ADHD- Role of a parent of a child with ADHD in improving behaviour and executive functioning skills

 

ADHD -Role of a parent of a child with ADHD  in improving behaviour and executive functioning skills.

A day in the life of a parent of a child diagnosed with ADHD is a rollercoaster ride. Sometimes, it seems fun when the child is energetic and playful enjoying every bit of the attention being showered on him. They are major attention seekers and thrive when they get it. They can easily engage you in an engrossing conversation as they are very good at verbal expression.

At other times, it could cause a lot of frustration, stress and anguish for the parents and caregivers.  They might need to be given constant reminders to focus on their behaviour and emotional issues.

What is ADHD?

ADHD is a neurodevelopmental disorder that is usually associated with hyperactivity, attention deficit, restlessness, poor communication skills and social skills. They also show poor concentration and executive functioning skills like planning, organizing, coordinating etc.

Earlier, ADHD was also referred to as ‘Attention Deficit Disorder’(ADD).  ADD is a milder representation of the symptoms of ADHD - that is without hyperactivity, ADD is no longer considered a medical diagnosis and doctors have been using the term ADHD to describe both the hyperactive and inattentive types.

There are 3 types of ADHD.

Primarily Inattentive

Primarily hyperactive-impulsive

Combined type 

PREVALENCE

ADHD in India

According to a study conducted in Coimbatore, Tamil Nadu, it was found that the prevalence of ADHD in children is higher than the global estimate, at 11.32%. The highest prevalence is found in ages 9 (at 26.4%) and 10 (at 25%).

 Further, the study showed that more males (66.7%) were found to have ADHD. Children who have ADHD were also observed to not only have poor academic performance and behavioural difficulty but also had problems with reading and writing.

IMPACT

Children diagnosed with ADHD might face the risk of social-emotional issues, poor academic progress and daily functioning as they get into adolescence and adulthood unless it is addressed at the earliest and appropriate intervention and therapies are provided.

 There could be manifestations of imbalances in emotion (trouble controlling anger, depression and mood swings, and relationship problems at work) and behaviour issues such as getting into addictions and substance abuse, and experiencing chronic boredom. 

 Children with ADHD could have difficulty with multiple issues like motor skills, directions, organisation skills, communication and social interaction and sometimes writing tasks. They are usually hesitant to write and hence take extra time to complete their writing assignments.

Fortunately, several strategies and measures can be used by parents to cope with the issues and bring about positive change in the development of a child with  ADHD.

THERAPIES  and TECHNIQUES 

1. Cognitive therapy

2.   Occupational therapy

3.   Play therapy

4.   Art therapy

5.   Social skills training

6.   Sensory Integration

7.   Academic intervention

8.   Mindfulness

9.   Classroom accommodations

10.  Behaviour therapy

Firstly parents should gain awareness about the condition. They should read about it, and get the child formally assessed by a clinical psychologist to understand the severity. It could be mild, moderate or severe. Once the assessment is done they can follow the recommendations given by the psychologist and coordinate with school teachers, school counselors and special educators for extra support and accommodations for the child. They should be in regular touch with the educators so that the child gets maximum attention from his caregivers. 

Over-exposure to gadgets and screens is one of the major causes of the poor academic focus of the child. Using gadgets could be addictive and it would be very difficult to wean them off the habit as they grow. The usage of gadgets should be limited for both adults and children in the family. Instead, the parents can engage them in educational board games.

The parents can take them out to historical places, parks, and cultural activities which will add value to their knowledge base and keep them productively engaged. 

Diet also plays a major role in the cognitive development of the child hence a good amount of attention should be given to it. Consumption of sugar and salt should be restricted. Studies have proven that excess consumption of sugar and carbs might lead to hyperactivity and attention deficit. The diet should consist more of vegetables and fruits. They should be habituated as early as possible. 

Children with ADHD usually struggle with organizing and planning. Parents need to set certain ground rules and a healthy routine which needs to be followed by everyone in the family as they often learn by emulating the adults. So certain things are followed by default. For example, waking up early and going to bed at a particular time. This is very important. 

