Nepal | October 30, 2020

Attention-Deficit/ Hyperactivity Disorder- Some common questions and their reliable answers.

Attention-Deficit/Hyperactivity Disorder Awareness Month

Dr Utkarsh Karki
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Not all children are intentionally mischievous, always naughty, or display certain behaviours on experiencing incompetent parenting. Those could be the symptoms of ADHD for which they need help and timely treatment.”

On the occasion of Attention-Deficit/ Hyperactivity Disorder (ADHD) awareness month, here are the answers to some of the commonly asked questions about the ‘disorder’.

What really is Attention-Deficit/Hyperactivity Disorder?

Attention-Deficit/ Hyperactivity Disorder is a common neuro-developmental condition with a childhood onset. It is important to understand that ADHD is essentially a set of behaviours that interferes with children’s development and functioning in various aspects of life.

The causes of ADHD are abnormalities in the structure, function and neurochemicals in the brain that impacts normal brain development, and there is delay in the normal maturation process of brain by three to five years.

This abnormality in brain development results in:

  • poor self-control and need for instant gratification

  • difficulty in sustained attention, forward thinking, planning and organization

  • poor sense of time

  • difficulty in managing one’s emotions and poor motivation.

The above set of difficulties results in significant negative impact in a child’s daily functioning.

Environmental risk factors for ADHD are smoking and alcohol consumption during pregnancy, stress during pregnancy, excess exposure to paint, lead poisoning, deficiency in vitamin B12, iodine, iron and in some cases child abuse and neglect, parenting style and extreme psychosocial deprivation.

How common is it?

Around five percent of children and three percent of adults are diagnosed to have ADHD. It is more common in boys than girls. There is no biological test for ADHD yet.

There are many celebrities with ADHD but doing exceptionally well in their field of work. Michael Phelps, swimmer and athlete who has won 22 Olympic medals, was diagnosed with ADHD at the age of 9.

Justin Timberlake, Grammy winning singer and actor also has ADHD.

What are the symptoms of ADHD?

It can present with symptoms of inattention or hyperactivity/impulsivity or both.

Inattention

  • inability to concentrate

  • tendency to be distracted easily

  • difficulty sustaining attention in tasks or play activities (e.g. during lectures, conversations or lengthy reading)

  • failing to complete tasks (e.g. starts tasks but quickly loses focus and is easily side tracked)

  • appears not to listen even in the absence of distraction

  • forgetful in daily activities and school materials, pencils, books, paperwork, keys, wallet)

  • difficulty organizing tasks and activities (e.g. messy, disorganized work, fails to meet deadlines, poor time management)

Hyperactivity and impulsivity

  • fidgety and unable to sit still (e.g. leaves his or her seat in classroom or office where sitting is required)

  • running and climbing where it is not appropriate

  • as if driven by an engine and always on the go (e.g. unable to be still for extended time as in restaurants, programs, meetings)

  • acting without thinking

  • trouble waiting his or her turn (e.g. while waiting in line)

  • often answers before a question has been completed (e.g. completes people’s sentences; cannot wait for turn in conversation)

Children are normally active, playful and fidgety, then why ADHD?

Children display hyperactivity, inattention and impulsivity quite commonly and do not necessarily have ADHD but if they are showing excessive levels of these behaviors, you start to think, “may be this is ADHD.”

ADHD is observable typically around the age of seven to eight at a point where demands of the school environment are starting to really make an impression on the child and when the formal education begins.

Not all children or adults with these behaviors have ADHD but if these behaviors interfere in everyday functioning and result in negative impact, for instance, on the child’s school performance, social relationships, peer interactions and on relationships within the family then it is a concern for which help should be sought.

In addition, the behaviors have to be present across situations, so not just at home, at school, not just in context of relationship with one person, like someone’s father, but also with friends.

Do children grow out of it?

Not really, it tends to continue in middle childhood, adolescence and then also in adulthood. As children grow, hyperactivity and impulsivity tend to decline, so it is often inattention that causes the most problems. However, the persistence of hyperactive/impulsive symptoms and impatience when waiting, can be particularly impairing for some adults with ADHD.

This disorder can continue in adulthood but the inattention is often experienced as excessive mind wandering and internal mental distractibility which could interfere with tasks such as reading, watching movies or following conversations.

Children as well as adults also experience difficulties in emotional regulation which means they often get easily irritable, frustrated or angry and they can also show marked mood swings throughout the day. In adults, it is commonly associated with suicidal tendencies, mood disorders, use of drugs and frequent road traffic accidents.

What are the treatment options?

First of all, we must understand that ADHD is completely treatable with different treatment options.

Depending on its severity treatment options are:

  • medications

  • environmental modifications with behaviour therapy or

  • a combination of both

In children with mild variety of ADHD, medications would not be indicated. However, for moderate to severe symptoms, medication is always the first choice of treatment.

Treatment should be strictly followed up under the supervision of child psychiatrist, psychiatrist and a clinical psychologist.

What about the role of diet?

The role of diet in ADHD is a very controversial topic. There is insufficient evidence for role of diet in reduction of ADHD symptoms. However, in some children, there could be a small reduction in their symptoms especially who have been tested for food intolerance for sugar, food colourings, food additives and preservatives.

In such instances, consultation with one’s paediatrician and dietician would be beneficial.

Lastly, ADHD is a very common problem in children with many treatment options but if not treated can lead to significant negative impact in a child’s life.

Dr Utkarsh Karki is a Child and Adolescent Psychiatrist at Child and Adolescent Psychiatry Unit, Kanti Children’s Hospital

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