Is this ADHD? – Understanding the signs

Dr Pramit Rastogi

Dr Pramit Rastogi

Children are naughty. They break things, do not listen, are noisy, throw tantrums, spend too little time on studies and too much on screens.

Children will be children, and that is what makes their childhood so endearing. But what is acceptable naughtiness and when does it become a disorder?

There are powerful tell-tale signs which are often missed by parents. Largely because the line between naughty or lazy or irresponsible and ADHD is blurred for most.

Attention Deficit Hyperactivity Disorder (ADHD) is caused by the deficiency of dopamine (a chemical in the brain), which affects a child's ability to self-regulate and get things done. Globally ADHD affects 1 in 10 children. And can be treated. Early identification and management of ADHD can be a game changer in mitigating its effects.

Under age 6

Being "naughty" is playfulness on the part of a child and a way to test boundaries. Not listening, throwing tantrums, or making noise is normal. However, children have an inbuilt mechanism of knowing when to stop. They can distinguish between authority figures - it is ok to be naughty with mommy but not with a teacher. Here are some signs that may indicate the onset of ADHD and not merely naughtiness.

• Frequent complaints from school - not sitting in class, pushing children, walking around when class is in progress, inability to wait for a turn.
• Difficulty managing a child in social contexts. - distress while travelling in a car or repeatedly kicking the back of a seat in an aeroplane.
• Lack of awareness of dangers - running across a road or running away in a shopping mall.
• Frequent and intense temper tantrums or meltdowns - hitting, screaming or hurting another child or pet.
• High prevalence of destructive behaviours. Often leaving parents feeling exhausted and incompetent.

Age 6-12

As children grow older, they look to assert themselves. They may want to do their homework after playing, question the "point of studying" or get carried away while trying to "fit in" or be "cool".

Mood swings, lack of interest in academics and some defiance at home is to be expected. However, at an aggregate, children are amenable and compliant with boundaries set by parents and teachers. Certain marked deviations could be signs of untreated ADHD.

• Requiring disproportionate parental effort in completing homework - taking an hour to complete an assignment that should take 10 mins.
• Difficulty following multi-step instructions. Resistance to writing answers in complete sentences or all the "steps" In Maths.
• Frequently lying about small things - blaming someone else for something they broke or forgot to get.
• Violent outbursts and reactions if a device or screen are taken away
• Being in the thick of conflict, drama, or breaking rules at school leading to disciplinary action
• Getting stuck in mood states, finding it difficult to move out of a low mood state or have explosive, short lived anger episodes followed by rapid resolution.

Age 13-18

Adolescents begin their journey to adulthood by demonstrating the ability to take responsibility. There is a constant urge to seek independent space and push boundaries. And conflict with parents is to be expected in the "teens". Here are some signs of untreated ADHD, which are often incorrectly passed off as ‘irresponsible, ‘disinterested' or ‘rude' behaviour.

• Inability to start large, important school projects or submit them on time. Not doing any academic assignment that is not graded
• Extreme procrastination impacting critical exams including boards which may lead to refusal to take the exams or start preparation at the last minute.
• Disciplinary action for breaking rules in school
• Dysregulated sleep. Going to bed extremely late, eventually leading to fatigue, falling behind in academics and refusing to go to school.
• Gravitating towards substances. Choosing friends and relationships that are unsafe. Frequently violating home rules around curfew and boundaries.
• Explosive anger which could include physical assault, threatening behaviour or use of abusive language against parents or siblings.

ADHD is an illness not a choice. Timely intervention can mitigate its affects. However, undiagnosed ADHD can sow the seeds of low achievement orientation and parent-child conflicts, with far reaching consequences in the future.

A child and adolescent psychiatrist, Dr Pramit Rastogi is the medical director at STEPS Center for Mental Health in Gurugram. He can be reached at pramit.rastogi@scfmh.com