Paying attention to ADHD
By Sarah R. Aurelio, Special to The Manila Times
What do German composer Ludwig van Beethoven and American Olympian swimmer Michael Phelps have in common?
These driven and highly focused individuals suffer from Attention-Deficit Hyperactivity Disorder (ADHD). But what exactly is ADHD?
“ADHD is a neurobiological disorder. This means that it originates in the brain,” explains developmental and behavioral pediatrician Mark Reysio-Cruz.
The doctor explained that ADHD has four subtypes, being: (1) Combined hyperactive-impulsive and inattentive; (2) predominantly hyperactive-impulse; (3) predominantly inattentive, also known as Attention-deficit Disorder or ADD; and (4) ADHD, not otherwise specified.
“From the categories, you will see that ADD is a subtype of ADHD,” Dr. Reysio-Cruz said. “ADD also presents with symptoms of hyperactivity and impulsivity but the predominant symptom is that of inattention affecting a child’s academic, social and/or occupational functioning in two or more settings.”
The most common symptoms of ADHD are inattention, hyperactivity and impulsiveness. Easily distracted, never finishing anything, disorganized and restless, children whose disorder go undiagnosed are often misunderstood by their parents, sometimes being punished for being difficult and undisciplined for mannerisms rooted in ADHD.
ADHD doesn’t have any degrees. According to Reysio-Cruz, it’s either you have it or you don’t.
While Dr. Reysio-Cruz is quick to point out that ADHD is not caused by what a child’s parent did or did not do. He says that the interplay of genetics, injury to the brain via infections, toxic elements (i.e. lead poisoning and alcohol), and trauma predispose a child to having this disorder. The environment is contributory to it due to the fact that it may aggravate the condition.
“It’s genetic,” states Ditas Martelino, president of the ADHD Society of the Philippines, a mother of three, two of which have ADHD. “That’s the trend of the studies . . . they [researchers] have identified the DNA markers,” she notes.
While science takes on ADHD, using technology to develop and further studies on it, medically the country isn’t quite equipped to handle such cases.
Dr. Reysio-Cruz says that anatomic MRI results support prominent role of frontal lobe dysfunction in ADHD and cortical-subcortical circuits while functional MRI’s show blood flow in different parts of the brain with certain parts of the brain having a decrease or increase in the flow in the brain of a child diagnosed with ADHD. However, neuro-imaging techniques have not been validated as tools for ADHD diagnosis or to inform treatment and are very expensive.
“In the medical field, children with ADHD are referred to and handled by developmental and behavioral/neuro-developmental pediatricians, child psychiatrists, pediatric neurologists, child and adolescent pediatricians, and neuropsychologists,” Dr. Reysio-Cruz explains.
It is the most common behavioral disorder in children, affecting three to five percent of school-aged children. Although the prevalence rate has neither gone up or down, Dr. Reysio-Cruz thinks that, “There are more cases diagnosed because of the increased awareness. Based on the prevalence rate of three to five percent, we are even probably under-diagnosing given the number of reported cases.”
The good news
Martelino informs The Manila Times that the ADHD Society of the Philippines, along with the medical associations that deal with the disorder, are now in the process of finalizing the clinical procedures guidelines in diagnosing it.
“When this is ready for implementation, even the pediatricians and general practitioners could diagnose ADHD already,” Martelino added.
Awareness and parents
“There is more awareness in the country about this disorder,” Dr.Reysio-Cruz said. “The ADHD Society of the Philippines is instrumental in bringing about this increased awareness.” He added that he believes that doctors, schools and parents are open to the disorder thanks to the increase in awareness.
The ADHD Society of the Philippines is a non-stock, non-profit organization dedicated to spreading awareness about the disorder and equipping parents and teachers on how to deal with children diagnosed with the disorder.
“It’s a big thing if the parents are trained to deal with their children,” Martelino explains. “It’s education and empowerment for the parent that’s important, because who else will ‘do battle’ with your child but you? I tell parents during our training seminars that their children cannot take medication for life. Behavioral therapy ends after adolescence. You’re the parents, you’ll be with them for life.”
Guillano Mendiola, a Culinary Arts student, attests to Martelino’s statement. He was diagnosed with ADD during his the latter half of his freshman year.
“Everything changed when I was diagnosed. My parents became patient. Even my sister was supportive. My parents even got me a tutor during my sophomore year . . . to keep me steady on my studies,” Mendiola said.
Dr. Reysio-Cruz says that the parents of children diagnosed with ADHD need to have a lot of love, patience and understanding for their children. “They have to advocate for their children and work with their children’s teachers, tutors, caregivers in providing a nurturing environment for their children. The goal should be to protect their child’s self-esteem,” he said.
Parents and ADHD
Dr. Reysio-Cruz advises parents not to see it (ADHD) as the apocalypse. “I mention famous people, both dead and alive, that has or had ADHD. After that I give them the both the best and the worst case scenarios and educate them on the management options.”
