Unusually impulsive, inattentive and hyper behaviour in children caught the eye of German physician Melchior Adam Weikard back in 1775 and led to the discovery of Attention Deficit Hyperactivity Disorder (ADHD). Ever since, research has furthered our understanding of this malady and how we, as parents, can cope with it.
Uzma Khalid found her son Usman’s behaviour overwhelmingly disturbing ever since he was a toddler. Easily angered by the most trivial of situations, Usman would oppose, deride, curse and physically abuse anyone who came in his way, regardless of where he was or who he was with. His performance at school was mediocre at best, with report cards replete with red marks and frequent warning letters issued by the school staff. “He put immense pressure on the whole household,” shares Uzma who had had enough by Usman’s 9th birthday and finally sought professional help on the suggestion of a friend. After rigorous assessment, the perpetually frustrated and displeased child was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Today, Usman’s fate is shared by almost 7% of children between the ages of six years and 12 years. ADHD has become the most common neurodevelopmental problem around the world. In fact, according to a survey conducted by pharmacy-giant Shire Pharmaceuticals in July 2014, these numbers might be underestimated. The study also revealed that most parents and teachers are unaware of ADHD altogether and often dismiss its symptoms as everyday personality traits. Dr Angel Adams, a London-based clinical psychologist and ADHD specialist, highlights the vague line between mental issues and the general attributes of a child, claiming that many patients go unattended due to this grey area and their parent’s inability to recognise the symptoms.
In general, unusually short attention spans, hyperactivity, impulsiveness and unruly and loud behaviour are indicative of ADHD in a child. Patients may resist learning, be unable to comprehend instructions and find it difficult to focus on a task, sit still or even hold back inappropriate comments. Based on a coalition of these symptoms, three forms of ADHD exist: the inattentive type, the hyper-activity impulsive type and lastly, a hybrid type that includes symptoms of the first two. What’s more is that these types may be exacerbated further in the form of other by-product problems like Oppositional Defiant Disorder, Tourette syndrome and other learning and anxiety disorders. “These symptoms can have detrimental consequences on a child’s social life, relationships and academic success,” explains Dr Adams. “As the child is told off often (due to their behaviour), the symptoms might trigger a vicious psychological cycle of trauma and insecurity.”
Modern research has focused on unearthing the underlying pathophysiology of ADHD to understand exactly what it might be that prompts these children to act out this way. Dr Russel Barkley, a psychologist and professor of psychiatry at The Medical University of South Carolina, reports that, “These children are unable to control their behaviour.” He further explains that neuroimaging techniques have elucidated a general reduction of brain structure in children with ADHD, including the cerebellum, frontal cortex and white-grey matter. Various circuitries in the brain have shown to be impaired. For instance, children with hyper-active impulsivity ADHD have reduced dopamine (a nuero-transmitter hormone) levels. Similarly, inattentive ADHD is characterised by less norepinephrine production (another nuero-transmitter hormone). Studies of the link between reduced brain volume and functioning revealed a positive correlation between the reduction and severity of the patient’s symptoms.
Nonetheless, it is equally important to understand the etiology of ADHD before it can be treated. Experts cite some external and internalised factors which could explain the occurrence of the disorder, such as genetics, nutrition and a child’s surrounding environment. Certain types of gene variations have been shown to be present in patients and a child with a relative suffering from ADHD is four times more likely to develop it himself. Inappropriate nutrition (increased sugar intake or lack of omega-3 fatty acids) have also been proved to trigger symptoms, along with smoking and drinking during pregnancy.
But, the occurrence of some symptoms doesn’t necessarily mean that a child has ADHD as many of them mesh with those of other disorders. If a child is, however, diagnosed with ADHD after assessment, a number of effective treatment plans comprising of psychotherapy and medicines are available. The two main types of therapy options are:
• Cognitive Behavioural Therapy (CBT): Based on the philosophy of thoughts, feelings, actions and physical sensations, this form of therapy is also known as ‘talking therapy’ and aims to understand where ADHD conditions arise. In general, CBT involves regular 30 to 60 minute sessions with a therapist who explores a child’s negative thoughts and behaviour and tries to rectify them.
• Behavioural therapy: Children with ADHD must be acknowledged for their good points regularly to boost self-esteem and positivity. The praise can be given via different creative means, such as star charts, small gifts or compliments.
