Your attention please
Dr. S. YAMUNA
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Attention Deficit Hyperkinetic Disorder (ADHD) is characterised by lack of concentration, inattentiveness, hyperactivity and impulsive behaviour.
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Fourteen-year-old Surya was asked to repeat Std. VIII and he was upset. His parents decided to change school and he sat for the Std. IX entrance exam, but he was given admission to only Std. VIII. Surya was a good student in his kindergarten but as he moved to the higher classes his grades began to slip and teachers complained about his inability to concentrate. They said he was always getting out of his seat in the class, was fidgety and impulsive. But they also added that he was intelligent.
When he was four, he had a respiratory tract infection. The doctor suggested that he may be hyperactive. Offended, his parents went to another doctor. As he grew up, his parents realised that it was difficult to make him focus on anything. He could not sit still to watch even his favourite programme on television. As he was not doing well in studies, his parents encouraged him in sports. He started cricket and then tennis coaching but could sustain both only for three months. The parents then encouraged him to learn to play the keyboard. He discontinued that also.
His parents were fed up. They tried to make him study so that he could pass his Std. VII examinations. They found that he was easily distracted. Finally he was promoted to Std. VIII with a warning, that unless his performance improves he would be detained. He continued to fare badly. Surya is a classical example of a condition known as Attention Deficit Hyperkinetic Disorder (ADHD). This condition is characterised by a difficulty in being able to be attentive and to concentrate, distraction, hyperactivity and impulsive behaviour. Forty to 60 per cent of all ADHD children continue to have these symptoms throughout adolescence and into adulthood. Hyperactivity reduces as age advances, but attention span continues to be short. Almost 50 to 70 per cent of all ADHD is never diagnosed. As children these symptoms are often diagnosed as being energetic and scatter brained. During adolescence, the demands of the secondary school and gradual decline of grades bring this condition to light.
More number of boys are diagnosed with ADHD than girls. This is because girls are not as disruptive, and parents do not expect them to perform as well as boys. Adolescents with ADHD have other associated conditions like specific learning disorders (i.e. disorders of reading, writing, maths and spelling), oppositional defiant disorder, conduct disorder, depressive disorder, tic disorder and so on.
Because of their inability to meet the expectation of parents, these teenagers are subject to constant criticism, discouragement, stress and frustration. Leaving them with very low self-esteem. They also have poor social skills, frequent outbursts of anger and increased interpersonal conflicts. Being impulsive they are more likely to meet with automobile accidents.
Once the child is diagnosed, treatment should begin with a counselling session for the parents, behaviour modification of the adolescent, and exercises like painting and so on to improve concentration. But medication is the key to therapy. Most teenagers do well with medication and encouragement, patience and understanding from parents and teachers. Many patients and parents worry about the overstated adverse side effects of the stimulant medication — e.g. Methylphenidate.
Untreated or under treated teenagers face major barriers to normal development and demonstrate serious impairment in social interactions, family and peer relationships and personality development. Timely medication enables these students to understand the nuances of each of the subjects clearly and thus climb up the academic ladder.
The author is a Chennai-based consultant paediatrician and adolescent physician.
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