Dr. WalidSarhan
During the nineteenth century and early twentieth century, many English and French doctors noticed that the activity of some children exceeds rational levels and that this coincides with lack of attention. In the second half of the last century, doctors from the United States became aware of these observations, and they started to describe and classify this disorder in the International Classification of Diseases, and the Diagnostic and Statistical Manual of Mental Disorders.It became clear that this disorder affects adults as well, that it might start in childhood and not necessarily subside with adulthood, and that if it continues, it affects thedifferent stages of an individual’s life.
ADHD is usually accompanied by several issues and affects a person’s confidence, leading to learning difficulties. The belief that it subsides with time isn’t always correct, as some ADHD patients might continue to suffer as they grow older, but many of them learn how to cope with the problem and end it, especially those who received treatment.
Symptoms might first appear between the age of two and three years old, and might take the form of difficulty in paying attention to the surroundings and therefore in concentrating on the topic and following instructions. It might seem like the child can’t hear or understand what he’s told, or like he/she is daydreaming and not very responsive to the world around him. Children with ADHD also find it hard to organize their assignments and activities, and often forget a lot and lose their belongings, books and toys, not to mention failing to do any chores or homework. They are noticeably distracted easily; any surrounding sound, movement or objects might draw their attention and distract them from what their mothers or teachersare explaining. Children with ADHD seem unable to sit or stand still, they move a lot even when they’re sitting or standing. We can say that they are constantly moving, talking and interrupting others speaking or playing. They don’t have the patience to listen to everything that is said and cannot wait or stand in lines. On the other hand, boys are more likely to suffer from ADHD than girls are; it is noticeable that girls often suffer from attention deficit while their activity remains in the normal range.
Normal children might be hyperactive, unpredictable andsuffer from attention deficit every now and then. It is normal for children not to be able to concentrate for long before they start going to school, and they often find it hard to carry on in one activity or game for a long time. Children and adults alike pay different degrees of attention and concentration based on their interest in the subject and their state; paying less attention and concentrating less when they’re hungry, tired, or upset. Similarly for hyperactivity, children have more energy, and it is common that their parents get tired before they do.Just because a child is different from his peers, that doesn’t necessarily mean that he has this disorder. ADGD can only be diagnosed by a qualified doctor and should not be diagnosed by parents or schools. For example, some children might have activity and attention problems at school and not at home, and vice versa. This indicates other problems in the child’s learning abilities, a learning disorder or a problem in the child’s parenting approach. Regardless, parents and schools should still provide their observations about the child without assuming a specific diagnosis.
As is the case in most mental disorders, ADHD has several causes and not just one. It is noticeable that some families are more likely to suffer from ADHD than others, and that genetics play a role in its occurrence.Many environmental factors have a possible effect during the critical periods of a child’s development, such as lead poisoning. Pregnancy and the risk factors that the child is exposed to, such as the mother’s consumption of alcohol and some medicines, might also play a role in the development of this condition.Premature birth can also increase the risk. Contrary to popular belief, it is not scientifically proven that eating too much sugar can cause hyperactivity, people often link it to eating certain kinds of food, but that has no scientific basis either.
ADHD might lead to academic failure and regarding the child as having limited abilities. Children suffering from the disorder are more prone to accidents and injuries, which means they suffer from low self-esteem and weak relationships with their peers and lackof acceptance from other children. They are also more likely to consume alcohol and drugs in their adolescence. The disorder might be associated with other conditions, such as mental, developmental, behavioral, and emotional disorders, as well as mood and anxiety disorders. As the patient grows older the diagnosis might be confused with bipolar mood disorder.
For the diagnosis, the doctor follows the common steps, from physical and mental examination to taking the child’s history from different places to school reports. Some questionnaires might be used to help the family and school respond to the questions. The next step is confirming the presence of the two parts of the symptoms:
1- Attention Deficit:
- -Often fails to pay attention to details, commits mistakes and showsindifferenceregarding studying and other activities.
- -Cannot maintain focus on homework or games, resulting in an inability to command skills.
- -Seems to be not listening when talked to and sometimes thought to have hearing problems.
