ADHD stands for Attention Deficit Hyperactivity Disorder, which is otherwise also referred to as Hyperkinetic Disorder. A mere mention of this name in the western world is sure to send a shiver down every self-respecting parent’s spine, who is having to deal with a child afflicted by this condition. Even though it has been largely recognised, studied and commented upon in the west, it is increasingly making its presence felt in India. Gone are the days when it was attributed as a secondary condition to pre-existing neurodevelopmental conditions or indeed due to "poor parenting skills". It appears, these days that almost every child born comes with a pre-fitted motor of inexhaustible restless energy.
There are, of course, sceptics who question the very existence of this condition, often backed up by very sound reasons. However, present this theory to that mother whose recalcitrant brat is tearing up the living room with a vengeance, while she attempts vainly to restore sanity, and then don't be surprised if she turns at you with equal vigour! I have witnessed myself, in my own private practice, the carnage that a child with ADHD can inflict in the consulting room, while I was attempting to obtain a full history from the parents.
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 more affected and the role of diet is also said to be vital, as also other developmental disorders, such as autism and mental retardation. According to the International Classification of Disorders Version 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. 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, are some of the signs that usually raise the suspicion. 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. I have seen both adolescents and adults; sometimes well into their 50s exhibiting 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 have a paradoxical effect of reducing the hyperactivity and inattention. As with any medication, they are characterised by their own set of side effects, as well as unique dosage regimes, which are best decided upon by professionals in conjunction with the family, on a case-to-case basis. The role of psychosocial interventions in the form of reinforcement techniques, psychoeducation, and supportive psychotherapy 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, is also advocated by some authors.
However, I would like to finish on a positive note here, as 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 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, rather than falling prey to that all too familiar Indian parental expectation of academic perfection.
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