Children with ADHD are very energetic and their energies need to be channelized constructively. The child should be engaged in regular physical activity, a structured sport like tennis, basketball badminton would be better. Apart from this, the parents can also try aerobics, Zumba, yoga, brain gym exercises etc at home. 

Since it is difficult for the child to focus in class and grasp all the concepts taught in school, the parents need to reinforce the concepts at home. It is also a good way of spending quality time with the child. A multi-sensory approach is recommended for such children as they learn better by doing, hands-on. Some of them could be visual learners. For these, they could show relevant videos. But the best way they enjoy learning is by doing wherein all the senses are being activated. For eg, parts of a plant or germination can be taught by making them plant something and sow seeds for germination. English concepts can be reinforced through word games and flash cards. This will ignite interest in learning for the child. Once the child’s interest is ignited, he will learn easily. 

Another strategy that could work for these children is chunking. Usually, the child does not show interest in studying or writing if the targets are huge. So we can break down the content into smaller chunks and set smaller targets so that the child is motivated. Most children are overwhelmed with the length of the content to be covered. Giving smaller targets would surely motivate them to start. 

Another tool that works well for these children is positive reinforcement. Small incentives and rewards in the form of a token economy can be given to encourage positive behaviour. Whenever the child completes a task on time or follows instructions to the best of his abilities, he should be rewarded. We need to endorse and appreciate so that the child understands the expected behaviour. When it comes to instructions the parents should refrain from giving multiple instructions at a time. It becomes difficult for them to process and follow. One instruction at a time is the best thing to do. 

Of course, all these strategies call for a lot of patience, tolerance, perseverance, resilience and empathy on the part of the parents. 

In terms of social impact, a child with ADHD can cause a lot of anxiety for the people around him, putting strains on parent/sibling-child relationships.

Children diagnosed with ADHD  also have difficulty with social interaction and emotion regulation. They should be exposed to various social settings so that they are accustomed to social etiquette and culture. They need to be often reminded about the ground rules and boundaries so that they are habituated to decent social manners. They may need social clues to get along with friends and peers. They like to have friends but need help to maintain friendships. Most times they also find it difficult to express themselves and put forth their opinions and problems. Hence, adults should interact with them more often about their challenges and solutions. 

To engage them productively and coach them in life skills, children can also be given chores to do at home depending on the age of the child. There are many tasks that the children are capable of doing. We as parents should trust the abilities of the child. They can be asked to put back things, dirty their room, lay the table, fold clothes, dust the furniture, water the plants make the bed etc. 

 

 

The parents should keep in touch regularly with the teachers, special educators, and counsellors. Thus, parents need to work with their healthcare providers (paediatricians, therapists, etc) and even with schools and teachers to help their children.

MEDICATION

Medicines used to manage ADHD symptoms help to balance and enhance neurotransmitters thereby improving symptoms. Stimulant medicines work for about 70-80% of people. They can be used to treat both moderate and severe symptoms of ADHD.

 Some stimulants are approved for children over the age of 3 and children over the age of 6, respectively. These medicines help children, teens, and adults who have a hard time at work, home or school.

 

There are other medicines as well. The alternative medicines include Amitriptyline, Bupropion, Escitalopram, and Venlafaxine. Doctors may prescribe these for the following reasons:

If stimulants and non-stimulants don’t work

If they cause side effects that you can’t live without

If you have other medical conditions

Parents in India are hesitant to subject their children to medication for ADHD. Reasons could be fear of side effects and fear of the child getting addicted to the drugs.

CITATIONS/REFERENCES

https://www.neeuro.com/blog/adhd-india#:~:text=Another%20ADHD%20study%20conducted%20in%20different%20parts%20of,million%20Indian%20children%20are%20diagnosed%20with%20ADHD%20annually.

https://www.empoweringparents.com/article/parenting-an-adhd-child-how-to-improve-their-behavior/

 OBESITY AND MENTAL HEALTH

 In medical terms, obesity is the excess amount of body weight. The cause and effects of obesity could differ based on the age, medical condition and environment. There could be various reasons for obesity depending upon the age. The most common reasons for obesity could be genetics, improper diet, lack of physical activity, sedentary life style and  certain medical conditions.

