Attention Deficit Hyperactive Disorder (ADHD)

What is Attention deficit hyperactive disorder (ADHD)?

ADHD is a kind of psychiatric illness having its manifestation during the early years of life. This is a developmental disorder it is called so as the symptoms of ADHD appear clearly by the age of five years and are more prominent during the early years of life. Only in some cases the symptoms persist with same severity in the adulthood.

How to identify ADHD?

There are certain differences which make children having ADHD different from other children:-

ü  Difficulty concentrating for long on any task,

ü  Leaving the task incomplete to take up a new task,

ü  Inability to prolong interest even on otherwise liked things,

ü  Disliking for tasks that require involvement and thinking,

ü  Excessive activity, inability to sit at a place for long,

ü  Running around as if being run by motor,

ü  Continuously moving hand, legs even when sitting,

ü  Very easily distractible,

ü  Making strange voices,

ü  Inability to wait for their turn,

ü  Blurting out the answer before the question is completed,

ü  Keep losing the things,

ü  Makes careless mistakes,

ü  Looses temper easily.

Any of the above mentioned symptoms when appear for long time and interfere with child’s education or other learning and development should be given adequate attention.

Does is mean child has poor intelligence?

In some cases the child having ADHD may have associated condition such as mental retardation, learning disorder, language disorders, conduct disorder (dissocial behavior) etc. but in cases where child does not have any other associated condition the poor performance of the child might only be because of his inability to pay attention to the task given to him rather than poor intelligence.

What causes ADHD?

There is no one cause of having ADHD but a combination of factors might be responsible for this.

1. Due to any neurotransmitter (Chemical) imbalance in the brain,
2. Due to various structural abnormalities in brain,
3. Lack of normal development in child before birth,
4. Effect of dangerous environment (lead exposure, trauma, poison, drug, alcohol, etc) to the child before or immediately after birth, etc.

What is the treatment of ADHD?

The children having ADHD can get help through medication prescribed by a trained psychiatrist as these medicine help reducing increased activity to some extent.

For other behavioral problems child require help from Clinical Psychologist and Special Educator.

How to control increased activity?

For controlling increased activity follow certain things given below:

ü  Let the child be involved into activities requiring high energy level such as racing, cycling, dancing for long time before asking him to sit at  a place for some work,

ü  Let the child do some extra exercise in morning,

ü  Encourage him to sit at a place for small duration and gradually increase the time, give child something that he likes when successfully does so,

ü  Establish contract with the child in which the goal and tasks are determined and the privileges that will be given for doing any task are mentioned. This contract is made with child and is followed by both the parties (i.e. child and caretaker), etc.

What to do to increase his attention?

ü  Allow the child to do task in part rather than whole at one time and encourage him with something that he likes (such as sweet, toy, allowing TV for 10 minutes etc.) for doing each part,

ü  Allow him to do tasks for small duration and gradually increase the duration, remember start with activities that child likes to do,

ü  Give small and clear instructions (i.e. get me the bottle, rather than get me the bottle which is kept over the table and pour the water in glass),

ü  Hold the shoulders of the child and look straight into his eyes while giving him instruction,

ü  Ask him to follow simple mazes, computer game etc,

ü  Remove extra distractions from the room where the child is to be taught something,

ü  Try to use as many sensory modalities as possible while teaching (i.e. make him see, touch, speak, hear a word while teaching rather than simply either see from book, or listen from teacher), etc.

What to do to control inability to wait (impulsivity)?

ü  Help the child understand that he will be given something if he delays his reaction to anything for some time and than gradually increase the time required to wait between a thing is given and the child to react to it,

ü  Teach the child to postpone the reaction only by a few seconds first and than increase the duration,

ü  React negatively if he blurts out before time, etc.

Can a child suffering from ADHD study in a regular school?

Yes, the child having ADHD can study in regular school, but he/she needs special attention and special training to cope with the problem

How can parent help the child?

The parents play a very important role for the treatment of such child as the training required for them has to be constant and structured for all the settings such as school, home, playground etc. for which the most concerned and constant trainer is parent.

OBSESSIVE COMPULSIVE DISORDER (OCD)

What is Obsessive-compulsive disorder?

