Tap chi KHOA HQC DHSP TPHCM Le Thi Minh Hd HlTOfNG NGHIEN ClTU VE TRE C 6 R 6 I LOAN TANG DONG GIAM CHU Y (ADHD) Le THI MINH HA'''' T6M TAT Bdi viet ndy de cgp vdn de nghien ci''''ni tre CP rdi logn tdng dp[.]
Tap chi KHOA HQC DHSP TPHCM Le Thi Minh Hd HlTOfNG NGHIEN ClTU VE TRE C R I LOAN TANG DONG GIAM CHU Y (ADHD) Le THI MINH HA' T6M TAT Bdi viet ndy de cgp vdn de nghien ci'ni tre CP rdi logn tdng dpng gidtn chu y (A DHD) chu yeu tgp trung vdo mpt so hudng nhu: bieu hi^n, dich te hpc (li!(' mac phdi), nguyen nhdn ciia roi loan ADHD vd ADHD di kem cdc hpi chung khde: ddng thdi phdt hi^n chdn dodn can thi^p, Iri li^u vd gido due tre co roi lopn ADHD Tit khda: roi loan giam chii y roi logn tdng dpng/xung dpng roi loan tdng dpng gidm chu y ABSTRACT A^^H" reseach trend into children with attention deficit hyperactivity disorder (ADHD) The article is about research into children with ADHD, focussing on some issues: symptoms, epidemiology (rate), causes of ADHD, ADHD and other syndromes, detection, diagnosis, intervention, treatment and education for children with ADHD Keywords inattention disorder, impulsi\ity/ hyperactivity disorder, attention deficit hyperactivity disorder Dat van de Rdi loan tang ddng giam chii y (tieng Anh la Attention Deficit Hyperactivity Disorder viet tdt la ADHD) Trong bdi ehiing toi sir dyng ten viet tat tieng Anh - ADHD de ehi rdi loan tang ddng giam chii y ADHD la mpt dang rdi loan phat trien thudng gap d tre em Theo "So tay chan doan vd thdng ke nhijng rdi nhieu tam than IV" (1994) (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition - DSM-IV), ADHD ed bilu hien qua miic tinh trang khong tap trung ehii y, hoat dpng khdng kiem soat va tdng boat dpng, lam anh hudng den viec hpe tap, phdt trien cam xiic va kT ndng xa hdi cua tre ' TS, TriFdng Dai hoc SLC pham TPHCM Hien tupng ADHD da xuat hien tir rdt Idu, ten gpi eiia no dupc thay doi theo thdi gian Chi DSM - IV dua thuat ngir "Roi loan tdng ddng giam ehii y", thi djnh danh roi loan ADHD vdi ede dang bieu hien: Giam thieu ehii y (Attention Dificit Disorder - ADD), tang dpng/xung dpng (Hyperactivity Disorder - HD) vd tdng dpng giam ehii y (Attention Deficit Hyperactivity Disorder ADHD) mdi dupe sii dyng rdng rai, thong nhdt khoa hpc Trong nhimg nam gdn day, nghien ciai ve tre ed rdi loan tdng ddng giam ehii y tap trung vdo mdt so hudng sau day: Nghien cii-u bieu hien ciia roi loan tang dpng giam chu y Vdi hon 30 nam nghien ciiu sau, rpng vl ADHD, Barkley R.A (1997) da nhdn manh cac trieu chung cdt loi 29 Tsp chi KHOA HOC BHSP TPHCM roi nhieu A D H D Id suy kem chirc ndng lif diiu chinh (Self - Regulation), ^f dieu khiin (Sell' - Control) vd khd ndng kiem chi (deficit inhibition) hdnh vl (7 tr.3131 Sau niy, cic tic gia khie nhu Quay (1997), Douglas (1999), Nigg (2001) cung cho kii-l q u i tuong ty [10, tr.75-79] Cdc nghien euu ve A D H D ciia Booth, Canu, Carlson Shin (1997 1998, 2002) d^ cip d^n ba dang bieu hi^n ca ban ciia A D H D : Gidm chu y ( A D D ) chiem uu the, tdng v j n dpng xung dpng (HD) chi^m uu th^ va