Yogesh Khosla
ADHD stands for Attention- Deficit Hyperactivity Disorder and almost 7-10% children are believed to be afflicted with this syndrome. Symptoms are quite easy to identify as we see so many of these unfortunate children around us. ADHD children can have some or all of the following:-
(i) Inattention is revealed in poor selective attention- attending to irrelevant stimuli and ignoring relevant stimuli. Children with this disorder are easily distracted and avoid the tasks that require paying attention for a long time span. ADHD children do badly in school.
(ii) Hyperactivity is reflected in enhanced motor activity. They move excessively, do not sit still and are permanently “on the move”.
(iii) Impulsivity is expressed as a lack of control in situations that require controlled attention or discipline. Children with ADHD are inclined to act without thinking or planning. They find it difficult to delay fulfillment of their needs.
ADHD is a serious disorder that can’t be dismissed as “naughty children who will be OK as they grow up”. If not treated properly, ADHD children will develop into adults who are under achievers in life having serious conduct problems and failing relationships. Experts find ADHD difficult to cure and recommend medication and/or psychotherapy and counseling. While the efficacy of medication, with serious side effects, is under debate and psychotherapy is largely unavailable in India, we are left with finding alternative credible solutions which can be executed by parents and teachers.
The causes of ADHD are not fully known. While biological-genetic factors could be involved to some extent for some ADHD children, it is largely the failure of parenting and teaching. Based on this premise, many credible strategies are being tried worldwide to help these unfortunate children. Collaboration between the child’s parents and the teachers, based on LOVE FOR THE CHILD, forms the basis for desirable positive changes. Of course, it is very difficult to be empathic toward those children who challenge us, who question our authority, who fail to do their homework, who cause great disturbance, who disrupt classes. Yet, it is precisely with these children that we must expend much energy to be empathic.
Main features of a multipronged attack on ADHD are described here under:
A well structured orderly environment
Gentle but firm enforcement of an orderly daily routine is a must for ADHD children. Parents can make a daily time table for the ADHD child in consultation with him/her. There should be pre decided timings for study, play, TV etc. An adult (parent/ teacher) should always be available near the child and should act as a protective presence. The protective parent should keep a watch unobtrusively, not intervening unnecessarily, but be available to check and guide before the next storm erupts or next failure arises. Distractions should be reduced as much as possible. All tasks, including study and home work, should be structured to proceed in a step-by-step manner. Assignments should be short and broken up into smaller parts. In the school, ADHD children should be seated on the front benches preferably with good role model children or “study buddy”. This peer/ buddy can be indirectly involved as collaborators to help. Work/study time should be short and interesting, adjusted to coincide with attention span of ADHD children, which is generally short. Tests/exams should be shorter and simpler for ADHD children. Pro-social behavior should be rewarded and praised hugely and there should be mild reprimand, without insults and humiliation, for mistakes and disruptions.
Improving observation and attention
Teachers and parents should design interesting activities which require paying sustained attention. For very young children, these could be stringing of beads, matching, sorting, colouring between lines, cutting and pasting, completing puzzles, listening to and narrating stories, listening to music. For older (primary level) children, attention can be improved by slow and loud reading. Children can be asked to see attentively all the objects in a room or on a table and then move out and name as many as possible. Many more such activities can be designed by loving and caring parents/teachers. Observing nature silently, praying, mindful body scan, mindful breathing, mindful listening to sounds, mindful eating without TV, are some of the activities that can surely help.
Checking Impulsive behaviour
ADHD children act impulsively without thinking about the consequences of their actions. Most of the times this lands them into trouble. A four step stop-think- and do training is the best strategy for learning behavior control. The first step to be learned is to stop, be calm, look and listen in order to understand what the problem is. The next step is to consider all possible solutions. The third step consists of executing the chosen solution. In the final step, the child learns to evaluate the process as well as the consequences of action undertaken.
This training is given initially through modeling by an adult (parent or teacher) wherein the adults acts /role plays someone who is faced with a problem- abused by a friend say. To start with, the adult goes through all the steps while constantly speaking what she is thinking and doing, instructing herself loudly. Subsequently, the child imitates the adult’s behavior, talking out loud as well. In the next stage, the child is instructed to whisper instead of talking out loud. Finally, the child guides his behavior, giving himself instructions by silent, inner speech.
Keeping in mind that, repetition and practice are vital for changing problematic behavior, this training process is repeated again and again putting the child into different imaginary problem situations.
This is Cognitive Behaviour Therapy (CBT) in action, which for a layman means modifying thoughts and behavior.
Play Therapy
Malavika Kapur, formerly Head of Clinical Psychology at NIMHANS, visiting professor of NIAS and consultant to WHO, UGC and ICSSR, has done extensive work, developing intervention packages for children and adolescents having psychological problems. In her authoritative book “Counselling Children with Psychological Problems”, she devotes a full chapter to “play” as a therapeutic intervention to cure psychological problems in children.
Says Kapur
” Play promotes the basic skills of attention and memory, advanced skills of problem solving, analysis and synthesis, planning of steps and planning ahead. In short, play promotes intelligence, creativity, language skills and communication. Social development is promoted by the rules of the game, where cooperative play, not cheating and waiting for one’s turn are promoted. The role of outdoor games for physical health is also quite obvious.”
Well structured and closely supervised play, especially outdoor games that require continuous involvement of children, can be of tremendous help in treating ADHD children. Training in classical dance and yoga can also help these children.
A combination of all the above strategies, executed by loving parents and empathic teachers as collaborators, can surely help in ameliorating the symptoms of ADHD.
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