Mediscene

Spot it and you can curb it

By Smriti Daniel

Attention-Deficit/Hyperactivity Disorder is one of the best understood disorders in children, and if diagnosed in time can be treated successfully says Prof. Erantha De Mel

Prof. Erantha De Mel

The number of children with Attention-Deficit/Hyperactivity Disorder (ADHD) is steadily swelling in Sri Lanka and more and more families and young victims are engaged in battling it. This is taking a constant, pervasive and exhausting toll on their lives and well-being.

Prof. Erantha De Mel, President of the Institute of Psychologists in Sri Lanka says: "ADHD is on the rise in Sri Lanka. These days about a third of children are described by their parents as 'overactive' and 5-20% of schoolchildren are so described by their teachers."

ADHD is one of the most common psychiatric disorders among schoolchildren, he says, explaining that he has even heard of a single class having several such children.

While this knowledge is fairly widespread, what is much less known is the probability that, of children who have ADHD, many continue to have it as adults. Several studies done in recent years estimate that between 30 and 70 percent of children with ADHD continue to exhibit symptoms even as adults.

There is, however, a silver lining to this cloud. Prof. De Mel says ADHD is one of the best understood disorders. This is bound to be of some reassurance to parents and also children who have ADHD. For a child to pull out of the disorder takes time, patience and commitment. The key to success is identifying it correctly and well in time. Teachers play a particularly crucial role in this, says Prof. De Mel, because parents can sometimes be blind to an abnormality in their children.

Symptoms

The principal symptoms are hyperactivity, inattention and impulsive behaviour, says Prof. De Mel. The list would also include extreme and persistent restlessness paired with, academic underachievement and difficulty withholding responses. "All these symptoms vary with the situation (depending on the demands the situation may pose on the child's self-control), so you may find teachers and parents giving different accounts of the child's behaviour," he cautions.

"Children with the disorder are often reckless and prone to accidents," he says. "They may also have learning difficulties, which result in part from poor attention and lack of persistence with tasks." Tools get lost, anything that requires concentration and effort is avoided and easy distraction is the order of the day. If left unchecked, many such children become increasingly disobedient, aggressive and prone to temper tantrums which in turn make them socially clumsy and unpopular. Completing the vicious circle, low self esteem, mood fluctuations and depression are common among ADHD sufferers.

"The need for treatment of ADHD is heightened by evidence that children with the disorder are more prone to delinquency, accidents and substance abuse," says Prof. De Mel.

Is it really ADHD?

"It is important not to jump to conclusions and label a child as having ADHD," states Prof. De Mel. The only way to be sure is to have an experienced professional examine your child and give a diagnosis. "One must be very specific," he urges, "because many normal children may have these symptoms, to differing degrees, or the symptoms may be caused by another disorder."

The behaviours must create a real handicap in at least two areas of a person's life, says Prof. De Mel. This means that a child who shows some symptoms but whose schoolwork or friendships are not harmed in any way does not have ADHD. Nor would a child who seems boisterously active on the playground but functions well elsewhere receive an ADHD diagnosis.

However, there are other possible causes of ADHD-like behaviour. For example, a sudden change in the child's life -- the death of a loved one, parental conflict, underachievement caused by a learning disability, undetected seizures (such as in petit mal or temporal lobe seizures), other medical disorders or even simple anxiety or depression can be the cause, he adds.

When does it begin? It always appears before the child is 7 years of age. The behaviour may continue well into adulthood, by which time it is hopefully under control. "Most symptoms appear before the child begins schooling," he says. "Sometimes the child has been over-active as a baby, but more often significant problems only begin when the child starts to talk. He is continuously on the move, exhausting his parents."

ADHD can take different forms, explains Prof. De Mel, adding that both need equal attention. An impatient, hyperactive child who acts without thinking may be considered a "naughty boy", while a child who is passive or lethargic may be viewed as merely unmotivated. Yet, both may have different types of ADHD.

Causes

The first question any parent asks is why their child is having ADHD. The thought that they may be responsible can be a heavy burden to bear. However, Prof. De Mel explains that while the social environment and child rearing methods are important factors to be considered, so are genetics and neurobiological influences.

Generally when a child is diagnosed with ADHD, a parent will admit to having had similar problems, reveals Prof. De Mel. For the first time that may help the parent understand some of the traits that have given him or her trouble over the years -- distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in automobile accidents. Understandably, a correct diagnosis of ADHD can bring a sense of relief.

In addition to genetics, the use of alcohol and cigarettes by pregnant women, birth complications and high levels of lead in the bodies of pre-school children have also been associated with higher risks of ADHD. While environmental factors may influence the severity of the disorder, especially the degree of impairment and suffering the child may experience, such factors do not seem to give rise to the condition by themselves. Therefore, parents are advised to focus on looking forward and finding the best possible way to help their child.

Treatment

Behaviour modification techniques can work wonders in these cases, while drug therapy may not be needed, Prof. De Mel reassures. Part of the process is being fully prepared for adaptive and maladaptive behaviour, consistently praising the child when progress is made and using 'time-outs' to give everyone a chance to cool down. Punishment should be kept to verbal reprimands, he says.

Mastering all this requires the supervision of a trained and experienced counsellor, stresses Prof. De Mel. It is encouraging that the family and the child face a difficult but not an insurmountable task. For the child to achieve his or her full potential, he or she should receive help, guidance and understanding from parents, guidance counsellors, and importantly from teachers and other school staff.

"The child's teachers will need advice about management including remedial teaching methods," says Prof. De Mel, explaining that they may be fighting what has become a habitual pattern of behaviour with the child. "It must also be kept in mind that a hyper-active child exhausts his parents, and they too will need support from the start of the treatment."

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