vira t i n g v i n dpng vira g i i m chu j (ADHD) Sandra Rief (2008) |4| JLI h$ thong cic nghien cim ciia nhieu tic g i i v^ bieu hi?n cua A D H D v i dua bang tdng hpp cic die diem h i n h \'i eua tre cd riii lojin A D D v i A D / H D nhu d bing sau d i y : Bdng / Biiu hien hdnh vi ciia tre cd rdi logn ADD Dang Giam chii y (ADD) •inHD[4j Bleu hi^n hdnh \i De bi xao nhdng bdi kich thich ben ngodi (hinh anh, am thanh, sy chuyen dpng mdi trudng xung quanh) Khdng tap trung nghe dupc ndi tryc tiep Khd khdn vi?c nhd va thyc hi?n theo hudng dan Khd khan Iri su chii y ddi vdi cae ho^t ddng deu ddn Hay quen thue hicn eac hoat dpng hdng Thudng tho than, mo mdng Kho bdt dau cong viec va thudng khdng hoim \ iec dupc giao De chan nan Ue oai (thudng ngii guc kVp) Khong biet td chirc sap xep cong viec (len kc hoaeh, lap thdi gian bieu, chuan bi bai) Thudng ldm mdt dung cu hpc tap KT ndng hpc tap kem Tang hoat dong/xung dong (AD/HD) Tdng dgng Xung dong 30 Luon "di chuyen" ho?ic hanh dpng nhu the bi ihoi thiic Rdi khdi eho ngoi khdng dupc phep Khong the ngdi yen (ludn nhdy len hodc khdi ghc nga \u6ng ghe, quy gdi, hodc dimg sat ban) Hau nhu khong ngimg hoat ddng Ludn miia may tay chan hode udn eo tren ghe Khd tham gia hoat ddng ma khdng gdy on Kho dn djnh tinh than hay gitir binh tTnh Kho dieu hoa ede hoat ddng/van ddng Gap nhieu khd khdn cae tinh hudng budc phai chd dpi Tap chi KHOA HQC DHSP TPHCM Li Thi ^ifl' Hd Vyt tra ldi trudc cdu hdi cham dirt Thudng cdt ngang hogic ngdt in ngudi khde Khong the chd hojie tam hoan y thich, mudn ed lap lire Biet lujit vd hgu qua nhung ludn phgm loi lK)ac vi phgm quy djnh T90 cdc tieng on khdng phii hpp Tham gia vdo nhQ-ng hogt dong nguy hiem md khong Iudng trude dupe hau qud (treo eao, chay \c khdng nhin dudng) nen de gdp lai nan Thieu kien nhan va de ehan nan De bi cuon hiit vao cde hoat dpng khde gay hirng thii hodc dc bj kich thich Danh kho chiu hodc giat ciia ban Nghien ciru djch te hpc (ti le mac ket qua eho thdy eii 10 tre thi co gdn tre phai) cd roi logn ADHD Theo nghien cim ndy, Hau het cac nghien cim duac thyc ti le tre ADHD gia tdng tir 7.8% (2003) hien va chdn dodn dii d ddu va nao din 9.5% (2007) \a 22% (2010) Trudng deu cho thdy ADHD la mdt hien tupng nhdm nghien cim, Susanna Visser giai mang linh toan edu, nd ndy sinh va ton tai thich nguyen nhdn, mpt mdt nhihig khdng phdn biet ranh gidi xa hdi vd \an budc tien manh su sang lpe tre, mat hoa cung nhu cac nhom dan tdc Theo khac, phu huynh cung ngdy cang cd y Cooper (2006), ti le luu hdnh tren the gidi thirc tdt hon viec quan sdt va tam khoang 3-6% d tre em va nhimg ngudi soat minh Nghien eiiu eiia Hpi Tam tre tudi Mpt nghien eiiu quoc te eiia than hpe Hoa Ki (2000) da ehi ti le gitra em Irai va gdi dao ddng tir 4:1 den Kewle> (2005) giira ede nha tdm li Australia va Bdc MT cho thay, neu tinh ca 9:1 phy thupc vao nhom nghien euu thong ho^c lam sang Vdi ti le trai:gai la nliung \eu to nguy co thi ti le ADHD cd tinh todn edu la 13% 4:1 dang dien hinh tdng dpng xung dpng/dang hdn hpp \ ira tang dpng Tai Hoa Ki, G