OCD is an illness characterized of some constant worries and fears which appear illogical or irrational to the person who is having it. But even than the sufferer is unable to let go or remove these worries for long time, he is only able to remove these worries for brief periods of time that too only after doing something which again appears irrational and excessive.

What is an Obsession?

Obsessions are thoughts, images, or a sudden intense desire that keeps coming to the mind of sufferer even when the person may find them senseless or even “bad” and unpleasant.

What is a compulsion?

A compulsion is a action that a person feels compelled to repeat again and again, though he or she has no desire to do so. These actions can be of any type some of the frequently seen behaviors are

• Frequently washing hands for long duration, 
• Taking long time in cleaning things,
• Checking door locks, knobs, switches etc repeatedly even he remembers clearly that he has checked  it,
• Keeping things in a “specific” order and feeling of major discomfort if things are not kept in that specific order,
• Speaking some words or phrases silently,
• Doing some acts such as moving in-out, up-down, etc repeatedly, etc.

How to identify OCD?

Obsessions and compulsions have few things in common like:-

·         An idea, a desire, an image forces into the person’s mind which is not liked by person,

·         A feeling of “something bad will happen” is experienced by the person either to himself or to family members,

·         In order to reduce this feeling, the person had to perform certain actions against his will,

·         The cycle goes on and on…..

·         The person recognizes it as irrational and senseless and feels a strong desire to resist

·         But they feel that they are compelled to take action to reduce it.

What are the major types of such thought that may disturb a person?

OCD may have 4 major types of content of disturbing thought:

Contamination of dirt and germs: the person usually believes that the contamination is spread from object to object or person to person by even a slight contact.

Irrational doubts: the person always feels guilty or responsible about having forgotten or committing something wrong which may have dire consequences.

Forceful thoughts: repetitive thoughts of sexual or aggressive acts that the person “feels” that he might have committed.

Symmetry: the person feels the need for precision or perfection and therefore become slow in performing the activities.

Is it only me who has this problem?

In general population 2-3 out of every 100 people suffer from OCD. 

At what age it can occur to me?

Though OCD can occur at any age, time or to person of any gender, but for men the average age of starting OCD is about 20 years and for women the average age of starting OCD symptoms is 22 years. At times people may have the illness even at the age of 35 or late. In some cases symptoms were found to be occurring at age of as young as 2-3 years.

What are the causes of OCD?

There are many reasons which are found to have their share in developing OCD but which of these reason is working in a person is not known. It is believed that not any one but the combination of the below mentioned reasons might be responsible for it:

• Certain chemical (serotonin) disturbance/misbalance in the body,
• Heredity can also play an important role. It can run in family from one generation to other,
• Development of “faulty relationship” between a non-threatening thing with a fearful thing that produces fear, anxiety or discomfort,
• In order to reduce this anxiety and discomfit the person discovers that certain actions reduce anxiety and develop active avoidance strategies to control the anxiety and accordingly, it strengthens and become fixed as learned pattern of compulsive behavior. 

Who have high chances of developing OCD?

Any person of  any gender, class, religion, caste or culture can have OCD. The chances of having it increase if there are other family members who are either having OCD or any other psychiatric problem.

Dose it ever get cured?

About 20-30% of patients having OCD recover completely from there symptoms whereas 40-50% have major improvement but not complete recovery. The recovery is facilitated by good support from family members and the persons own efforts to follow instruction of the professional Psychiatrist and Clinical Psychologist.

What are the treatments available?

OCD can be very effectively treated with the help of medications along with psychotherapy.  The medications are safe, non habit forming should be taken under supervision.

The most common and effective therapies for OCD are:

·         Exposure and response prevention in which the patient is repeatedly exposed to fearful thing that produces obsession and compulsive behaviors and helped in a scientific manner to control the symptoms,

·         Desensitization,

·         Thought stopping,

·         Flooding,

·         Aversive conditioning,

·         Group therapy,

·         Family therapy

Always remember –

·         It is an illness and not bad character,

·         Just like any other physical illness which has some causes and treatment OCD also has a treatment,

Contacting a mental health professional (Psychiatrist, Clinical Psychologist) on seeing any such symptoms is a good idea because right consultation at right time can help the person the most.

Dementia: Early Identification for Early Intervention

What is dementia?

