Lets Now Talk About Attention Deficit/Hyperactivity Disorder (ADHD)

This condition is increasingly in the news and been diagnosed more often recently.It is a disorder in attention and focusing and behavior, afflicting some children usually starting at the age of five.  It shows more often in boys rather than girls. 

The child with this condition is restless, unable to stand still or pay attention, even impulsive, often explosive and often into small mischief.  This child is generally difficult to manage or settle in routines

More often than not, the child is also distempered, may have mood swings, and wet the bed beyond the age of toilet training.  Some of these children are also prone to a fascination with fires.

All these symptoms, in terms of severity are above and beyond the usual spirited or even the occasionally exuberant behavior of kids of this age.  Overall Children with ADHD are more alert curious and active than others.

We do not know the cause even though we have some idea.  For a small number the cause has been traced in a defect in certain genes of the so-called “fragile chromosome syndrome.”   For others there are troubles with the pregnancy or use of alcohol or drugs by the mother while pregnant.  But for the majority no cause can be found .  The majority belong to a group of kids who are born with an extreme temperamental type.  These kids tend to be inquisitive, restless, inner-directed, aloof quick-minded, curious, easily bored and a kind “path finders” from birth.

In fact, many of these kids if their symptoms are relatively mild and not incapacitating, may become successful businessmen, entrepreneurs and creative people.  Nevertheless, the one’s with the extreme form need intervention both in terms of psychotherapy and medications.

We do not know why the number is increasing.  It could be that we are becoming more and more aware in studying them.  It may be that there may be certain toxic factors in modern life including food that may have a triggering effect or even being the cause, even though this has never been verified. 

We do know that many of these kids come from families where relatives or even the father or mother, themselves may have some form of difficulties including anxiety, bipolar condition and generally may be one of them intense himself.

These problems if left untreated, besides creating havoc in their environment as well as a vacuum around them in terms of peers or siblings, these kids, if untreated are falling increasingly behind in school as they are unable to learn.

There are two forms of ADHD- the one where the children are only inattentive and unfocused and the ones who in addition are hyperactive as well.  The latter tend to be all over the place and are usually boys. Girls afflicted with this condition tend to be day-dreamy. 

The diagnosis is made observing a child who is unable to focus, stay still, concentrate and or perform simple mathematical calculations like subtraction.

Furthermore, school teachers report them as children who speak out of turn, walk around class, walk out of class, and display inappropriate behavior.

They tend to be behind their peers in writing skills, easily frustrated, quick-minded, impatient, easily bored and unusually very intelligent.  They tend to respond violently or irritated if other classmates try to cross or tease them.

They are also frequently bed-wetters (enuretic) and often are fascinated with matches and fire.

At the present time we treat these children quite successfully with psychotherapy and medications.

Strangely enough, the medicine used tends to make adults hyperactive, frantic, anxious as they are stimulants.  Yet, these same medicines make children with ADHD calmer, more attentive, and better able to learn as well as improve their relationship with their peers in school and family members. often dramatically.

Bed wetting is treated with yet other medications, quite effectively.

Unfortunately, all these medications have side effects.  The main one is loss of appetite or weight.   There exist combinations of medications used that work well without this side effects.  Many times if one does not work then another class of equally strong stimulant will do the trick.   Their weight and blood pressure have to be monitored.

The long term effect of medications should be benign but we should always be suspicious about the future of a growing child especially with such strong medications

Regarding the problem of bed wetting there are two or three medications that can do the trick successfully.  Ideally the child should not be treated with medications alone.  They should also see a counselor, social worker or specializing therapist if available.  In psychotherapy the child is trained as to how to handle restraints as well persistent work school habits.

The child in this age is plastic and can easily accommodate new habits including the new habits assigned by their therapist. 

They say that when these children grow, they continue to take these medications.   However, I am very suspicious as a clinician in terms of giving them stimulants as adults, although many do, especially the so-called captives of the industry.  These adults may eventually take Cocaine or amphetamines on the side.

In addition I recommend fish oil 1000 mg daily which has a good effect in the brain in terms of avoiding inflammation and augmenting attentiveness even though the results are not clear cut with it.

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