J August (1996) nghien ciiu tren 7.231 tre em ldp - tai vira gidm tap trung Ti le trai va gdi ngang dang giam chii y Ti le 22 trudng tieu hpe eho thdy, ti le tre ADHD 3-6% [11, tr.384-385] Theo chung gitra trai:gai d trudng phd thong la Barkley R A (2000) khoang 3-7% tre 9:1 (Cooper \a G'Regan, 2001) [12 dp tuoi hpc dudng eo roi loan tr.11-13] ADHD, dieu cd nghia la moi ldp hpc d Anh, theo nghien ciiu eiia Taylor d Hoa Ki CO hodc em bi chiing benh va Hemsley (1995) khoang 0.5-1% tre cd [8, tr.20] Theo Gojdstein (2006) rdi loan ADHD Nghien ciiu eiia Trung khodng 5-8% tre ADHD nhdm tre tam sire khde quoc gia tren 69.000 tre tai 4-17 tudi [12, tr 11 ] Mpt nghien euu gan England va 4200 tre tir 6-16 tuoi tai Wales cho thdy 1% tre cd chung benh ddy eiia Trung tdm kiem sodt ngan ngira Nghien cim eiia Bp Gido due viing dich benh Hoa Ki (2010), bang caeh phdng van cha me eiia tre tir 4-17 tudi, Bde Ireland (2005) tren 345.000 tre vd 31 Tgp chl KHOA HOC BHSP TPHCM tjw jy nam j,vt* 21.000 tre d sir Wales (2000) cho thay cir nghiSn cim cho thay 0,53% tre ADHD, mpt Idp hpc cd 30 em thi cd em cd nghTa li cd 5,3 tre ADHD 1000 tri Trong dd nhdm tre 7-11 tudi ed ti I; ADHD Nghien ciru ciia Wheeler (2007) tren 431 tre ciia 256 trudng, k^t qui mdc ADHD cao nh& (xem bang 2) BAng Ti H Ire ADHD iheo dp luiil Igl Anh [12 tr 12] Tuoi 4-5 5-7 7-11 11-14 14-16 17-19 Khdng biet Tong cpng Ti If % 12 37 31 13 100 S& lu-pTig hpc sinh 17 50 152 129 54 11 413 - Khoang 6% tre em d Australia dupe chdn dodn cd rdi loan ADHD, tire la trung binh moi ldp hpc ed em mdc ehung benh Mdt nghien cim dya tren su ddnh gid kT Iudng vd chdn dodn dua tren nhung ddc diem ldm sang tren 10.438 tre tir 5-15 tudi cho thay ed 3,6% Ire trai \a 0.85% tre gdi co rdi nhieu ADHD (Ford, 2003) Tgi Canada, ndm 2002 nghien ciru dilu tra ti 1? ADHD theo nhdm tudi tren 2400 tre 4-16 tudi d Otario \ a 2674 tre 416 tudi d Quebec Cac nhd nghien eijru sir dyng bang li?t ke hanh vi danh cho tre, eho eha m? vd cho gido \ien Ket qua nhu bang sau da\: Bdng Ti le tre ADHD theo nhom tuoi tai Canada (Nguon chinh phd Canada 2002) [2 tr U] Nguon thong tin Tir tre Tir cha me Tir giio vien 32 Gidi linh Tre gdi Tre trai Tong so Tre gii Tre trai Tong so Tre gdi Tre trai Tong so Nhdm tuoi 6-8 tuoi 9-11 tuoi 1.8"o 1.5% 5.6" 6.9% 3,8% 4,1% 9,6% 6.9% 7.5% 12.1% 9.8% 4,3% 2,1% 7.3% 4.8% 2.9% 13,2% 8,1% | Tgp chi KHOA HQC DHSP TPHCM d Phdp, theo D Marcelli, khodng 3% tre trudc tudi d^y thi cd rdi nhieu ADHD vd nlu xdc dinh chdn dodn thdi diem tre bdt ddu di hpc (6-7 tudi) cho thay ti 1? be trai gap 10 lan be gdi Cdc nghien ciiu khde d ede nai nhu: Colombia ADHD d tre trai Id 19.8% va tre gdi la 12.3% (Pineda, 2003), d Nh^t 7%, Trung Quoc 6-8%, Newzeland tren 7% [8, tr.23] Polanczyk vd cpng su (2007) da tien hanh nghien eim tdng hpp Igi nhiing nghien ciru \e djch te hpc ADHD tai cdc viing tir Bdc vd Nam Hoa Ki, Chau Au, Chau phi, Chau A, Chdu Dai Duong den viing Trung Ddng Tir ket qiia ede nghien eim eho thdy, khdng cd su khac biet Idn ve ti le ADHD cac nghien eim tai ede nude tren