Articles on attention deficit hyperactivity disorder

Is Your Child Inattentive, Hyperactive and Impulsive?

Dr. Darpan Kaur, Psychiatrist
Children and adolescents can have symptoms of inattentiveness, hyperactivity, lack of concentration, impulsivity, etc. Many a times, children experience some amount of inattentiveness and hyperactivity in the context of normal development . However, when these symptoms become severe, excessive, persistent, seen across multiple situations of classroom  setting ,  home setting , social setting, etc and the child is experiencing problems in his academics and social functioning because of these symptoms, then the child  may be having a disorder called ADHD ( Attention Deficit Hyperactivity Disorder).Children can have an Inattentive Type of ADHD where inattentiveness is the main symptom or they can have Hyperactive - Impulsive Type of ADHD where excessive hyperactivity  and impulsive behaviors are  the  main symptoms or they can have Combined Type of ADHD which has all features of  inattentiveness, hyperactivity and impulsivity. It is found in both boys and girls, but reported to be more common in boys than in girls.There are standard clinical criteria in psychiatry classification systems such as DSM-V and ICD- 10 for diagnosing ADHD which are used by psychiatrists in evaluating whether your child is just experiencing some symptoms or a full blown disorder based on symptoms, settings, severity, developmental age, etc. There are  clinical rating scales which may be used to for additional assessments and plan interventions accordingly. ADHD can lead to problems in academics and education as the child faces significant problem in focusing in the classroom, paying attention, gets distracted easily while studying and hence it can reflect in day to day school work and even affect his or her performance in exams. A child with ADHD can also have problems in social behavior because of inability to sit in one place and impulsivity in behavior and can appear disruptive in classrooms. They can also have problems with their peers and can have problems in friendships because of their impulsivity, hyperactivity and behavioral overlay.Kindly consult a psychiatrist if your child is experiencing symptoms of ADHD. It may be preferable to consult a psychiatrist with expertise/ training in child and adolescent psychiatry if resources are  available  who can evaluate your child clinically, plan some assessments for ADHD, advise you certain blood tests and electrophysiological investigations as per expertise, guide you regarding role of medications to improve child’s attention and concentration  and role of therapies such as Behavior therapy, Parent management training therapy, etc . The psychiatrist will counsel your child to deal with his problems in studies and behavior and  suggest some therapeutic  tips to improve your child attention and concentration,  do psychological therapy for your child as per  clinical expertise and school of training in child and adolescent psychiatry. Parents  also be need to be taught positive parenting practices to improve the child's overall behavior and techniques to improve the child's attention and reduce problematic behaviors of hyperactivity and impulsivity.The psychiatrist may refer your child for a Neurologist consultation, preferably a Pediatric Neurologist if there are any neurological signs and symptoms in the child as per clinical expertise to rule out any neurological conditions which can have symptoms of inattentiveness, hyperactivity etc. Certain conditions like seizures and nutritional deficiencies can have inattentiveness and hyperactivity as symptoms which may need to be evaluated.  Multidisciplinary approaches comprising of child and adolescent psychiatry, pediatric neurology, child psychology, OT and educational liasion  are  useful for comprehensive assessment and holistic  management of the child with ADHD. 

Hiking- Nature's Healthy Solution for Adhd and Anxiety!

