Deficit Hyperactivity Disorder:

60 per cent of children diagnosed with ADHD

Dr Ruwan M. Jayatunge

Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral development disorder affecting about three to per cent of the world’s population. ADHD was first described by Dr. Heinrich Hoffman in 1845.

He eloquently wrote about the children with ADHD and their characteritics. Contemporary studies concur that the symptoms of ADHD are caused by a neurological dysfunction within the brain mostly due to a deficiency in a specific neurotransmitter in the lower area of the brain. The principal characteristics of ADHD are inattention, hyperactivity and impulsivity.

Preschool and early school years: Deficit Hyperactivity Disorder is a condition that become apparent in some children in the preschool and early school years. Sometimes it may persist into adulthood. About 60 per cent of children diagnosed with ADHD retain the condition as adults. These children need care and attention. When hyperactivity, distractibility, poor concentration, or impulsivity begins to affect performance in school, social relationship, or ability to accomplish day-to-day activities diminish. Therefore they need treatment.

According to the US based statistics an estimated three to five per cent of school age children suffer from ADHD. Although there are no statistics available in Sri Lanka a considerable number of children are affected by ADHD and many do not receive any treatment. In our school system ADHD children are considered as bad students who are disobedient. But the fact is their behaviour is caused by complex etiological factors and they are not bad by nature.

Risk Factors

1) Major etiologic contributors include adverse responses to food additives, intolerances to foods. Too much refined sugar Chocolate and Genetically Modified Food can increase hyperativity in some children. Common food additives and colorings can increase hyperactive behaviour some artificial additives increase hyperactivity and decrease attention span in a wide range of children.

2) Sensitivities to environmental chemicals, molds and fungi,

3) Exposures to neurodevelopmental toxins, such as heavy metals and organohalide pollutants.

Case Study

Master H who studies in the year five often distracts his peers in the classroom. According to his class teacher sometimes he goes out of the class without any permission.

He has a poor concentration and inattentiveness. Frequently he becomes agitated and restless sometimes endangering himself to accidents. His academic skills are bellow average. In the exams master H makes careless mistakes may be due to attentiveness. Master H has trouble organising activities. He doesn’t want to do things that take a lot of mental effort for a long period of time and also forgetful in daily activities.

General Strategies to Comabt ADHD

Parent Education is vital. The parents must be taught how to handle the children. Some parents use corporal punishment that can lead to the damage of the personality. Parent Coached Social Skill Training gives insight and handiness to manage an ADHD child more effectively.

Medications are necessary since there is an imbalance in brain chemistry. The medications must be prescribed by a qualified medical professional. Ritalin (methylpenidate) is widely used to treat ADHD. Medications must be prescribed by a qualified Physician.

Apart from drug therapy special Psychotherapeutic approaches are essential. Behaviour Modification Programs for Home and School can be used to minimise inattentiveness and to improve concentration. Relaxation training advances emotional control and the child is able to face day-today activities without a much tension.

CBT or Cognitive Behavioral Therapy is important to improve motivation, problem solving skills and self-esteem. Some experts recommend Fun Cognitive Rehabilitation Exercises (Brain Training) to improve attention span.

Cyber Therapy is another mode of treatment that can be used in ADHD. In cyber therapy especially designed computer animation programmes are used to enhance attention, concentration, eye contact and fine motor movements.

The therapist should allow the child to change work sites frequently while completing homework or studying. Behavioral approaches can be attempted to help the child concentrate on sitting still, staying on task or thinking before acting. Many ADHD children can be managed via music therapy.

Music therapy reduces their excessive stress factors. In order to enhance their productivity guidance must be given to the students to verbalise a plan before solving problems or undertaking a task. The therapist should provide opportunities for student to show divergent, creative, imaginary thinking.

On most occasions ADHD children have a good IQ and if their massive energy is used prolifically a good results can be expected. Art Benjamin the famous Professor in Mathematics was an ADHD child and he was able to conquer the illness. Therefore ADHD is not a paralysing condition. If the positive guidance is given to the child he/she can be a productive person.

 Signs and symptoms

They have a poor attention span They have a difficulty in organising tasks and activities Acts as if “driven by a motor” and cannot remain still Difficulty remaining seated Easily distracted Gives answers to questions before they are completed Difficulty following instructions from others Difficulty sustaining attention in tasks or play activities Shifts from one uncompleted task to another Talks excessively Interrupts others Does not seem to listen Engages in physically dangerous activities without considering the possible consequences Restless and do not follow the commands.

