Understanding a condition that 5 out of 100 Australians are likely to have
We all know kids who always fidget, who are always on the go, who cannot wait for their turn, who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clear they are given, or who talk back abruptly at inappropriate times. Sometimes these children are pointed to as naughty or criticised for being undisciplined. Or sometimes mom and dad are blamed for their poor parenting skills. However, these are the kids who may have attention deficit hyperactivity disorder (ADHD), which makes it difficult for them to control their impulses. As a result, they can act or speaks abruptly without thinking the consequences of their action.
ADHD is a developmental condition which can cause poor attention, concentration and control of impulses. Kids with ADHD are generally very fidgety and are easily distracted and sometime can be disruptive in the classroom. It can affect children’s personal, academic and social life, and family functioning. With medical treatment, understanding and care, a child with ADHD can live a normal life. It is a very common condition and is Australia about 3-5 of every 100 children in Australia have ADHD. It is much more common in boys than girls. It affects children of all social, economic and educational background though it is more common in low socio-economic social state
Signs and signals
The signs and symptoms of ADHD typically appear before the age of seven. According to specialists before 6 years of age, it can be difficult to differentiate between ADHD and normal childhood behaviour. But if the problems persist for more than 6 months and are affecting the child across the board in multiple situations—at home, grandparents’ house, at school, at birthday party, and at sports it is more likely to be an ADHD rather than normal childhood behaviour. On the other hand, if the symptoms occur only in some situations, it’s probably not ADHD. It is important to understand where the child is struggling most—at sports, at school, socially, academically we can work together to find right solutions and capitalise on strengths.
There are three main features needed to diagnose ADHD—inattention, hyperactivity, and impulsivity. The presentation of ADHD in each child may be different and that depends upon which characteristics predominate. Child may have inattentive type, hyperactive type or both-combined type of ADHD. Children with hyperactive ADHD are easy to diagnose as compared to inattentive type. Children with hyperactive type ADHD constantly fidgets and squirms, has difficulty sitting still, playing quietly, or relaxing, moves around constantly, often runs or climbs inappropriately, talks excessively, may have a quick temper and Impulsive behaviour. The impulsive behaviour can cause poor self-control, poor emotional regulation leading to classroom disruption and aggressive behaviour, and they can be disrespectful. They interrupt conversations, invade other people’s space, ask irrelevant questions in class. It is difficult for them to be patient and wait for their turn.
‘Inattentive type’ is more common in girls and is often missed because these children are generally not disruptive in the class. Generally, there is a myth that all children with ADHD are hyperactive. In fact, only some percentage of children with ADHD are hyperactive, but many others have only attention problem with no associated hyperactivity. Children with ADHD, who are inattentive and not overly active, may have symptoms of day dreaming, forgetfulness, poor organisation, and easy distractibility.
Children with ADHD are often able to concentrate on activities they enjoy, which is against the belief that children with ADHD never pay attention and can never focus on task for long time. But they struggle keeping on focus despite all the best efforts, particularly when the task is not interactive and interesting. They usually have fleeting concentration and shifts from task to task very quickly without finishing first task. Children with ADHD may have fantastic concentration in 1:1 environment (at home) but they are not able to filter out the needed instructions in school classroom environment of 1:25 children. They have trouble staying organised, planning, and finishing projects on time. They frequently lose or misplace homework, books, toys, or other items.
As a usual childhood development by age four or five most children learn how to be respectful to others, how to follow instructions and wait for their turn. Generally, ADHD peaks symptoms peaks at 8-9 years of age but most children by the time they reach school age their ADHD symptoms are easily picked by the school teachers.
It is important to remember that mere symptoms of inattention, impulsivity, or hyperactivity do not mean that child has ADHD. There are many medical conditions, ranging from epilepsy, learning difficulties, and sleep disorders, to thyroid, bullying, anxiety, and depression. Also, life events-post traumatic stress disorder, divorce, disharmonic family environment can mimic ADHD.
ADHD children do have many day to day negative issues but there are many positive aspects of ADHD in children. Children ADHD are generally very creative and imaginative. They have multiple ideas in their mind and use their artistic brain in various fields and ways. They are generally full of energy and drive and they work hard to achieve their goal. Many of the ADHD children are high achievers at school. They may have gifted range of cognitive ability. These children are generally very entertaining, full of enthusiasm and rarely boring.
ADHD is generally a lifelong problem but it does not mean your child needs medication for the whole life. Some symptoms of ADHD like hyperactivity improve with the age, but overall it is unlikely your child will outgrow the problem. But with treatment-with medication or without medication child learns how to manage the symptoms best.
Symptoms of ADHD can cause many problems if not treated timely. Children may struggle in school, get into frequent trouble-multiple detentions, suspensions from school, and find it hard to get along with others or make friends. These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.
Back on track
But with right treatment and support, child can get back on track for success in all areas of life. There are many modalities used to treat ADHD. Medication though often prescribed for ADHD, may not be the best option. It is always good to discuss all the available options with your paediatrician.
Other effective treatments for ADHD may be to have a good understanding of disease by the whole family and school, and providing the child with behaviour therapy, support at home and school. Children with ADHD needs clear and short instructions rather than having multiple instructions. They need clear, simple and consistent structured plan of their day to day activities. They need clear communication of positive and negative rewards and consequences of their actions. Keeping the child busy with physical activities is another way of spending their extra energy. Maintaining good sleep hygiene is important and good quality sleep helps in reducing the symptoms of ADHD. Teaching social skills at home and school is very useful. Enrolling your child in Social Skill Group will add to their social skills.
ADHD does interfere with learning at school because these children cannot sit and listen, and cannot retain the academic information given at school. It is important to have meeting with school staff, paediatrician and psychologist to understand your child’ weaknesses and strengths and make strategies to work on weakness, and at the same time use their strengths as a weapon to encourage him.
The writer is a senior paediatrician, and Director, Western Specialist Centre