Proper diagnosis can lead to better treatment options.
WHEN he was a toddler, Adam’s parents noticed that he was always restless, fidgety and losing interest in people or situations around him within seconds.
But they thought it was typical behaviour for a young boy and were confident he would outgrow it once he was in school.
Unfortunately, the pattern continued when Adam started primary school. When he was 11, the situation became worse. As he got bigger and stronger, he hurt himself and other children unintentionally while playing. His academic performance was also poor since he could not pay attention in class.
When his teachers told his parents that Adam was restless, impulsive, inattentive and difficult to handle, they admitted that he behaved the same way at home.
They then consulted a child psychologist to determine if there was anything wrong with him.
Using in-clinic sessions, interviews with his parents and teachers and assessment tests, Adam was finally diagnosed with attention deficit hyperactivity disorder (ADHD).
In addition to ADHD, he was also found to be suffering from tactile sensory dysfunction, which means he is sensitive to sound. Because of his sensory processing disorder, he gets easily distracted by noise around him. This, in turn, creates problems for him at school and at home.
His parents did not want Adam to be put on medication but they were concerned about getting him treatment. Eventually, given that his symptoms were not severe, Adam was treated with behavioural and occupational therapy.
Fortunately, he was responsive to the intervention and within three years, became functional and was no longer in therapy.
PROPER DIAGNOSIS
According to the American Psychiatric Association, ADHD is one of the most common mental disorders affecting children. Symptoms include inattention (not being able to keep focus), hyperactivity (excess movements that are not fit for the setting) and impulsivity (hasty acts that occur in the moment without thought).
ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork.
Although common, the condition is often misunderstood. There are many myths that often can lead to over-diagnosis of the condition.
Pantai Hospital Kuala Lumpur child psychologist Katyana Azman believes the condition is over-diagnosed as parents think an active child is an ADHD child. Even clinicians tend to quickly diagnose children as young as 2 years old, just by using their behaviour patterns.
Parents tend to “Google-diagnose” their child. It is not wrong for them to want to understand the condition better, but they must get confirmation from medical experts, she says.
“There are various assessment criteria to ensure whether the restless behaviour is due to a disorder. The behaviour pattern has to occur across the board. If the child is hyperactive and restless in school, but he is not displaying the same behaviour at home, it is not ADHD.”
Katyana says there are three areas that have to be looked at for diagnosis — inattention, hyperactivity and impulse control.
Inattention is when they can’t focus long enough and they tend to be disruptive and forgetful as the brain cannot retain information.
Hyperactivity is when they are restless, fidgety and cannot sit still for normal routines such as doing lessons or having meals.
Impulse control is linked to actions that can lead to them getting hurt all the time. Older children might participate in risky behaviour.
MANAGING SYMPTOMS
Katyana says when all these criteria are in place, then only can the child be diagnosed. It should not just be based on symptoms when he is at school or at home.
“The behaviour must be with everybody and in any situation. Another issue is that they must not suffer from any diseases or illnesses.
“I would prefer to assess the child after the age of 4 because by that time, we can see the behaviour pattern. There are certain abilities that they can do as they have started kindergarten.
“If they are younger than that, how do we assess their ability to sit still in class when they have never gone to school? How do we assess their ability to focus when they are too young?”
The assessment is important because the goal is to help them manage their symptoms. While ADHD does not affect cognitive and motor skills, sufferers are still unable to become functional human beings, she adds.
“When they are not functional as a child of that age, then it is a problem. If their behaviour is so disruptive that they are struggling at home and in school, get help.”
Katyana says at the moment there is no cure for ADHD but it is vital that parents seek treatment when diagnosed, as lack of treatment can leave a social impact on these children. Depending on the child’s condition, treatment options include medication or therapy or a combination of both.
If the condition is not addressed, such children will struggle academically, suffer from low self-esteem and feel isolated as other children will not want to be with them. Society’s perception also plays a role as people see fidgety and restless children as a result of bad parenting.
Katyana says parents who refuse to accept that their child has ADHD will deny the child access to care. Sometimes parents’ personal beliefs on the situation can make it worse.
“I think that with any disorder, if not provided with the right amount of support, the situation will snowball as the child gets older. And the older they get, the harder it is to break the habit.
“It is easier to manage inattention and impulse control in a 5-year-old compared to a 13-year-old. Although they are not physically disabled, it will affect their ability as adults in whatever area they choose to be.”
INFLUENCE OF DIET
She says one of the most common issues related to over-diagnosis of ADHD is diet. Many people believe that sugar causes ADHD and decide to eliminate food that contains glucose.
There is no scientific research to back this claim although it is proven that processed sugar is a stimulant and can make a child more anxious and fidgety. There are parents who say their children are more manageable without sugar and that is a possibility because they don’t have a stimulant in their diet.
“You can limit the consumption of processed sugar, especially before bedtime or when they need to focus on lessons. I always tell parents that children need glucose, protein and carbohydrates because they are growing.
“When they don’t get balanced meals, they are lethargic and can’t focus. If you want to remove certain things from their diet, do so with the advice of a dietitian or doctor.”
Katyana says with intervention, children with ADHD are no longer isolated and can be placed with their peers.
“Peer interaction is important as it helps them develop good social and communication skills. If a child with ADHD but intact cognitive skills is put in a special school, it affects his self-esteem and results in emotional issues.
“The Government has also provided support for children with ADHD and other learning disabilities to have access to school. They are placed in small rooms and allowed more time during exams. I think with this in place, parents are less worried.”
As for adult ADHD, Katyana says it happens because they were never diagnosed as children. This is because 20 or 30 years ago, there was little information on ADHD. In addition, academic performance was not scrutinised at every level like it is today.
“It is possible that they managed their symptoms at that time because there was less stress. They learnt to adapt to the environment. If they managed to get into university they might have avoided certain classes that required attention and focus. They manoeuvred certain issues.
“They ultimately may seek treatment because they cannot focus on their work and always feel anxious. However, the prevalence of adult ADHD is low because very few come forward.”
Globally five per cent of children suffer from ADHD and between two and three per cent of adults have the condition.