Attention deficiency disorder: Treat, don't beat

Sometimes children with an attention deficiency disorder just need the right kind of attention.

Imagine driving a car with your foot on the accelerator but there are no brakes. Try and feel the panic and the absolute lack of control over what will happen. Now imagine feeling like that all the time. This is the simplest way to understand what goes on inside the brain of someone with Attention Deficit/Hyperactivity Disorder (AD/HD) — a condition that manifests itself as a poor attention span, increased activity and impulsivity.

“He is bouncing off the walls, he cannot sit still, he goes up and down the stairs a thousand times a day, jumps off the sofa or bed,” says Faiza, who’s son has AD/HD. “He does not pay attention to homework and needs constant redirection to do anything. He does not listen to me when I talk to him. He is an intelligent kid but does not live up to his potential,’’ she says describing her eight-year-old son Musa’s behaviour to the doctor. These are some of the common complaints from the parents of children diagnosed with AD/HD.

AD/HD is a neuro-developmental disorder, with both genes and environmental factors linked to its development. Different studies have shown that five to ten per cent of the American population has AD/HD. In Pakistan, the disorder is grossly undiagnosed, under-diagnosed or misdiagnosed with most young patients suffering from verbal and physical abuse by their families, peers and teachers. The untreated or under-treated AD/HD, can take a significant toll on the life of the person and society.

If untreated, some of the children have greater chances of developing adult AD/HD with more symptoms of inattentiveness, forgetfulness and difficulty in organising tasks. These are the people who often lose their cell phones or keys and miss appointments. They are always on the go and feel an urge to keep themselves busy and find different things at home to fix. They find long conversations boring, and relaxation, even on a vacation, a difficult concept to grasp. However, it should be kept in mind that not every person who is active, disruptive and inattentive has AD/HD. To be absolutely sure, one needs a clinical diagnosis that involves examinations and collateral information with extensive personal histories.

The treatment for AD/HD is multi-tier, and a comprehensive approach is necessary for symptoms control with a psychiatrist, therapist, parents and teachers taking part by forming a team. Psycho-education covering the diagnosis, treatment and prognosis should be provided. A child psychiatrist should monitor medication (which have established their effectiveness in clinical trials), whereas a therapist should teach the child to behave differently in difficult situations. Similarly, parents need to be educated in effective parenting skills that include setting of boundaries and rewards for better behaviour. The treatment should be revisited at appropriate intervals and frequent feedback from all members of the treatment team should be incorporated before deciding what to do next. Physical and verbal punishment has a counterproductive effect on the treatment and should be avoided.

Unfortunately, there is a scarcity of child psychiatrists in Pakistan. According to the World Health Organisation, there are only 320 psychiatrists in Pakistan to deal with 176 million patients. There is a pressing need for psychiatrists, pediatricians and general practitioners to learn more about AD/HD in order to provide diagnosis and treatment. It is often the right help at the right time that can draw the dividing line between a jail and a job for these patients.

Published in The Express Tribune, Sunday Magazine, December 8^th, 2013.