Our clinic pays much attention to children having hyperactivity disorder and attention deficit by making full use of a pediatric psychiatrist’s practice, specialized in this sphere. Patients are much different: children, adolescents, young adults visit the consultation. Similarity in them is that they show at least one symptom of ADHD syndrome (see footnote no.1.).
A child could be lively, bustling and being on high, unpredictable, disorganized, disorderly, inattentive, day-dreamer, star-gazer, piffler, mumbling and rousing, exhaustible and on the surface exhaustless, perfectionist and underperforming, helpless and assertive, gentle and angry, lacking self-confidence or prig, bossy or reserved.
One of the most important characteristics of ADHD syndrome is that children may be engaged intensely in all those things that are interesting, challenging and new for them, and these are all that could generate positive sensations, emotion and attachment. Typical example is that the child who cannot sit through a lunch at the table, could play with Legos for long hours.
What will happen during the consultation?
First the specialist – on the basis of a discussion and questionnaires – determines the actual complaints in details and then takes the child’s medical history (anamnesis) including the circumstances of the problems’ appearance and their development. During this course the doctor observes the child’s behavior, motion, attitude, appearance and tries to make contact by means of activities (drawing, plays and games, chatting) matching his or her age. By this way he tries to collect further information to evaluate the seriousness of the symptoms (see footnote no.2.) and to define the accompanying disorders and secondary defects.
The psychiatrist cannot neglect the interrelationship between physical and psychological processes and may recommend laboratory or imaging (ultrasound, CT, MRI) examinations which could confirm the diagnosis. At the same time, with the assistance of experienced special education teacher or psychologist, it is necessary to make tests to evaluate the child’s attention, cognitive abilities, motoric coordination and partial abilities – if these enquiries haven’t been taken before.
Time factor is important
Next step is to report back the results of the examinations, to detail the clinical aspects and to explain the complaints and disorders (psychoeducation). This will lead to the therapy phase involving the personalized treatment plan which implies the assignment of the recommended developmental procedures, life-management counseling, problem oriented behavior therapy elements and if necessary medicinal treatment, being the most effective part of the symptomatology in question (see footnote no.3.). The most important factor is that the child should be seen by the specialist in time (see footnote no.2.), because by this way secondary defects, being the consequence of failures, possible setbacks and other effects, could be eliminated. The necessary therapies (see footnote no.3.) will help the child to have a balanced personality and be ready for adulthood.
The following phenomena may draw the attention to the possibility of the existence of the child’s ADHD:
learning and behavior problems, uneven schoolwork (sometimes fairly good, sometimes very poor), disorganization, roller coaster emotions, eccentric behavior, tendency to burst of anger and to go off the deep end, emotional bursts.
After some time as a consequence of the problems’ escalation secondary defects may be observed like self-depreciating, lack of motivation, hopelessness, black mood and distress, physical symptoms (headache, abdominal pains etc.); later in older age chaotic life-management and other psychiatric clinical aspects could be realized by people around the patient.
What state of affairs the parents experience at school?
Teachers complain that the child’s school marks are poorer than those which could be received in relation to his or her abilities. They say that the child is lazy, indifferent, engaged only in matters that are interesting for him/her, learns only for the teachers whom he likes. He has goods days when his behavior is well-rounded and sharp in understanding, but also bad days when he is disintegrated and cannot complete even the easiest tasks.
Next day he cannot recall the lesson that he learned with difficulties the previous evening. He does not keep the rules at school and disturbs the class by standing up, putting his things from one place to another, making noise and fidgeting or simply does not pay attention, fells into a reverie and cannot set up a list of priorities. He often loses his doings or leaves them throughout the school. When he is little it is impossible to go to a shop with him and it is life threatening to let him move on the streets since something is always happening to him. He is determined, always debating and rebellious. He denies the existence of homework and finally when he prepares it he does it for long hours or shuffles through it – in a word a lot of attention, time and efforts have to be devoted to him.
Their problems and life story show a typical pattern which should be surveyed and evaluated by the specialist.
What forecast could we envisage?
By passing the different maturity phases of the nervous system symptoms may be less and less serious, till young adulthood part of the disease could be asymptomatic. Principally the symptom of motoric restlessness and hyperactivity disappears but in many cases the subjective emotion of inward disquiet may last for a longer time. Especially attention deficit and poor management of everyday tasks are the disorders which remain characteristic for adulthood too. Impulsivity may also continue till reaching adult age. Without treatment 80 % of the involved children may face further psychiatric diseases, be liable to behavior problems, mood and anxiety disorders, personality disorders and different addictions.
With the help of in-time professional assistance and helpful family background they have better chances to become self-accepting, emphatic, creative and cooperative adults who are capable of happiness.