Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children and adolescents. ADHD is often chronic with prominent symptoms and impairment spanning into adulthood. ADHD is often associated with co-occurring disorders including disruptive, mood, anxiety, and substance abuse. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry and neuropsychological data. Consideration of all aspects of an individual s life needs to be considered in the diagnosis and treatment of ADHD. 

Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for ADHD and comorbid problems. Pharmacotherapy including stimulants, noradrenergic agents, alpha agonists, and antidepressants plays a fundamental role in the long-term management of ADHD across the lifespan. 

The management of ADHD includes consideration of two major areas: non-pharmacological (educational remediation, individual and family psychotherapy) and pharmacotherapy. 

I personally support Psychotherapy. Specialized educational planning based on the child s difficulties is necessary in a majority of cases. Since learning disorders co-occur in one-third of ADHD youth, ADHD individuals should be screened and appropriate individualised educational plans developed. Educational adjustments should be considered in individuals with ADHD with difficulties in behavioral or academic performance. Increased structure, predictable routine, learning aids, resource room time, and checked homework are among typical educational considerations in these individuals. Similar modifications in the home environment should be undertaken to optimize the ability to complete homework. For youth, frequent parental communication with the school about the child s progress is essential. 

Symptoms in children and teenagers 

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six. They occur in more than one situation, such as at home and at school. The main signs of each behavioural problem are detailed below:

Inattentiveness: having a short attention span and being easily distracted making careless mistakes   for example, in schoolwork appearing forgetful or losing things being unable to stick at tasks that are tedious or time-consuming appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks 
Hyperactivity and impulsiveness: being unable to sit still, especially in calm or quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger 
These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline. 

Related conditions in children and teenagers 

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as: 

anxiety disorder   which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness 
oppositional defiant disorder (ODD)   this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers 
conduct disorder   this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals 
depression 
sleep problems   finding it difficult to get to sleep at night, and having irregular sleeping patterns 
autistic spectrum disorder (ASD)   this affects social interaction, communication, interests and behaviour 
epilepsy   a condition that affects the brain and causes repeated fits or seizures 
Tourette s syndrome   a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics 
learning difficulties   such as dyslexia Symptoms in adults In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD. 
ADHD is a developmental disorder; it's believed that it can't develop in adults without it first appearing during childhood. But it's known that symptoms of ADHD often persist from childhood into a person's teenage years, and then adulthood. Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood. By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives. The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD. But some specialists say that the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms. 

Some specialists have suggested the following list of symptoms associated with ADHD in adults: 

carelessness and lack of attention to detail 
continually starting new tasks before finishing old ones 
poor organisational skills 
inability to focus or prioritise 
continually losing or misplacing things 
forgetfulness 
restlessness and edginess 
difficulty keeping quiet and speaking out of turn 
blurting out responses and often interrupting others 
mood swings, irritability and a quick temper 
inability to deal with stress 
extreme impatience 
taking risks in activities, often with little or no regard for personal safety or the safety of others   for example, driving dangerously 
Additional problems in adults with ADHD As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: 

personality disorders   conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others 
bipolar disorder   a condition that affects your moods, which can swing from one extreme to another 
obsessive-compulsive disorder (OCD)   a condition that causes obsessive thoughts and compulsive behaviour 
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job. If you notice any of the above in your child or yourself , it is worth making the effort and spending some time and money to have your child and or yourself assessed on a priority basis as ADHD causes neural changes in the brain. 

Attention Deficit Hyperactivity Disorder (ADHD) - A Guide!

The primary or milk teeth begins to erupt at about 6 months of life with the complete set in place by 2.5 years of age, and the entire set is replaced by the age of 14. The benefits of some of the preventive dental measures are outlined below.

Maternal care during pregnancy: the teeth begin to form during the second trimester of pregnancy. It is very important that the maternal diet includes sufficient amounts of calcium, potassium, and fluoride for optimal tooth mineralization. Good tooth structure has greater resistance to decay than hypomineralized teeth.

Routine oral hygiene: for the first 6 months, though there are no teeth, after each nursing, end it with a spoonful or two of water to wash down the milk. Gradually, the gums can be just wiped with a gauze pad or soft cotton to remove any residual bacteria. The baby also gets used to this habit, and once the teeth are in, there are lesser bacteria for the decay process to begin.

Once the teeth begin to erupt, the nursing habits also need to be modified to ensure the baby is not allowed to go to sleep with a bottle. This is a common practice to put the baby to sleep and should be avoided to reduce the occurrence of nursing bottle caries.

Fluoride application: fluoride has been shown to have significant benefits in preventing caries. Once routine dental visits begin, then the dentist will be able to tell if fluoride needs to be applied. This can happen either in the form of a gel or varnish that is applied in the dental office or as a paste that is used at home. This helps in building resistance to decay.

