A preschooler who tears through the house like a tornado, a 4-year-old who talks incessantly and blurts out the answer even before hearing the full question, a 6-year-old who butts into a game and is surprised when the others reject him, an 8-year-old day-dreamer who is never able to find her homework folder, and is unable to focus for long on a task, shifting from one unfinished task to another… they are all different children, yet each could be having Attention Deficit Hyperactivity Disorder (ADHD). ADHD is the most common, yet most misunderstood of all childhood psychiatric illnesses.
Parents feel guilty when they receive repeated calls or notes from their child’s teacher saying that he can’t sit still, his behaviour is disruptive, or that he is inattentive and disorganised. ADHD is a complex disorder, often misdiagnosed. There is a great deal of confusion about where to draw the line between typical childhood behaviour and that which signals a clinical condition requiring treatment.
“Youngsters with ADHD have problems that show up more often, last longer, and are more intense than those observed in the average child,” explains Dr. Rakesh Ghildiyal, Professor and Head of Psychiatry, MGM Medical College, Navi Mumbai. If his behaviour lands him frequently in trouble at home and school, then it’s important to find out why, the sooner the better.
Difficulty with academics
“Kids with ADHD act without thinking, are hyperactive, and have trouble focussing. They may understand what’s expected of them but have trouble following through because they can’t sit still, pay attention or attend to details,” says Dr. Anjali Chhabria, Mumbai-based Consultant Psychiatrist. Not all affected individuals manifest all the symptoms of the behaviour subtypes associated with ADHD. But usually children with ADHD are found to have difficulty with academics, and emotional and social functioning. A diagnosis is made bearing in mind three factors — symptoms, dysfunction and duration of the child’s behaviour. “The symptoms of hyperactivity and inattention should be present in more than one setting (school and home) and should persist for a longer period of time, six or more symptoms of hyperactivity and impulsivity should persist for at least six months and behaviour found inconsistent with the developmental level required to diagnose ADHD,” says Dr. Ghildiyal. The child’s behaviour must fall in one of these subtypes before age 7. Doctors and therapists rely on a comprehensive developmental history, detailed questionnaires and rating scales to assess a child’s behaviour and level of impairment over the years.
The unusual behaviour can be linked to stress at home. Kids from a broken home, who have been through illness, a change of school or other significant life event, may suddenly begin to act oddly or become forgetful. To avoid misdiagnosis, it is important to consider whether these factors have played a role in the onset of symptoms.
Boys are more likely to be diagnosed with ADHD though no one knows if the problem is more common among them. But the disorganised quiet girl is often overlooked even though her ADHD may be just as severe as that of boy bouncing in his seat beside her.
“Since ADHD children are impulsive, they are very curious. They like experimenting with new things without being aware of the dangers. These kids are more likely to resort to drugs, smoking and alcohol early in life,” says Dr. Chhabria. They are often reprimanded in school and at home because of their disruptive behaviour. This lowers their self-esteem and they develop negative feelings. As they have difficulty controlling their behaviour, they are unable to focus, or focus so intensely on specific details that they miss the bigger and more important picture.
“The good news is that with proper medication and behaviour therapies kids with ADHD can learn to manage their symptoms,” says Dr. Ashok Tapaswi, a Mumbai-based child specialist.
Different therapies
“In India, we rely more on different kinds of programmes to treat ADHD kids. However, the programme as well as its duration differs from one child to another,” says Dr. Chhabria. Alternative treatments such as special educational interventions, diet manipulation, visual training, allergy treatment, and attention training are some steps to help kids stay organised and improve their concentration. There’s growing evidence that parents working with the school can help rein in their child’s behaviour. Dedicating a specific time and place for homework, creating a checklist every day, using a planner to track assignments and taking time to review homework are some ways to help kids cope.
Children outgrow ADHD by the time they are16-18. Hyperactivity diminishes with age but symptoms of inattention tend to remain constant. Although it can be a challenge to raise kids with ADHD, it’s important to remember, they are not being difficult on purpose. Parents should take advantage of the support and education facilities available to help children with ADHD achieve success.