Dementia is a psychiatric condition characterized of certain major changes in a persons’ ability to remember things and other day to day behaviors.

What causes dementia?

Dementia is a common term used to indicate a group of conditions characterized of similar manifestations but having different etiologies in different people such as due to Alzheimer disease, vascular degeneration etc. The major cause behind the condition is the gradual degeneration (death) of brain cells, which are the building blocks of brain and are responsible for the regular day to day behaviors and abilities of a person.

What are the major changes in the behaviors of such patients?

Dementia is mainly characterized of following symptoms

·      Gradual loss of memory leading to inability to remember names, relations, faces, where things were kept,

·      The person may forget the way to home and may get lost at the place which was very familiar to him/her,

·       Person may get lost even in his own home or office,

·       Inability to dress-up oneself, shave oneself, tie shoelaces, bathe properly, combing etc,

·      Complete change in the personality such as increased jocularity, disinhibition,

·      Sudden anger outbursts, irritability, risk taking behavior,

·      Urinating in cloths or at inappropriate places,

·      Inability to recognize things of daily use,

·      Inability to understand commands or to express what they want to say,

·      Inability to coordinate the simple body movements (such as picking up cup, use knife)

Is it aging or illness?

Though after the age of 60 or above anyone may have some of gradual deterioration of memory functions but in cases where the problems increase rapidly and start having major problems in day to day life may require immediate psychiatric consultation.

What to do if some of your known person has any of the above mentioned symptoms?

If any of your known has any of the above mentioned problems you must seek consultation from a psychiatrist who may help the patient by prescribing the medications which may slow down the process of gradual death of brain cells and thus resulting in slowing down the process of behavioral problems.

“He forgets his way and gets lost” what to do for this?

To help the person who loses his way when gone out

·    Should not be allowed to travel very far alone, but he should be given freedom to move out for a small walk (if required under supervision)

·       When going out a paper slip/diary indicating the address, name, and the name of the person whom to contact in case of need should be kept in his pocket,

·        The person can be given a location guide or map which can help the person in case of confusion about directions, etc.

If the person gets lost even within the house

·        In such cases certain arrow marks towards toilet, bedroom etc can be placed,

·        Name of the place in bold letters can be written and pasted at different places,

·        In case the person leaves home as he sees the door a mirror can be placed over the door’s back so that the person gets distracted as he reaches the door.

·         A night bulb must be lit up in night.

·        There should be adequate lighting in the room of the patient, etc.

What can be done if he forgets names, dates, people etc?

·           Person should be shown his old photographs, letters, videos etc frequently,

·        Whenever anybody comes to meet him/her he should be introduced by name and relationship rather than asking patient to identify him (such as “Look your daughter Seema has come to meet you with her husband Amit, they have come after a week to see you would you like to meet them?”),

·           Keep large calendars, clock and pictures of family members in patient’s room,

·           Indicate in bold letters about what is kept here, such as “MEDICINE” over the cupboard where medicine is kept,

What if he gets angry or remains irritable unnecessarily?

·           Try to understand the patients confusion and avoid arguments with him,

·            Do not blame patient for his condition,

·            Try to keep the activities structured,

·             Keep less articles (distractions) in the room of patient,

·            Use audible but polite voice while interacting with him,

·            Allow him/her to walk around and engage in activities that he likes to do, etc.

What to do if he urinates in bed/clothes?

·             Try to track the time of the day when he urinated for a few days and then make it a habit to ask patient to use toilet before that identified time comes,

·              Patient can be reminded to use toilet even if does not feel the need after every two hours,

·              Give him a privilege if he remains dry for the whole night,

·      Train patient to hold the urine for longer duration gradually increasing time between liquid intake and elimination of urine, etc.

Can dementia be cured?

In some cases where the cause is not the degeneration there the condition can be reversed with right treatment. Mostly dementia is often a result of gradual degeneration of brain building blocks thus once it has been started it can only be slowed down but cannot be reversed. It puts a big onus on the caregivers, as it requires constant care.

Learning (A Psychological Perspective)

In Psychological perspective learning is viewed as follows:

Learning is defined as a change in behaviour resulting from repeated practice, and both the environment and the behaviour interact to produce the learned change. It is acquiring new or modifying existing knowledge, behaviours, skills, values, or preferences and may involve synthesizing different types of information.

