“I absolutely love my 4-year-old nephew but I cannot stand him for more than an hour!!” Said my friend ruefully when we were having a telephone conversation”. He cannot sit still, is constantly fidgety, often refuses to listen, interrupts me constantly, often is impulsive in his aggression and hurts his cousins without there being malice in his actions. I hate to say this but sometimes I actually tell his parents I am not at home when they want to come over with him!!”.
He was speaking of a kid who had been diagnosed as having the attention deficit hyperactive disorder, a chronic condition that has received a lot of flack in the media and by the anti-psychiatry brigade wherein there is an issue with concentration, restlessness and impulsiveness. It has nothing to do with intelligence so we have very bright kids who are having this issue, as well as those who may be low intellectually but then, not surprisingly, by and large; those with a higher IQ seem to do better overall.
ADHD begins in childhood and often persists into adulthood. Symptoms may be different as one gets older the adult may be mildly restless rather than hyperactive but there is a difficulty with maintaining relationships and coping with social and occupational situations.
Kids with ADHD often struggle with low self-esteem, troubled relationships, and poor performance in school. They tend to have more accidents and injuries of all kinds and are often not easily accepted by their peers and adults. They also are at increased risk of alcohol and drug abuse, and other delinquent behaviour.
Literature suggests that a diagnosis of ADHD may be associated with widespread changes in the brain macro-and microstructure, including the orbito-medial prefrontal cortex, right anterior cingulate, and the left fronto-occipital fasciculus. There also seems to be a reduction in brain size, and smaller brain volume, especially in the region of the amygdala and hippocampus, which are believed to be responsible for emotional processing and impulsivity. Dysfunctional brain connectivity is also implicated as is the deregulation of the dopamine system in the brain.
The treatment is with medication and behaviour therapy, as well as environmental control and parental/ teacher education. While a number of people are extremely against medicating kids who have ADHD, it is still the bedrock of all treatment and known to have produced wonderful results. This, of course, has to be done under the supervision of a psychiatrist.
Behavioural modification techniques are also useful to reduce environmental stimuli which can trigger off problematic behaviours.
I remember laughing when a bright kid with ADHD walked into my clinic and announced how he knew there was a problem when he realized that he was getting distracted while reading a book about how NOT to get distracted and about how he could listen, ignore and forget all at the same time!!
I remember tearing up when I saw a mum wearing a T-shirt that said My son has ADHD which means he lacks that gene that makes so many people judgemental and uncompassionate.
Let us choose to be as positive as possible with our kids and adults who have ADHD, they certainly deserve it!!!
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