Lens implant a delicate operation

Dr. Upali Mendis Consultant Opthalmologist and a former Director of the Eye Hospital, Colombo writing to the HealthWatch on aftercare of patients following cataract eye surgery says that lens implant is an extremely delicate eye operation with the patient having to undergo some amount of discomfort for a short period.

Following are some of the difficulties and the instructions to follow to minimise them.

Instructions to patients after cataract surgery

Cataract surgery with insertion of an intraocular lens implant is an extremely delicate operation using modern surgical procedures. It provides relief to cataract patients. However, until a brief period after surgery, patients may suffer some amount of discomfort. Following are such difficulties and related instructions for patients.

You will be discharged from hospital about an hour after surgery and may travel home in your vehicle or public transport. The day of surgery should be spent in rest. Although you may feel weak that feeling will gradually fade away after a day or so.

Therefore, someone should be near you to provide assistance on the first day. You are advised to use the toilet and have normal meals.

The eye pad is not removed until the day after surgery and if you have a headache or pain in the eye, Panadol will relieve your symptoms.

There is no restriction on watching television. A sleeping tablet will help if you have difficulty in sleep.

Also on the following day, you may wash your face, sparing the operated eye, brush your teeth, shave and comb your hair and use a sponge or piece of cloth when washing your face. You can also have a body wash the day after surgery, but a bath only in 7 days.

You will be examined at the clinic the day after surgery. You will be given instructions on the use of eye drops on your first visit. After the first day, gradually return to your normal activities.

If employed, you can resume work 1 or 2 weeks after surgery.

During the first week after surgery, you should not exert yourself too much. Lifting heavy weights and constipation should be avoided. Vegetables and fruits should be eaten so as to prevent constipation.

You are advised not to smoke or consume liquor without the doctor’s permission.

In no event should you rub your eye hard. Cover the eye with a pad for about a week, especially when sleeping. This is very important to prevent accidental injury during sleep.

When sleeping, avoid resting your face downwards in a manner to avoid pressure on the eye. You can keep the eye open during the day. Long journeys and crowded places should be avoided for a week.

Carrying small children should particularly be avoided since they may accidentally poke their finger in your eye and cause injury.

You may read as long as you have no pain, with the spectacles that you have used before the operation.

There should be no pain in the eye after the first day. If there is pain, increase in redness or reduction in vision, you should see the doctor without delay.

Usually for a few days after surgery, you may experience a bluish hue of the environment. Do not worry about this. It is natural after surgery and will gradually disappear.

Itching and discomfort may occur. These are natural after surgery and should not cause alarm. Dry scabs may sometimes form upon the eyelashes. They can be removed using a piece of cotton wool soaked in warm water in a gentle manner. Recovery of vision is not only a gradual process, but differs from person to person.

Six to eight weeks after surgery you will be examined for spectacles.

After some months or years, if the vision decreases, it could be due to thickening of the capsule of the lens. Vision then can be restored with laser treatment.

 What is stress?

Continued from last week

Every problem is either a stumbling block or a stepping stone. It’s so the way you view it.

Dana Myatt

Why do some people face challenges well and others don’t?

The way we appraise a challenging situation determines our response to it. There are several reasons why some people respond poorly to challenging situations whilst others may calmly go through the same situation with only (if at all) a little discomfort.

* Do you feel you are in control of your life?

When we feel that we have the ability to control our lives the way we want to, we experience less stress. Those who feel that they can control their destiny in most areas of their lives (marriage, job or income) feel less stress than those who feel that they have hardly any control. When you feel that you are the master of your life you feel more empowered, happy and less stressed.

* Your Personality

We have seen, that sometimes, even slim, physically active, non-smokers, who have no other risk factors, getting heart attacks. Could a person’s personality have anything to do with the risk of getting heart attacks?

It seems that people who have high levels of anger and cynicism, are more likely to get heart attacks than those who are compassionate and content with their lives.

Anger is the intense feeling of rage and fury that comes when faced with an unexpected change. People who, for whatever reason, seem to be always angry, put stress on themselves which is harmful to both their physical and mental health. Closely related to anger is cynicism, the second personality quality that puts you on high levels of stress. Cynics dislike and distrust others and their ideas.

They have nothing good to say about other people. They can only express their feelings and thoughts by being very critical. Anger and cynicism are not the only dangerous emotions. Depression too can be deadly!

Feelings of anger, cynicism and depression place the body under stress. It wears down the physical emotional well being of the person.

If you be angry, cynical or depressed, they can have spiralling effect. These feelings can keep increase unless you identify the problem and correct it.

Any person can become angry - that is easy. But, to be angry with the right person, to the right degree, at the right time, for the right purpose and in the right way..... That is not easy.

