys or privileges
玛西:几年前我们要去加利福尼亚呆两周 Marcy: A few years ago we were going to California for two weeks
和两个孩子一起上路 and both my children were on that
最后我采用的办法是 and then what I did was at the end
他们可以用手中的扑克筹码兑换成零钱 they could trade back the chips for a nickel, a piece, or whatever
这样他们去加利福尼亚才有零花钱用 so they had spending money to go to California
这样我们度过了一段最为太平的时光 and that was the most peaceful time during that time
否则可能会是一个令人抓狂的时光 which would have been an otherwise crazy time for us
刚开始实施起来有点困难 It was difficult to implement in the beginning
需要反复实践 and it took a lot of practice
但是一旦实施起来 每个环节都完善得不错 but once we actually used it we perfected the system pretty much
上车时我们必须带上扑克筹码 and we had to carry poker chips with us in the car
保姆也得学会怎么做 the babysitter had to learn how to do it
我妈妈也得学会怎么做 You know, my mother had to learn how to use it
这样在和朋友开车前往的途中 So that... we'd be riding with friends in the car
如果出现某种情况我会说 and something would occur and I'd say
噢 杰米我们有一个筹码游戏 Oh Jamie here's a chip
我的朋友马上说 薯条 你在说什么？ and friends would say, "potato chips? What are you talking about?"
然后我就会跟朋友们解释 And they all got to understand
有时我朋友会这样提醒他 and sometimes the friends would predict and would say to him
噢 你又多了一张扑克 oh you got a chip for that
或者 你马上会失去一张 or, "you're gonna lose a chip"
通过这种方式 让他感觉到每个人都参与其中 and so, everyone was on his case
我们实施得很成功 效果非常好 and it was really successful; it worked out well
帕特里夏·亨宁森:这个单词怎样念？ Patricia Henningson : What do we call this?
孩子:像这一个... Child: Like, this one...
帕特里夏·亨宁森:对不起 看着我 Patricia Henningson is: Excuse me, look at me
孩子:什么？ Child: What?
帕特里夏·亨宁森:你今天要怎样才能得分？ Patricia Henningson: You're getting points for what today?
孩子:表现好才行 Child: Being good
帕特里夏·亨宁森:当然我知道 但是... Patricia Henningson is: Of course, but, when I say to you...
当我这样和你说话 我问了一个问题对吗？ I ask you a question, right?
孩子:是的 Child: Yeah
帕特里夏·亨宁森:你给出回答就可以了 Patricia Henning son: You just get the answer like that
不必告诉我所有的原因 You don't have to give me all the reasons why
孩子: 是的 Child: No
帕特里夏·亨宁森:明白了吗？ Patricia Henningson : Ok?
但你不能回答时咕咕哝哝模糊不清 You want to swallow your voice
讲述:约翰患有ADHD不仅在家里有问题 Narrator: John, with ADHD, not only had problems at home
在学校也有很多麻烦 but also at school
一个患有ADHD的孩子如果不及时发现 Unrecognized, and left untreated
或者不及时治疗 a child with ADHD
就会有下面这些风险 比如学业问题 runs the risk of a multitude of problems with schoolwork
师生以及同学的相处矛盾等等 teachers and other students
帕特里夏·亨宁森:噢 做得好 Patricia Henningson: Oh, nice job. Ok
讲述:帕特里夏·亨宁森 Narrator: Patricia Henningson
是一位特殊患儿教师 is a Special Ed. teacher
她的教学对象是具有某些问题行为的孩子 who works with children with behavioral problems
比如ADHD患儿 such as ADHD
三年前她开始和 She began working with
马萨诸塞大学的心理学家一起工作 the University of Massachusetts psychologists three years ago
孩子:(听不清) 你看见谁了？ Children: (INAUDIBLE) Who you see?
帕特里夏·亨宁森:基本上我就是教导他们 Patricia Henningson is: I am basically teaching them
每时每刻都要调整自己 to tune into themselves at every moment of the day
就是让他们静下来思考一下 you know, just to stop and think
审时度势 然后想一个计划 look at the situation and come up with a plan
因为如果不这样训练他们的话 Because, if they don't, that's when, you know
因为他们易于冲动 they're so impulsive and...
而周边随时随地都有事情发生 there's just so much going on
他们要集中注意力很难 it's so difficult for them to focus
那就会出大乱子了 that things can go wrong
有时看着他们感觉很滑稽 I mean, you know, at times it's comical
当你看到屋子里的东西歪七倒八 because you watch things fall down
纸张扔得到处都是 and papers falling all over the place
你看着他们 他们看着你 and you just look at them, like... and they're looking at you
谁让你们这样做的 他们都不承认 who made you do it? And they didn't
帕特里夏·亨宁森:我应该怎么做？ Patricia Henningson is: What am I supposed to do?