the gidi va ti le ehung la 5,2% [12.tr.l47] Viet Nam, Nguyen Thi Van Thanh va Nguyin Sinh Phuc (2007) nghien cim tren 1594 hpe sinh d hai trudng lieu hpc tai Ha Npi eho thay ti le mdc benh la 3,01% [2] Theo Vo Thj Minh Chi, ti ie ADHD d hpe sinh THCS la 0,73% (nam 1,28%, nu 0,19%) Tdm lai, theo DSM IV, khodng 35% tre em mac chimg rdi nhieu ADHD, eon Lien dodn Sire khoe Tri tue The gidi cho rang khoang 3-7% tre em d tudi den trudng bj dnh hudng bdi roi loan Nghien ciiii nguyen nhan ADHD Viec tim kiem nguyen nhan eua ADHD kha phiic tap bdi tinh khong thudn nhdt eua nhung tre da dupc chdn dodn ADHD Cac bdng chung cho thdy rang mdt nguyen nhdn nhdt khong the gidi thich duac eho roi loan Le Thi Minh Ha YIU td di truyen (gene) dupc de cap den mpt nghien ciru tren 238 c^p song sinh (Goodman vd Stevenson, 1989) dd tim sy phu hpp cho chan dodn lam sdng tdng dpng d 51% ede c^p sinh ddi eiing Irirng vd 33% ede edp sinh ddi khac trung Nghien ciru mdi day ciia ede nhd khoa hpc Trudng Dgi hpe Cardiff (Anh) eho thay, mpt nhtJng nguyen nhdn eiia ADHD Id gene xau Ket ludn tren riit sau nghien euu 366 tre mdc chiing ADHD \a nh^n nhiing khac bi?t r6 ret ndo ciia cae em so vdi tre binh thudng Nhtmg tre ed rdi loan ADHD thudng cd tinh trang thieu hodc thira nhiem sdc the eao gap doi so vdi tre binh thudng khde Cac nghien ciiu gan ddy da neu len su khde biet ehiic nang eiia nao, trao doi chat d nao thap hon miic binh thudng cua nu- mdc ADHD [4, tr.l57] Mdt nghien cim quan trpng khac sudt 10 ndm ciia Vien Sire khoe Tdm thdn Quoc gia Hoa Ki da so sdnh nhimg ldp chup cpng hudng tir MRJ d nam gidi binh thudng vd mde ADHD, eho thdy thiiy tran d nhung tre mde ADHD nho hon [U, tr.246-247] Hang loat nghien eiiu trac nghiem tdm li - than kinh \e chirc ndng cua thiiy tran (viec kiem che dap ling hanh vi) cho rdng, eo su suy yeu ddng ke d phan ndy eiia nao bp tre ADHD [7, tr.31] Nghien eim ADHD nhieu nam da chii y tdi dnh hudng eiia edc doc to tir mdi trudng su tien trien eiia chiing rdi loan tang ddng Chat nicotin Id mdt dpe to ed dnh hudng den tien trien 33 So 39 ndm 2012 T?p chl KHOA HOC BHSP TPHCM nguding cua c^ng dong cd dnh hudng den eiia ADHD, die bi?t nguiji me hiit vi?c sdng Ipc, phit hi?n, dinh gii, trj lieu thudc Milbcrger vi cpng sy (1996) bio vd gido dMC tre cd roi lo?n ADHD [5, cio ring 22'%i ngudi me eua nhirng tre tr 124-136] Bruno Bettelheim eho ring, mdc ADHD hut tren mpt bao thutic la d mpt so tre qui nhjiy cim, l^i di kem vdi moi suot qud trinh mang thai, cich gido dye ddc dodn ciia bo m?, ddc so \di nhdm doi chimg ehi cd 8% Han biet nguiti m? kim kien tri, de bifc bpi nira nhihig nghien ciru tren dpng vit cho hay ciu bin yeu eau dua tre phai thiiy nicotin Idm tdng giai phdng dopamin ving Idi Nii-u dua \ti l?i khdng ving Idi, va giy tdng dpng (John vi cpng str, thi quan he m? - sdm trd nen xung 1982; Fung vii Lau, 1989) Dpa tren ca dpt vi tre cing ed bieu hipn tdng dpng sd ciia nhihig so lipu Milbcrger vii Theo Ross hinh vi tdng dpng ed the dupe cpng sg: dd gia thuyet rdng hut thuoc d md hinh hda tu hdnh