Dr. Lalith

What is ADHD?

ADHD, also called attention-deficit disorder, is a behavior disorder, usually first diagnosed in childhood, that is characterized by inattention, impulsivity, and, in some cases, hyperactivity. These symptoms usually occur together; however, one may occur without the other(s).

The symptoms of hyperactivity, when present, are almost always apparent by the age of 7 and may be present in very young preschoolers. Inattention or attention-deficit may not be evident until a child faces the expectations of elementary school.

What are the different types of ADHD?

Three major types of ADHD include the following:

• ADHD, combined type. This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.

• ADHD, impulsive/hyperactive type. This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility.

• ADHD, inattentive and distractible type. This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity.

What causes attention-deficit/hyperactivity disorder?

ADHD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown. Available evidence suggests that ADHD is genetic. It is a brain-based biological disorder. Low levels of dopamine (a brain chemical), which is a neurotransmitter (a type of brain chemical), are found in children with ADHD. Brain imaging studies using PET scanners (positron emission tomography; a form of brain imaging that makes it possible to observe the human brain at work) show that brain metabolism in children with ADHD is lower in the areas of the brain that control attention, social judgment, and movement.

Who is affected by attention-deficit/hyperactivity disorder?

Estimates suggest that about 4% to 12% of children have ADHD. Boys are 2 to 3 times more likely to have ADHD of the hyperactive or combined type than girls.

Many parents of children with ADHD experienced symptoms of ADHD when they were younger. ADHD is commonly found in brothers and sisters within the same family. Most families seek help when their child's symptoms begin to interfere with learning and adjustment to the expectations of school and age-appropriate activities.

What are the symptoms of attention-deficit/hyperactivity disorder?

The following are the most common symptoms of ADHD. However, each child may experience symptoms differently. The 3 categories of symptoms of ADHD include the following:

• Inattention:

  • Short attention span for age (difficulty sustaining attention)

  • Difficulty listening to others

  • Difficulty attending to details

  • Easily distracted

  • Forgetfulness

  • Poor organizational skills for age

  • Poor study skills for age

• Impulsivity:

  • Often interrupts others

  • Has difficulty waiting for his or her turn in school and/or social games

  • Tends to blurt out answers instead of waiting to be called upon

  • Takes frequent risks, and often without thinking before acting

• Hyperactivity:

  • Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion

  • Has difficulty remaining in his/her seat even when it is expected

  • Fidgets with hands or squirms when in his or her seat; fidgeting excessively

  • Talks excessively

  • Has difficulty engaging in quiet activities

  • Loses or forgets things repeatedly and often

  • Inability to stay on task; shifts from one task to another without bringing any to completion

The symptoms of ADHD may resemble other medical conditions or behavior problems. Keep in mind that many of these symptoms may occur in children and teens who do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your child's doctor for a diagnosis.

How is attention-deficit/hyperactivity disorder diagnosed?

ADHD is the most commonly diagnosed behavior disorder of childhood. A pediatrician, child psychiatrist, or a qualified mental health professional usually identifies ADHD in children. A detailed history of the child's behavior from parents and teachers, observations of the child's behavior, and psychoeducational testing contribute to making the diagnosis of ADHD. Because ADHD is a group of symptoms, diagnosis depends on evaluating results from several different sources, including physical, neurological, and psychological testing. Certain tests may be used to rule out other conditions, and some may be used to test intelligence and certain skill sets. Consult your child's doctor for more information.

Treatment for attention-deficit/hyperactivity disorder

Specific treatment for attention-deficit/hyperactivity disorder will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of your child's symptoms

• Your child's tolerance for specific medications or therapies

• Expectations for the course of the condition

• Your opinion or preference

Major components of treatment for children with ADHD include parental support and education in behavioral training, appropriate school placement, and medication. Treatment with a psychostimulant is highly effective in most children with ADHD.

Treatment may include:

• Psychostimulant medications. These medications are used for their ability to balance chemicals in the brain that prohibit the child from maintaining attention and controlling impulses. They help "stimulate" or help the brain to focus and may be used to reduce the major characteristics of ADHD.
  Medications that are commonly used to treat ADHD include the following:

  • Methylphenidate (Ritalin, Metadate, Concerta, Methylin)

  • Dextroamphetamine (Dexedrine, Dextrostat)

  • A mixture of amphetamine salts (Adderall)

  • Atomoxetine (Strattera). A nonstimulant SNRI (selective serotonin norepinephrine reuptake inhibitor) medication with benefits for related mood symptoms. 