当我们说 我们应该怎么做时 When we have this time saying that, what are we supposed to do
是什么意思？ What is it?
我们要听课 还有呢？ We listen. What else?
我们定规则 要求孩子们守规矩 We make the rules, we make it tied to behavior
孩子:发言前要举手 所有的... Child: You raise your hand, everything...
帕特里夏·亨宁森:对不起 Patricia Henningsonis: Excuse me
当你和某人对话时... when you're talking to someone (INAUDIBLE)...
教授:大家看教室的墙壁很拥挤啊 Pro: You see how busy the walls are?
必须这样 One thing is like
因为这里的孩子很难长时间记住一样东西 because it's hard for kids to sustain things up here
通常需要把条条框框都贴在墙壁上 you usually need to put boards and rules on the wall
这样才可以随时提醒孩子 so you can constantly prompt kids
要遵守哪些规则 to externally see what the rules are
帕特里夏·亨宁森:因为他们需要别人随时提醒 Patricia Henningsonis: because they have to be continuously reminded
他们还需要不断的有人提醒他们有一个目标 they also have to be continuously reminded that there is a goal
每天结束时 他们会达到这个目标 and at the end of the day, they'll achieve this goal
这种即时性 就是一种筹码 but, the immediacy is the token
讲述:扑克筹码用于增强正向行为 Narrator: Poker chips are given to reinforce positive behaviors
如果能马上给予他们奖励的话效果最好 this is most effective when they're given almost immediately
帕特里夏·亨宁森:主要的目的其实是 Patricia Henningsonis: The main focus is
为了鼓励他们循规蹈矩 to really encourage them
去做积极的事情 to behave, to do the positive thing
我的担心是 担心他们会形成一种误解 I think the misunderstanding that they have in mind is they're only
那就是他们所做的每一件事情 you know, they're only doing it because
仅是为了获得一定的奖励 they're going to get something out of it
这其实是有违我们宗旨的 but it's not true
因为他们需要习得如何管理自己行为的能力 Because they do learn to manage their own behaviors
纠正一些错误的行为 to tune into the proper behaviors
形成恰当的行为 and to tune into the wrong behaviors
接受事件的结果 并从结果中汲取经验 and accept the consequence for it and learn from the consequence
讲述:尽管对ADHD的 Narrator: Despite advances in understanding
理解和管理都有进步 and managing Attention Deficit Hyperactivity Disorder
但是只有五分之一的孩子会被治愈 only about one in five children will outgrow the disorder
没有治愈的孩子会有一系列弱点 Those that don't may be vulnerable to a range of problems
包括学业 求职 including difficulties getting through school
以及维持情感关系上都会有很多困难 or holding a job, or maintaining relationships
另外还有滥用成瘾物质问题 Others may have trouble with substance abuse
还有四分之一则会因为严重的反社会行为 and about one in four will develop serious anti-social behavior
多次被抓进监狱 marked by repeated arrests
拉塞尔A·巴克利:障碍的影响是非常大的 Russell A. Barkley: The disorder is one that's very curious
尽管很多病例似乎都是由生物原因引起的 because although it seems to have a biological cause to it in many cases
但是随着孩子们长大成人随之而来的结果 the outcome of the children as they grow older
都纯粹是社会性的 深受社会环境的影响 is purely the result of social circumstances
所以长大成人后表现的好坏 So, how well you're doing in adulthood, or how poorly you're doing
和儿童时期问题的严重性 或引起障碍的原因 has very little to do with how severe your problems were in childhood
关系很小 or what your causes of your disorder are
相反主要关系在于你父母 Instead, it has a lot more to do with how your family
是如何选择处理孩子所面临的问题的 chose to deal with your problems
他们是否理解孩子患有发展性障碍 whether they understood you had a developmental disorder
是否对你严厉惩罚 whether they used a great deal of punishment
严格进行控制和约束 and control and discipline
或者他们是否非常在意你的问题 or whether they were very sensitive to your problems
尽管也会试着规划你的人生 and although they tried to structure your life
但是他们不会对你有过度的控制和过分的惩罚 they were not over-controlling and excessively punitive with you
玛西:(听不清)鲜花和花瓶在这两个盒子里? Marcy: (INAUDIBLE) flowers and vases in the two boxes?
詹姆斯:错 James: No
玛西:好 这里必须要回答对错吗？ Marcy: Ok, do you have to answer yes or no?
