Dr. Nirmal G. Choraria

Your child needs complete care whether it is emotional, psychological or physical. A thorough evaluation of your child’s body and mind is vital at nascent stages. Especially if you observed any complaints by your little one that may require medical help, such as:

1. Frequent headaches
Much like adults, children too can experience headaches that last from 30 minutes to 3 hours. A range of primary or secondary headaches like, migraine, meningitis, sinusitis or tension may affect children due to neurological issues.

2. Blurry vision
If you observe either a vision developmental delay or near-sightedness and farsightedness in your child, it might be related to neurological issues.

3. Slurred Speech
If your child is 7-8 months and is not responding to sounds or cannot babble non-sense words, it calls for a neurological check-up.

4. Motor and Co-ordination Delay
Sometimes babies are unable to perform motor skill activities like crawling, walking or using fingers to grip or hold, such delay requires attention of the parent.

5. Fatigue
Check if your kid has become lazy and decreased his physical activities due to fatigue and tiredness suddenly of late.

6. Abnormal Movements
Common involuntary movements or tics like eye blinking, twitching of nose, grimacing or making sounds is in some cases overlooked. Tourette syndrome is an example of such a tic, which has been evaluated as a neurological issue.

7. Tremors or Seizures
Children are prone to febrile seizures (fits) or tremors along with fever that occur between 6 months and 5 years. These are signs of neurological issues that require an immediate check-up.

8. Numbness in Limbs
Neurological complications in your child’s infancy may also cause joint pain and numbness of arms and legs.

9. Behavioural disorders
A change in behaviour or attitude in your child is noticed if he/she is suffering from attention-deficit/hyperactivity disorder, school problems, sleep issues, intellectual disability or other neural conditions.

10. Weakness
This symptom is tricky in children, as it may be confused with general tiredness by your human eye. It may be unheard of but many children face trouble in performing easy tasks. A neurological exam may identify the source for treatments.

An underlying problem to the nervous system can cause harm or impairment in the normal growth and development of your kid. Early diagnosis helps in correct care, recovery and prevention of long-term problems. You can opt for a routine neurological examination if you find such symptoms in your child. These exams check the functioning of your child’s brain, spinal cord, nerves that come from the brain and spinal cord and offers accurate diagnosis. If you wish to discuss about any specific problem, you can consult a Pediatrician.

Parents are always concerned about their child's physical health, but often ignore their mental health. Along with physical well-being, your child's mental well-being is also equally important.

The following are eight tips to improve your child's mental well-being:

1. Adequate sleep- Sufficient amount of sleep is required for a child to stay mentally fit. Parents often engage their children with various classes and activities and compromise on their sleeping hours. This in turn affects the child's mental state. Therefore, as a parent, you must take care not to compromise on your child's sleeping hours.

2. Allowing them to play- Nowadays, children are overburdened with studies and other learning activities. They do not get to play quite often. But as a parent, you must take care of your child's schedule, so that he/she can have proper playtime too. Playing involves physical activity as well as creativity in certain cases. This helps to improve mental health.

3. Learning to share and care- You must take care to inculcate in your child the values of sharing and caring. These little things can also help improve your child's mental health. Learning how to share with others and caring for others will help them to stay happy.

4. Regular exercise- Encouraging your child to regularly exercise will not only help improve his/her physical health, but also mental health. It will also help them to reduce stress and maintain a good mood as well.

5. Listen to them- Parents often ignore when children are speaking on less important matters; may be about a new friend or a strict teacher in school. But as a parent, you must take out some time from your daily schedule to listen out to their stories. Listening to them attentively will make them feel important, increase their confidence and hence, improve their mental well-being.

6. Encourage them to make friends- Encouraging your child to make new friends will help them to socialize better. They will feel confident about themselves and also open up. This can boost up their mental well-being.

7. Good nourishment- Proper nourishment is not only essential for being physically fit, but also mentally fit. Good nourishment will help them stay healthy physically and increase their energy levels. This in turn will positively affect their mental health.

8. Make them feel safe- Children need to feel safe in order to stay mentally fit. Try and spend some time with them every day. As a parent, always make your children realize that you are right beside them. Listen to their problems and help them find solutions to solve those instead of scolding them. Help them to relax and feel secure to stay mentally fit.

In case you have a concern or query you can always consult an expert & get answers to your questions!

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.

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:

1. 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 

2. 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. If you wish to discuss about any specific problem, you can consult a psychologist.