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/