  • Lisdexamfetamine (Vyvanse)

  Psychostimulants have been used to treat childhood behavior disorders since the 1930s and have been widely studied. Traditional immediate release stimulants take effect in the body quickly, work for 1 to 4 hours, and then are eliminated from the body. Many long-acting stimulant medications are also available, lasting 8 to 9 hours, and requiring 1 daily dosing. Doses of stimulant medications need to be timed to match the child's school schedule to help the child pay attention for a longer period of time and improve classroom performance. The common side effects of stimulants may include, but are not limited to, the following:

  • Insomnia

  • Decreased appetite

  • Stomach aches

  • Headaches

  • Jitteriness

  • Rebound activation (when the effect of the stimulant wears off, hyperactive and impulsive behaviors may increase for a short period of time)

  Most side effects of stimulant use are mild, decrease with regular use, and respond to dose changes. Always discuss potential side effects with your child's doctor.
  
  Antidepressant medications may also be administered for children and adolescents with ADHD to help improve attention while decreasing aggression, anxiety, and/or depression.

• Psychosocial treatments. Parenting children with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills for parents can help reduce stress for all family members. Training in behavior management skills for parents usually occurs in a group setting which encourages parent-to-parent support. Behavior management skills may include the following:

  • Point systems

  • Contingent attention (responding to the child with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)

  Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes use of daily behavior reports that communicate in-school behaviors to parents.
  
  Behavior management techniques tend to improve targeted behaviors (such as completing school work or keeping the child's hands to himself or herself), but are not usually helpful in reducing overall inattention, hyperactivity, or impulsivity.

Prevention of attention-deficit/hyperactivity disorder

Preventive measures to reduce the incidence of ADHD in children are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with ADHD.

Tonsillitis, in the easiest terms, is the swelling of tonsils in our throat that is accompanied by symptoms like throat pain, difficulty in swallowing/ drinking, altered voice and fever etc.

As in the case of most infections, the occurrence of tonsillitis is more common in children due to relatively lower immunity and habits that invite infections. Let's take a look at the first line of defence when you have a cranky child with swollen tonsils.

1. Make your child gargle with salty warm water: This treatment is most helpful in any infection in the mouth. Add half teaspoonful of salt to a glass of warm water and make the child gargle with the mixture as many times in the day as possible (to a maximum of 5 times). Continue till the condition prevails.

Make sure the child spits out the water and not drinks it.

2. Antibiotics: Consult the ent specialist and have the antibiotics if it is a bacterial cause as per the doctor. Take the alternative treatment prescribed in case of other causes. The entire course of medication should be completed even if the kid gets better sooner to eliminate all traces of bacteria.

3. Painkiller/numbing lozenges: Painkillers that are prescribed by the doctor can be given to ease the pain. Same is the case with lozenges but care should be taken that he/she should not have too many of these.

4. Allow him/her to take rest: It does help in a betterment of the condition!

5. Give warm (not hot) soothing food: Soup, ginger honey mixture, ginger tea can help soothe the inflamed tonsils in most cases. The condition, more often than not, gets better within 7-10 days.

From terrorism to natural disasters, there are a number of traumatic events that constantly hurl themselves at us. Given the amount of stress it causes an adult, imagine how a child can process this information. Often traumatic events that occur in childhood can trigger phobias and anxiety disorders that last a lifetime if not dealt correctly.

Each child responds to trauma in a different way depending on the circumstances and their age and personality. What is common is that all children turn towards their parents and teachers for support in these situations. Hence, it is important to understand how to help your child deal with traumatic events.

Here are a few steps you should follow:

1. Provide comfort: The first thing to do in a traumatic event is to reassure and comfort the child. Reinforce your child's sense of security by following a normal schedule and maintaining regular eating and sleeping habits. Encourage your child to talk and ask questions and discuss the situation with them in a way appropriate to your child's age and concerns.
2. Accept their needs: Children show the need for reassurance in different ways. For some, it may be the need for extra physical contact in the form of hugs while for others it may be ensuring that their favourite teddy bear is with them constantly. Be patient with children and indulge their needs in such situations.
3. Limit the amount of information available: Media often magnifies a traumatic event making it all the more difficult for a child to apprehend. Children can often be mislead or frustrated by media coverage of a traumatic event. Thus, it is a good idea to limit the use of television, radios and internet. As far as possible do not let your child watch the news alone.
4. Stay in touch: If your child goes to school, his or her teacher is the parent figure at school. Stay connected with your child's teachers and the other adults in their life to monitor changes in behavioral patterns.
5. Create distractions: If left alone with nothing to do, a child's mind will dwell on the trauma. Encourage them to find a hobby to cope with the negative emotions. Music and art are two good outlets for stress. You could also play board games, read or play outdoors to distract them.
6. Get professional help: Sometimes you may need help to deal with a traumatic event in your child's life. If your child shows signs of behavioral changes, academic problems, emotional outbursts, anxiety, depression, insomnia or social withdrawal; you should consult a professional counselor.

In India 61 million people are victims of diabetes. Diabetes disease is related to metabolic, in which oxidation of carbohydrates and glucose is not fully detected. Diabetes mellitus is a chronic metabolic disorder in which the body fails to convert sugars, starches and other foods into energy. Many of the foods you eat are normally converted into a type of sugar called glucose during digestion. The bloodstream then carries glucose through the body. The hormone, insulin, then turns glucose into quick energy or is stored for futher use. In diabetic people, the body either does not make enough insulin or it cannot use the insulin correctly. This is why too much glucose builds up in the bloodstream.

