ADHD in Children: FAQ Part 3

- What causes ADHD? 

The exact causes of ADHD are still not fully understood. However, it is likely to be due to a number of factors coming together. We know that ADHD can be inherited and that the genes controlling the chemicals or neurotransmitters in the brain are different in those with ADHD.

- What are common symptoms that parents can look for to identify that their child has ADHD? 

There are two main domains of symptoms; attention deficits and hyperactivity. The main symptom is difficulty in paying attention. A child with ADHD may have problems listening and following instructions, finishing tasks, is forgetful and easily loses his belongings. He distractible, tend to daydream and make careless mistakes. He will avoid activities that require sustained concentration or that might be boring. In the hyperactivity domain, he is restless and cannot sit still. He may run and climb on things constantly and when seated, may tend to squirm and fidget. The ADHD child is always on the go, will talk excessively and cannot play quietly.

- What are the most effective ways to treat patients between the ages of 3 and 10? 

Most of the time, we only start to diagnose ADHD for children who are 5 and above. This is because, unless very severe, inattention and hyperactivity can be quite common in children 3-5 and may improve naturally as they mature. ADHD can be treated with medications. Currently, two main types of medications are available, stimulants and norepinephrine uptake inhibitors. They help ADHD by increasing the level of neurotransmitters (chemical messengers) in the brain called dopamine and norepinephrine. Behavioural modifications and therapy are also useful treatments and are always given alongside medications.

- Many proponents of ‘food as medicine’ claim that ADHD symptoms can be controlled through a change in dietary habits – how much truth is there to this claim? 

There has not been any proof about these claims and studies done have consistently shown that dietary changes have no bearing on ADHD symptoms. The exception to this is fish oil which has shown to improve attention deficits symptoms and decrease hyperactivity in some cases.

Question of the week (19 November 2015)

"I have trouble falling asleep at night and as a result I feel tired in the mornings. This leaves me feeling sluggish and unproductive during the day. What can I do?"

Many do not realise that waking up well is as important as falling asleep to prevent insomnia. If you allow a lousy night of sleep to upset you the next morning such that you stay in bed, refuse to exercise and give yourself an excuse to be sluggish, a negative vicious cycle will be ensue, which results in the poor sleep perpetuating the next night. However, if you wake up well, exercise and be active upon waking, your brain will know it is the morning and it will signal to you when it is night and this results in a healthy circadian rhythm and better sleep.

Suggestions:

1) Improve your sleep quality by observing good sleep hygiene:

-Go to bed and get out of bed the same time all the time.  

-Have a soothing pre-sleep routine

-Avoid doing things in bed except sleep and sex to prevent feeling alert in bed all the time

-Avoid tossing and turning in bed for more than 15 minutes if you cannot fall asleep as you will get anxious. Go to another room and read a book and try to sleep again when tired.

2) Establish a good exercise schedule. Try and do so in the morning so as to wake the mind up and do not let one night of poor sleep stop you from exercising. The best way to stop that sluggish feeling is to stay active and activated by fun activities!

FAQ: Physical Punishment in Children

What age is deemed appropriate when it comes to disciplining a child (toddlers included)?

Discipline should start as early as 8 months. This can be a simple "no" for example when the baby plays with the remote control. However, the baby should also be praised if he obeys the instructions.

Are there any benefits to using physical punishment (caning or a smack on the bottom/Palm) on a child? What about parents who incorporate this punishment at an early age?

Whether physical punishment is appropriate boils down to the cultural  background and values of the family. Most western studies have shown that physical punishment is detrimental to the child. I would suggest minimising using physical punishments as parents may then only focus on punishment and not on teaching or educating the child. Nevertheless, physical punishment, when incorporated with consistency and non punitively, can be a quick and effective way of disciplining the child. 

What consequences might a child have if he is reprimanded or caned at an early age? 

If a child is fairly and appropriately reprimanded or even caned, and the reasons why these punishments meted out are carefully explained, I do not think that the child will have any consequence. However, if a parent metes out punishments, especially physical ones, as he or she is frustrated, this can lead the child to learn to react violently when distressed. If the physical punishments escalates inappropriately, it may become physical abuse and may scar the child permanently leading to long term psychological difficulties. 

Could this lead to a more disciplined child? Or might it have possible negative effects?