There are several ways with which to take ADHD head on, one of which is the multimodal treatment that is medication, behavioral therapy or both.
“ADHD is a manageable condition, Dr. Reysio-Cruz added. “The best scientific evidence supports a combination of medication, behavior therapy, and educational accommodations.”
Another way to deal with it is via logbook therapy. Martelino says she used it with her daughter when things were getting out of hand in school.
“When her school bell rang at the end of each subject, she would go to her teacher and the teacher would check if she wrote the correct assignment and/or project down. After which the teacher would sign it,” Martelino told The Times. “When the homework or project was submitted, the teacher would sign the logbook again.”
There is no particular diet that a child diagnosed with ADHD should follow. Dr. Reysio-Cruz simply recommends a well-balanced meal to contribute to growth and development.
“There is no scientific evidence that sugar, food dye, additives, et cetera cause ADHD,” Dr. Reysio-Cruz explained. But should parents notice that certain food make their children lean towards hyperactivity, he advises that they avoid these food items.
Dr. Reysio-Cruz recommends that watching television be minimized as it contributes to the child’s lessening focus, making a child get used to the fast pace of seeing and hearing things.
How diagnosed children deal with it
Mendiola said that he copes with his ADD through self-control. He never studies at home since a lot of things tempt him. “Problem is, I’m easily tempted with things I like, the TV, the computer, even sleeping, so I have to leave the house so that I can study. I go to my school library, sit there alone, studying.”
Dr.Reysio-Cruz says that there are several conditions closely related to ADHD. “Children with ADHD are at increased risk for having or developing depression, anxiety disorder, oppositional defiant disorder, conduct disorder, tic disorder and learning disability,” he added.
Fortunately for Mendiola, he did not fall prey to these conditions. “I don’t feel misunderstood. Neither do I feel different from other people,” he said. In jest, he added, “Actually there are times when I feel that some of my friends have ADHD or ADD because some of them are simply makulit.”
One of Martelino’s children with ADHD had a narrow escape with depression after suffering from an embarrassing situation in school. Martelino was well aware of the symptoms of depression and quietly observed her child’s behavior after a friend informed her of the problem.
“I remember telling his teachers and the administrators that it was a good thing I knew my child had ADHD and that I was aware he was prone to depression so I keep a close eye on him. But what about the other children who also suffered the same embarrassment along with my son?” Martelino said.
How having ADHD is not so bad
Having ADHD though is not all bad. Dr.Reysio-Cruz explains that emerging literature provides support for the hypothesis that abnormalities in frontal networks or frontal-striatal dysfunction and catecholamine dysregulation are involved but while this is so adds that children with ADHD are often smart and creative.
Martelino expresses no doubts when she says that yes, children with ADHD seem to possess an x-factor, but adds that while this is so, some schools are in denial.
“Take my daughter, for example,” Martelino elucidated. “When she was first diagnosed with ADHD, I would always have a case conference with her teachers every year. I would also bring a doctor or therapist to talk to the teachers as well, to explain to them what ADHD is.”
She got mixed reactions in return. “Some of the teachers accepted it, while others were in denial,” she says.
“Her teachers back in grade school were surprised that she could beat the honor students in science quiz bees when she wasn’t even an honor student herself,” Martelino said. “In her classroom, her teachers would berate her for daydreaming, forgetting something. But she’s smart.” Martelino’s daughter, who is now studying in an exclusive girls college in the country, has an above-average IQ.
If you would like more information regarding ADHD, you may contact the ADHD Society of the Philippines at the following numbers: (02) 426-8568 or telefax (02) 927-3468.The ADHD Society also offers support groups for parents, parent and teacher training, and referrals to doctors.
Does your child have ADHD?
Dr. Mark Reysio-Cruz has provided The Manila Times with a list* that presents parents with symptoms of ADHD.
1. Does not pay attention to details or makes careless mistakes with, for example, homework
2. Has difficulty keeping attention to what needs to be done
3. Does not seem to listen when spoken to directly
4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand)
5. Has difficulty organizing tasks and activities
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort
7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books)
8. Is easily distracted by noises or other stimuli
9. Is forgetful in daily activities
10. Fidgets with hands or feet or squirms in seat
11. Leaves seat when remaining seated is expected
12. Runs about or climbs too much when remaining seated is expected
13. Has difficulty playing or beginning quiet play activities
14. Is “on the go” or often acts as if “driven by a motor”
15. Talks too much
16. Blurts out answers before questions have been completed
17. Has difficulty waiting his or her turn
18. Interrupts or intrudes in on others’ conversations and/or activities
*Source: Copyright 2002 American Academy of Pediatrics and National Initiative for Children’s Healthcare Quality. Revised 1102