When all else fails, doctors resort to medication to calm — if not cure — ADHD. Stimulant medicines like Ritalin and Adderal are prescribed to boost dopamine production while non-stimulant drugs like Strattera work on norepinephrine. Although these may not cure ADHD completely, they allow the patient to learn new skills and develop new, improved habits and help them concentrate better and control their impulses.
Unfortunately, much like any other medicinal treatment, these drugs pose certain side-effects which could hinder progress. Strattera, for instance, has been associated with severe consequences like liver injury, heart defects and even suicidal thoughts. Other common problems include headaches, insomnia, mood instability, nausea, vomiting and loss of appetite. Doctors might, therefore, try breaks in between treatment to ascertain whether further medication is needed or not.
Nonetheless, for treatments to work, support from parents is absolutely crucial. As world-renowned ADHD expert Dr Ned Hallowell said, “Parenting a child with ADHD isn’t a sprint but a marathon!” Strength, support and a whole lot of patience is necessary when dealing with patients, so much so that many hospitals around the world offer therapy for parents along with children. Books such as Parenting Children with ADHD: 10 Lessons Medicine Cannot Teach by Dr Vincent J Monastra and Super Parenting for ADD: An Innovative Approach to Raising Your Distracted Child have been published as guides for desperate parents.
Having an afflicted child is never easy. Parents must not only be patient with the child but remember to love and support one another as well to present a united front. More importantly, they must realise that the emotional turmoil and stinging regret that might creep up during a tantrum is absolutely normal. Some easy strategies for even the worst of fits which can make one feel less like a monster and more like parents include:
Discuss in detail: Explaining why something is wrong might encourage a child to refrain from doing it again. Apologies should be encouraged so that the child take more responsibility for their actions. If a child makes a mistake, parents should reenact the situation, doing it correctly.
Say it differently: Parents must keep in mind that different children respond differently and changing the way you speak to them might help. For instance, when giving them a task, phrasing it in two completely different tones will definitely get the message across.
Ground them reasonably: This is particularly important for parents dealing with troublesome teenagers. If the teen abuses a certain privilege (eg cellphones), it is best to remove the privilege briefly and make them earn it back via household chores or improved grades.
Look for a better way: Disciplinary moments can be made into learning opportunities by reminding children that everyone makes mistakes and there are better ways to deal with similar tensions in the future. Parents should brainstorm these ways with their child, making them think and develop their own ideas. In fact, every time things get tense and one feels the urge to yell, they should instead hold a private conversation with the child in a quiet room where no one will disturb them. This will cut off a possible unpleasant exchange which might be regretted later.
Take a moment: Simply counting to 10 before lashing out can save parents from a great deal of verbal negativity which will only worsen the situation.
The best discipline combines a stringent code of conduct with basic respect for a child. Experts encourage parents to listen to their children’s concerns and empathise with them rather than behave like a strict drill sergeant. It is also important for parents to remind their troubled little ones that no matter what happens, they will always be loved. Leadership and love are the two main pillars of effective parenting.
ADHD and drug abuse in youngsters
There is some scientific evidence which suggests that children with ADHD are more likely to develop substance addictions than undiagnosed ones. This is due to the constriction of brain pathways and loss of dopamine which are the main causes of the disorder. Drugs like cocaine, methamphetamine, ecstasy, nicotine, opium, marijuana and even alcohol spur dopamine production. Several studies have successfully correlated drug dependency with norepinephrine as well. Not to mention, patients of ADHD are generally more socially inept and relatively challenged in academics which encourages them to resort to drugs to alleviate their anxieties.
Children with ADHD are equally likely to excel
In a TedX session from April 2013, Stephen Tonti, a senior directing major at Carnegie Mellon University, introduced an interesting angle to ADHD. He proposed that it should not be regarded as a disorder but a cognitive difference as it enables one to hyper-focus on something that catches their attention. Having dealt with ADHD his entire life, Tonti believes that the disorder is not always reason enough to impede a patient’s academic and professional success. The ability to hyper-focus is common among most children with ADHD and according to Tonti, trying out different activities until a child finds the one that interests them the most can be very beneficial. Uzma Khalid, for example, reports that her son Usman has an exceptional talent for painting, despite his vexatious behaviour.
There is a large number of celebrities who have admitted to suffering from ADHD, including Maroon 5 frontman Adam Levine and popular comedian Jim Carrey. Billionaire and founder of the Virgin group Sir Richard Branson was also diagnosed with ADHD as a child. The success achieved by these personalities proves that having ADHD does not make it impossible to achieve excellence.
Published in The Express Tribune, Ms T, February 15th, 2015.