A report issued by the Indian Academy of Paediatrics (IAP) noted that Attention Deficit Hypersensitivity Disorder (ADHD) is highly prevalent in children in India.
According to the report, it could be the most common neuro-behavioural disorder among children in the country.
“One of the biggest problems is that there was no one guideline or consensus that is standardised across our country. There is ambiguity over assessments, evaluations, diagnosis, intervention – this prevents every child from getting the best intervention and prevents the family from receiving the best advice to manage the child’s problems,” said Dr Samir Dalwai, President of Indian Academy of Paediatrics, Mumbai Branch, Neuro-developmental Paediatrician and the founder,head of New Horizons Child Development Centre, Mumbai
He added, “Thus, these children suffer socially and academically and are denied their basic rights.
ADHD is very prevalent in India. With the current need to provide a proper evaluation and management, Dr Dalwai and other experts from across the country held a two-day consultation with all stakeholders and came out with standardised national guidelines for the same.
“A 2013 study in southern India reported a prevalence of 11.3% in primary school children (sample size of 770 children, of 6-11 years of age). In terms of centre-based data, a retrospective study at New Horizons in Mumbai reviewed archival data (2009-2012) from case records of 1301 children presenting with developmental concerns (mean age: 6 years) and identified 422 children with ADHD or 32.4%,” said Dr Dalwai, lead author of the guidelines.
ADHD is a chronic condition and thus education of patients, families, and teachers regarding the diagnosis is an integral part of management. Involvement of patient and its family in the management program is extremely vital. This guideline lays down the standard of care for the same.
“ADHD has both inattention as well as hyperactivity/impulsivity. In many cases, the hyperactivity may come down, but the inattention may remain. Controlling the symptoms could be possible,” said Dr Harish Shetty, Consulting Psychiatrist at LH Hiranandani hospital, Powai.
The report further states that this developmental condition often co-exists with other conditions like Oppositional Defiant Disorder, Conduct Disorder, Learning Disability, and Anxiety. Hence, the diagnosis of ADHD requires a systematic, multidisciplinary approach.
“Guidelines and consensus are very important. But we need to understand that every child is different,” added Dr Shetty.
It is often very difficult to even identify kids with ADHD, say experts. “Yes, to identify at a very young age is difficult. But you need to pay keen attention to pick up some signs. Look for consistency in patterns.”
He explained, “The organisational skills of these kids are generally very bad. Their self-esteem is pretty low, they are very impulsive too,” said Havovi Hyderabadwalla, a clinical as well as a forensic psychologist and also the co-founder of Mind Mandala.
“These children often get labelled as naughty, fidgety, forgetful or mischievous, and that delays diagnosis and intervention,” said Sohini Chatterjee, Clinical Director and Psychologist, New Horizons.
“Such guidelines are essential for our country. It will create awareness about ADHD among the Medical professionals and parents. It will help to avoid the negligence about early intervention for those who are in need,” said Dr Geetha M Arora, neonatal & paediatric Occupational therapist at Fortis Healthcare, Noida.
“I wish to place on record the indomitable spirit and the indefatigable efforts of the office bearers and members of IAP and Chapter of Neuro Developmental Paediatrics, National President Dr Anupam Sachdev, Dr Sachidanand Kamath, contribution of the experts, all the members of the Chapter and the persistence of my colleagues at New Horizons who helped with the detailed drafting. To them all, I owe my gratitude,” added Dr Dalwai.
“I congratulate the members of the Academy and I wish these guidelines serve the community optimally,” said Dr Anupam Sachdev, National President of the Academy
Strategies for parents and teachers to regulate behaviours in children with ADHD
- Maintaining a daily schedule (e.g., time table, post- its, reminders)
- Using charts and checklists to help the child stay ‘on task’
- Keeping distractions to a minimum
- Limiting choices
- Providing specific and logical places for the child to keep his school books, toys, and clothes
- Setting small, reachable goals
- Rewarding positive behaviour (e.g., with a ‘token economy’)
- Identifying unintentional reinforcement of negative behaviours
- Finding activities in which the child can be successful (e.g., hobbies, sports)
- Using calm discipline (e.g., time out, distraction, removing the child from the situation)
Source: Dr Dalwai et al. Evaluation and management of attention deficit hyperactivity disorder
“These guidelines are freely downloadable from the Internet and we welcome everyone from professionals to parents to teachers, not only in India, but in South East Asia (since these ‘Make in India’ Guidelines are the first in this region) to use them to benefit the millions of children with ADHD,” added Dr Dalwai.