STERN CENSURE. Gentle admonishing. Tearful entreaties. Incessant nagging. Everything fell on deaf ears. He wouldn't heed to anything his parents or teachers told him unless it sparked off some interest in him. He wouldn't complete his homework on time. And if by any miracle he did, the assignment would be strewn with silly mistakes you could have sworn a four-year old wouldn't make. He wouldn't sit quietly for two minutes together, even in classrooms. He would blurt out answers even if he knew perfectly well that the teachers had addressed the questions to his classmates. He would pick up fights with his friends at the drop of a hat without giving a thought to the consequences of his actions.

Before long, his parents and teachers branded him a spoilt brat. Only he wasn't. He had a genetic neuro-chemical problem called Attention Deficit Disorder (ADD).

It took a few sessions with ADD experts for his parents to realise that his inattention was not deliberate. Only he was built in a way that he had trouble keeping attention for long stretches and giving close attention to details unless it captured his attention.

Neither were the impulsive acts such as getting into a fight or blurting out answers in classrooms an utter disregard for order. Rather it was due to the absence of inner language, which normal children usually master by the age of 3-4 and internalise by the age of 11, and use to inhibit their behaviour.

Some of the ADD children, like our protagonist, are also hyperactive. They find it extremely difficult to reign in their restlessness. Extremely fidgety, they would move about in classrooms, climb up chairs and tables, without a thought about the appropriateness of the situation. In girls, the hyperactivity is often noticed as excessive chattering.

Not alone

Studies have revealed that about 6-15 percentage of children worldwide, suffer from one or other form of Attention Deficit Disorder.

Dubai, with its mixed expatriate population, should have a higher rate than that. "Places with a transient population such as Dubai, Hong Kong and Zurich would normally have higher rates of incidence. I wouldn't be surprised if each class here has at least 3-4 children with ADD," says Dr Rajeshree Singhania, Neuro Developmental Paediatrician, Singhania Children's Clinic.

Unfortunately, chances are most of them would go undiagnosed and untreated. Research shows that in spite of ADD being in the media spotlight for many years now, 60 percentage of affected kids grow up into adults with ADD. A pointer that the disorder is still under-diagnosed and under treated as against the reputation of being an over-diagnosed fad in media circles.

One of the reasons why it remains under-diagnosed may be due to the fact that it is a difficult disorder to pick up. Unless it is of the hyperactive type called Attention Deficit Hyperactive Disorder, which is less prevalent than ADD, it needs extremely discerning and aware teachers and parents to even doubt ADD.

All brats don't have ADD

But then not every inattentive hyperactive brat has Attention Deficit Disorder. As Dr Singhania puts it, "ADD is not a checklist diagnosis." The symptoms of ADD within the cardinal features of inattention, impulsivity and hyperactivity should be evident in kids for more than at least six months continuously, and some of them must have been present before the kid became seven years old. Before diagnosing them with ADD, doctors need to assess in detail whether these symptoms have become a disruptive presence in their social, emotional, behavioural and educational spheres.

Dr Singhania cannot but overstress the importance of understanding the crucial role a healthy and supportive environment plays in keeping ADD in check.

Too much rote learning, too much of homework, little physical exertion, incessant nagging by parents and teachers, all could spin off complications in ADD kids.

In the US, studies have found out that about 75 percentage of the ADD kids developed interpersonal problems, 60 % had behavioural issues and a sizeable number had learning and language difficulties due to their inattention problem.

Most of the ADD children have above average IQ. But the difficulties they face in the application of their intelligence in tedious processes such as exams and class assignments make them a poor student. Failure to capitalise on their faculties and realise their full potential daunt these children. Constant taunts from parents and teacher make matters worse. The underachiever tag that teachers and parents are ever so eager to put on to students injure their developing self-esteem.

Without the mature handling of these kids by teachers, these functional difficulties snowball into greater behavioural issues resulting, more often than not, in their expulsion from schools. Frequent expulsions, the ensuing turmoil and stress drive them to anxiety and depression.

In Dr Singhania's assessment, about 60- 70 percentage of ADD children suffer from anxiety and depression. It is a dangerous trend as a good many can develop suicidal tendencies thereafter.

Therapy

All the more reason to focus on early diagnosis and treatment. Stimulant medicines form the core of treatment for ADD as it is a neuro-chemical disorder. However, simultaneous psychotherapy can do wonders by attending to the associated behavioural and social problems and helping the children adjust with their dysfunction. Including the family in the therapy can go a long way in mitigating the damaging effects of ADD by providing emotional stability and the necessary support system.

Schools can also chip in by giving ADD children special consideration. Less homework, more exam time, appropriate therapy to overcome language and learning difficulties would all make their time at school less stressful.

Thankfully, ADD children don't have to depend on stimulant medicines all their life. They need it only till they do intensive studies that require concentration. For all the good stimulant medicines such as Ritalin do, it has drawn a lot of flak for its supposedly addictive nature.

"Long term studies have proven that Ritalin, which comes from cocaine, is not addictive in nature. What the detractors of Ritalin point out as addiction is merely the reappearance of ADD symptoms such as anxiety, aggressiveness etc on its withdrawal. Yet the press goes on harping about its harmful effects without realising the extremely beneficial role it plays in relieving the kids of ADD symptoms," emphasizes Dr Singhania.

With a bit of support from understanding parents and teachers and an effective treatment plan, ADD children can surmount difficulties that present early in life to have successful careers and fulfilling lives. Just help the kids identify their own aptitude and set them off on an interesting career path. Once hooked to an exciting profession, they come out with flying colours because of their ability to focus deeply on a topic. So next time, don't look flabbergasted when you hear about a doctor or an engineer with Attention Deficit Disorder. However, it would do them a world of good if they steer clear of secretarial jobs as they make a complete mess of it due to their executive function defect. Otherwise, the future looks bright for ADD kids.

Dubai Community Health Centre conducts bi-weekly Support Group for Parents of ADHD from 7:00 pm to 8:00 pm. Ms Rachna Buxani, a licensed counselor, will be the facilitator.

For more information, call Tel: -04 3953939

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