Dr. Deepak Shah, Homeopath
The next time someone tells you to take a hike, don't be offended – do it! Your mental well-being and overall health will thank you . By know, we all know that exercise is a great way to keep weight in check, but it's also an ideal way to boost mental clarity, fend of depression and reduce anxiety. Why turn to Big Pharma drugs that promise to do the same, when you can take a walk in nature and improve your health, minus the high costs and terrible side effects?In fact, studies have proven that hiking provides tremendous health benefits. One such study, which was published in the Proceedings of the National Academy of Sciences, found that, compared to people who walked for 90 minutes in an urban environment, those who walked for that same amount of time in a natural environment reported lowered levels of persistent negative thoughts.Hiking in natural environment lessens depression, negative thoughts-The published study, which notes that 70 percent of people are projected to live in urban areas by 2050, states that talking a "90-min walk through a natural environment may be vital for mental health in our rapidly urbanizing world."Outdoor activity in nature boosts creative thinking ability, diminishes ADHD symptoms-A different study also found that spending time walking in nature can help children who suffer from attention deficit hyperactivity disorder (ADHD). Those with ADHD tend to demonstrate hyperactivity, have difficulty remaining focused and have impulse control issues. However, it was found that children who participated in "green outdoor activities" had reductions in such behaviors, making the case that exposure to nature is helpful for anyone in need of controlling their impulsive actions or waning attention span.Walking or hiking in nature has also been found to reduce anxiety, increase self-esteem and diminish stress levels.A focus on "park prescriptions" over Big Pharma-So important is spending time walking in nature that many doctors are even "prescribing"patients what's been dubbed as "park prescriptions" and it's anything but the typical recommendation you might expect from a medical professional.The mental and physical benefits of walking in nature are plenty; do your best to get out there and experience the benefits for yourself!Sources for this article include:Collective-Evolution.com | PNAS.org | Blogs.NaturalNews.com | Slender.news | Science.NaturalNews.com | Natural.News

ADHD in Children and Role of Homoeopathy

Dr. Shelja, Homeopath
Does your child find it hard to focus????Symptoms:Kids with ADHD are fidgety and easily distracted.They cannnot pay attention to work. Mistakes a lot and cannot do work which need a lot of concentrationThey are hyperactive child always in hurry,can not sit still in one place and talks a lotThey have trouble in waiting for their turn in class or in any game.They have outburst of temper tantrumThey start many projects but do not finish any completelyCauses:Children with ADHD has less activity in brain that control attention. They have imbalance in brain chemicals called neurotransmitters.Treatment:The medications that are generally used to treat ADHD cause many side-effects that can be quite harmful to a small child.Homeopathic remedies can help curing the ADHD without causing any side effects. These medicines are natural and are very safe to be taken. Homeopathy is said to be very effective for children, and it can be considered as alternative treatment. Homeopathic remedies are prescribed as per the symptoms observed in the child and have to be taken in dosages as prescribed by the homeopath.  Each child is assessed as the unique person they are. The remedy must reflect everything about the child. A detailed history is fundamental to the correct choice of remedy. The homeopath will ask about the health of the child and the family, the pregnancy and delivery, early development, vaccinations, life events, schooling, favourite foods, drinks and other detail history to find out correct medicine.A few homoeopathic medicines are:CinaChammomilaStramoniumTuberculinumVeretrumalbTarantulaZinc metThese medicines should be taken under supervision of authorised homoeopathic doctor.

Attention Deficit Hyperactivity Disorder: Important For Your Complete Understanding