The main reason is irregular meal, mental stress, lack of exercise. There are two major types of diabetes:

Type 1

• This is popularly known as juvenile onset diabetes. 
• Here, the body produces little or no insulin. It occurs most often in childhood or in the teens and could be inherited.
• People with this type of diabetes need daily injections of insulin. They must balance their daily intake of food and activities carefully with their insulin shots to stay alive.

Type 2

• Also known as adult onset diabetes, this occurs around 35 to 40 years. The more common of the two types, it accounts for about 80 per cent of the diabetics.
• Here, though the pancreas produce adequate insulin, body cells show reduced sensitivity towards it.
• Type 2 diabetes is usually triggered by obesity. The best way to fight it is by weight loss, exercise and dietary control.
• Sometimes, oral medication or insulin injections are also needed.

Symptoms of diabetes

• Extreme thirst and hunger
• Frequent urination
• Sores or bruises that heal slowly
• Dry, itchy skin
• Unexplained weight loss
• Unusual tiredness or drowsiness
• Tingling or numbness in the hands or feetsymptoms of diabetes

The role of diet in diabetes
Meal of diabetic patient is depending on calories. Which decides on it s age, weight, gender, height, working etc. Depending on each person s different   different dietary chart is created. We must take special care of time and amount of food in diabetes. Here we are giving diet chart for general diabetes patient.

Diabetes diet chart:

• Morning at 6:   teaspoon fenugreek (methi) powder + water. 
• Morning at 7: 1 cup sugar free tea + 1-2 mary biscuits.
• Morning at 8.30: 1 plate upma or oatmeal + half bowl sprouted grains + 100ml cream-free milk without sugar
• Morning at 10.30: 1 small fruit or 1 cup thin and sugar free buttermilk or lemon water
• Lunch at 1: 2 roti of mixed flour, 1 bowl rice, 1 bowl pulse, 1 bowl yogurt, half cup soybean or cheese vegetable, half bowl green vegetable, one plate salad
• 4 pm: 1 cup tea without sugar + 1-2 less sugar biscuits or toast
• 6 pm: 1 cup soup
• 8.30 pm: 2 roti of mixed flour, 1 bowl rice, 1 bowl pulse, half bowl green vegetable, one plate salad
• 10.30 pm: take 1 cup cream free milk without sugar.

When you feel hungry intake raw vegetables, salad, black tea, soups, thin buttermilk, lemon water. Avoid it: molasses, sugar, honey, sweets, dry fruits. Foods you must avoid!

1. Salt: salt is the greatest culprit for diabetics. You get enough salt from vegetables in inorganic form, so reduce the intake of inorganic salt.
2. Sugar: sucrose, a table sugar, provides nothing but calories and carbohydrates. Also, you need calcium to digest sucrose. Insufficient sucrose intake might lead to calcium being leached off the bones. Substitute sucrose with natural sugar, like honey, jaggery (gur), etc.
3. Fat: excessive fat intake is definitely not a good habit. Try and exclude fried items from your diet totally. But, remember, you must have a small quantity of oil to absorb fat-soluble vitamins, especially vitamin E.
4. For non-vegetarians: Try and stop the intake of red meat completely. Try to go in for a vegetarian diet. If you cannot, decrease the consumption of eggs and poultry. You can, however, eat lean fish two to three times a week.
5. Whole milk and products: Try to switch to low fat milk and its products like yogurt (curd). Replace high fat cheese with low fat cottage cheese.
6. Tea and coffee: Do not have than two cups of the conventional tea or decaffeinated coffee every day. Try to switch to herbal teas.
7. White flour and its products: Replace these with whole grains, wholewheat or soya breads and unpolished rice.
8. Foods with a high glycemic index: Avoid white rice, potatoes, carrots, breads and banana -- they increase the blood-sugar levels. 

Advice for diabetes patient:

1. 35-40 minute faster walk every day.
2. Diabetic person should eat food between times intervals like take breakfast in morning, lunch, some snakes and dinner.
3. Avoid oily food.
4. Intake more fiber foods in meals. It increases glucose level gradually in blood and keeps control.
5. Do not take fast and also don t go much party.
6. Diabetic person should eat food slowly.

Calorific requirement:

1.  An obese middle aged or elderly patient with mild diabetes 1000 -1600 kcal.
2.  An elderly diabetic but not over weight  1400 -1800 kcal.
3.  A young active diabetic  1800 -3000 kcal.
4.  Daily intake of carbohydrate: 1/10th of total calories approximately  180gm.
5.  Daily intake of protein: 60gm to 110gm.
6.  Daily intake of fat: 50gm to 150gm.