詹姆斯:可能是吧 James: Probably
玛西:这里说 用已知信息解决 Marcy: It says, "solve, and use information"
讲述:詹姆斯以后会怎样发展我们还不知道 Narrator: The outcome for James is unknown
但是他是否能克服自己的障碍 But his best chance for overcoming his disorder
主要取决于他所处的抚育以及人为构建的环境 comes from the nurturing and structured environment in which he lives
玛西:你也听到了 关于所有这类孩子 Marcy: You hear such gloomy pictures out there
前景不算乐观 about all these children
所有这些预测都可能降临在每一个孩子身上 that all of these things could potentially happen to them
很多时候孩子的成长 and a lot of times it does even with
的确和父母的养育和支持分不开 some training or supportive parents
我们的监督已经足够全面了 But I think monitoring things closely as we do
我们监督他们的药物治疗情况 We monitor the medication
定期检查方案 调整基础 we're looking into programs, moderating the basis
我在他身上花费了很多精力 and I'm closely involved with him
希望结合这些 可以让他成功克服障碍 and I hope that that combination will help him be successful
而更加激烈的破坏性行为障碍则是... A more violent disruptive behavior disorder is...
教授:对于这个视频有什么问题或意见吗? Pro: Questions or comments about the video?
儿童患上ADHD的比例是多少? What percentage of kids have ADHD?
学生:百分之三 Student: Three
教授:对 应该是百分之三到百分之五 Prof: Yeah, put down three to five percent
他们说是百分之三 they said three percent
但是也有研究说是百分之五 有些出入 but different studies said five, different rates
男孩患ADHD的概率至少是女孩的两倍 Boys are at least twice as likely...other studies
有研究甚至说是四倍 even find up to four times as likely as girls to have ADHD
这样男孩患上ADHD或ADD的百分比 so, the boys are up to ten percent of them
就上升到百分之十 possibly have ADHD or ADD in childhood
进化心理学家提出了一种理论... One theory that evolutionary psychologists puts forward about...
总的来说为什么会存在ADD疾病 well, why are there gender differences in ADD and, in general
以及发病率为什么会有性别差异 about ADD in general, why it exists
回到我之前讲过的 It kind of goes back to what I was saying about the
学校教育以及刚才潘克赛普的那句引用... kind of, schooling and that Panksepp quote
这个理论 认为ADD疾病可能是 But they think that it's... ADD is potentially a product of
人类进化 以及原始狩猎采集的副产品 kind of like evolution and being hunter-gatherers
男人更具猎人气质 也不断向猎人的方向进化 with men being more hunters, and having evolved to be hunters
男人所从事的体力活动也更多 and do, kind of, physical, and kind of motor activities more
这都是生存所需 And then that was what was needed for survival
尽管这种思考很有趣 This, by the way, is not generally accepted, although it's
但是并不被普遍接受 you know, it's interesting to think about
这种假设并不是不成立 只是难以证实 It's not that it's been disconfirmed, it's just hard to prove
很多进化理论某种程度上都存在这样的问题 There's a lot of evolutionary theory as one way or the other
不过 这里的理念基本是 男人 But the idea is that, you know, that maybe men
尤其是在狩猎社会 particularly in hunting kind of societies
就是按猎人进化而来的 you know, were evolved a certain way and now that
而现在要他们安安静静的坐在教室里 they're, kind of, made to sit still in classrooms
如果在这种场合下他们表现出ADD症状 if that's where you see these symptoms of ADD
那就是因为一种历史错位 It's a mismatch between the way they were, kind of
是他们繁衍了几千年的方式 bred for thousands of years
和他们现在被期望的行为模式之间的一种错位 and what they're asked of now
那么ADHD有哪些症状呢? What are the symptoms?
这位心理学家同时认为 亚洲社会的生活方式 and the same person also suggests that Asian societies
要比欧洲或非洲社会更加田园 were more pastoral than say, European or African societies
这也就部分解释了为什么亚洲的ADD发病率 and that partially explains why you see slightly greater rates of ADD
要略低于欧洲和非洲的发病率 in European or African societies than Asian
强调一下这些都是纯臆测的 Again, this is all speculative
但这是一个非常有趣的理论 but it's kind of interesting theory
ADHD有哪些症状呢？ What are the symptoms of ADHD?
我们已经仔细谈论过 We already went over that
过度活跃 易于冲动 注意力涣散 hyperactivity, impulsivity, attention deficits
ADD疾病是如何... How is ADD...
对不起 ADHD是如何被诊断的呢？ I'm sorry, ADHD, diagnosed?
行为量表 Behavior rating scales
具体是根据父母和教师的报告来对比正常儿童 in particular teachers and parents against norms
还有视频里让孩子解答数学问题 Like that thing where they had the kid do the math problems
当时那个孩子有在电话上乱按 对吧? and the kid was pounding on the phone?
有这样的 That's...it's... the things like that
还有让孩子坐在地上玩玩具 or even just having kids play with toys on the floor
这些都是惯用的方法 are often used
但是这些手段都... But it's... those are more, kind of
心理学家认为都是比较主观的 subjective from the psychologist's point of view
和全国规范通用的问卷调查不一样 unlike these questionnaires which have been normed across the country
这种方式... like that thing with using the, you know...
