ADHD is the most common behavioural disorder among children with approximately 5-8% of children being affected at any point of time in India. A lot many times parents and teachers might come to their primary health giver with complaint of child not doing academically well or being inattentive. Would all of these children come under the category of ADHD.
ADHD may either present with:
1. Inattention.
2. Hyperactivity-impulsivity.
When should I suspect that my child has ADHD?
When the child has symptoms of either of the main presentations. Common symtoms are as given in the table.
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Inattention means child
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Hyperactivity-impulsivity means child
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a) Does not give attention to
details, makes careless mistakes in schoolwork.
b) difficulty sustaining
attention.
c) does not listen when spoken
to directly
d) does not follow through on
instructions and fails to finish schoolwork but not due to the oppositional
behaviour or failure to understand instructions.
e) has difficulty organizing
tasks and activities like arranging the bag.
f) avoids, dislikes, or is
reluctant to engage in tasks needing mental effort like school work
g) Often loses things like
toys, school assignments, pencils, books etc.
h) easily distracted and will
leave the work if the doorbell or phone rings
i) forgetful
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a) Often fidgets with hands or
feet or squirms in seat frequently.
b) leaves seat in classroom
with out any definitve reason.
c) Often runs about or climbs
excessively in situations in which it is inappropriate like in temples,
social gatherings etc. (in adolescents it may be limited to subjective
feeling of restlessness)
d) unable to play or engage in
leisure activities quietly
e) often “on the go” or often
acts as if “driven by a motor”
f) talks excessively &
blurts out answers before the question has been completed
g) Often interrupts or intrude
on others (e.g. butts into conversations or games awaiting turn
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ADHD – causation?
There have been various theories regarding the reason of ADHD, however none has been specified. Genetics, dietary and environmental factors do play a significant role.
Why is recognizing ADHD important?
It is often the high activity level, high disruptive behaviour, inability to utilize intelligence properly; academic underachievement and difficulty getting along with peers which makes early recognition and mangement of ADHD imperative. ADHD has few co morbid disorders like oppositional defiant
disorder; conduct disorder, depressive and anxiety disorders. These disorders if recognised early leads to early interventions which may lead to better management of child behaviour.
What the long term implications?
The disorder follows different course over the long run. Infrequently but possibly, it may subside on its own. In a large number, the inattentive symptoms continue in later life. The patient, if left untreated have high chances of mood disorders, drug dependence and anti-social personality traits in adulthood.
What are the treatment options?
Treatment options are pharmacological and psychotherapy. The medicine treatment is often combined with parents training and patients’ concentration building exercises,though children may have difficulty in sustaining attention during the psychotherapy sessions. The results of treatment are promising in the long run with substantial remission rates.
Contributed by:
Dr Rajiv Mehta
Consultant Psychiatry
Sir Ganga Ram Hospital
MD, Psychiatry
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