Aadhya was a very active baby, walking at nine months and always on the go. Her parents thought their “nonstop baby” was simply very independent. But then the problems started.
First, was Aadhya’s refusal to stay in her car seat. She would scream until we took her out of it.
When Aadhya was 3, she was climbing out of her baby cot at all hours of the night. Put to bed regularly, at 7pm, she would stay awake until 1 am and be up again at five.
Over the next few years, a pre-school found Aadhya’s behaviour so disruptive that her parents were asked to keep her at home; baby sitters refused to go to the house.
As a seven year old, Aadhya raced around the room at play while the other children were sitting in a circle. She was always in motion at school, squirmming, putting her hair band on, taking it off, going to another child’s seat.
By the time she was eight, her parents were convinced that Aadhya was not just high strung. Something was wrong. Her teacher agreed and recommended a medical assessment.
As Aadhya’s pediatrician, I asked her parents and her teacher to complete questionnaires used to screen children for a condition known as attention-deficit-hyperactivity disorder (ADHD).
Experts generally estimate that three to five percent of school age children have this disorder. These youngsters are easily distracted. They don’t shout out the sights and sounds around them, and they have great difficulty focusing on a task at hand, such as schoolwork.
The descriptions of Aadhya’s behavior contained in the questionnaires from her parents and her teacher were typical of ADHD. Aadhya began a two week trial of Ritalin, a stimulant that, ironically, has a stabilizing effect and allows the child to focus on the activity at hand.
There was an immediate and dramatic change in Aadhya’s behaviour. “All of a sudden, we had an even-keeled daughter,” her mother says, “We could even watch a movie together.” Aadhya’s teacher noted a tremendous improvement in her concentration and ability to finish her work. She continued to do well as long as she stayed on the medication, and she had no negative side effects. Indeed, Ritalin’s side effects are usually minor – such as some loss of appetite or difficulty falling asleep.
After a while, Aadhya was taken off medication. By age 14, she was thriving both socially and academically.
Not all cases of attention deficit hyperactivity disorder are as dramatic as Aadhya’s. But most school classes now include one or more children who have ADHD. Some ate being treated with medication, usually combined with behavior modification and special educational assistance to reduce hyperactivity and lengthen attention span.
Classroom measures to help ADHD youngsters perform better may include placing the child in the first row, where teachers can monitor behavior more closely and provide feedback, having the teacher ensure direct eye contact before giving instructions and establishing clear time limits for completion of each task.
It helps remove as many visual distractions as possible – even to the point of having the youngsters desk face a wall that is free of pictures and is away from windows.
Parents are advised that when giving instructions at home, they should have the child’s full eye contact, without distractions such as TV or radio. They are usually advised to give only one instruction at a time. Household chores and homework should have specific times allotted for beginning and completion, with regular praise for good performance.
The treatment doesn’t cure the problem for all ADHD children, but it significantly helps more than 75 percent of them.
Many parents have questions about ADHD. Is it a disorder or a disease? Or do these children simply represent one extreme of normal development – are they merely high strung kids? What will become of them in the future?
Recent findings suggested that the symptoms may be linked to imbalance of brain blood flow, chemical function and electrical activity between the right and left halves of the brain.
Preliminary evidence points to a deficiency in the availability of dopamine – “a chemical messenger,” or neurotransmitter – in the brains of children with ADHD. Medication seems to remedy this imbalance, reducing hyperactivity and improving attention span.
Studies indicate that between 20 and 32 percent of parents and siblings of ADHD children also have the condition. This strongly suggests that heredity plays an important role in the disorder.
Although ADHD symptoms tend to diminish as youngsters grow older, estimates are that 70 to 80 percent of affected children continue to show some symptoms as teenagers.
Long term follow up studies show that symptoms persist into adulthood in two thirds of the cases. Many ADHD children make a satisfactory adjustment in adult6 life, but there is no single childhood factor that allows for a reliable prediction of how a particular individual will do as an adult.
However, we find that many respond remarkably well to medication even though the condition has gone untreated for decades.
Although there is no single test that establishes a diagnosis of ADHD, there is agreement among experts as to the minimum criteria for such a diagnosis. Psychiatrists often require that atleast 12 or 18 symptoms be present for at least 6 months.
Where were hyperactive children decades ago, before terms like ADHD were introduced? Pscychologists and paediatricians will tell you that they were unrecognized or were categorized under labels such as “smart but couldn’t learn,” “daydreamers” or “lazy”
They will also tell you that classroom problems of a child with the disorder have been amplified by large class sizes, coupled with mainstreaming into regular classes of children with a a variety of problems, all of whom need individual attention.” As a result.” He says there is a risk that some teachers, in desperation may look to medication as first line treatment, when education and behavioral management are at least as important as pills.”
For medication to be considered, experts say the symptoms should be sufficiently disabling to leave little doubt about its need. Also a youngster’s response to medication should be dramatic to justify its continued use. And no child should ever be put on medication simply because parents have low tolerance for a normal, high-energy kid.
In the next few years, we will likely learn more about the genetics and the anatomical and chemical disturbances in the brain that cause hyperactivity. Meanwhile, parents of ADHD children should take comfort that most youngsters with this condition can be helped now to achieve greater success in the classroom, at home and in their adult lives.