我的意思是 对于这个孩子要等多长时间 I mean there's no norm how long it takes a kid
才开始乱砸电话 并没有一个 to start pounding on the phone
全国范围内的规定 you know, across the country
像视频里这么大的 十岁左右的孩子... for kids that are ten years old, like that kid was
但仅仅是问卷调查以及其它一些常用的任务 But so, it's not just questionnaires
来判断ADHD是不够的 that's typically other tasks to, kind of, elicit this to see if...
如果一个孩子出现ADHD症状 cuz that's one thing with ADD too is that
则需要对学校家庭等诸多环境变量进行考察 you would expect to see a multiple context – school, home
甚至即使是在治疗室 and then even when you come into a therapy office
或研究所里 or a research office
也要看看 不同的领域里都有哪些不同问题 you would expect to see difficulties in those different domains
如果在不同领域里 面对沉闷任务 and if don't see difficulties in the different domains
孩子没有表现出困难 to dull tasks, then that might suggest
这可能意味着问题背后有更多的环境因素 something about it being more contextual
比如孩子的老师 and something about your teacher
孩子老师管理学生的方式 and the way your teacher handles your class
或者孩子父母平常的管教方式不当 or your parents and the way your parents handle you
而不是孩子本身出了什么问题 rather than something that's intrinsic to you
好了 刚才视频里的孩子都有哪些异常行为？ Right, so you saw the kid, kind of, like... what did he do?
撕扯桌上的... Start crumbling up the desk
你们可以看到在视频里 but you can, kind of, see, you know
这个孩子在撕扯桌上的纸张 the kid that that was crumbling up the paper
他首先是乱按电话 Well, first he was pounding on the phone
乱按按键 然后把电话猛地挂掉 He was hitting the buttons and then he slams down
然后开始撕扯桌上的纸张 and then he was, like, crumbling up his papers
很明显他感到很受挫 He was obviously getting frustrated
这里有很多种可能 There's probably multiple things going on there
第一是在解答这些数学问题时感到力不从心 One is, he's having a hard time doing the problem
所以他有挫折感 so he's getting frustrated
在解答这些问题时感到困难 His hard time doing the problems, though
这可能是因为... is probably a reflection both of, just in general
我只是在这里做个假设 and I'm making an assumption here
因为我也不了解视频里的这个孩子 because I don't know about this kid in the video
他可能数学功课学得不是很好 that he's probably has had a hard time learning math problems
他做的像是加减运算 Addition... it looks like he was doing addition or subtraction
或者可能是乘法运算 or maybe multiplication, I don't know
我也不知道试卷上是些什么题目 Some sort of problems on the sheet
他可能在完成这些作业时 But, so maybe he is delayed
能力不足 in terms of being able to do those, at the same time...
这一点属于历史因素 so, that's, kind of, like, historical thing
但是现下因素是 他也没有获得足够的刺激 but then at the current time he was probably also under-stimulated
他必须要一个人坐在房间里做题 by having to sit there with nobody else in the room to doing those
这样他的挫败感可能被这种环境激化了... so, some of the frustration is probably fueled by that...
就比如我自己 当我很疲惫或者生病时 I know for myself that, like, when I'm tired or sick
当我感到动力不足时 you know, when my motivations are low, I can find myself, like
我就会像刚才那个孩子一样... self-stimulating like that kid, you know
进行自我刺激 by pounding on...
我偶尔会 比如说跟自己说话 but I do it, like, sometimes. I'll, like, just talk to myself...
不是说长时间自言自语啦 I mean not, like, at length, but like, you know
我发现如果生病时 I find that when I'm sick
我会长时间的坐在沙发上 I'm moping around the house
我也会站起来拖拖地等等 you know, like, you're sitting on the couch, or whatever
因为我知道我需要站起来做点什么活动活动 but I know I need to get up and do something
类似于 加油 振作起来 这样的自我鼓励 like, "come on, get up"
我认为这种情况可能和那些ADHD患儿 You know, like... but I think it's probably related to somewhat
有某种内在的联系 what's going on with Attention Deficit kids
并不仅仅是他们病了或累了的时候 you know, not just when you're sick or tired
而是...因为他们的大脑的运作机理 but, kind of, because of their way their brain is
马上我们要讲到 And we're gonna get that in a second, but just
需要自我创造刺激 kind of, needing to create self-stimulation
来增强他们正在做的事情的趣味性 to stay interested in what they're doing
巴克利认为ADHD的根源是... What does Barkley believe the roots to...
谁注意到了？ ADHD的根源？ Who caught that? Huh? The roots of ADHD?
学生:父母不管教方式不良 Student: Bad parents?
教授:是因为脑前额叶 Prof: Frontal lobe
不良管教方式？ Bad parenting?
不对 事实上是 他有强调说其根源 No. In fact, he made a point of saying it was not that
是动机控制中心的脑前额叶 Frontal lobe, which is the center of motivation
也被称为 执行中心 is also called the Executive Center
我希望你们了解这个术语 执行中心 I want you to know that term, Executive Center
一开始我就讲过 这种自我调控的理念 And like I said, at the outset, this whole self-regulation idea...