Ms. Manavi Khurana, Psychologist
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric conditions of childhood and adolescence affecting 4-12% of children, with a significantly higher percentage of males being diagnosed. ADHD is a persistent problem, manifesting its core symptoms throughout the life cycle, with impairments reflected in a child’s academic performance, peer relationships, family functioning, self-esteem and overall quality of life.Despite its high societal cost, the syndrome is poorly understood. The intent of this article is to educate parents and teachers about the signs and symptoms of ADHD leading to early diagnosis and consequent early intervention.ADHD is a syndrome, reflecting a cluster of symptoms, which are grouped under three broad categories- inattention, hyperactivity and impulsivity. Both the DSM-5 and ICD-10 (manuals for diagnosing mental disorders) share these core clinical criteria. It is important to remember that the symptoms should be maladaptive and inconsistent with the development of the child.ADHD is a condition which is pervasive and persistent: it pervades into a wide variety of situations over a long period of time that disturbs functioning and lowers quality of life. The symptoms should have been present continuously for 6 months by the time the child reaches the age of 7 years.Inattention symptoms include: not paying close attention to details or making careless mistakes in work, failing to sustain attention in activities, not appearing to listen what is being told, failing to follow through instructions, impairment in organising tasks, avoiding or strongly disliking activities requiring sustained mental effort, losing things frequently, and being easily distracted by external stimuli.Hyperactivity is reflected by the following: Fidgeting often with hands or feet or squirming in the seat, often leaving seat in situations where remaining seated in expected, running about often or climbing in situations which are inappropriate, being unduly noisy, and seeming ‘on the go’.Impulsivity symptoms include: Blurting out answers before questions have been completed, failing to wait for one’s turn, interrupting or intruding on others, and talking excessively.More often than not, there is a mixed picture in children, reflecting some parts of all three criteria. Of these core criteria, hyperactivity (because of the distress it causes to the caregiver) is often the quickest to be observed and picked up, and often becomes the reason for psychological referral.Often when children are referred to mental health services, parents/ teachers describe them as being overly naughty and disobedient. The nature of the symptomatology is such that it is easy to misattribute the ADHD syndrome (especially the hyperactivity and impulsivity type) to plain naughtiness, leading to harsh punishment being meted out to the child for no fault of his own.On the other hand, at times true ADHD symptoms are overlooked, because it is a common belief that it is normal for children (especially males) to be naughty during their developing years. Though there is a higher prevalence of the condition among males as compared to females (4:1), recent research has suggested that the rates among girls might be highly underrepresented.This is because of the stereotype of someone with ADHD is a hyperactive little boy, and girls usually don’t fit into that. Their symptoms differ from those of the boys (more of the inattention type, hence less disruptive to the caregivers) which makes it less likely that they will be noticed.The causes of ADHD are manifold. Most of the research evidence points towards genetic factors and disturbances in brain functioning (which explains why the condition is a neuro-developmental one).Environmental factors are more important in maintaining the condition rather than causing it. Parents often blame themselves for their child’s condition and wonder what they could have done to prevent it. Knowing that the cause is biological (and hence out of their control) may help in absolving themselves of the blame. Needless to say, parents, teachers and caregivers go through an enormous amount of distress in handling a child with ADHD. Mostly they unsuccessfully resort to physical punishments and other aversive procedures such as extreme criticism, failing to realise the ineffectiveness of the strategies.With all the negative connotations attached to the diagnostic label of ADHD, one may easily overlook the immense difficulties that children with ADHD have to face each day. Enduring mockery, punishments and criticism from everyone around them brings intense feelings of shame, low self-esteem, sadness, and anger.Children sometimes deliberately display “bad behaviour” in order to mask the real issues they face. For an accurate and complete diagnosis, it is imperative that the child is assessed by a Psychologist.Assessments are usually paper-pencil tests completed across multiple settings- at home, at school and at the clinic. Direct observation, standardized tests and subjective reports are combined to arrive at a diagnosis. An early diagnosis leads to early intervention, which prevents the magnitude of difficulties that the child and caregivers would have to otherwise face. Intervention strategies are multi-modal in nature. The parent, the school and the (various) mental health professionals work in collaboration to manage the child’s condition. It is important to recognise that the child spends a lot of his/ her time in school and hence it also becomes the school’s responsibility to provide the appropriate environment for the child.Children with ADHD often endure a lot of bullying by their peers and are neglected by them. With schools and its teachers holding academic performance as the benchmark of evaluating children, the needs of a child with ADHD are somewhere lost. Parents and teachers need to work closely with the mental health professional in order to gain a better understanding of the child and make an individualistic behavioural management plan for the child keeping in mind his interests, hobbies and personality traits. Cognitive remediation exercises are also taught to the child in order to increase his attention span.Medication is given in a few cases (especially to children with extreme hyperactivity). There is understandably a considerable amount of parental anxiety regarding the side effects and addictive properties of such medications. Research points to the fact that the side effects seem to be low in comparison to the potential benefits of the medication. Monitoring a careful increase in dosage, appropriate timing and precise watch over any side effects should be done by the caregiver and the treating psychiatrist.Parents often wonder whether their children will ever get cured of the condition. It is important to know that because ADHD is a neuro-developmental problem, it may be excellently managed but not cured. This means that there needs to be a continuous effort by the parent, child and the school to work in unison with the treating team in order to deal effectively with the problem. The realisation that the issue is the condition and not the child himself will go a long way in managing target symptoms and helping the child lead his life smoothly.

