Sunday, 4 May 2014

ADHD

ADHD, which stands for Attention Deficit Hyperactivity Disorder, also called Hyperkinetic Disorder, is increasingly being recognised as a clinical problem in India.  More and more parents, exasperated with having to deal with the lack of attention, misdirected antics, and poor scholastic performances in their little ones are visiting specialists to seek help.  Gone are the days when it was explained away as being 'just childishness' or something which could be set right with a couple of tight slaps.  In these days, when corporal punishment is looked down upon at all levels, there is a need for managing this condition differently, especially since excessive punishment could have a negative impact in the long run.

Parents reach a stage of desperation after trying to cope with the extreme recalcitrance exhibited by the children.  Poor parenting skills and excessive use of punitive measures, often to no avail, further compound the problem.  In addition, since almost every child born in this day and age appears to have a pre-fitted motor of inexhaustible restless energy, it augurs well for parents to be able to recognise the signs and symptoms of the condition and seek early help.
  
The origins of this condition, as with other complex conditions, is multi-factorial and does not depend on any one explanatory thought.  Genetics is said to play a role, as also upbringing, triggering that oft-repeated debate about nature versus nurture.  Boys are said to be more affected and the role of diet is also said to be vital.  Other developmental disorders, such as autism, mental retardation or specific learning disabilities may co-exist with the condition.  According to the International Classification of Disorders Version 10 (ICD-10), devised by the World Health Organisation as an aide to diagnosing disorders of the mind and body, three factors are considered in each child; inattention, hyperactivity and impulsivity, with certain number of symptoms to be present under each factor to make a full diagnosis of ADHD. 

The signs will be obvious right from the beginning to an observant parent or teacher.  The hyperactivity should be pervasive, that is, persistent in all situations; whether at home, at school or elsewhere.  In addition, the other recognisable signs include:

  • inability to sit still,
  • displaying a never-ending resource of often ill-directed energy,
  • destructive behaviour not amenable to suggestions or curbed by punishment,
  • failing to learn from previous mistakes,
  • poor attention and concentration and
  • a tendency to blurt out answers or interrupt other children at play or in answering.
These symptoms are contrary to the behaviour expected of the child whilst at school and hampers learning, often leading to several complaints from teachers to the parents.  These children may be either very popular due to their natural tendency to break the ice and make friends or very unpopular due to their irksome habit of getting into others’ way.

It is better to seek help and advice at an early stage as the condition, contrary to popular belief, persists well into adolescence and even adulthood.  Several individuals, sometimes well into their 50s exhibit signs of the condition, albeit at a subtler level.  Help is available in the form of medication, usually referred to as stimulants, which are actually variants of amphetamines and help reduce the hyperactivity and inattention.  As with any medication, they have their own set of side effects, as well as unique dosage regimes, which are best decided upon by professionals in conjunction with the family. 

The role of psychosocial interventions in the form of reinforcement techniques, proper education about the illness, and behaviour therapy is as crucial as that of any of the drugs.  Salt and sugar restriction, as well as avoiding foodstuff containing the additive, mono-sodium glutamate (MSG), is also advocated.  Some parents may find alternative modes of therapy such as Ayurveda and homeopathy more efficacious.


Finally, one should not make the mistake of labeling natural exuberance and assertiveness of a child as ADHD; what with opinions as to the very existence of the condition itself vary among professionals.  On a more positive note, it is not all bad news if your child has ADHD.  Even though academic performance may not be up to scratch, children with the condition can be very creative and more inclined towards sports.  Some of the best artists and sportspersons have had ADHD during their childhood, so it is important not to lose heart.  It may well be about channelising all this explosive energy in the right direction and allowing the child to express herself creatively or through physical activity, instead of laying excessive emphasis on academic perfection.