Pit and fissure sealants: the tooth has a number of pits and fissures which are 8 times more vulnerable to decay than other surfaces. Deep pits are shown to harbor more bacteria and thereby greater incidence of caries. There are sealants which are thin resins that can be applied on the tooth, which can reduce bacteria accumulation and further decay.

Space maintainers: in the event that a child has lost a tooth, either due to trauma or decay and subsequent infection, then a space maintainer should be placed within the next 3 months. This helps in maintaining the space and establishing a good bite during the transition phase and later, once the permanent teeth are in place.

Orthodontic treatment: if there is malocclusion, then early intervention helps by reducing treatment time and getting better results as the teeth and periodontium are still very elastic and are more malleable to movement.

By doing these preventive measures early in life, the result is a child who has healthier teeth, less decay, less pain, and a happy smile all the time!

Benefits of Preventive Dental Treatments in Children

How to diagnose asthma in children

Asthma in children under the age of 5 is a matter of concern. It is not a rare disease and early diagnosis is important. Common signs of asthma in children are:

1. Recurring bronchitis
2. Wheezing
3. Discomfort in the chest
4. Coughing
5. Trouble breathing

While some children have persistent yet mild symptoms, some children have severe attacks at times. Seasonal allergies and smoke make the symptoms worse.

What to notice?
While feeding an infant, if you notice that your child is facing shortness of breath, it might be a symptom of asthma. In a toddler, if your notice a decreased desire to run and play, or easy fatigue, then this could be a symptom of asthma. Asthma attacks for many children under the age of 5 are worsened when they catch cold or have any other respiratory infections. All these, if noticed should not be ignored and your child's pediatrician should be consulted.

The above mentioned symptoms were mild. Some children have it worse and the attacks can be life-threatening, needing immediate treatment. If your child is under the age of 5 and you see them doing one of the following, contact emergency services immediately:

1. Trouble in speaking because they have restricted breathing
2. When they are breathing in, the effort is so much that the abdomen is getting sucked in
3. Gasping for air.

Diagnosing asthma in a child can be tricky as symptoms like coughing, wheezing, etc can be for other conditions also. Once a child is a little older and if the symptoms persist, breathing and lung function tests are taken to gauge the situation. 

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How To Diagnose Asthma In Children, Before It Attacks?

Which baby doesn't spit up their food! This is usually not a reason to worry, but if this spitting up is chronic and is accompanied by other symptoms it is known as Gastroesophageal reflux disease or GERD. Severe GERD can cause weight loss and breathing problems and thus, should not be ignored.

Reflux occurs when food is pushed out of the stomach and back up the esophagus. This is usually because the digestive system in babies is not yet fully developed. Vomiting often during the day is one of the most common symptoms of GERD. Other symptoms include:
- A persistent cough
- Choking or gagging while eating
- Refusing to eat
- Crying while feeding
- Heartburn
- Pain in the stomach

Most cases of GERD can be diagnosed by its symptoms and a look at the baby's medical history. In some cases, additional tests may be required, such as:

Barium swallow
The child is given a chalky substance to drink. This highlights the esophagus, stomach and upper part of the small intestines in a special X-ray. It is used to check if there are any blockages in the digestive system.
pH probe

A long, thin tube with a probe at one end is put down the child's throat. This is kept in the esophagus for 24 hours. The probe measures the levels of acidity in the stomach. This test is usually done when the child complains of breathing problems along with reflux.

Upper GI endoscopy
Here the doctor puts a thin, flexible tube down the child's throat. At one end of the tube is a camera that allows the doctor to look into the esophagus, stomach and small intestine.

Gastric emptying study
One of the causes of reflux is the slow emptying of the stomach. To check this, the doctor will mix a radioactive chemical with the baby's milk that allows a special camera to follow its path down the digestive system.

In most cases, GERD can be treated by making a few lifestyle changes. Some of these are:
- Raise the head of the baby's crib
- After feeding the baby, do not let him lie down, but hold him upright for half an hour or so.
- Change his feeding schedule
- Ask your doctor if you can try giving him solid food. Else, check if you can thicken his feed with cereal.
- Make the baby burp after feeding

Most infants outgrow this condition within a year, so do not stress yourself and enjoy life with your baby.

Gastro-Oesophageal Reflux In Babies

Epilepsy is a neurological condition that leads to recurrent seizures. Seizures arise when electrical activity in the brain suddenly surges causing a temporary disturbance within the messaging systems located between the brain cells.

Epilepsy is more common in children below the age of two years and adults above the age of 65 years.

Seizure Types

Seizures are classified into two main categories depending on their area of impact. 

