What we need to know about Attention Deficit Hyperactivity Disorder- ADHD
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“ He just doesn’t sit still! We get tired but he won’t.. has a motor on his feet, this kid..”,
“Oh I am fed up with him. There are constant complaints from his teacher that he keeps disturbing the class. I have tried everything… tried to explain, tried to give rewards, tried shouting. But nothing works, and I don’t know what to do. I am at my wits end. It's such a helpless and embarrassing situation, being constantly called by his teachers in school.”
“ She is such a good kid otherwise.. except for this daydreaming. God knows where she gets lost. She just cant be attentive and present in class.”
These are just a few typical dialogues we would hear when we witness a parent or a teacher talking about a child with ADHD. These children quite easily get mislabelled as naughty, zoned out, mischievous, or even disruptive. The major downside to that being, the real problem goes undetected, and the children are kept from receiving the help they need. Ultimately the child who is already facing multiple difficulties in school, on playgrounds, at home, due to ADHD, is further burdened with these labels, affecting his/her confidence and self image, and keeps suffering for a long time to come.
However, this need not be the case, and the picture need not be bleak for children with ADHD. Early identification and intervention with these kids, can bring about a world of change and can equip them as well as the adults around them with skills to manage the problem more efficiently.
But before we jump into that, lets have a look at
Attention Deficit Hyperactivity Disorder or ADHD as it is commonly referred to, is a neurodevelopmental disorder. Some studies indicate that around 12 % of Indian children are found to have ADHD making it one of the most common psychological issues in children.
ADHD usually starts to become evident as the child begins schooling and the intensity of the problem increases. Children who are naughty, energetic etc are found to gradually settle down in classrooms, where they are expected to behave in a certain way. They adapt to these rules and expectations. A child with ADHD however, is unable to do so, making him/her stand out as a problem child. Teachers or parents often are quick to judge that the child does this purposefully to cause trouble and thus begins the cycle of punishments, labelling and persevering problem behaviour.
ADHD is primarily characterised by 3 main symptoms :
Different combinations of these symptom categories lead to the 3 main subtypes of ADHD, i.e. Predominantly hyperactive, Predominantly inattentive, and Combined subtype of ADHD.
Inattention refers to an inability to sustain attention on a given thing or task for long periods of time. This commonly manifests as poor concentration, being easily distractable, getting disturbed by small distractions like outside noises etc losing focus. Sometimes in the absence of hyperactivity, these children might not appear ‘naughty’ as children with ADHD often do, but are called out frequently in class for being zoned out, lost in thoughts, or mentally absent.
Impulsivity is the inability to think before acting. These children often appear in a hurry to do things, typically answering questions before hearing the entire question, giving up on things quickly without paying heed to consequences or jumping into action before listening to instructions on the playground etc.
Both of the above symptoms may lead to behaviours such as carelessly making repetitive mistakes, forgetfulness, and being overly talkative.
Hyperactivity is the most commonly and easily identified symptom of ADHD. Hyperactive children seem to have boundless energy, are always on the go and find it extremely difficult to stay still physically. You might notice them leaving their seats frequently and unnecessarily, fidgeting when they are made to stay in one place, not having enough patience to stand in queues and noticeably restless.
We saw the outward signs of ADHD which we can then identify in children. But what really goes on behind the scenes? What causes these behaviours ?
As mentioned right at the beginning, ADHD is a neurodevelopmental issue, which implies that the brain has a role to play.
“Executive functions” are the brain functions that are responsible for our ability to plan, organize, to regulate our behaviours and emotions and to take well thought out decisions. It’s precisely dysfunction of these brain processes which lead to the behaviours we see in ADHD. There could be multiple root causes that lead to an executive dysfunction such as alcohol consumption by mother during pregnancy, hereditary factors etc.
This is what differentiates them from other ‘naughty’, ‘disruptive’ children. Children with ADHD are in no way purposefully engaging in problem behaviours. They simply do not have a well functioning remote control or regulator to manage their behaviour.
Since we talk of ADHD in reference to children, some people might have the misconception that it is limited to childhood. Although we see hyperactivity reducing slightly as children grow older and reach adolescence, the problem in no way has disappeared. Without an intervention, we rob our children of tools to manage these issues and that can lead to more harmful manifestations of the same underlying symptoms. They are at a higher risk for issues like harmful drug use, rash driving, inability to maintain relationships, and be skilled in social settings.
One good news about this is the brain’s property of neuroplasticity. Neuroplasticity essentially means that the brain can be modified and trained to function differently. Thus, we can train the brain to pay attention better, to be more focused, to plan and organize, and to ignore distractions.
Clinical psychologists working with children can design interventions to help children be more skilled at these executive functions. However, there is no magic wand that they wield and the brain does not get retrained in a day. Consistent efforts, support, and commitment by the child’s parents, teachers, and therapists are the key to change.
Parents can be active participants in the child’s intervention. As retraining is all about practicing, they can ensure that the intervention does not stay limited to the school, or therapist’s office. Parents can create opportunities for the child to participate in activities that help them improve their executive functions. These can be simple activities such as sorting grains at home, playing with puzzles that require sustained attention, physical activity to channel their energy etc.
On the other hand, they can also make sure to minimize those stimuli from their environment that feed the ADHD and are harmful for the child’s brain. The most critical of these being screen time.
Apart from things that parents do for behavioural modification, their emotional support, encouragement, and acceptance is what goes a long way in keeping the child motivated and emotionally healthy in the face of the ADHD struggles.
Teachers who understand ADHD well can contribute a great deal in creating an environment that’s most amenable for a child with ADHD. Many a times teachers complain that they fall short on time and it is not feasible for them to create and execute special activities for these children. But there are simple classroom modifications that can definitely help children with ADHD focus and do better in class.
Seating them closer to the teacher, breaking down classwork into smaller subtasks, giving gentle reminders, allowing small breaks rather than forcing the child to continue with the task even when the child’s attention is exhausted are just some of those changes which are practically possible in an inclusive classroom.
