Here’s what you didn’t know about ADHD

“As mothers, we are conditioned to have great expectations from our children,” says Madhavi Jain, a Mumbai-based homemaker. “Their health and their behaviour are an indication of our expertise, and we want everything to be perfect. Hence it is difficult to accept that something is wrong with our children.

Jain’s son was diagnosed with attention deficit hyperactivity disorder (ADHD) in 2002, when he was seven years old.

What is ADHD?

ADHD is one of the most common neurodevelopmental disorders. It is first diagnosed in childhood and often lasts into adulthood, says the Centres for Disease Control and Prevention (CDC), a US federal agency.

Though studies indicate that the overall worldwide prevalence of ADHD among children below 18 years of age is 5.29 per cent, many cases go undiagnosed until well into adulthood. 

Dr Vikram Jada, a Bengaluru-based consultant neuropsychiatrist, says ADHD is a complex disorder and can be of three types: hyperactive type (kids exhibit hyperactivity), inattentive type (kids are inattentive) or combined type (they show both the hyperactivity and inattentiveness symptoms). And the signs can be seen as early as six months, peak between seven to 11 years of age, and sometimes are carried into adulthood.

Hyperactivity manifests as restlessness in kids in multiple settings such as problems in conformity, problems at school, poor academic performance, disruptive behaviour, and frequent problems with discipline. Inattentiveness is exhibited through daydreaming and the inability to complete a task, says Dr BG Girishchandra, a consultant psychiatrist from Bengaluru.

Is ADHD hereditary?

Dr Girishchandra says the links between nerve cells in the human brain facilitate learning and adaptiveness. Disturbances in the brain development processes interfere with the connections between the nerve cells and myelination (covering of nerve cells with myelin, a thin sheath that enables them to transmit information faster), leading to ADHD.

“ADHD has a strong genetic predisposition,” says Dr Jada. “Most cases are inherited.”

Bengaluru-based consulting psychiatrist Dr Asifa Khaleel says ADHD can also be a result of birth trauma. If the mother faces complications during labour or if baby has had hypoxia (low levels of oxygen in the body tissues) due to the umbilical cord being wrapped around the neck or has difficulty breathing, he or she can develop ADHD.

The CDC lists brain injury, alcohol and tobacco use during pregnancy, premature delivery and low birth weight as possible causes of ADHD.

Accepting ADHD

Jain, the homemaker from Mumbai, says she kept getting calls from school every day that her son was very restless and destructive in class. “While I knew that my son was very naughty and aggressive since the age of two, I believed that he would settle down once he started school,” she says.

But things didn’t go as planned. The school’s management asked Jain to consult a psychiatrist and look for a special school for her son. “I was very upset on being asked to consult a psychiatrist just because my son was ‘naughty’,” she says.

Dr Jada feels that acceptance is one of the biggest hurdles parents need to overcome when it comes to ADHD. “There is a lot of denial among parents regarding their child’s condition,” he says. “Most families believe that ADHD is a ‘moral failure’, shows carelessness on the part of the child and can be contained by force and punishment.”

Dr Girishchandra feels it is either ignorance or the resistance due to social stigma that sends parents into denial mode. “Acceptance of the condition, early diagnosis and timely treatment can normalize the growth curve in children,” says Dr Khaleel. “The hyperactivity settles down with age in kids, but the inattentiveness that remains, if unaddressed, can lead to ‘conduct disorders’ and anti-social behaviour in adulthood.”

Moreover, only the very hyperactive kids get noticed and the inattentive types go mostly undiagnosed because their grades are good in the lower classes. It’s only in the higher classes when the syllabus complexity increases that these children face challenges and cannot cope. The high IQ in kids tends to mask ADHD symptoms, says Dr Jada.

Diagnosis

“A clinical assessment is required by experienced psychiatrists and paediatricians for an ADHD diagnosis,” says Dr Girishchandra.

Dr Khaleel advises intervention if the child’s hyperactivity or lack of focus is significantly interfering with his or her performance and daily routine.

The child’s condition is assessed by an ADHD rating scale, observation of their behaviour in multiple settings and the history shared by the parents. To rule out any learning disabilities related to writing or reading that sometimes come with ADHD, the child may be required to take a written test or go through an educational assessment, says Dr Khaleel.

Jain says the assessments were “long, tedious, and very emotionally and physically draining” in the case of her son. “Our life was put on hold,” she says. Jain also remembers the moment when the psychiatrist confirmed that her son had ADHD. “It was heartbreaking,” she says.

Treating ADHD

“Although ADHD is not curable, it can be effectively managed with parent management techniques, therapy and medication,” says Dr Jada.

ADHD children benefit tremendously from consistent, stable and positive reinforcement from parents. This includes spending quality time with the child, getting more involved in their routine, giving them adequate attention without overindulging, and avoiding penalizing them for behaviour beyond their control, he says. Therapy includes counselling, based on age and the severity of the condition, cognitive-behavioural therapy (CBT: a type of talk therapy to understand their emotions) and art therapy (to express their emotions better).

“However, if symptoms are very severe and the child is finding it challenging to stay calm and focus despite parental support and therapy, then medication can help,” says Dr Jada.

Dr Khaleel encourages parents to give one-on-one attention to the child and play various concentration-enhancing brain games with them in surroundings free from distractions.

“Introducing sports, physical activities and skill training as a part of the treatment helps significantly,” says Dr Girishchandra.

Jain’s son was prescribed medication to help him benefit from the therapies he was taking at a counselling centre in Mumbai. But he experienced a significant loss of appetite and had difficulty sleeping well, says Jain.

Dr Khaleel agrees that medications can sometimes have side effects like irregular sleep, loss of appetite, headaches, sedation and stunted growth. “Hence we advise taking breaks from medication over the weekends or during vacations.”

Fitting in

According to Dr Khaleel, children with ADHD fit in well in a normal school with a little extra support from the teachers. He suggests letting them sit in the front row and assigning simple tasks to them frequently, such as distributing notebooks or cleaning the blackboard. They should also be allowed to take a break or go for a walk if required, he says. Some schools even have a shadow teacher who gives personal attention to children with ADHD.

Only if the ADHD symptoms are severe and if the condition is accompanied by learning disabilities and mental retardation should parents opt for a special school, says Dr Khaleel.

“We opted for a normal school but with a lower class strength so that my son received the attention and patience he deserved,” says Jain, whose son is now 27 years old and an operations executive with an MNC.

“ADHD is not a disability,” says Dr Jada. “The academics get affected initially only due to the symptoms and not because the children are intellectually compromised in any way. Their creativity should be allowed to flow without restrictions, and they deserve the same love, support, and acceptance as the other kids.”