A focal seizure is one that affects only one part or area of the brain whereas a generalised seizure affects the whole brain. Further, both focal and generalised seizures have various sub-categories which are as follows-

Previous nomenclature- 

Partial Seizure

  Simple Partial Seizure
  Complex Partial Seizure
  Partial Seizure with Secondary Generalization

Generalized Seizure

  Absence Seizures
  Myoclonic Seizure
  Atonic Seizure
  Tonic Seizure
  Tonic-clonic Seizure
  Mixed Seizure
  Status Epilepticus

Latest nomenclature of seizure types:

Focal seizures-

  Focal aware seizures
  Focal impaired awareness seizures (previously called complex partial seizures)
. Bilateral tonic clonic seizures

Generalised onset seizures-

  Tonic clonic seizures.
  Atonic seizures (sometimes called drop attacks) and tonic seizure.
  Myoclonic seizures.
  Absence seizures.

Symptoms

The well know symptom of epilepsy is a convulsion/ fit, a few other symptoms include-

  Intermittent spells of fainting. When this happens the patient is likely to lose control of his/her bladder or bowel movements. Following this, the person is likely to suffer from extreme tiredness.
  Spells of a blackout with difficulty in remembering
  Becoming unresponsive to any instructions or questions asked during brief periods of time
  Bouts of continuous blinking without any known reason
  Inappropriate movements that keep on occurring
  Changes in sensory perceptions
  Sudden stiffness in the body

Reasons for Epilepsy

Messaging systems within the brain are responsible for every function that goes about in your body. A disruption to this system caused by defective electrical activity leads to epilepsy in a person. Many people inherit epilepsy while others may develop this condition as a result of-

  Head trauma sustained during an accident
  A stroke or a tumour that has affected the brain impairing its normal capabilities
  An injury to the brain before or during birth
  Associated with developmental issues
  Infections of the brain

Treatment for Epilepsy

Epilepsy in childhood can be treated by using medications and by adopting dietary changes in some cases. Medications for epilepsy mainly include-

  Anticonvulsants - Helps control seizures and manages the symptoms of epilepsy
  Medications for nerve pain - Reduce pain that is caused by the damaged nerves

These medications should be consumed as and when prescribed by the doctor. You must consult a paediatrician for this, as he/she will take your child s physical and mental in consideration before starting the treatment.

Seizures that occur in childhood may be benign. This means that it will not continue into one s adult life. Further, those children who have suffered from epilepsy in their childhood have been seen to have normal mental and intellectual development in their adulthood. However, some epilepsy syndromes in children can have a devastating effect on the child.

Seizure threshold is a term that is used to refer to the conditions that are important for the production of seizures. The threshold is lower for people who are more prone to having seizures whereas the threshold is higher for those who do not have a tendency to suffer from seizures.

A Complete Guide To Childhood Epilepsy!

Cochlear Implant is an electronic device replaced with the inner ear (cochlea) of the patients who are unable to send sound waves to the brain.

The surgery is performed on the patients who have the problem of hearing loss due to the damaged hair cells in the inner ears. The implant helps the patient to hear which are not responding to other hearing aids.

Conditions for Cochlear Implant:

Cochlear implants help people to hear with clarity. They are not like hearing aids, which make the sound louder, but it helps send sound waves to the brain and replaces the damaged hair cells in the inner ear. Following are cases where it is beneficial:

People who find it difficult to hear clearly with hearing aids.

Those with moderate hearing loss in both ears.

Patients with 50% or fewer score in the sentence recognition test.

Patients with 60% or less score in sentence recognition test with hearing aids on.

It is suggested to opt for cochlear implants in both ears. The reason is to give the patient a better perspective of sound direction and clarity in understanding the words.

How does the Cochlear Implant work?

Cochlear Implant is an electronic device with an embedded sound processor that has to be worn outside ears or on the body. Following steps are involved in cochlear implant:

The sound captured by the processor is converted digitally by the processor and sent to the coil inside the ears of the patient.

The implant converts digitally coded sound waves to electrical impulses.

The electric impulse simulates the hearing nerve of the patient.

Then sends these impulses to the brain.

Benefits of Cochlear Implants:

The cochlear implant is a blessing for people who have been suffering from hearing loss for a very long time. It provides aid to people who have not benefited from hearing devices. The benefits of the cochlear implant are:

Hear better.

Studies have shown that people with cochlear implants have better sentence recognition scores instead of hearing aids.

The patient can concentrate better in the crowd and can hear conversations across the table.

Reconnect with the missed sounds.

Enjoy music on the phone.

Cochlear Implant improves the quality of life of people with hearing loss. It gives them an aid to understand and engage themselves in a conversation. However, it takes time to learn the interpretation of the sound signals that are received from cochlear implants. But, the patient can learn and lead a normal life with the implant. The factors which affect the benefits of Cochlear implants are:

The extent of hearing loss

The duration of the hearing loss and the condition before implantation

Damage to inner hair cells

Other health issues

The practice and rehabilitation time have been done in practice after implantation

The cochlear implant is performed in the patients after taking extensive tests determining the condition of the patients. It is activated after 2-6 weeks of surgery to give the surgery site a time to heal. Most people are discharged from the hospital after surgery and are prepared for the use of an implant. There are training sessions and classes for patients who have just gone for cochlear implants.

Cochlear Implant - How Do They Help?

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