A Confused State of Mind

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Aryan* is a normal healthy eight year old boy who can outwit the brightest student in his class with his sharp memory if he so desires. But his restlessness, lack of attention and poor concentration completely overpowers him and derails him off the tracks right into the path of confusion. Very often he tends to respond before he has considered things properly and doesn’t know when to stop. He has problems following directions and staying focused, is easily distracted, bored or frustrated with tasks and is impulsive, not stopping to think before he acts. It is very usual for him to ask, “Mother, will grandfather become a skeleton after he dies?” in the middle of a preaching session. And in the classroom when the teacher asks, “Who can tell me what a verb is?” he may be that single boy who will say, “Mr. P did you just pass gas?” While the horrified mother gasps in exasperation and the teacher squirms in embarrassment it can take a while for the two to comprehend that his words weren’t intentional and that he wasn’t trying to be impudent. He plainly suffers from a disorder called Attention Deficit Hyperactivity Disorder – ADHD.

What is ADHD?
One of the most common chronic conditions affecting children, ADHD often goes undetected as most of the signs tend to overlap with typical early childhood behaviors. The condition becomes apparent once the child begins pre-school or elementary. Researches show that in approximately half of the cases, the onset of ADHD is before the age of four and the disorder occurs as much as four to nine times more in boys than in girls. Hence, parents need to be more aware and have to pay more attention to behavioral assessment of their child. When we have to adhere to a norm where a child’s development is strictly measured in terms of academic excellence, it can be a long and trying journey for a child who faces difficulty filtering out all the information coming into his brain. Since most of the parents and teachers are not aware of this disorder, they often doubt the child’s intellectual prowess thereby leading to a child’s mounting frustrations. While it cannot be considered a learning disability, it can certainly hamper the learning process if help is not forthcoming.
ADHD is thought to be caused by a chemical imbalance in the brain that affects the parts controlling attention, concentration and impulsiveness. According to Chhori Laxmi Maharjan, who has a Master’s degree in clinical psychology and is the Senior Counselor and Manager at Ankur Counseling Centre, “Many causes are thought to be related to this disorder but till date, a definitive cause of ADHD has not been found.” She adds, “However, scientists and psychologists believe that there are number of causes which have been influencing ADHD which are as follows:
• Biological factors (functions and chemical messengers in the brain)
• Heredity may play a role (30-50% of children with ADHD have a sibling or parent who has the disorder, Faraone & Doyle,2001)
• Prenatal and postnatal abnormalities (maternal use of alcohol and cigarettes, long duration of labor, malnutrition during the first year of life, Dulcan,1989)”
Symptoms of ADHD are generally categorized into three groups: inattention, hyperactivity and impulsiveness.

Inattention
A child with ADHD
• is easily distracted
• has difficulty following directions or finishing tasks and projects
• does not appear to be listening when someone is speaking
• does not pay attention and makes careless mistakes
• is forgetful about daily activities and has difficulty remembering
• avoids or dislikes activities that require sitting still or sustained effort
• has a tendency to daydream
• has trouble staying organized, organizing daily tasks and planning ahead
• frequently loses or misplaces homework, books, toys, or personal items

Hyperactivity
A child with ADHD
• often squirms, fidgets when sitting
• has difficulty remaining seated
• has difficulty playing quietly
• is always moving, such as running or climbing on things
• talks excessively
• may have a quick temper or a “short fuse”

Impulsivity
A child with ADHD
• has difficulty waiting for his or her turn in group situations
• blurts out answers before the question has been completed
• often interrupts others and intrudes in others’ personal businesses like conversations and games
• says the wrong thing at the wrong time
• is unable to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
• guesses, rather than taking time to solve a problem
With every possibility of the above given symptoms getting confused with early childhood developments, Chhori Laxmi says, “The initial phase of this disorder is noticeable detection of behavioral, social and emotional disturbances. The very common characteristics of children with ADHD include general immaturity and clumsiness. Elementary school teachers significantly report that this type of child has difficulty working independently, completing any kind of seated work, has listening problem and organizing work. A parent has to often remind them to complete their homework and they also notice frequent destruction or damages or loss of toys during play. At least eight of the symptoms should have been seen before the age of seven years. This will help a parent to figure out whether the child should be evaluated for ADHD by an expert or not. The psychiatrists and psychologists then take references from ICD (International Classification of Mental and Behavior Disorder) and DSM-IV (Diagnostic Statistical Manual-Revised IV) to diagnose ADHD. Besides these, there are other authorized books which give us standardized and scientific criterions in authenticating the case.”

Diagnosing correctly
Notably, not all children with ADHD are hyperactive; ADHD children who are inattentive but not hyperactive may instead seem to be unmotivated and constantly are lost in their own world.
Amar Bhattarai*, father of 12 year old Akash* had come to Ankur Counseling Center seemingly frustrated. The first thing he had asked was whether the centre could take his son and care for him on a daily basis. Taken aback by such a strange request, the counselor gently prodded him to share his feelings. He sighed and said that his son, a 4th grader, had a problem in school. He constantly struggled to complete his assigned tasks due to his below par attention span and lack of concentration. When his academic performance suffered, the teachers at the school started suspecting him of having a very low IQ and believed that he had a learning disability. He could not maintain a proper peer relationship and had to be constantly reminded by the teachers to be gentle and to greet them properly.
When the teachers suggested moving him from his school, Amar went to a psychiatrist who prescribed some medications which did not improve his behavior. He then visited a number of centers which dealt with children having disorders. When he saw physically and mentally challenged children with Cerebral Palsy, Autism and Down’s Syndrome, he assessed that his son didn’t actually suffer from that kind of disorder. That’s when he came to ACC seeking help and Akash was diagnosed with ADHD. Unlike his younger brother who is very independent, Akash needs help with very simple tasks like tying his shoelaces and needs more instructions to complete even small tasks. Besides being intellectually challenged, he can remember numbers quickly and is very good in singing.
The severity of ADHD is categorized as mild, moderate and severe. Some of the symptoms can be as severe as a tendency to engage, or often engaging in, physically dangerous activities without considering the possible consequences. They also have difficulty accepting responsibility for actions, projecting blame for problems on others, and failing to learn from experiences. They have a low self esteem and poor social and emotional skills. Research shows that children with ADHD often have above-average intelligence but find the entire learning process a challenge. And their refusal to conform to the accepted standards of academics in a society obsessed with nothing less than excellent, makes blending with the rest a gargantuan task.
“To deal and manage with ADHD, only the efforts of parents and teachers is not enough, so a combination of medication, behavioral management, effective teaching and parental monitoring as a holistic approach improves ADHD,” says Chhori Laxmi. Friends of Needy Children (FNC) / Ankur Counseling Center (ACC) has been working in this field since 2006. It provides individual and group counseling sessions to the children and youth by using different therapies or treatment interventions such as Sand Play therapy, Child Parent Relationship Therapy, Positive Discipline Techniques, Cognitive Behavior Therapy, Creative Movement Therapy, etc.