Obesity could adversely affect both physical and mental health. It could lead to a number of physical ailments such as Type 2 Diabetes, Hypertension, Thyroid, High levels of LDL, certain cancers, heart disease, liver damage, arthritis etc.

Obesity also affects mental health adversely. The impact could be different at different stages of a person’s life. In childhood the person could go through fear of being ridiculed or bullied. This could lead to anxiety, low self confidence and low self-esteem. Impressions and insecurities during childhood are long lasting and could impact self-image of a child which could continue through adulthood.

Then again, during adolescence, puberty, physiological and hormonal changes could lead to obesity. During this period, self-image  and self-identity play a major role. Teenagers are conscious about their appearance and experience “Imaginary audience”. They might go through stress and anxiety if they think they are overweight and how people perceive them. They could  be paranoid about how they look, what they should eat,  what they wear and the friends they have. It could affect their social- emotional wellbeing to a great degree. It could also lead to eating disorders like Anorexia Nervosa, Bulimia, substance abuse, bipolar disorder and depression in worst cases. It could also be due to peer pressure and body shaming.

Both men and women tend to gain weight post marriage and if they don’t take precautions it could lead to obesity. Women may not be able to shed the extra weight gained during pregnancy and might reach a level of obesity. This could affect their mental health. They might feel, demotivated, stressed and anxious. As they enter their  50s, during menopause women tend to gain weight and find it very  difficult  to shed the  extra pounds. As they grow older they become more conscious of their health which itself is very stressful and may lead to anxiety, depression and Alzheimer’s.

Obesity can be prevented and reversed by practising a healthy life style through proper diet, regular physical activity and relaxation techniques like meditation, yoga, mindfulness to combat stress and anxiety.

Kalyani Garimella

Counselling Psychologist

Clover Learning Center

Hyderabad

 I AM SPECIAL... I AM ME!

Let me try

Let me fly!

Give me wings 

To better things!

Give me a chance,

 To advance!

Let me seek,

And not freak!

Let me shine,

And feel fine!

Give me a reason,

To smile every season!

Give me the power,

to grow forever!

I want to thrive,

And not always strive!

I want to be a master,

Sooner or later!

I want to reach, 

That is all I beseech!!

                                        by Kalyani Garimella

JEALOUSY VS. INSPIRATION

Jealousy according to me is just the other side of Inspiration. If we flip the card, the other side would be inspiration. When one is feeling jealous… they are actually, looking at some positive aspect or attribute of the other person which they would like to have. It could be a material thing, a relationship or an achievement.

 If we feel bad about it and say “Oh! I do not have that”, it is jealousy but if we feel “Oh! I could have that or achieve that if I try then that becomes an inspiration. So, jealousy could be turned into a positive feeling… an inspiration if we choose to look at it that way.

For instance, if our counterpart or colleague is doing very well professionally and is very successful, one could feel jealous or get inspired by the way the person is leading his or her life. It is all about the choices we make and our perspective. We can observe and learn from others instead of feeling jealous. Of course, the circumstances could be different but we  can make an attempt. 

Comparing and feeling jealous about material things doesn’t make much sense as they are perishable and not always necessary to have. Material things can never be a bench mark for success or happiness. So I don’t think it is a good idea to compare and feel jealous about material things.

 Relationships are very personal and depend on a lot of things.  They may depend on the gender, the circumstances, the age, our culture, values, attitudes, beliefs etc. Now, professional success and achievements also depend on a lot of things so how can we compare and feel jealous?? It is better to just look at the person, and imbibe what appeals to you… be inspired and learn rather than feel jealous and do nothing about it.

So all we need to do is to just flip the card and look at the other side and follow our true instinct.

By Kalyani Garimella 

 PARENTING

Parenting is like flying a kite …You need to hold the string but loose enough to let it fly and soar high in the sky. If you hold too tight it will not be able to fly and will not reach great heights and on the other hand if don’t hold it firmly chances are it might fall down. So it’s all about striking a balance

                 

•          Model the behaviour you expect from them
• .       Listen actively but not say Yes to everything

 

1.    

