Ravi, 8 years old, is an intelligent boy. However, his parents and teachers observed several issues and this led to a psychiatry consultation. Here is the list of complaints compiled by Ravi’s mother at the initial consultation:
His school work is incomplete, he overlooks details as he copies from the board, seems to make careless mistakes in his notebooks
He does not concentrate in the class, often seems lost in his own world
When somebody is speaking to him, he is unable to sustain his attention after a minute or so
He understands instructions, but does not carry them through – he quickly looses focus and gets diverted into something else
He is disorganized in the way he manages his belongings, loses his books and belongings frequently
He is intelligent, understands everything, but cannot sustain his mental effort. He scores well in small tests, but can’t do well in longer tests
He forgets important instructions from his teachers and parents
He can’t sit still – keeps moving. He is always ‘on the move’
Suddenly leaves his seat while in the class when he should not
When left unmonitored he runs or climbs. He has frequent injuries
He is unable to play in a group – as he does not follow the rules. Interrupts or intrudes on others in conversations, games, or activities
Talks a lot – almost nonstop at times
Blurts out answers before a question has been completed by his teacher
Has trouble waiting his or her turn
He may suddenly run across the road, or knock over things in the supermarket
Ravi was assessed by a psychiatrist and later, psychometric evaluation was done by a clinical psychologist. A diagnosis of Attention-deficit/hyperactivity disorder (ADHD) was made after these check-ups.
ADHD is a brain disorder characterized by inattention, hyperactivity or impulsivity that interferes with functioning or development. Elaborate criteria have been developed to diagnose ADHD.
Inattention means that a person has a difficulty sustaining focus, wanders off tasks at hand, lacks persistence, and is disorganized. Such problems may superficially appear to be due to defiance or lack of comprehension, but it is not so – evaluation will clearly show the difficulty in holding attention.
Hyperactivity means a person is restless, moves about all the time, including situations in which it is not appropriate. He fidgets, taps, or talks.
Impulsivity means a person makes sudden, hasty actions without first thinking about them. Such actions may have a potential for harm. An impulsive person may be socially intrusive without considering the consequences.
It is common for any child to apparently have some of the symptoms listed by Ravi’s mother. However, in a child with ADHD, these symptoms are severe, occur frequently and interfere with the child’s schooling, day to day activities or his development. Other medical and psychiatric conditions need to be ruled out before the diagnosis of ADHD is confirmed.
ADHD has its onset in early childhood. Symptoms may continue into adulthood. It can cause the child to fall behind normal development, have academic problems, and lead to indiscipline. ADHD has is more common in boys than girls. It has a strong genetic component. Untreated ADHD can form the ground to the development of conduct disorder and substance abuse.
Effective medical and behavioral management is available for ADHD. Ravi responded well to treatment and had a significant reduction in his symptoms. His behavior and academic performance improved. As he progressed, his self esteem improved and in a year he was among the best students in his class.
Please note that the information in this case study should not be considered as medical advice for an individual’s condition. If anyone shows or feel symptoms of a possible medical condition, we strongly encourage you to seek advice from your primary physician or a mental health professional for an evaluation as soon as possible.
The names been changed to protect the privacy of individuals.