Dr. Sudheendra

(mental health awareness series) The Child Who Does Not Sit Still and is quite a Handful. ADHD Attention Deficit Hyperactivity Disorder is the most common psychiatric diagnosis made in children. The two important components of ADHD are: - a) psychological inattentiveness and b) motor hyperactivity. The intelligence is typically normal. 3-5% of all children have ADHD and it is mostly diagnosed between 3-5 years of age. Most children mature out of it after adolescence, but some do carry it into adulthood. The three types of ADHD are a) predominantly hyperactive, fidgety type, b) predominantly inattentive, dreamy type and c) combination of both. The last is the commonest. Boys present more with hyperactivity and girls more with inattentiveness. As hyperactivity is more disruptive, boys are brought into treatment more commonly and earlier. Hyperactivity leads to disturbance at school and at home; and inattentiveness to not being able to concentrate and learn and a result lagging behind inspite of normal intelligence. The hyperactive child fidgets and squirms when seated. In class, he keeps moving from his seat on the pretext of borrowing things from his class fellows and every now and repeatedly asks for permission to use the washroom. These children have difficulty in engaging quietly in play or a leisure activity. They are always on the go and act as if ‘driven by a motor’. In a shopping mall sometimes, we see a five-year-old going up alone in an escalator chased by a harried mother several steps down. The mothers typically are anxious and thin from all the running around. The children often walk in the direction of blinking lights or any source of excitement and are liable to get lost. The predominantly ‘in-attentive type’ children fail to give full attention to details and make careless mistakes in schoolwork and homework. The child has difficulty in sustaining attention in tasks, often does not seem to listen when called, even when sitting next and seems forgetful in daily activities. However, memory itself is normal. To recall something from memory the event must be first registered. If at the time of the event, the attention is somewhere else it does not get registered and so cannot be recalled. In the caricature of the ‘absent minded professor’ the professor is not forgetful; he is just inattentive. Aggressive behaviour and conduct disorders sometimes supervene, in the hyperactive category and make the picture complex. The hyperactive kid get into fights, beats, and get beaten. I saw a kid years back, who to keep himself away from fights, would kill insects and lizards and pin those to curtains, spooking the parents. ADHD is now believed to be a neuro-developmental illness with a delayed maturity of only certain functions. Environmental factors like a chaotic childhood with a lot of people coming and going have also been cited as a factor. Most of us, when sitting in a restaurant and absorbed in a conversation, are oblivious of the sounds and the activity around us and do not look up even if people pass by our table. Just for the sake of understanding, let us assume that this happens because our brain has some ‘gating mechanism’ which screens out these irrelevant stimuli so we can concentrate on the task at hand. In these children, to carry the analogy further these gating mechanisms develop late and till then, so to speak they are at the mercy of environmental stimuli, whether it is the sound of cutlery from a distant table or the entrance door opening. Treatment is with both medication and behaviour therapy along with parental counselling. Paradoxically the stimulants make these kids less hyperactive. It happens because the stimulants increase attention and concentration. That is why older students during exams take stimulants when they must study hard, in addition to for their alerting effect. Non-stimulant medications are also there. In adult ADHD the hyperactivity mellows down or turns into restlessness but the inattentiveness persists. Mind of these people, while listening to somebody even in a one-to-one situation. In adult ADHD the hyperactivity has mellowed down or it turns into restlessness but the inattentiveness persists. Mind of these people, while listening to somebody even in a one-to-one situation drifts off and after a couple of minutes when they manage to snap back have just a hazy clue of what was told. In managerial circles would be classified as having poor listening skills. However, they are aware of it; they just do not know it is a disorder. Their seniors put it down to carelessness. There is believed to be an association between adult ADHD and substance use disorders. Psychiatrists have been blamed by the Antipsychiatry lobby to “pathologize naughtiness in children, label it ADHD and give them medication un- necessarily.” However naughty or badly behaved children are different from ADHD children. They have a say in the matter, and they can behave well when they want to while children with ADHD cannot, even when they want to and sometimes during therapy, they tell you this with tears in their eyes.

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