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Non-Medical Treatment of
Attention Deficit Hyperactivity Disorder (ADHD)

Preeti Gupta, Clinical Psychologist

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ADHD, once called hyperkinesis or minimal brain dysfunction, is one of the most common mental disorders among children. It affects 3 to 5 percent of all children. Two to three times more boys than girls are affected. ADHD often continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain. These children may not be able to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them. To their family, classmates or teachers, they seem to exist in a whirlwind of disorganized activity. As a result, the disorder can spoil the person's relationships with others in addition to disrupting their daily life, consuming energy, and diminishing self- esteem.

Symptoms of ADHD or Understanding the problem

ADHD is typically defined as a triad of inattention, impulsivity and hyperactivity. But for the correct diagnosis of ADHD these behaviours should be excessive, long term, and pervasive. They should be a continuous problem and not just a response to a temporary situation.

Signs of inattention include:

• Becoming easily distracted by irrelevant sights and sounds.

• Failing to pay attention to details and making careless mistakes.

• Rarely following instruction carefully and completely.

• Losing or forgetting things like toys, pencil, books and tools needed for a task.

Signs of hyperactivity and impulsivity are:

• Feeling restless, often fidgeting with hands or feet, or squirming

• Running, climbing or leaving a seat in situations where sitting or quiet behaviour is expected.

• Blurting out answer before hearing the whole question

• Having difficulty waiting in line of for a turn

Some additional dysfunction, which are not just incidental symptoms in fact they are hard to live with; are as follows:

• Lack of foresight, i.e. lack of ability to predict the results of our behaviour, which is a major adaptive ability of humans.

• Poor hindsight, i.e. trouble in learning from mistakes.

• ADHD behaviours are often based on reactions taking only the present moment into account. It is not that the child with ADHD doesn't care about failure; it is that the future and past don't even exist. Such is the nature of the disability.

• Poor organization

• Trouble returning to task

• Poor sense of time

• Poor ability to utilize "self-talk" to work through a problem

• Poor sense of self awareness

• Gets frustrated easily

• Hyper focused at times

• Frequently overwhelmed

• Gets angry frequently and quickly

• Trouble paying attention to others

• Lying, cursing, stealing and blaming others become frequent component of ADHD, especially as the child gets older

Many parents see signs of an attention deficit in toddlers long before the child enters school. In many cases the teachers is the first to recognize that a child is hyperactive or inattentive because teachers work with many children and they come to know how average children behave in learning situations that require attention and self control. In such cases parents/ teachers should consult psychologist to assess whether the child has an attention disorder or is just immature has hyperactivity or is just exuberant.

Can any other conditions produce these symptoms?

There are many conditions that can produce similar behaviours. Few of them are:

• Underachievement at school due to a Learning disability.

• Attention lapses caused by seizures.

• A middle ear infection that causes an intermittent hearing problem

• Disruptive or unresponsive behaviour due to anxiety or depression.

It's also important to realize that during certain stages of development, the majority of children at that stage tend to be inattentive, hyperactive, or impulsive but do not have ADHD. Preschoolers have lots of energy and run everywhere they go, but this doesn't mean they are hyperactive. ADHD is a serious diagnosis that may require long term treatment with counseling and meditation.

What causes ADHD?

It has been found that many different genetic, medical, temperamental and environmental risks can produce symptoms indistinguishable from ADHD. If extreme enough, virtually any single factor can, by itself, lead to the syndrome. However it is quite rare that single risk factor occur; rather it is not common to see genetic, medical and other risk occur in combination.

Non- medical treatment for ADHD

Life can be hard for children with ADHD. They're the ones who are so often in trouble at school, can't finish a game, and lose friends. It's not easy coping with these frustrations day after day. Some children release their frustration by acting contrary, starting fights, or destroying property. Some turn the frustration into body ailments, like the child who gets a stomachache each day before school. Others hold their needs and fears inside, so that no one sees how badly they feel.

Medication can help to control some of the behaviour problem that may have lead to family turmoil. But more often, there are other aspects of the problem that medication can't touch. Both parents and their children may need special help to develop techniques for managing the patterns of behaviour. In such cases, mental health professionals can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other.

Several intervention approaches are available such as:

• Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. As they talk, the psychologist tries to help them understand how they can change.

• Cognitive-behavioural therapy helps people work on immediate issues. Rather than helping people understand their feeling and actions, it supports them directly in changing their behaviour. The support might be practical assistance or to encourage new behaviours by giving praise or rewards each time the person acts in the desired way. A psychologist might use such techniques to help a belligerent child to control his fighting, or an impulsive teenager to think before she speaks.

• Social skill training can also help children learn new behaviors. In social skill training, the therapist discusses and models appropriate behaviours like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice.

• Parenting skills training offered by therapist or in special classes gives parents tools and techniques for managing their child's behaviour. Parents may also be taught to give the child "quality time" each day, in which they share a pleasurable or relaxed activity.

In addition, parents may follow the simple principles of management, which are given below:

1. Keep a sense of humor. Seek to enjoy, not to scream.

2. Hate ADHD, not the person with it.

3. You do not have a standard child. You can view the issue as a disability. Or, you can view it as both. The perspective of "standard," though, is not an option.

4. Instead of punishing wrong behaviour, set a reward for the correct behaviour you would rather replace it with. Rewards should be immediate, frequent, powerful, clearly defined, and consistent.

5. Plan ahead. Give warning before transition. Discuss in advance what is expected. Have the child repeat out loud the terms he just agreed to.

6. Don't argue; nag; or attempt unsolicited and spontaneous transplants of your wisdom to your child. Instead, either a) decide that the issue is aggravating but not significant enough to warrant intervention; or b) make an appointment with your child to discuss the issue.

7. When temper of the child flare; allow everyone to cool off. Serious discussion can only occur during times of composure.

8. Especially with teens, negotiate, negotiate, and negotiate. Parents need to model negotiation, not inflexiblity. Don't worry about losing control: the parent always gets to decide when negotiation is over and which compromise is accepted.

9. Although it is not the child's "fault," he will still ultimately be the one to take the consequences of his behaviour.

10. Forgive your child and yourself nightly. You didn't ask to live with the effects of ADHD any more than did your child.

11. This is not a contest with your child. The winner is not the one with more points. The winner is the one who's child still loves them when they graduate high school.

12. May allow only one or two playmates at a time so that child doesn't get overstimulated.

13. Help the child divide a large task into small steps, then praise the child as each step is completed

14. Learn to use stress management methods such as relaxation techniques, meditation etc.

Remember, the chances for success are good, especially for children with: higher socio-economic status, higher intelligence, better early peer relations, less aggression, less psychopathology in the parents, and less conflict with their parents. We can't solve all of the problems at once. Stay calm.

Author: Ms. Preeti Gupta, Research Assistant (Clinical Psychologist), Department of Psychiatry, All India Institute of Medical Sciences, New Delhi.


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