Learning and performance are related but should not be confused; when performance is adversely affected by insufficient motivation or by anxiety, learning that has occurred may not be demonstrable.
To assess learning, an aspect of performance, such as the accuracy of a motor skill or the ability to recognize and repeat words, is measured. (A bad result might not necessarily indicate poor learning??? Einstein never got good grades!)

There are three major theories of learning as follows:

• Classical conditioning: as a result of the contiguity of environmental events
• Operant conditioning: consequences of a person's actions.
• Social learning: reciprocal interaction between the person and the environment.

Classic (also called respondent) conditioning results from the repeated pairing of a neutral (conditioned) stimulus with one that evokes a response (unconditioned stimulus), such that the neutral stimulus eventually comes to evoke the response.
The time relation between the presentation of the conditioned and unconditioned stimuli is important and varies for optimal learning from a fraction of a second to several seconds. (e.g. Pavlov's famous bell and food experiment on dogs, where dogs started salivating on sound of bell only, when bell sound and food was closely given)

Operant conditioning (first theorised by B. F. Skinner): Whereas in classic conditioning an animal is passive or restrained and behavior is reinforced by the experimenter, in operant conditioning the animal is active and behaves in a way that produces a reward; thus learning occurs as a consequence of action.

For example, a rat receives a reinforcing stimulus (food) only when it correctly responds by pressing a lever or a good report card for student, incentive for employees acts as reinforcer for further performance.
Food, approval, praise, good grades, or any other response that satisfies a need in an animal or a person can serve as a reward.
Operant conditioning is related to trial-and-error learning.
In trial-and-error learning, a person or animal attempts to solve a problem by trying different actions until one proves successful.
A freely moving organism behaves in a way that is instrumental in producing a reward.

Social learning theory relies on role modeling, identification, and human interactions.
A person can learn by imitating the behavior of another person, but personal factors are involved.
Persons learn by observing others, intentionally or accidentally; this process is described as modelling, or learning through imitation.
When a person dislikes a role model, imitative behavior is unlikely.
If a chosen model reflects healthy norms and values, the person develops self-efficacy, the capacity to adapt to normal, everyday life as well as to threatening situations.

It is possible to eliminate negative behavior patterns by having a person learn alternative techniques from other role models.
• Phobias in children.
• weight reduction
• smoking cessation programs
• group treatment plans in which members of the group learn from one another.

Learning changes brain structures
The neurobiological basis of learning is located in the structures of the brain involved in forming and storing information, which include the hippocampus, the cortex, and the cerebellum.

One hundred billion neurons in the brain are involved in forming memories, including a layer of 4.6 million cells in the hippocampus.

How leaning causes changes in brain?
Learning begins with the senses taking in an environmental stimulus that is eventually transformed into a memory trace or memory link.

1. An electrical or chemical impulse, passing through a neuron when the brain receives information, triggers the formation of connections between synapses.
2. Increase in synaptic connections when learning occurs.
3. Long-term memories have increased time to link with many locations in the cortex and, thus, are retained longer than short-term memories.
4. The more connections, the better the chance of contacting a neural pathway leading to the memory.
5. Repeated reliving of a memory enhances its permanence

Storage is the key to a good memory. Relating material to something that is already known creates more pathways and increases the storage power.
Processing information at a semantic level involves more of the mind than does rote memorization.
Semantic information decays at a slower rate than information superficially memorized, without meaning and comprehension.

You learn what you want to =Motivation
Motivation is a state of being that produces a tendency toward action.
The state may be one of deprivation (e.g., hunger), a value system, need for money or a strongly held belief (e.g., religion).
Biological mechanisms play an important role in motivating behavior.
Social motives, such as the need for recognition and achievement, also account for behavioral patterns (e.g., studying hard to get good grades).

Practical Tips for students to improve learning:
Select the field that you really like, then motivation is inherent in the job.
Make small achievable targets...organise your time and resources
Dont compare too much with others, focus on self.
Link informations to one another...creating a sort of network in mind
Reward & praise yourself, others for good work

Practise and revise... Start early...no short cuts!

Adolescent Conflicts: How to deal with them?

This piece of information may be helpful for the parents and families where the children are approaching adolescence. Problems in these areas mostly lands the families in trouble.