我们还说过ADD we've been talking about ADD
事实上就是处于自我控制体系极端的人们 which is on this end
但疾病本身也会塑造极端案例的个体 But it forms this end of the spectrum of people just as much
在耶鲁毕业生中有这样一个研究 I know there was a study of Yale graduates
对即将毕业的本科生做的调查 undergraduates leaving Yale
问他们是否有一个十年人生规划 asking them what their... do they have a ten-year plan?
即是毕业之后所要从事的行业有何打算？ What was their plan for what they were doing after graduation?
这个研究至少是在20年前做的 Well, the... and this is at least probably 20 years ago
我认为是在80年代做的 I believe it was done in the 80'
百分之十的学生对之后的人生 those ten percent of graduates who have a solid ten-year plan
有一个清晰的十年规划 for what they were gonna do
事实上十年后 他们又进行了跟踪调查 Well, they actually followed them up ten years later
这百分之十的学生所创造的财富 and those ten percent had ninety percent of the wealth
相当于整个毕业班的百分之九十 of all the graduating class
所以 这种执行能力 And so, this executive functioning
以及设定长远目标的能力 and the ability to set goals
并不仅仅跟安安分分的坐着完成家庭作业有关 is not related just to sitting still and doing homework
而很大程度上在于 but also on a larger scale it's related to...
你是否能设定人生目标 然后朝着它们奋斗 can you set goals in life, go towards them?
这对于成功至关重要 And it means a lot for success
无论是财富上的成功 whether your success is financial
还是你对生活的其它预期 or whatever you want out of life
比如帮助困难儿童 拯救热带雨林等等 you know, helping kids, doing whatever, helping the rain forest
能够制定长远的人生目标 you know, being able to set goals and
并矢志不渝的追求 kind of, keep your eye on that
一步步达成目标 这才是成功之道 and take steps towards it, is kind of a life success thing
又扯远了 在周一我们就要结束这个课题了 We need to stop. We'll finish going over this on Monday
我们刚才复习了这个ADHD视频 还有答案 Ok, we were going over the ADHD video, going over the answers
每个10个...4个... we had ten each... four...
利他林或右旋苯丙胺 What is the process by which Ritalin or Dexedrine
对ADHD患儿的功效是怎样的呢 听清了没? helps a kid with ADHD? You got that?
学生:(听不清) Student: (INAUDIBLE)
我想知道(听不清) I want to know (INAUDIBLE)
那个部位不够活跃 which is seen less active
但是这仅仅更(听不清) but really it is simply more impulse (INAUDIBLE)
教授:好 对了 Prof: Ok, so... right
这类药物所产生的效果很矛盾 So, it's a paradoxical effect
它们实际上是一种刺激药物 可以增强某些东西 It's actually a stimulant that seems to be increasing something
尽管ADHD患儿表现出来的行为似乎是 even though the ADHD kid's behavior seem
需要降低某些东西 like you wanna slow something down
不一定...这里主要有两种 Not exactly sure... there's two main biological brain things
大脑的生物运作模式 that may be going on
多半是多巴胺这种化学物质 Probably Dopamine, which is a chemical, like, your neurons
就像是大脑中神经元之间的信息... like the messages between neurons in your brain
多巴胺作为一种化学物质 Like Dopamine is a chemical
会导致脑内神经突出释放出信号 that causes the synapse that sends a message
ADHD患儿的情况下 Well, with ADHD kids this thing
会使多巴胺... that pulls Dopamine out of the...
这玩意叫做转运体 it's called a Transporter, it's called...
通过药物刺激使得神经突触打开 it re-updates the chemical from the neuron
这样神经元突触就会释放出更多的多巴胺 It keeps it back out of this, kind of, the synaptic opening there
实际上 患儿的转运体更为活跃 That they have, in fact, overactive transporters
因此 可以说 患儿脑内游离的 meaning, pulling up those... mean so there's not as much
多巴胺水平就更低 kind of like, floating Dopamine in a sense
所以ADHD患儿大脑的多巴胺水平是较低的 And so that, in fact, that they have lower levels...
这也是部分... and that's part of this....
