“A child who can never stay in one place, is always on the go, is messy and doesn’t complete a task, is hot-tempered, impulsive and always leaves things behind at school.” These are some ways parents describe this particular group of children and adolescents who may have Attention Deficit Hyperactive Disorder or ADHD. However, in the recent past, ADHD has become a much hackneyed and sometimes misunderstood term. Using ADHD as a label for children with difficult behaviour arising from multiple reasons is unhelpful.
The name itself is misleading because in more ways than one, these children have difficulties regulating their attention rather than being attention deficit. Thus, their attention tends to drift easily. It is difficult to refocus and they may have difficulties concentrating on multiple things at once.
However, inattention and hyperactivity are very relative terms, dependent on the environment and the demands placed on an individual. Thus, differentiating ADHD from other factors affecting attention is a complicated task, requiring expertise and experience.
While ADHD is a problem, all issues having to do with attention are not ADHD. Even in the case of ADHD, these problems can be related to the environment. They arise when there is a mismatch between the attention capacity and the demand of the task at hand. In this day and age, with the high need to excel in academics placed on children, the demand placed on their attention capacity is also high.
The 3 main symptom clusters in ADHD are related to attention, hyperactivity and impulsivity. Other representations of this disorder include a child who is unable to plan his activities, a severe dislike for tasks that require attention (like academic work!), frequently losing or misplacing items at school, not responding to his name because he is so engrossed in an activity, being unable to engage in play in a calm manner and jumping into and interrupting conversations between others. While being impulsive may not be unusual for children, some children with ADHD are impulsive to the level that it is dangerous. In some children, this may lead to recurrent accidents. However, these are only indicators and have to be seen in context. The symptoms should also be persistent and several of these issues need to be present together.
While “the boy who is always on the go and is impossible to contain” is easily identified by parents, a girl who is silent and apparently calm but struggles to regulate her attention is less easily understood. Both children may have ADHD and may benefit from assessment. It has been shown that girls with this condition have issues with attention rather than hyperactivity. For parents who have concerns, it might be valuable to discuss these with their children’s teachers, as they will be able to give a different perspective to the issue as they are in a position to observe them in a structured environment (the classroom).
Some children with ADHD also have issues in higher order functions, or what are called executive functions. However, not all children with this condition have these deficits. These functions include working memory, planning and impulse and emotional regulation.Thus, remembering a list of things to do and planning it out might actually be more difficult for these children rather them being “lazy”.
Causes for ADHD
While ADHD is currently considered a neurodevelopmental disorder, it can be understood as a delay in the development of attention and self-regulation. The largest imaging study of its kind was conducted recently, indicating that several parts of the brain showed subtle differences in children with ADHD.
Heritability or the component thought to be due to genetics is high in ADHD. However, this does not mean that because the father or a sibling has ADHD, other siblings should have it too. The association is more complex. It is also thought that the symptoms of ADHD are on a spectrum, thus some may have more difficulties than others. Furthermore, environmental factors in the early development of the brain too are believed to affect ADHD. A low birth weight and smoking during pregnancy are among the better described and studied factors associated with this condition.
Treatment would depend on the individual needs and circumstances of each child. As it is important not to label conditions that can be explained otherwise as ADHD, a broad understanding of the circumstances and factors affecting the child is important. A first step would be a thorough assessment to exclude other medical, psychiatric, family and environmental issues. For example, learning difficulties and family issues can both be present in an inattentive child.
Treatment is usually a combination of medication, behavioural modifications, modified teaching and environmental modifications. It is also important to regularly reassess children with ADHD as their circumstances and attention capacities may have changed, requiring changes to be made to the treatment plan. Some symptoms of ADHD, especially hyperactivity and impulsivity, also improve as children reach adulthood. As children with ADHD are known to have many other issues that go together with the disorder like anxiety, learning difficulties and disobedience, these issues may also need to be addressed. If they are not addressed, it may lead to secondary problems like refusing to go to school.
However, ADHD is not a disorder that you should be afraid of. With proper understanding and management, children with this condition can grow up to become successful adults.