- -Doesn’t follow instructions and fails to complete his homework or other tasks.
- -Has difficulty in organizing his assignments and activities.
- -Avoids, hates and is reluctant to engage in tasks that require a lot of effort and constant perseverance, such as school assignments or house chores.
- -Often loses things he/she needs to complete activities and tasks such as toys, movies, and books.
- -Easily distracted by anything other than the required subject or task.
- -Forgets often while performing daily activities, causing the family to believe he/she has memory problems.
2. Hyperactivity and Impulsiveness
- -Fidgets and moves his limbs whether standing or sitting
- -Leaves his seat in class or anywhere else when he’s supposed to stay seated.
- -Runs and climbs things in inappropriate situations.
- -Usually has a difficulty playing quietly and might ruin games.
- -Always seems ready to move and his/her parents describe him as being on an engine.
- -Often talks nonstop and is described as chattering excessively
- -Might give wrong rushed answers before the question is over.
- -Cannot wait for his/her turn or for anything.
- -Often interrupts others and interferes in other people’s conversations or playing.
It is clear that these problems affect the child’s performance and abilities and make him different from those of his age. The symptoms should last for no less than six months and be noticed in more than one situation before they’re called a disorder.
There are three sub-types of ADHD:
- When attention deficit is dominant.
- When hyperactivity is more prominent.
- A combination of hyperactivity and attention deficit.
Differential diagnosis must be taken into account in the diagnosis, which means that other disorders with similar symptoms should be ruled out; these disorders include learning and language disorders, mood and anxiety disorders, in addition to other forms of disorders associated with sight, hearing, sleeping, thyroid gland or drug abuse and different brain injuries.
When it comes to the prevalence of the disorder, it appears that 3-7% of schoolchildren suffer from ADHD, although these numbers vary between different studies and from one place to another. It is more common to diagnose children with ADHD in the United States than it is in Europe and the rest of the world.
It is worth mentioning that not all naughty children and those that show a lack of attention in a class have ADHD. The diagnosis can be used as a cover for those who suffer from a minor intellectual disability or learning disability, or other behavioural and emotional problems. The children might be normal while their teachers and families might not be able to handle them.They might expect the child to be quiet and always listen to what he’s told, not accepting any contrary behaviour and considering it a disease that needs to be treated. Upon a closer look, the problem might actually be with the parents or the school.
As for treatment, medication is usually the first thing to come to people’s minds. In reality though, a plan is developed after precise diagnosis, and one of the main points included in this plan is the proper treatment of the child, whether at home or school, and treating the child with the appropriate behaviour modification approaches, in addition to reward and punishment. Punishment can be in the form of detention and deprivation, whereas reward is the opposite and cannot be acquired if the child’s behavior is not appropriate. This approach can be used with more than one child in the family, keeping in mind that constant beating, offending and scolding can teach the kid to be violent.
Some children need medical treatment, which the doctor prescribes and follows up. It is not recommended to use these medicines without a specialist’s approval. That doesn’t necessarily mean not to follow the behavioral and educational approaches, adjusting the daily schedule of the child, and even the speaking techniques, since not even normal children can listen for long instances, let alone children with ADHD. Short sentences are the most useful approach, not excessive explanation, as well as using simple vocabulary and without mixing words from several languages.
With the right follow-up combined with behavioral and medical treatment, children can overcome this problem, although it might have effects even after they finish school, go to college and start working. These effects might be minor, thus the person can cope with them. Some patients might still require treatment even in their twenties or later on, especially if their lack of attention is constant and affects their progress in work and life in general.
I must conclude with mentioning that Arab parents are interested in reading the pamphlets or catalogs of cellphones or computers that they buy, and often read them carefully and look for them online, but they rarely read a book about children and adolescents’ development and the right approach to tackling the problems they face. Most people claim that their educational approach is a modern one, without being specific as to what that means except that it’s different from their parents’ approach, although their parents’ might not necessarily be wrong. Educational approaches must be clear, but schools in the Arab world in general are much more interested in academic achievement than they are in upbringing, behavior, thought, discipline and other fundamentals for a balanced successful individual.