vi cua bo m? hay ngudi me cd the inh hudng den he thdng anh chi em rupt Mdi quan he bd me tiet dopamin ciia bio thai dang phit trien eai li mdi quan h? hai chieu Chi can Cic nhi nghien cim eung ehi rdng, bo m? cua nhimg tre ADHD nhieu nguy CO cho tre tiep xuc vdi thudc la mpnh lenh \a cd nhihig tuong tdc tieu trudc sinh lim cho tre mie ADHD eye \di ire thi chung se bieu hien it phuc cao gap 2,4 lan, tiep xiie vdi dpe to chi tiing menh lenh han \a cd nhiing tucmg lam cho tre mie ADHD cao gip 2,3 lin, neu tre tiep xiie ci hai ddc td thudc li \ ;i tie tieu cyc hem vdi bd me [7] 5, Nghien eihi ADHD di kem edc hoi chi trude sinh se Idm cho tre mdc phii chung khac benh ADHD eao gip 5.5 lin so vdi tre Hdu het cic nghien eim cho thay binh thudng 60-70% tre ADHD cd rdi loan khie di M Beiser, R Dion, A (iolowiec kem hodc phii chung sdng tinh (2000) phin tich cae sd lieu tren 1555 tre trang ciia nhieu logi tgt khie Nghien ciru li din ban xir va 489 tre nhap cu d Bac cua Szamari, OITord va l!o\ le (1989) cho Mt, Greenfield (2003), cic tic gia cho ket qua nhu a bang sau diy: thiy yeu to vin hda nhu ngdn ngii, giii trj niem tin tru\en thdng, tip qudn vi tin Bdng Tie ADHD cd kem rdi loan khde TT So rdi loan di kem ADHD 34 Cd rdi loan Cd rdi lo^n Co roi loan Tilf % 44 32 11 Tgp chi KHOA HQC DHSP TPHCM Pliffner vd cpng sy (1999) nghien euu tren 111 Ire ADHD cd ket qua tuang tu Vilens va nhiJng ngudi khde (2002) eho rdng 75% tre trude tudi hpe va 80% tre d tudi hpc cd it nhdt mpt roi logn khac di kem Cde nghien ciiu cho tha\ roi logn di kem ADHD thudng la ede roi logn chdng ddi (Oppositional Defiant Disorder ODD), roi logn cu xir (Conduct CD), roi loan hpe lap Disorder (Learning Disorder - LD) Trong cac trudng thong 70% hpc sinh ADHD cdn phdi gido dye ddc biet so hpc sinh cd khd khan \e hanh \ i cdm xue eung luang duang sd hpc sinh eo kho khan ve hpe [8 tr 184-200] Nghien ciiu ciia Satterfield & Sehnell (1997) eho thdy tre ADHD co rdi logn hdnh vi (Behaviors Disorders), khodng 54-67% tre tuoi dupe gdi den kham lam sang eo ADHD va cung dupe ehan dodn cd rdi loan chong ddi, 20-50% tre 8-9 tuoi va 44-50% tre d tudi vj thdnh nien ADHD cd rdi loan cu xii di kem Theo Cooper va Billon (2002), tre ADHD CO roi logn chong doi, roi loan cu xir hoac kho khan ve hpc (Learning Difficulties), kho dpe (Dyslexia), roi logn ldi noi vd ngdn ngii (Speech & Language Disorders), roi loan dong van (Dyspraxia), tinh todn (DyscalcuMa), kha nang phoi hop tay mat, viet, trang thai suy nhupc va lo au, am dnh, ties (may giat co), kho ngii va hpi ehung Toutette (may, giat van dpng va it nhdt ed mdt tat phat dm, Georges Gilles de la Tourette, ngudi nhdn hpi chimg nay), phd ly ki LS Thi ^i"ft f^ff Asperger, khd ndng ty dieu hda cdm xue, kho ty qudn li thdi gian va kl hoach hdnh dpng, cd van de giao tiep vdi ngudi xung quanh Han 50% Ire ADHD cd van de bpe lp edm xiic va kT ndng xd hpi [12 tr.l3] Theo Fintan O'Regan (2002) khoang 50-70% lie ADHD khdng/it bgn, 70-80% suy yeu kha ndng lao dpng, 4050% sC tham gia vao ede hogl dpng ehiing doi xd