All That You Need to Know About Attention-Deficit/hyperactivity Disorder

Dr. Vykunta Raju K. N, Neurologist
INTRODUCTIONAttention-deficit/hyperactivity disorder (ADHD) refers to a constellation of inappropriate behaviors found in many children. The essential feature of ADHD is apersistent pattern of inattention and/or hyperactivity-impulsivity. Thesefeatures are more frequently displayed and more severe, than typically observedin a child at comparable level of development. They may be unusually activeand/or impulsive for their age. Children with ADHD have trouble payingattention in various settings like at school, athome or at work. These behaviors may contribute to significant problems insocial relationships and learning. For this reason, children with ADHD aresometimes seen as being "difficult" or as having behavior problems.DefinitionAlthough there is no single, comprehensive and concise definition ofADHD. There are specific elements of Attention-deficit/hyperactivity disorder.     · Inattention · Impulsivity· HyperactivityThe symptoms should be inconsistent with developmental level and should have persisted for at least 6 months, to a degree that is maladaptive and inconsistent with developmental level and causes impairment. The symptoms should be present in 2 or more settings (e.g. at school or work, and at home) and there must be clear evidence of clinically significant impairment in social, academic or occupational functioning. Clinical features  Symptoms of ADHD appear gradually over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention. Parents may seek help when the child's hyperactivity, distractibility, poor concentration and impulsivity begin to affect performance in school, and social relationships with other children or behavior at home. In order to meet the diagnostic criteria, the abnormal behaviors must be excessive, long-term, and pervasive, as described below. Although the behaviors must appear before the age of seven years and continue for at least six months;the child should be at least 6 years old before a diagnosis of ADHD can be made with certainty. A crucial consideration is that the behaviors must create areal handicap in academic and social settings of a child's life.Some common symptoms of ADHD include:· Often fails to give close attention to details or making careless mistakes· Often has difficulty sustaining attention to tasks· Often appears not to listen when spoken to directly· Often fails to following structions carefully and completely· Loses or forgets important things· Feels restless, often fidgets with hands or feet· Runs or climbs excessively in inappropriate situations· Often talks excessively      · Often blurts out answers before hearing the whole question· Often has difficulty in waiting for his/her turn while playingThe DSM-IV TR diagnostic criteria list the common clinical features which are helpful in making the diagnosis.Early pointers of ADHD There are some unusual features in the behavior of the child even in early years of childhood which may hint towards this disorder. Toddlers and pre-school childrenHyperactivityAlways movingBeing on the goChanges the focus of activity frequentlyAppears to be without purpose or goalMarked clumsiness, accident proneImpulsivityShifts activities unpredictablyBehavior may be disruptive and dangerous even without provocationDoes not listen to parentsDoes not learn from mistakesUnresponsive to praise or punishmentInattentionEasily distractibleDoes not complete activities Cannot play aloneVery disorganizedCannot deal with complex stimuli in a planned way Example: The child cannot concentrate on a single activity for more than a few minutes and shifts to another activity frequently.However, since these features may be a reflection of the upper limit of normal development (for that age) or inappropriate parental responses to maladaptive behavior, it is imperative that the child is not labelled as suffering from ADHD until he is at least 6 years old.BROAD PRINCIPLES OF MANAGEMENTManagement of primary problem There are various treatment options for symptoms of inattention and hyperactivity which may be given concurrently. These are mentioned in detail below.Behavioral and Psychological TreatmentThis is an integral component of management and complete elaboration is beyond the scope of this module. Readers may refer to relevant texts. Some of the techniques that are used are:· Reinforcement of positivebehaviors by praise or by providing incentives like (gold star or ‘happy face’)in daily consistency charts · Provide a distraction-free environment in school and at home for children · Social skills training · Adapting tasks to the child’s abilities Pharmacological treatment It includes use of:· Stimulant Medications: Methyl phenidate and Nor epinephrine re uptake inhibitors (Atomoxitine)· Non-stimulant Medications: These are useful in around 30% of children who may not tolerate or respond to stimulant medicines. These include Tricyclic antidepressants, selective Serotonin Receptive Inhibitors etc.Management of associated problems/ co-morbidities:· Specific learning disability: special education and remedial teaching · Oppositional Defiant Behavior (negativistic, defiant, disobedient, and hostile behavior toward authority figures): Behavior modification techniques and management.· Conduct Disorder: Behavior modification and appropriate medication· Anxiety and depression: Medication and psychological intervention· Epilepsy: use of anti epileptic drugs · Tourette syndrome (A disorder of recurrent, multiple motor and vocal tics with onset before the age of 18years): Pharmacological treatment has some role.Steps for prevention:Primary - Avoiding environmental risk factors such as maternal smoking during pregnancy and Lead exposure.Secondary - Early identification of the symptoms and early institution of appropriate treatment.Tertiary                                                                                    In schoolAt homeReferral patternSpecial benefits · There are no special benefits for children with ADHD except in the State of Maharashtra, where extra time and writer for examinations are allowed.Support to the family with an affected child· The multidisciplinary team can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other.· Assist the family in finding better ways to handle the disruptive behaviors and promote change.· In a young child, parents should be taught techniques for coping with and improving the child's behavior.