Aristotle

The fire you kindle for your enemy often burns you more than him

A Chinese proverb

Stress affects your

overall health

We need to keep the negative stressors in our lives to a minimum. We need to change the way we look at threatening or challenging situations. Otherwise, we will become exhausted and end up in emotional and physical breakdown. This breakdown may come quickly or slowly over many years.

Evidence from experiments suggests that stress may be a factor contributing to risk of heart attacks.

The effect may be direct or operative through other risk factors such as high blood pressure, smoking, physical inactivity, high cholesterol and being overweight.

Those under stress may overeat, start smoking (or smoke more cigarettes) and give up exercise.

Are you likely to fall ill because of stress?

Complete the following personal assessment and see for yourself!

Which of the following events have you experienced in the past 12 months? Place a ..... in front of each item.

Event Score
Death of spouse - 100
Divorce - 73
Marital separation - 65
Jail term - 63
Death of a close family member - 63
Personal injury or illness - 53
Marriage - 50
Fired at work - 47
Marital reconciliation - 45
Retirement - 45
Family member falling ill - 44
Pregnancy - 40
Sex difficulties - 39
Gain of new family member - 39
Business readjustment - 39
Change in financial status - 38
Death of a close friend - 37
Change to different line of work - 36
More arguments with the spouse - 35
High mortgage - 31
Foreclosure of mortgage or loan - 30
Change in responsibilities at work - 29
Son or daughter leaving home - 29
Trouble with in-laws - 29
Outstanding personal achievement - 28
Wife begins or stops working - 26
Begin or end school/university - 26
Change in living conditions - 25
Revision of personal habits - 24
Trouble with boss - 24
Change in work hours or conditions - 20
Change in residence - 20
Change in schools - 20
Change in recreation - 19
Change in religious activities - 19
Change in social activities - 18
Small mortgage or loan - 17
Change in sleeping habits - 16
Change in number of family get-togethers - 15
Change in eating habits - 15
Vacation - 13
Major religious festival - 12
Minor violations of the law - 11
TOTAL SCORE ......

Robots in Medical Surgery

Robots are on the way in taking over from humans in the field of medical surgery too, as seen in this picture from Singapore where a robot is seen in the Mount Elizabeth Hospital Singapore operating on a patient, watched by only one doctor.

According to a leaflet put out on this Da Vinci Surgical System it is stated - This surgical robot is designed to enable your surgeon to be more precise, to advance his/her technique and to enhance his/her capability to perform complex minimal access surgery.

This system replicates your surgeon’s movements in real time. It cannot be programmed nor can it make decisions on its own to move in any way or perform any kind of surgical manoeuvres without your surgeon’s direct control.

Self evaluation checklist for patients

Will I benefit from a Genetic Consultation?

Anyone with a concern about any condition running in the family may benefit from a genetic consultation. If you answer ‘Yes’ to any of the questions below then, you definitely stand to benefit from a genetic consultation.

Pre-marital

Does your partner to be or you have a genetic condition? Yes .. No ..

Does your partner to be or you have a family history of a genetic condition or mental retardation? Yes ... No ...

Is your partner to be a blood relative of yours? Yes ... No ...

Pre-conception

Do you have an infertility problem? Yes ... No ...

Did you (your wife) have two or more miscarriages? Yes ... No ...

Did you (your wife) give birth to a stillborn child? Yes ... No ...

Did you (your wife) give birth to a child with a genetic or birth defect? Yes ... No ...

Infant/Child

Does your child look ‘not right’? Yes ... No ...

Is your child growing very slowly (very short) or very fast (very tall)? Yes ... No ...

Does your child have ambiguous or abnormal genitalia? Yes ... No ...

Does your child have developmental delay or mental retardation? Yes ... No ...

Does your child have any abnormal behaviour? Yes ... No ...

Does your child have any muscular weakness? Yes ... No ...

Does your child have any bleeding tendency? Yes ... No ...

Does your child have blindness or deafness? Yes ... No ...

Adolescent/Adult

Is your daughter’s menarche delayed? Yes ... No ...

Is there anyone in your family with a known genetic condition? Yes ... No ...

Is any one of the following conditions seen in more than two family members - young onset diabetes, colorectal cancer, breast cancer? Yes ... No ...

Has any of your relatives developed the following conditions at a very young age - Heart Attack, stroke, deep vein thrombosis? Yes ... No ... Are you taking warfarin treatment? Yes ... No ...

Old age

Are you planning to take hormone replacement therapy? Yes ... No ...

Do you have a family history of dementia? Yes ... No ...

(Sent to the Health Watch by the IMPA)