The home should be a safe base

Adolescent children are exploring life, but need a base to come back to. Home should be the place where they feel safe, protected cared and will be taken seriously. A safe place is usually a peaceful one.

 

Mutual support

Parents need to agree between themselves about their basic values and rules, and be supportive and unambiguous in applying them.

It's difficult for a teenager to respect parents who are always at each other's throats or undermining each other. A common problem is for one parent to ally with their child against the other parent. This usually leads to constant family trouble.

Listening Really

Parents are a source of advice, sympathy and comfort, if they listen to the youngsters. A teenager needs to know that his or her parents will not automatically pass a judgement and criticise. They will be forthcoming with their problems, rather than raise a tantrum. Patient listening is important.

Rules

It is reasonable that parents should decide what the ground rules are. Whilst adolescents may protest, sensible rules can be the basis for security and agreement. They must be:

•  Clear, so everybody knows where they stand.
•  Where possible, they should be agreed with the children.
•  Consistent, so everyone sticks to them.
•  Reasonable.
• Less restrictive as children become more responsible.

You can't (and shouldn't) have rules for everything. While some issues will not be negotiable, there should be room for bargaining on others.
Punishments, such as loss of pocket money, will only work if they are established in advance. Don't threaten these if you are not willing to carry them out.

Rewards for behaving well are just as important - probably more important, in fact.

 

In case of disagreements

Involve your children in making family rules - like all of us, they are more likely to stick to rules if they can see some logic to them and have helped to make them. If a teenager is reluctant to discuss rules for him or herself, they may still do this if they can see that it might be helpful for younger brothers or sisters.

A lot of things adolescents do may be irritating to parents (as parents probably irritate them), but not all are worth an argument. It's usually better to spend time on praising good decisions or behaviour. Many annoying habits will burn themselves out once parents stop reacting to them.

 

Don't compete with them

Adolescents are growing and gaining strengths, and having a lot of opportunities and may be very busy, making the parents feel older for the first time. At times jealousy can be the underlying reason for all sorts of arguments and trouble.

 

Physical punishment

Although it is now viewed as unhelpful, many people still occasionally smack younger children. It create’s the impression that violence is an acceptable way to solve difficulties. This means that they are more likely to grow up to use violence as adults. It can create a cycle of violence

 

Parents are the prime example

Although they are becoming more independent, the children will still learn a lot about how to behave from the parents. If you don't want them to swear, don't swear yourself. If you don't want them to get drunk, don't get drunk yourself. If you don't want them to be violent, don't use violence yourself. If you want them to be kind and generous to other people ….. try to be like this yourself. “Do as I say, not as I do” just won't work.

 

Thankless Teenagers

Don't worry if your children aren't as grateful as you' like. It's great if they are, but they may not be until they have children of their own and realise how demanding it can be.

 

When to seek help

• Sometimes, all of this may not be enough and you (or your child) may be unable to cope. Worries about the physical changes of adolescence can be discussed with the family doctor
• If there is violence in your family - parents hitting one another, children hitting each other, parents hitting children or children hitting parents - ask for help.
• When problems arise at school, school refusal or decline in grades are there.
• Psychological help may be needed if relationships are the issue.
• Adolescents who experience turmoil or distress for more than a few months - persistent depression, anxiety, serious eating disorders or difficult behaviour - generally require professional help.
• Specialist help can help the whole family.

Unravelling Adolescence Conflicts: Few Facts

The Growing Years

The teenage years can be a source of emotional trauma for whole of the family. A void can grow between parents and their children during adolescence. Why should many of the families land into trouble?

It's a time of rapid physical development and deep emotional changes. These are exciting, but can also be confusing and uncomfortable for child and parent alike.
The process of rapid physical changes in adolescence is called puberty. The hormone changes responsible actually begin some years earlier and may produce periods of moodiness and restlessness.
Besides rapid physical growth and these changes include
For girls: menstrual periods, breast development, growth of under-arm, body and pubic hair.
For boys: voice becoming deeper, growth of body and pubic hair, facial hair, erections and nocturnal emissions.
Teenagers may sleep more as growth and development uses a lot of energy
Parents become less important in their children's eyes as their life outside the family develops.
Parents often feel rejected, and in a sense they are. But this is often necessary for young people to develop their own identity. In spite of the differences and arguments the children will usually think a lot of the parents.

