Right treatment helps hyperactive kids lead normal lives

By Rita A. Widiadana

SINGAPORE (JP): Six-year-old Vincent is a smart and handsome student but his teachers keep complaining that he cannot sit still and, therefore, he never finishes his school work.

In the classroom, Vincent is always in motion, shouting at his friends, squirming while his teacher delivers the lessons.

In the playground, he is a "nuisance" and a "troublemaker". His teachers assumed initially he was just another "bad" boy.

Dewi Widya, one of the teachers, recalled: "At first, I thought Vincent was just a naughty boy who wanted to attract attention from his teachers and friends." But, based on her meticulous observation, Vincent does all of his misdeeds unintentionally.

"He just didn't realize why he was behaving like that," she said.

Vincent was fortunate, the teacher has just taken part in a seminar on hyperactive children, organized by a local university.

"I saw so many symptoms similar to those experienced by Vincent and many other students in my class," observed Dewi.

In Indonesia and other Asian countries, there are hundreds of thousands or perhaps millions of hyperactive children who are left undiagnosed and receive no professional help.

Dr. Lionel Lim Chee Chong, associate professor of child psychiatry at Singapore's National University, in his office at Mount Elizabeth Hospital, Singapore, said the medical term for hyperactivity is Attention Deficit Hyperactive Disorder (ADHD).

In the past, the doctor said, these children were often regarded as learning disabled or the product of unhealthy diets. "Worst still, some of them were being mislabeled as emotionally disturbed, naughty, lazy or misbehaving students," he said.

It is very important for parents and teachers to notice the symptoms of hyperactivity in children because it results in social, academic and occupational impairment during childhood and later in their adult lives if not treated properly, Dr. Lim said.

An ADHD child usually displays three core symptoms: hyperactivity, impulsivity and distractibility.

These three symptoms are usually present before the age of 7. The American Psychiatric Association classified ADHD into three subtypes: ADHD-inattentive type, ADHD-hyperactive type and ADHD- combined type.

Lim said that children with ADHD inattentive symptoms are less obvious than those who have hyperactivity and impulsivity symptoms. "These children cause the most problems in school because they cannot concentrate on their work and teachers may overlook them," he warned.

On the other hand, children with hyperactivity and impulsivity show excessive restlessness and overactivity.

"Children with impulsivity tend to blurt out answers in class before the questions have been completed. Teachers may easily recognize them," he said. They may interrupt or intrude on others and find it difficult to wait in line, he added.

Children with ADHD may frequently experience mood swings, become increasingly isolated and have difficulty in getting along with their friends.

"Many children with ADHD become unpopular students because of their behavior," the doctor noted.

But, many parents are still confused and often ask questions on how common ADHD is in any society.

"In the past two decades, experts still believed that ADHD only appeared in the Western world but this theory was invalid," he said. ADHD is currently found in any race and society in every part of the globe.

U.S. studies suggest that 4 percent to 6 percent of school-age children have ADHD. In Britain, the figure is lower, estimated at 3 percent to 5 percent. Investigations in Hong Kong have reported that 24 percent of schoolboys are considered to be hyperactive by both parents and teachers.

Widespread

"Experts in Asia estimate that 3 percent to 10 percent of school-aged children suffer from ADHD," Lim revealed. It has also been observed that boys with ADHD tend to outnumber girls about 3-1.

Although ADHD is now widespread, people still do not understand whether it is a disease or just a disorder. Or just children experiencing extreme behavior during their development.

To date, experts have not yet arrived at a precise conclusion of the causes of hyperactivity but studies suggest that it may be some form of disturbance or dysfunction of the brain.

"It could be an infection during pregnancy or post natal," the doctor suggested.

A preliminary study has revealed that there is a deficiency in the availability of dopamine -- a "chemical messenger" or neurotransmitter -- in the brain of children with ADHD.

Medication seems to remedy this imbalance, reducing hyperactivity and improving attention spans.

The doctor also pointed out that heredity may be a significant factor. "Ten percent of my patients have a family history of ADHD."

A number of his patients' parents realized they also suffered from similar symptoms when they were children that even persisted during their adulthood.

"Have you ever missed your appointments or forgotten where have you put your keys? You may suffer from an adult-form of ADHD," the doctor warned.

However, the doctor argued, it is important to stress that not every child who is hyperactive, impulsive or inattentive suffers from ADHD. For example, children who are facing difficulties with their studies, children who have emotional worries and those who lack motivation can also exhibit similar symptoms.

Medical assessment

"Therefore, proper assessment, evaluation and intervention by qualified professionals is necessary because if the condition is left untreated, it has long-term consequences," he said.

These individuals, he said, are likely to encounter failure, grow up with low self-esteem and may not achieve their full potential.

Children with ADHD can be treated with medication, combined with behavioral modification and special education assistance to reduce hyperactivity and lengthen attention span.

Medication, he said, was be very helpful. "Around 80 percent of my patients who receive medication show improvement in their concentration," he said.

Currently, doctors often prescribe Ritalin, a stimulant that has reportedly a stabilizing effect and allows the child to focus on the activity at hand.

"Many parents fear that medication may have serious side effects," he said. There are some side effects, including drowsiness and lack of appetite.

Children with ADHD should only be given medication for certain periods of time.

"Children should not be given medication just because they are highly active and parents are having trouble dealing with them," he said.

He said that children can only be termed as having ADHD when other factor affecting their behavior, like family problems and autism, have been ruled out.

"Medication and therapy may not totally cure the symptoms but certainly they will minimize the long-term consequences of ADHD to enable the child lead more fulfilling lives in the future," he said.