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Understanding the ADHD child

Careless mistakes, impatience and tantrums may point to a disorder, says Jitendra Nagpal

education Updated: Jan 06, 2010 10:34 IST
Jitendra Nagpal

At a parent-teacher meeting, Siddharth Singh was told that his 15-year-old daughter was highly distracted in class and paid no attention to what was being taught. Singh had heard this before, but this time, with her Class X exams near, he was worried.

Singh consulted a doctor and was shocked to learn that his daughter was suffering from a condition known as attention deficit hyperactivity disorder.

ADHD is a condition that becomes apparent in some children in the pre-school and early school years. Some symptoms may persist even in adolescence and adult life. It is estimated that 3 to 5 per cent of all children have ADHD. This means in a classroom of 25 to 30 children, it is likely that at least one or two will have the disorder.

This condition can affect a child’s life at school, within the family, with peers and also within himself or herself. The child may lose confidence and develop a negative self-image based on repeated struggles or failures.

ADHD was first described by Dr Heinrich Hoffman in 1845. A physician who wrote on medicine and psychiatry, Dr Hoffman became interested in writing for children when he could not find suitable material to read to his three-year-old son. The result was a book of poems, about children and their characteristics. The Story of Fidgety Philip was a lucid description of a little boy who suffered from attention deficit hyperactivity disorder.

What is ADHD?
All children are active, but a few are hyperactive. They may sleep only a few hours at a time. When awake, they are constantly in motion, darting from one activity to another.

How is the condition identified?
The child receives a diagnosis based on prolonged occurrences of eight or more out of a possible 14 symptoms before the age of seven. These are:
. Often fidgets with hands or feet or squirms in seat.
. Has difficulty remaining in seat when required to do so.
. Is easily distracted by external stimuli.
. Is always “on the go” or acts as if “driven by a motor”.
. Has difficulty waiting turn in games or group situations.
. Often blurts out answers to questions before they have been completed.
. Often shifts from one uncompleted activity to another.
. Often talks excessively.
. Often interrupts or intrudes.
. Often does not listen.
. Often loses things necessary for tasks or activities at school or at home.
. Often engages in physically dangerous activities without considering the
consequences.

What can a parent do?
A ‘behaviour checklist’ that provides information on types and severity of symptoms can help you make a management plan. Second, a thorough psychological screening of the case can be done at the nearest hospital or a child guidance centre.

What should the test include?
An evaluation must include:
1 A medical, academic and family history. This is done through a structured interview with parents or guardians.

2 Behaviour rating scales, ability tests, and observations from people who are close to the person being assessed.

What does treatment include?
A treatment plan needs to take a holistic view of the individual. Often, teacher training, parent training, family therapy, or individual counselling are needed.

Other components are a supportive environment, teaching the person organisational skills, memory skills, time management and making them aware about the physical setting in which they are most productive.

Does medication help?
Although medication can aid treatment for moderate to severe cases, it is only a part of the plan. Medication may help to increase the attention span and reduce hyperactivity. This facilitates the behaviour modification programme and acceptance of the child in family and society.

Deciding if and when medication should be stopped is based on the child’s ability to control his behaviour on his own. As he matures and becomes more aware of his behaviour, he may find himself more in control.

Do children outgrow ADHD?
The disorder may show diminished hyperactivity but attention span and impulse control problems may persist. If untreated, secondary problems may arise, including emotional distress, drug abuse, and so on. If properly treated, most individuals have productive lives and cope well.

The author is a senior consultant psychiatrist with Moolchand Medcity and Vimhans, New Delhi. Send him an email at hthorizons@hindustantimes.com, marked ‘Dr Nagpal’