hpi, bi nhieu tai nan han va phdng xe nhanh han, de ed nguy co sir dyng chat gay nghien d tuoi \i nien va de CO hanh dong pham toi d tuoi trudng [6] Ngoai ra, tre ADHD cung gap kho khdn ve giao tiep vdi cdc ban ciing tudi, kem cae kl nang xa hpi va ty dieu ehinh cam xiie [10, tr.385] Nghien ciiu ciia D R Blachman va S Hinshaw (2002) nhan thdy tre ADHD khd dupc ban be ciing lira chap nhan hem Nghien ciru eiia Milieh Balantine L\nam (2001) eho thdy khodng 10-40% tre den kham ldm sdng ADHD co roi logn lo du, tram cdm Su hien dien ciia rdi loan lo au cd khuynh hudng lam giam di cudng dp ciia nhijng hanh vi gdy hdn va it boc dong hon Tre em thudc loai kem ehii y thudng eo roi logn lo au di kem han [6] G J August va cdng sy (1996) nghien ciru cac roi logn kem theo d 204 hpe sinh tilu hpc ADHD [10, tr.384387] Ket qud dupc trinh bay d bieu sau day: 35 JU jy nurri AU T?p chl KHOA HOC OHSP TPHCM Biiu dd I Tie ADHD cd niQl so rdi logn di kem Cac nghien euu khie cung cho thay ti rdi losin khieu khieh chong doi dao dpng tir 41-93"o va idi loan lo iu hay roi lo?n cam xuc tit 13-51% (Burt, Krueger, McGue, & laeono, 2001; I'oniess, Kavale, & San Miguel 1998; Jensem Martin & Cantwell, 1997; Jensen, Shertvette, Zenakis, & Ritchters, 1993) 65%> phu huynh ed tre tir 6-13 tudi bj rdi loan cim xuc bao cio rdng hp bi ADHD [9] ADHD vd khd khdn ve h(>c: R Delong (1995) dd nghien cihi tre rdi lo?n ADHD 6-9 tudi d Phdp, theo dng khoang 41 -80% sd tre ndy cd roi l o ^ hpe tap Mpt nghien cim khde ciia M Touzin va cpng sif (1997) tren 350 tre em 4-16 tudi t^i khoa Tdm bfnh tre em ciia b?nh \ len Robert Debre tai Phdp, ket qud dupc trinh bay d bieu dd dudi ddy: |2] Biiu dd Z Tre ADHD cd khd khdn ve hQC Theo Barkle.\ khoang 35% tre ADHD bd hpc trudc ldp 12, 58% luu ban it nhat mdt ndm, ti le tre ADHD bi luu ban, dinh ehi hpe tip, dudi hpe gip ba lin tre binh thudng Mpt nghien ciru khac ciia DuPaul & Mc Murray (1990), Barkley (2003), cd 20-25% tre ADHD cd van de vdi cic mdn Toin/ Tip doc/ Chinh ta, khd khan dieu hpp van 36 dpng tinh \ a van dpng thd, ngdn ngii dien dat kem liru loat, yeu ndng hoach dinh \a td chirc |22 tr 184-200] Nghien cim ciia Brown, hpe vien sue khde tam thdn Hoa Ki (1999) cho thdy gin mot phan ba so tre ADHD cd kem vdi chimg khd hpc, hoic rdi loan dpe (August va Garflnkel, 1990) Mpt nghien cim khie cung khdng dinh tren 25% tre ADHD co Tgp chi KHOA HOC BHSP TPHCM khiem khuySt die bipt rd r?t vS hpe tip [12, tr 384-385] Cdc tdc gid Hynd vd nhihig ngudi khie (1995), Riccio vd nhimg ngudi khie (1996, 1998) dd nghien ciru so sdnh mpt nhdm tre ADHD khdng cd bieu hi?n lam sing vi mpt nhdm tre ADHD ed bieu hipn lim sing ve khd hpe Thep do, nhimg tre ADHD khdng cd bieu hien ldm sing ve khd hpc U Thi Minh Hi thudng khdng ehii y den nhOng ySu ciu chi tijt ciia bii hpc, lim sai dp bit cin, thudng trinh hoic khdng thich nhOng vipc ddi hdi phdi tri sy no lyc chu y [10, tr 305] Nghien euu eiia Fitan O'Regan dgy hpc vd qudn li tr6 ADHD (2002) dupc trinh biy d bing sau diy: Bdng Tre cd rdi logn ADHD vol cdc vdn de a Iritdng h