Sunday, 05 December 2021 | Dr Sona Kaushal Gupta | Dehradun

A distraught parent tells me about his son when he brings him for a session of counseling, “My nine-year old son keeps running around the house the whole day and does not sit still even for a moment. He is restless at home and even in school, and his teachers use to complain about this when he was attending school.Now that he has online classes he hardly focusses on his work and we have to force him to sit down and attend his class otherwise he quickly leaves his chair and starts running here and there. He does not concentrate or complete his homework and leaves it incomplete. He gets angry very fast and is very impulsive. He speaks out of turn and does not let us complete our sentence.He does not focus even on his game when he plays with other children and picks up a fight with them very fast.”

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and may prolong into adulthood. It consists of a triad of symptoms and mainly includes difficulty in sustaining attention, hyperactivity and impulsive behaviour. ADHD symptoms usually start before 12 years of age and in some children, they’re noticeable as early as three years of age and occur more often in males than in females.

ADHD can be of three sub types. Those who suffer from the predominantly inattentive sub type are usually inattentive and their parents and teachers complain that they do not pay attention to what they are doing and make careless mistakes. They lack focus and it appears as if they are not listening. They have difficulty in following instructions and fail to finish their schoolwork and other chores. They have trouble in organising their work, doing their homework and keep forgetting and losing their things such as their toys, assignments, pencils etc

In the predominantly hyperactive/impulsive sub type, majority of symptoms are hyperactive and impulsive.Such children are very fidgety and keep tapping and wriggling in their seat. They hardly sit and keep running around and look as if they are on a constant go. They talk too much and often speak or act out of turn. They interrupt and intrude others play or conversation and cannot wait for their turn- they are hardly ever quiet.Parents complain that it feels as if they have to deal with a swirling high speed tornado and they  feel drained out. The combined sub type is a mix of inattentive symptoms and hyperactive/impulsive symptoms

However we should not be very quick in diagnosing children as ADHD. It is seen that many healthy older children or teenagers may be inattentive, hyperactive or impulsive at one time or another. All this also depends on their interest and understanding. Preschoolers may also have short attention spans and keep shifting their focus from one activity to another. Young children are naturally very energetic and some may naturally have a higher activity level than others. If children have problems in school but get along well at home or with friends or some  children are hyperactive or inattentive at home, but whose schoolwork and friendships are good then we need to look for other issues which may be affecting such children.

What exactly is the cause of ADHD is not clear, and the research continues. However some factors that may be involved in the development of ADHD are genetics, the environment where the children grow upor some problems with the central nervous system during the developmental stage. ADHD cannot be diagnosed by any single test and it requires  a mental health professional, like a psychologist or psychiatrist, or a pediatrician to do so. It has been seen that many other behavioural and psychological problems like sleep disorders, anxiety, depression and certain types of learning disabilities can also have similar symptoms.

Here are the criteria to diagnose ADHD.But these are presented just for your information. Only trained healthcare providers can diagnose or treat ADHD.

Inattention- Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least six months, and they are inappropriate for developmental level. The patient often fails to give close attention to details or makes careless mistakes in schoolwork, at work or with other activities. He has trouble holding attention on tasks or play activities, often does not seem to listen when spoken to directly, often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace and has trouble organising tasks and activities. The patient often avoids, dislikes or is reluctant to do tasks that require mental effort over a long period of time, frequently loses things necessary for tasks and activities, is often easily distracted and also frequently forgetful in daily activities.

Hyperactivity and Impulsivity- Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least six months to an extent that is disruptive and inappropriate for the person’s developmental level. The patient often fidgets with or taps hands or feet, or squirms in seat, frequently leaves seat in situations when remaining seated is expected, tends to run about or climb in situations where it is not appropriate, is often unable to play or take part in leisure activities quietly, is often “on the go” acting as if “driven by a motor”, frequently talks excessively, tends to blurt out an answer before a question has been completed and often interrupts or intrudes on others.

In addition, the following conditions must be met. Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities). There is clear evidence that the symptoms interfere with or reduce the quality of social, school or work functioning. The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The remedy is psychotherapy and sometimes medication for the patient.
(The author is a neuro psychologist & founder of a crisis helpline. Views expressed are personal)

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