1.   

•        Be empathetic but firm
• .      Express care and concern but don’t pamper/ spoil them

• .       Correct them using logical consequences

• .       Provide them but not over indulge. Delay gratification
• .       Understand their thoughts, feelings and ideas before you come to a conclusion
• .       Have expectations but keep them reasonable based on their capabilities

• .       Accept your mistakes and don’t hesitate to apologize

•   .   Model respect to others especially elderly people
•       Treat them the way you would treat your friend or colleague especially teenagers

•   .   Give them space but make sure you have entry into it
•   .   Give them choices and encourage them to take their decisions

     

•   .   Negotiate with them when there is a difference of opinion
•   .   Monitor but don’t police them
•   .   Don’t use blame, threat or bribe to correct them

 

    

 

10 WAYS TO PREVENT  DIGITAL ADDICTION DURING THE PANDEMIC

 In the present age of technology and the current scenario, the usage  of computers and other gadgets has become inevitable. Digital learning has replaced traditional classrooms and children are required to use digital equipment like laptops, tablets, mobile phones etc..However, due to this requirement, gadget usage while still not an addiction is definitely a compulsion for the children today. As we all know excess of anything could be detrimental  for the body and mind. Over indulgenc or exposure to  gadgets could lead to gadget addiction and it is very difficult to undo the impact. Gadget addiction can have an adverse affect on the cognitive and social-emotional development of children.

AFFECTS OF EXCESSIVE EXPOSURE TO SCREENS

1.      Emotional issues such as irritability and frustration

2.      Aggressive /Impulsive behaviour

3.      Poor social skills

4.      Poor communication skills

5.      Vision problems

6.      Procrastination

7.      Poor muscle tone

8.      Eating disorders

9.      Obesity

10.  Lethargy

11.  Poor academic performance

12.  Lack of interest in other activities

The good news is there are ways to prevent and cope with the problem.

1.      MODELLING-Children usually tend to emulate elders and follow them. If adults in the house spend a lot of time with gadgets,  children will have a good reason to do so.  Parents and other adults should curtail the usage of gadgets and lead by example.

2.      LIMIT  SCREEN TIME- You can restrict screen time by having a schedule and fixing the amount of time you, as a family, spend time with gadgets.  Yes, it is necessary to check our phone from time to time for important notifications but that need not be constant.  You can leave your phone unattended for half an hour or so. You can restrict the usage of laptops and tablets for digital learning and academic purposes. Screen time should be limited to 2-3 hours per day. Try and limit the number of gadgets your child has access to .

3.      HOUSEHOLD CHORES – Try and engage the children in household chores like laying the table,  putting back things, dusting the furniture and appliances, folding clothes, watering plants, filling water bottles, mopping the floor,  kneading dough,  chopping vegetables and so on depending  on their age and ability. Explain why they need to do it and ask politely rather imposing and insisting.

4.      SPEND TIME- Children are our priority and responsibility. They need your time and attention. In between your work,  take short breaks and talk to the children, listen to them and ask how they feel.  We usually tend to allow them to use gadgets when  we are unable to give them time. You can play board games  and engage in art and craft activities with them as and when possible. In case there are grandparents around you should encourage the children to spend time with them. Grandparents are good at communicating with children and enjoy doing so. 

5.      PHYSICAL ACTIVITY- Engage the children in physical activities such as zumba,  dance, yoga, hopscotch, aerobics,  cycling, table tennis and badminton if space permits.

6.      BOOK READING- Reading books should be a part of your daily routine to encourage children to inculcate the habit. Avoid eBooks and kindle.  If adults in the house have the inclination towards reading and share their knowledge,  children will be motivated to read. It is good idea to do pair reading with children.

