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ADHD symptoms and diagnosis

Unfortunately because of lack of awareness about Attention Deficit Hyperactivity Disorder parents seek professional help only when their children’s academic performance dips. All other problems are swept under the ‘bad behaviour’ and ‘indiscipline’ carpet – Aarti C. Rajaratnam

Anwar Kumar is a class VIII student in a private school in Coimbatore. His teachers know him as the child who is ‘always on the go’; he is constantly fidgeting, cannot sit still, and dislikes rules. But curiously although physically active, he hates sports and games. He also never plays by the rules and his peers shy away from including him in their teams. He has trouble making friends and often gets into ugly spats, dislikes fantasy play and insist on having his way even if it means hurting others. 

Nandini Raghupathi is also a class VIII student at an international school in Chennai.  She can complete her academic work only with support from the school’s remedial teacher. When writing a test/exam she often submits a blank paper because she forgets to check if she wrote on both sides of the paper. She says hurtful things to people and has no ‘filter’ when it comes to using foul language or information sharing. She is not accepted into adolescent cliques because her classmates feel she can’t keep secrets. Nandini repeatedly misplaces books and stationery items at school. Her mother never sends her out to the local store because she not only forgets what she has to buy and loses the money given, but also wanders away into neighbours’ homes within the large apartment complex. 

Anwar and Nandini both dislike tasks that require sustained mental activity, are forgetful, easily distracted, cannot wait for their turn in games and conversations, get into trouble because their teachers feel that they don’t listen when spoken to and often interrupt others and/or talk excessively and without direction. Both children are lost when executing tasks that involve multiple levels of organisation or instruction. 

All this is because Anwar and Nandini are suffering Attention Deficit Hyperactivity Disorder (ADHD). Anwar has the hyperactivity-impulsivity subtype of ADHD and Nandini the inattention subtype. Unfortunately because of lack of awareness about ADHD, parents seek professional help too late, only when their children’s academic performance dips. All other symptoms are swept under the ‘bad behaviour’ and ‘indiscipline’ carpet. ADHD children have problems managing executive functions — cognitive skills which facilitate critical thinking and self-regulation. Therefore they struggle to control impulses, sustain attention, regulate emotions, memory and cognitive flexibility. This adversely affects their social skills, capability to complete tasks, solve problems, manage time, manage information and emotional expression. 

Most medical practitioners prescribe drugs for children with severe ADHD, especially when the symptoms interfere with their safety because of inability to gauge risks and consequences. But drugs are not the entire solution. Supplementary sensory integration and occupational therapy are essential in the initial stages of treatment. This should be supported by activities to improve emotional regulation, academic and social skills. A remedial educator and speech therapist is usually required to support learning and speech. 

Sleep deprivation, gadgets addiction, diets rich in sugar and processed food, severe emotional trauma and abuse and insufficient outdoor play can also translate into ADHD-like symptoms in children. Moreover children with high intelligence, aka gifted children, and natural kinesthetic learners, also often exhibit ADHD symptoms. However, they don’t lack social skills and are capable of organising themselves to complete tasks. Children with gadgets addiction and sleep deprivation usually settle down when their basic physiological needs are met and children with emotional trauma usually bounce back in a supportive and therapeutic environment. Therefore a professional and correct diagnosis of ADHD is required before any therapy/treatment is prescribed.

(Aarti C. Rajaratnam is director of the Child Guidance Centre and Counseling Clinic, Salem/Chennai)

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