As mentioned above, it depends largely of the punishment is meted out appropriately. A parent must never can or hit the child out of frustration. The punishment must be predetermined and meted out consistently, and proportionate to the age of the child and the bad behavior. A good amount of teaching and education must follow suit. If so, the child understand why he is punished and learn from it leading to better discipline. 

At what age would physical punishment (caning or a smack on the bottom/palm) be deemed ok for a child? Why?

Physical punishment, if at all used, should only be used when the child can understand the correlation between his actions and consequences. This would be at the earliest 3-4 year old. 

What is the best way to properly discipline a child? 

A positive approach is often best. Therefore encouraging good behaviour with use of techniques such as star chart / reward chart will be desirable. Using methods such as time out when a child is throwing tantrum or misbehaving is also useful. 

Most importantly, it is most important to be consistent and firm in disciplining the child. Do not be punitive and do not shame the child. 

Fears in Children: 4 Questions Answered

Q: How should a parent help a child cope with his/her fear of the dark, bad dreams, clowns and strangers?

Generally mild fears and simple phobias can be ignored if they are not affecting the life of the child to a huge extent. They are usually a passing phase and the child will slowly get better as he matures. Parents should remain calm and not be frustrated with these. Most importantly, do not be punitive and start calling the child names, as this will cause further low self esteem.

Q: How can a parent help the child get over the fear?

If for some reasons, the child's fear and phobia is affecting his life, he can be gradually exposed to the feared object. Parents can start by telling positive stories of these feared objects. For eg. adventures in the dark or a friendly helpful clown. They can also share their own experiences with their fears when they were young. Subsequently they can increase the degree of exposure slowly. If serious, it is best to get professional guidance.

Q: Are there any "don'ts" when trying to help a child get over the fear?

i) Don't push the child, give him time.

ii) Don't criticise the child as this makes him more fearful.

iii) Don't bother with the fear or phobia, if it is not really affecting the child's life.

iv) Don't ignore working on your own anxiety and fears, as the child may have learnt it from the parents.

Q: What's the likelihood of the fear being brought over to the child's adulthood?

Most children have fears as they continue to have magical thinking and believe in their fantasies, for eg. monsters. However, as we grow older, we lose these magical thinking and the fears mostly go away as well.

Four Differences Between Depression and Burnout

The article, Four Differences Between Depression and Burnout, has been moved here.

Bulimia Nervosa FAQ

Bulimia nervosa is an eating disorder characterized by cycles of binge eating and purging, or consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight.

What are the common reasons for bulimia?  

The way media portrays and idealizes a slim physique has often been found to be the main culprit. This in turn leads to peer pressure in teenage girls and youths to stay thin and results in distortion of body image. There can also be a biological or genetic predisposition.

What are the warning signs of the disease, if I were a parent, how can I detect it?

If the child starts becoming secretive about her meals, parents need to start taking note. Parents may notice that they try to restrict their diet and then loses control and binge eat at other times. They may disappear or spend a lot of time in the toilet, often to purge or vomit the food out.

What are the dangers of bulimia? Are they the same as anorexia, or more dangerous? (will the stomach acid harm the throat walls, other complications e.g?)

Bulimia and Anorexia are really two sides of the same coin. From a physical point of view, Anorexia and restricting one's diet is more dangerous. However,Bulimia can also cause a myriad of physical problems such as electrolyte imbalance, cardiovascular problems like irregular rhythm, digestive issues and throat and mouth problems. Having Bulimia is likely to predispose one to Anorexia as well.

How different are the profiles of patients of bulimia and anorexia? (since maybe bulimia is a more active way of coping, while anorexia seems passive?)

I believe they are the same illness presenting differently and at different times. Many anorexic patients go on to binge and develop bulimia after the anorexia episode. As such the profile is very much the same. In young adolescent girls exposed to a culture which emphasises a slim physique.

 How is the treatment for bulimia? is it the same as anorexia?

As with anorexia, the first step is to recognise the problem and to seek help. The need for hospitalisation is often lower in Bulimia as compared to Anorexia where low body weight can sometimes be a medical emergency and refeeding needs to be carried out quickly and safely in the hospital. Unlike in Anorexia, medication like antidepressant plays a role in helping with the urge of binging and purging. Psychotherapy is an important component of treatment in both.

Attention Deficit Hyper Activity Disorder (ADHD / ADD) Medications Cheatsheet

The article on Attention Deficit Hyper Activity Disorder (ADHD / ADD) Medications Cheatsheet  has been moved here.