我之前提到过的 有点像是有一个刺激阈限 I think I've mentioned, it's like stimulation threshold
这类孩子实际需要更多的外部刺激 that they actually need more external stimulation
才能对大脑中的多巴胺造成影响 which has an effect on Dopamine, kind of, in the brain
一些证据表明 And so, for example, there's some evidence that
如果给予ADHD患儿低水平的刺激 if give ADHD kids low levels of stimulation
不至于造成分神的 that's not distracting
比如 当他们学习时 或听课时 but say, putting on music in the background
播放一些背景音乐 when they try to study, or in class
或者有人说过在教室顶部边缘 Or I've even heard people that put, like, Christmas lights
挂上一些圣诞灯饰 in a classroom along the top rim of the room
这些闪闪的彩灯并不足以转移孩子们注意力 and they just, kind of like, flash, you know, not distractingly
但是却可以给他们提供一点背景上的视觉刺激 but just provide a little visual stimulation in the background
这样的手段可以帮助ADHD患儿 That, things like that
更好的集中注意力 can help ADHD kids focus
因为这样才更接近他们的刺激阈限 because it's getting their stimulation threshold closer to
但是对于像我们这样的一般人 where, like, the rest of us typically are
就有点... And it's something that...
我记得肯定有人研究过音乐 actually there's at least one study with music that
背景音乐的刺激作用 background music... again, you don't wanna put on something
这里指的并不是放一些类似死亡金属的音乐 that draws attention to itself, like, you know
这类音乐本身就会分散你的注意力 like death metal, or something like that
而是一些 比如我自己就觉得... But, like, something that, kind of... actually, for myself I know...
我想说的是... and, what I was gonna say is it
至少有证据显示 (这样的刺激)不会使得 there is at least some evidence that it doesn't distract
非ADHD类型的人分神 kind of none ADHD types
事实上我想说的是... and, in fact, I think, again, like, what we're gonna talk about
我们说到利他林的作用 we are talking about – Ritalin
说到我们所有人其实都是一个整体 like how we're all on a continuum
反正我自己吧 I know for myself, I have this, like, DVD
格里高利圣咏或者这样的CD like, Gregorian chants – or a CD, that just
我可以在阅读的时候连续放上几个小时 you know, can play for hours and I can be reading something
而自己却浑然不觉 and I don't even know that it's on
这里不是说明我听力上有什么问题 that I'm not processing at all what's going on, like, auditorally
而我发现在读书的时候 But yet, I find myself, like, you know, looking...
跳回去重读前面段落的几率更少 finding myself going back over things less
就像我之前说过的 you know, like I said before
发现我的眼睛已经看完了一整页 your eyes are going across the page
才意识到自己什么也没读进去 and you realize you haven't read it
如果能有一些刺激的话... I do that less if I have something like that, or some sort of
在我看书学习的时候放上一段轻柔的背景音乐 you know, subtle background music while I'm studying
情况会好点...我没有患ADHD and I'm not a... I don't have ADHD
可能只是有些... If anything I'm probably on the...
上周 in fact, just last week I was at a...
我和一些朋友在哥伦比亚共进午餐 some friends we were in Columbia having dinner
当时服务员非常忙 and the waitress was, like, all over the place
难以唤起她们的注意 You know, like, hard to get her attention and then...
一个很活泼的女服务员 but she was just... a very bubbly
当时我们在和她开玩笑 and she like... but she tells us... we were joking around with her
她告诉我们她患有ADHD and she's, like, tells us she has ADHD
我朋友开玩笑说 我有ASUD And then my friend goes, "well I have ASUD"
我患上了注意力过剩障碍(ASUD) he's like, "I've got Attention Surplus Underactive Disorder"
事实上在某种程度上 我们每个人都有 and, actually to some extent, a lot of us maybe fit that
比如我们都可以长时间的坐在某个地方 meaning, like, we can sit there and concentrate on things
专心致志的做某事而完全不受外界的干扰 for a long time without, like, being distracted by external things
你们有没有谁 不管是不是因为ADHD Ritalin, how many of you have, either for ADHD reasons or not
服用过林他林或者右旋苯丙胺吗? like, tried Ritalin or Dexedrine?
能说一下它们的效果吗？ Now, what are the effects like?
学生:我以前有服用过利他林类似的药物 Student: I've been on some form of Ritalin
开始的第一天(听不清) since the first day (INAUDIBLE)
我思维清晰(听不清) everything I can think of and (INAUDIBLE)
对我帮助很大 and it helps me so much
并不是说没了它我就不能思考了 not that I can't function without it
而是这让我精力更加充沛 更专注学习 but it's much more energy, it's more tied to study
更能集中注意力 it makes me more focus
除了药物 我也配合了行为治疗 Doing that, I also have behavioral therapy
他们引导你要如何 which is, they teach you how
这些都有利于集中注意力 and what it feels to be concentrated
所以即使没有药物我也能够控制 so, I am capable of functioning without it
只是结合药物效果更显著 but it helps dramatically
我的确有服用过 and I do have it
但是因为我服用的时间太长了 but, because I've been on it for so long
每个月我都要抽血化验以确保 I'm part of the... I take blood tests every month to make sure that
我的肝脏和肾(听不清)没有收到影响 like, my liver and kidney (INAUDIBLE) are functioning
由于我长期服用这类药物 since I've been on it for such a long time
而且剂量很大我... such a very high dose for... but I...
