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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.
The causes
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.
Unequipped
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.
Symptoms
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
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