Behavioural Problems in Adolescence
Teenagers and their parents complain about each other's behaviour. Parents often feel they have lost any sort of control or influence over their child.

Adolescents want their parents to be clear and consistent about rules and boundaries, but at the same time may resent any restrictions on their growing freedom and ability to decide for themselves.

Young people can crave excitement in a way that most adults find difficult to understand - and exciting activities may be dangerous.

Disagreements are common and normal, but when to conserned? As a general rule, the chances of children being at risk of getting into trouble are more if their parents don't know where they are. So, try to keep a track of what the children want and where they are going to spend their time

School Refusal can be due to:

1. difficulties in separating from parents
2. being perfectionist, and becoming depressed because they can't do as well as they would want to disturbed family life, with early separation from or death of parent.
3. an established pattern which may have started at primary school. Such children often have physical symptoms, such as headache or stomach-ache.
4. Bullying can also cause all of the above. Most young people do not break the law, but those who do are usually boys. 

Many adolescents diet. Fortunately, few will develop serious eating disorders like anorexia or bulimia. However, these are more likely to occur in those who take up serious dieting, think very little of themselves, are under stress and who have been over-weight as a child.

Many teenagers experiment with alcohol and illegal drugs. Regular use of drugs or alcohol is much less common.

Adolescence has often been projected as bad time. However, the scenario is not as bad and most teenagers actually like their parents and feel that they get on well with them.

It is a time when the process of growing up can help people to make positive changes, and to put the problems of the past behind them.

It is not just a difficult stage, although it can feel very much like it at times. The anxiety experienced by parents is not one sided. Periods of uncertainty, turmoil and unhappiness are also experienced by the adolescent.

Difficult times come and go, but most adolescents don't develop serious problems. It's worth remembering this when things are difficult.

Parents may sometimes start to feel that they have failed. But still they continue to play a crucial part in their children's lives. Helping the children grow through adolescence can be profoundly satisfying.

Marital Therapy

Marriage is one of the biggest gambles of life. If the gamble works, adjustment and compromise becomes the life mantra and if it doesn’t work then divorce or extramarital affairs are the outcome. If the marriage works, it doesn’t mean it is perfect. Perfect marriage is an illusion. It happens only in Mills and Boons novels. Once the honeymoon period is over, the curtain from the eyes is lifted and a clearer picture emerges. The same spouse who seemed to be carved out with utmost perfection becomes a bundle of imperfections. Fights, arguments, negative feelings & cribbing become a rule rather than an exception. If you feel that now nothing can happen and separation is the answer, think again. If love and motivation to stay together exists and no present extra marital affairs and violence or gross untreatable mental illness exists in either of the partner hope exists.

Marital therapy is the treatment of choice when such a problem becomes difficult to solve. The problem is approached in a step wise manner through a series of sessions. These are paced as per the problems in a professional and scientific manner. Few tips are given below.

No one is 100% bad or good. If there are lacunae within your partner, there must be something good as well. You can keep concentrating on the negatives and keep feeling worse but if there is anything positive, think about it which will give at least a ray of hope to move on.

Whenever feeling low, think of all the happy memories and the good times you spent together which will not only lift away the despair but also will help you in thinking clearly.

Years of marriage results in blame game whereby responsibility for anything that has gone wrong is passed on to the other partner. Shedding away the responsibility is the easiest thing to do and takes the guilt away as well. Think again. Attacking your partner will always result in defensive reaction by the other partner, the result of which will always be a fight.

Discuss issues with your partner, things that make you happy or sad, what are your expectations, how can this alliance be improved. Communication very important; which should be done in the right fashion. If you don’t talk; you can’t talk your way out.

Realise your own mistakes and how you rectify them. Change has to be brought in both the partners so why not start from your own self. Write down your positives and negatives and do the same for your partner as well.

Imagine how it would be like to be married to your own self. Then you might be able to understand the position of your spouse better. It would also help you in understanding your own self.

Long term marriages work on strengths and not weaknesses. Concentrate on the strengths of your partner and build upon it. Concentrate your energies in constructive things around you which give you happiness.