我的妈妈是一所学校的校长 and my mom is a principal at a school
这基本是一所针对学习障碍儿童的私立学校 and that's mostly learning disabled private school
我偶尔会去充当一下替补 and I can play as a substitute there is
这对我影响很大 and it makes such a huge difference
教授:嗯哼 Pro: Yeah
学生:这里的孩子其实算不上是学习有问题 Student: I mean, and it's not even a sort of studying
因为太小了还没有这个能力 because some of them are too young to study
而是一些行为上的训练...对不起 but behavioral stuff and they can sit... come on, sorry
只要他们能坐下来安静的完成作业 and they can sit and focus on work
效率就会显著的提高 is significantly more efficient
教授:谁有朋友 Pro: Yeah, how many people have friends
不是因为ADHD原因 like here, that, not for ADHD reasons
而是为了帮助学习考试 but have taken Ritalin or Dexedrine
而服用利他林或右旋苯丙胺的? just to help them study for exams?
甚至是高中的时候 有这样的同学吗？ or even in high school were there people like that?
这些药物已经变得如此流行 I mean, it's an issue that
已经是一个热门话题 these drugs have gotten so popular
这些药物随时可以弄得到 that they're available
人们靠服药来学习 and people take them just to study
大多数人...因为一个总体概念是我们所有人 and, a lot of people, or most people... again, the whole idea of
其实某种程度上都有一些注意力涣散等问题 being on a continuum how able you are to focus
某种程度上 这些药物对我们大家都有帮助 You know, it's gonna help everybody to some extent
无论是在学校 还是已经不是学生了 even if you're here instead of out here
这些药物都可以用来帮助你提高注意力 you might put you up here
以更好的学习或生活 in terms of being able to focus and study
很显然 这类药物也是有副作用的 Now, it certainly does have side effects as well
更重要的是 the main thing that parents
一些父母会发现自己的孩子用药后 I think, say when their kids are put on it is
我的孩子变得麻木不仁 my kid has become a zombie
像是失去了生活的激情 and, like, has lost, like, zest for life
可能这些孩子不够活跃 You know, like, not as active
他们希望自己的孩子能更顽皮 更活跃一点 They, kind of, miss the playful, maybe a little too overactive kid
但是这就有些像是塞翁失马 But it does have other...
这类药物对食欲和睡眠也有影响 it can have other, kind of, effects on appetite and sleep
目前为止这类药物没有长期的负面效果 But as far as we know doesn't have long-term effects
对儿童不会造成长期的负面效应 you know, like, negative long-term effects on kids
另外一个作为一个心理学家 Another kind of sobering thing
值得深思的问题就是 as a psychologist is that it is
事实上最能强有力的帮助孩子 in fact, the case that it's the most powerful thing we know
集中注意力的 that help focus attention
就是家庭正向行为疗法 that even really good behavior therapy with the family
帮助父母制定出一个家庭奖赏体制 helping the parents, kind of, figure out a reward system at home
就像我们在视频里看到的那样 like we saw in the video, like
老师手里小小的奖励物品 类似这样的东西 the teacher with the little tokens and stuff like that
但是除了制定家庭奖赏体制 But figuring out a comprehensive rewards system at home
药物治疗的作用也不可忽视 that the medication actually is better at...
至少在治疗注意力涣散上 at least the attention part of things
对孩子有立竿见影的作用 and making overnight changes in that for kids
最大型的一项研究... The biggest study...
一个全面的综合性的研究 this is in the overheads
由于时间的关系我们就不一一详解了 which we're not gonna have enough time to go through the whole study
只是针对其中的一部分关于ADHD的内容 but part of the overheads of what the lecture I was gonna do on ADHD
如果我们有时间完成 if we have time to finish
这是联邦政府发起的规模最大的项目 It was the biggest study by the federal government
对象是数以百计的孩子 is looked at with hundreds of kids
目的是为了对比刺激类药物 the effects of stimulant medication versus
和各种强化行为疗法的效果 like, intensive, different kind of behavioral treatments
后者也就是需要父母配合 meaning working with parents
和老师一起为孩子建立一个奖赏体制 working with the teachers to come up with rewards systems for the kid
以及针对孩子的个体化辅导治疗 and also, kind of, a individual tutoring for the kid
如果把这两种方式结合起来 Looking at those two things combined
观察其效果 发现收效甚微 and then looking at, like, nothing at all
也不是全无效果 But it wasn't actually nothing at all
如果不仅仅是为了做调查的话 it was like, whatever the kid would get if it wasn't for this study
如果父母也去学校了解情况并参与其中的话 So, if their parents went and got a councilor at school
无论怎样孩子都会有所受益 and get involved, that was, you know, a part of that
这个研究得出的结论是 But, the outcomes of that study are that
就注意力不集中症状来说 in terms of attention symptoms that the two...
