ADHD

This is known as Attention Deficit Hyperactivity Disorder that is characterized by inattention, hyperactivity and Impulsivity. It is a chronic problem and usually due to chemical imbalance in the brain. These are classified as Combined type, Predominantly inattentive and Predominantly hyperactive type of ADHD. There is no known cause of ADHD but there lies a genetic component in that it tends to run in families.

What is the impact of ADHD?

Over time as they get older, children with ADHD tend to have a lessening of the symptoms. The one symptom that could get better with age is the hyperactivity. This however does not mean that the condition gets cured. Children with Attention Deficit Hyperactivity Disorder will continue to have the disorder well into their adolescent and teenage years. If left untreated, there may be challenges with learning, aggression, indulging in antisocial activities, substance abuse, conduct disorder, school suspensions etc

Often, children with this condition tend to experience low self-esteem and have a higher chance of school failure and drop-outs.

Signs and symptoms

Impulsivity is the most common presentation with losing control of emotions easily, acting without thinking and always wanting to be first or heard. Inattention is also rather common characterized by difficulty concentrating, forgetting easily and not fully completing tasks before moving to others. Hyperactivity is characterized by constant restlessness. Of note, is that these symptoms are common in young children and may not necessarily be caused by ADHD. An extreme show of the above with a failure to outgrow them over 6 months should be a cause of concern.

When should you see us?

If you notice an extreme of the above even with growth, seek out the help of a trained professional. This will help rule out ADHD. There is no singular test for ADHD and a variety of tests will be needed to make the diagnosis. ADHD diagnosis is made from history and observations made by parents, teachers and medical practitioners. Your child might need to undergo a comprehensive assessment by a paediatric Psychologist.

Treatment with behaviour modification therapy

Behaviour modification therapy aims at equipping the parents, teachers as well as children with ADHD with the ability to control the inattention, tame the hyperactivity and master calmness.

Resources

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Here are some ways behaviour modification may be of help:

  • It encourages a reward system to ensure that good behaviour is strived for.
  • It emphasizes on the importance of having rules and following them.
  • Emphasizes the importance of structure both at school and at home.
  • It also encourages using time-out to learn about why bad behaviour is wrong.
    It shows the importance of giving clear precise commands.

Treatment

The most common drug of choice for ADHD is a stimulant that works to control awake and response centres in the brain. Stimulant medication should always be taken under the consultation of a Paediatrician or a child psychiatrist. The most common side effect of this medication is stomach upset, an inability to sleep and emotional lability. The other group of medications of choice are non-stimulants, a drug of choice for kids with Anxiety and ADHD. The recent drug is Intuniv which has a good defect as an adjuvant therapy.

We have an Occupational Therapist and a Psychologist at Kids Health Space. Book an appointment with our Paediatricians and allied health team at Kids Health Space for multidisciplinary team management.

Opposition Defiant Disorder (ODD)

A childhood disorder characterized by a pattern of disobedience, hostility, and defiance, vengefulness towards adults or authority figures.

Facts

It is a mental disorder and psychiatrists; mental health experts and child development professionals can help the parent in managing the condition.
It is challenging to distinguish between children with an assertive personality from those with oppositional defiant disorder.

How common is ODD?

ODD is fairly common in the world. At any point in time, about 1-16% of teens and children show signs of ODD. It is more common in boys than in girls. This condition peaks at 12 with a slow decline in the early 20s.

ODD ranks high in the reasons for mental health visits to doctors.

Causes of ODD

  1. The most common cause is genetics
    A child’s inborn temperament goes a long way in determining how they respond to the environment around them. There is unfortunately nothing that can be done about this factor.
  2. Inconsistent discipline
    A child who is exposed to a lot of discipline and overly lax rules is likely to be oppositional. There has to be a balance between consequences and liberties in a guardian-child relationship.
  3. Abuse, neglect and exposure to violence
    Children tend to emulate what they see and what they go through. Family stress and turmoil may worsen the symptoms.

Symptoms

They are generally observed during kindergarten years or later but almost always before puberty.

The emotional and behavioural symptoms should last at least six months to meet the diagnostic criteria.

Behavioural and emotional symptoms:
  • Irritability as the child often lashes out and is easily annoyed by others.
  • Frequently argues with people in authority or adults.
  • Physical fights with other children.
  • Refuses to follow instructions or known rules.
  • Making deliberate attempts to irritate those around.
  • Blaming others for their behaviour or misconduct.
  • Being resentful and seeking revenge against those whom they think have offended them.
Cognitive symptoms:
  • Poor concentration.
  • Often displays frustration.
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Psychosocial symptoms:
  • Low self-esteem.
  • Consistent negativity and perceived gloom.
  • Difficulty starting and maintaining friendships.

The severity varies:

Mild— Symptoms apparent in only one setting, be it home, school, or with peers.
Moderate— Shows symptoms in at least two settings.
Severe— Shows symptoms in three or more settings.

When should you see our doctor?

If in the parent’s own observation and assessment the child is displaying symptoms suggestive of ODD or the parent feels they lack the capacity to properly parent the child, help should be sought from licensed child psychologists or child psychiatrists.

Diagnosis

ODD is diagnosed after a comprehensive and thorough psychological evaluation by a Psychologist or Paediatrician. In addiction an accurate account of the observations made by the parents and teachers will help arrive at the correct diagnosis.

Treatment

Psychologist behavioural therapies using different approaches is the standard treatment. The approaches include family therapy, and group therapy. The interventions focus on teaching the child on how to make correct interpersonal interactions with both adults and peers.

The treatment may last for several months.

Drug therapy is not necessary for the management of ODD unless there are other associated disorders such as anxiety or aggression or Attention Deficit Hyperactivity Disorder (ADHD).

Book an appointment with our Paediatricians and Psychologist at Kids Health Space for multidisciplinary team management.