What Is the Real Cause of Addiction?

Ms. Raisa Luther, Psychotherapist
Do you sometimes wonder what the actual cause of addiction is?  It’s a unique mix of risk factors and influences — genetic and environmental. It’s uncommon that merely one thing drives an individual to addiction. Instead, it’s a heady mix of nature and nurture. Here’s how these work together to create a potentially devastating condition:Nature (Genetics)1. Dopamine handlingSome people are genetically predisposed to addiction. Such individuals are born with a certain genetic make-up in their dopamine receptors that makes them ‘enjoy’ potentially addictive substances more than ‘normal’ people. This increases the risk for addiction.2. Psychological issues and self-medicationGenetics often influence indirectly. For instance, persons living with other psychiatric disorders associated with genes (such as depression, anxiety, bipolar disorder, etc.) can have a tendency to self-medicate with an addictive substance.  They feel ‘better’ with medication – this may lead to addiction. Over time, escapist self-medication can escalate to addiction. In such cases, it is not a tendency toward addiction but the propensity for an underlying vulnerability that can lead to addiction.Nurture (Environment)Apart from genetics, environmental factors also play an important role.1. Childhood traumaEarly life negative experiences, such as neglect, emotional or physical or sexual abuse, etc., can increase the risk for addictions regardless of genes.According to a study, unresolved early life (prior to 18 years) trauma can lead to later-life problems. Survivors of chronic childhood trauma are: 1.8 times as likely to smoke cigarettes1.9 times as likely to develop obesity2.4 times as likely to experience anxiety3.6 times as likely to be develop depression3.6 times as likely to be promiscuous7.2 times as likely to get into alcoholism11.1 times as likely to become a drug addict2. Early exposure to addictive substances or behaviorEarly exposure to alcohol or drugs can lead to chronic addiction. In today’s world, kids are exposed to drugs such as marijuana and alcohol at a younger age (12 – 14 years) and are vulnerable to addiction in later years. Due to Internet and the massive supply of easily accessible erotic content, children as young as 11 get their first exposure to porn. About 41 percent of existing adult sex addicts were using porn before age 12. Studies indicate that the lower the age of first use, the higher the likelihood of addiction — sexual and otherwise. The cause of addiction isn’t nature or nurture. Both can come together in a person and influence his or her behavior.Treatment is effectiveWhatever the causes, the presenting problem may be an addicted person – abusing alcohol, drugs or indulging in some other damaging behavior. Recovery requires support from professionals. Just as the causes may vary, treatment also needs to be individualized to suit the individual. Addiction therapy also involves helping the addict resolve his childhood issues.  