我们把药物治疗 和行为疗法奖赏体制结合药物 the medication alone, and medication plus the behavioral treatment
分成两组 the reward systems, you know, were the two groups
这两组的疗效最为显著 that showed the best improvement
而药物结合行为奖赏制度的那一组 the medication plus the behavioral
就提高注意力集中而言 rewards systems –were not higher
效果并不见得就比单纯的药物 in terms of getting better attention in the kids
更加理想 than medication by itself
所以可以看出药物本身的力量 So, medication by itself was, you know
和奖赏体制行为疗法一样强大 as powerful as also having all this reward system
当时研究发现还有一点 Now, the one thing though that did...
仅是依靠行为疗法奖赏体制而不结合药物治疗 and the behavioral reward system without medication
对于孩子集中注意力的能力 was not as good at reducing
既不会降低也不能提高 or improving kids' abilities to focus attention
作为一个心理学家 这一点让我深思 So, as a psychologist, you know, that's, kind of, sobering
因为就我本人而言 我一度想过 cuz I at one point in my life I was thinking
我喜欢心理学吗？ do I wanna go into psychology?
还是我更想研究精神病学？ Do I wanna go into psychiatry?
这两者主要的区别就是上不上医学院 the main difference being going to Med-school
作为一名精神病学家你可以开药 and being a psychiatristis you can prescribe drugs
而现在我作为一名心理学家 不可以 and I, as a psychologist, can't
因为在那时我开始接触谈话疗法 It was because at the time I was into, kind of, talk therapy
对于提高家庭和孩子的生活质量 what can we do to work with families
我们能做些什么呢？ and kids that improve their lives?
但是ADHD是这样一种特别的案例 but ADHD is one case in which medication is
药物的确可以帮助患者 you know, the does have a benefit
它能够起到光靠家庭协作所起不到的作用 It can do things that just working with the family can't
至少最新研究已经证实了这一点 or at least the evidence to date suggests that
下面我要讲的和第七个问题有关 Now, I should say though... and this relates to Question Seven...
也就是为何单纯药物治疗 there was... that I was saying how the medication by itself
对比药物加行为疗法 versus medication versus behavioral treatment
在提高注意力上的效果一样 were the same in terms of attention symptoms
但是可以看到有家庭配合的行为治疗系统 But you did see some better, kind of, reduction in anxiety in kids
的确可以更好地降低孩子的焦虑 with the behavioral systems working the family
这就和下面这个问题有关了 巴克利认为 So that relates to this question, like, well what does Barkley think
尽管起初一个孩子的病因是先天生理上的 the terms whether a kid will persist in having difficulties
而他是否会一直有困难的关键在于 even though the origins, he clearly says, seem to be biological
家庭教育 这是预测一个孩子 He says family processes
能否取得长期成果的一个最大的因素 are the strongest predictors of long-term success
这并不尽然就只和注意力 还有学习能力有关 Now, that's not necessarily with attention and the ability to study
还关乎他们在成长中是否还存在其它问题 but in terms of whether they're gonna have other kinds of problems
比如是否能和其他孩子和睦相处 like getting along with other kids and develop anxiety
是否会发展形成焦虑 抑郁 depression, conduct disorder
行为障碍等类似问题 those kinds of things
这些东西是家庭和父母是可以影响的 That is something that families and parents can influence
至于集中注意力的能力 but the ability to pay attention
这对于ADHD患儿来说将是一个终身的问题 is gonna be a life-long issue for a kid with ADHD
而利他林这类药物 and that's another thing about Ritalin is
它并不能根治 患者必须长期服用 it's not a cure; you have to keep taking it
一旦药效褪去...也不尽然就会... You know, like, once it wears off, you know, you don't necessarily...
但事实上你不可能... in fact, you're not likely to... you know
为了保持效果 患者需要一直服用 you need to keep taking it for it to have its effect
有多少ADHD患儿可以痊愈？ How many Children outgrow of ADHD?
学生:五分之一 Student: One in five
教授:对 五分之一 Prof: one in five
这就像我刚说过的 And so, that's kind of consistent of what I just said
它会一直存在 which is, it's gonna be...
如果你患上了注意力缺陷障碍 if you have this attention deficit
它可能会一直都伴随着你 it's gonna be something that, kind of, just stays with you
这是一生都要面对的事情 it's gonna be a life-long thing
所以这一点必须意识到 考虑到 they have to be aware of and think about it
我们把它看成是一种残疾 so, we think of it as a disability
多少患者会发展形成反社会人格障碍？ And how many will have an Anti-social Personality Disorder?
学生:四分之一 Student: One in four
教授:对 四分之一 Prof: One in four
这里再次强调一下 我之前也讲过 So, again, like I said before
大多数有注意力障碍问题的孩子 a lot of the kids with attention problems
长大后都会有一定的行为问题 then become conduct problems
好了 今天就讲到这儿 Ok, let's stop there...