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Attention deficit hyperactive disorder or ADHD is erroneously considered to be a 20th century phenomenon affecting mainly children from developed nations. Actually, it was first described in 1845 by a psychiatrist in a boy called â€œfidgety Philipâ€. Today, the worldwide incidence is 3-5 per cent, irrespective of nationality. In referral paediatric clinics, it is as high as 15.5 per cent. The average age at diagnosis is eight years with a 6:1 male-to-female ratio.
Children who have the hyperactive impulsive type of ADHD are unbearably fidgety, restless and impatient, always running, jumping, climbing and blurting out inappropriate comments. They often receive corporal punishment from frustrated parents and teachers. Others, with the inattentive type of ADHD, are dreamy and bored, with difficulty in paying attention, learning something new or completing a task. Homework becomes a particular problem, with assignments forgotten, books misplaced and the final unsatisfactorily completed task full of erasures and errors.
Around 40 per cent of children with ADHD (especially boys) are argumentative, defiant, stubborn, non-compliant and belligerent. They lie, steal, fight, bully others, have temper tantrums and engage in vandalism. Eventually, as teenagers, they may gravitate towards drugs and alcohol.
To make a diagnosis of ADHD:
* The symptoms should have set in before the age of seven years and have lasted for at least six months
* They should cause difficulties in the childâ€™s life, in school, at play, at home, in the community and in social settings
* The changes should not have been precipitated by a sudden traumatic event like the death of a parent
* There should be no diagnosed medical ailments like seizures, middle ear infections or a learning disability to explain the symptoms.
Society often finds fault with the parents of children with ADHD. They are criticised for faulty nurturing and lack of parental discipline. But parents are actually helpless, as ADHD has a genetic and neurobiologic basis. Scans have shown that the frontal lobes, temporal grey matter, caudate nucleus and cerebellum of the brains of these children are 34 per cent smaller than normal in volume. Also, the brain has lower levels of a signal-processing chemical called dopamine.
The exact reason for these changes is not known. However,
* ADHD runs in families. About 25 per cent of the close relatives of ADHD children also have similar disorders as opposed to 5 per cent in the general population
* Women who smoke and drink during pregnancy have a higher incidence of children with ADHD
* High blood lead levels have been demonstrated in some children with ADHD. This, however, is not a consistent finding
* A sugar high has been blamed for some of the symptoms. This is a label for the increased level of activity following the ingestion of highly refined sugars or carbohydrates, which enter the bloodstream rapidly and produce fluctuations in blood glucose levels. This is particularly true if (as in the case of cola drinks) the food also contains caffeine (a stimulant) and food additives. Diet restrictions reducing the quantities of such food help in some cases.
Children with ADHD hate change in any form. They need a scheduled, regimented life with the same routine every day. All their belongings should also be organised and kept in specific places. With structured care, these children show a great deal of improvement and are able to integrate into society. About 30 to 70 per cent of children with ADHD continue to have symptoms in adult life. Academic excellence â€” a prelude to higher studies and a good job â€” may remain elusive. This is aggravated by poor social skills. They remain easily distracted, hyperactive and impulsive and have difficulty with deadlines, prioritisation and social engagements. Decision-making is an almost insurmountable hurdle. They also have problems holding down a steady job. Many are able to function on computers and are intelligent enough to do programming and other jobs which do not require social interaction. Around 80 per cent need to continue to live with parents or siblings.
Some children do not improve despite psychotherapy and a structured environment. They require medication with mental stimulants like methylphenidate and atmoxetine. They do well if they take their medication, which may need to be continued into adult life.
Competition is fierce in India, for education, jobs, promotions and success. Reservations and capitation fees are a way of life. In this scenario, parents may find it difficult to cope with a hyperactive, inattentive, disobedient and impulsive child who does not conform to social norms.
It is often difficult for the parents to accept that their child has ADHD. They feel depressed and guilty, even though it is not their fault. And despite all folklore to the contrary, an arranged marriage to an unsuspecting spouse does not cure the problem.
Source:The Telegraph (Kolkata, India)