7.      DIY ACTIVITES- When you are unable to give them time, provide the children with a lot of material  and let them experiment with DIY activities.  You can give them things like paper cups, paper plates, straws, plastic spoons,  ice cream sticks,  cotton balls, buttons, rubber bands,  old business cards, newspaper and of course stationery items like glue, scissors tape pencils sketch pens etc. Children usually like to engage in hands on activities and they are sure to come up with something creative. You can organise them in boxes and containers so that  the kids can put them back easily.

8.      .COMMUNICATION- Positive communication is very essential for the social -emotional well being of children.  You should communicate more often with the children so that they feel connected. You may not be able to have long conversations with them but try and listen to them for a few minutes even though you are busy. This  gives them a sense of priority. At  some point, during the day, make it a point to have a short conversation with the children about what they would like to do the next day apart from studies.

9.      NATURE WALK- If possible, take them out or to the terrace and let them spend some time outdoors. You can go to a nearby park as well.  Of course, you need to prepare them for social distancing and other precautions to be followed when you go out.

10.  POSITION OF THE COMPUTER-  Long hours in front of the screen could lead to eye strain and neck pain. To  reduce eye strain, the ideal computer screen position is at a 10 to 15 degree angle below eye level, assuming your child is sitting straight up and looking straight ahead. The top of the computer screen should be at eye level so your child can scroll down with his eyes rather than looking up and down and straining their neck. Place the laptop / Computer/ Tablet in the common area  to facilitate monitoring the child’s online learning.

Considering our time constraints, it may not be easy to implement all these suggestions but it is worth trying. In case of teenagers, we need to explain the consequences and long term impact of excessive use of gadgets. Negotiation and persuasion works better than threats and confiscation. Positive reinforcement can often  be used to encourage self restraint and self discipline. 

Thank you!! Stay safe!! Stay calm!!

TIPS FOR  PARENTS DURING LOCKDOWN

 Dear parents,  are you getting stressed with homeschooling and getting the children to attend the online classes and complete their assignments  during this lockdown period?  Here are a few tips which you could try, to get your child to do his/her  homework/ assignments/tasks etc.

1.        Please don’t force your child to complete study assignments when he/she  is resisting. Negotiate with the child and link it with an activity that he/she  prefers. Give him the homework assignment soon after he has enjoyed his play. ( It could even be a video game)

2.       Try and have a schedule and a specific time allotted to complete school assignments like watching pre recorded videos, worksheets etc. There are sample schedules available on the net which you can modify according to your convenience. Encourage your child to make the schedule himself/ herself. That makes them accountable and responsible.

3.       Appreciate his / her  efforts to sit and complete his/her work after it is done. The child feels encouraged and motivated to do it again the next time. Something as small as a high five or a word of praise can boost your child’s self esteem.

4.       Talk about his/her teachers’ efforts to create the videos and worksheets and how happy she would be when he submits it on time.

5.       Talk about the benefits of being one of the first in the class to submit homework.  For example, explain how watching the pre recorded videos will help him stay ahead of the class and give him an edge.

6.       Avoid engaging  in your preferred activities while the child is doing his homework. Read a book or pick up a chore instead. Modelling helps.

7.        Encourage the child to organize his  study space and be ready for the online class 10 mins  before the scheduled time.

8.       Create a conducive environment for the child to attend the online classes so that he takes it seriously and respects everyone’s time.

9.       Let’s teach  them to set simple goals, prioritize and get a sense of achievement. Eventually they need to understand that they are doing it for themselves,  for their own progress and growth and not to please others.

110.   We need to be patient with them. It is not easy for them too. They have been deprived of social interaction and outdoor activity which matters to them the most. They may not be able to express their  fears and stress verbally and may show it in other ways.

11.    You can reduce screen time by encouraging them to engage in physical activities like dance, aerobics, martial arts, gardening, household chores etc. Set a time limit for gadget usage or gadget free time for everyone at home during the day.

12.    Encourage self correction so that they don’t feel corrected and judged all the time. This way they also learn to reflect and introspect which will benefit them in the long run.

The key to good study habits is developing a routine, learning to prioritize  and setting goals for achieving study goals. With practice and persistence, kids will fall into a positive pattern of behaviour, which should begin to produce solid and consistent results over time.

Thank you! Stay safe! Stay healthy!