To Build Skills, You Need More Than Medication

Dr. Tishya Mahindru Shahani, Psychologist
Sumit, a six year old boy (name and age changed) was referred to clinic because of over-active, inattentive, and disruptive behaviour. His hyperactivity and uninhibited behaviour caused problems in school. He would impulsively hit other children, knock things off his desks, and erase material on the blackboard, and damage books and other school property. He seemed to be in perpetual motion, talking, moving about, and darting from one area of the classroom to another. He demanded an inordinate amount of attention from his parents and his teachers, as he was intensely jealous of other children, including his own brother. He felt stupid and had a seriously devaluated self-image. Neurological tests revealed that there was no significant organic brain disorder. Attention Deficit Hyperactivity Disorder(ADHD), often referred to as “hyperactivity” is characterized by difficulties that interfere with effective task oriented behaviour—particularly impulsivity, excessive or exaggerated motor activity such as aimlessness or haphazard running or fidgeting, and difficulties in sustaining attention (Brodeur & Pond, 2001). Hyperactive people tend to talk incessantly and to be socially intrusive and immature. They have difficulty in getting along with their parents because they do not obey rules. Their behaviour problems are also viewed negatively by their peers. “I think for many adults with ADHD, therapy is essential,” says David W. Goodman, M.D., assistant professor of psychiatry at the Johns Hopkins University, school of medicine. While ADHD medicines are effective, they may not be enough, the person struggles with the disorganized habits, low self-esteem etc.The answer to these problems is therapy. Therapy with ADHD is not always a conservative traditional one; open ended talks don’t always work. Adults with ADHD often need practical concrete help; it’s the symptoms like disorganization, forgetfulness that are really interfering with their lives. People with ADHD need to focus on “functioning” to improve their lives. J. Russel Ramsay, PhD says that a person with ADHD knows his problems; what he lacks is the set of skills that will help him get organized. ADHD therapy is precisely about learning to overcome these problems and learning to get organized in daily routine. Following are the basic psychosocial remedies that could help:Understand your condition: A therapist can help you understand how ADHD has affected your life. The therapist would make you realize that the problems are due to a medical condition and not due to any other personal failure.Improve social skills: The therapist will help you improve social skills that have been lacking due to ADHD. Skills like communicating, reading social cues, knowing how to behave in different situations, are improved.Get organized: The therapist might give very specific recommendations to reduce the chaos in the life of an individual with ADHD. He may give visual or auditory cues to remember things. The level of specificity may help ADHD patients a lot.Challenge negative beliefs: People with ADHD can grow up to be individuals with low self-confidence, low self-worth and with a lot of self-doubt. They come to think that certain tasks are beyond their capacities. Therapists can help people question their own self-limiting beliefs and later overcome them.Change your habit: Psychosocial treatments may help people in identifying the wrong habits and problem behaviours and would help them to change it. It teaches the individual to manage his own problems by using rewards and punishments.Now, therapists might use a number of approaches in treating ADHD. While ADHD therapy can work well with children, it is often less successful with adults and needs to be combined with medication.Certain adults with mild symptoms, who are functioning well, may be benefited with therapy alone; but in severe cases therapy would work best as a compliment to medication.

Depression - a Slow Poison

Dr. Naresh Vadlamani, Psychiatrist
Throughout the course of our lives, we all experience episodes of unhappiness, sadness, or grief precipitated by unexpected events like failure in exams, rejection by loved one, death of a close one, personal tragedy or difficulty such as divorce, loss of a job, etc and may feel depressed (some people call this "the blues"). Most of us are able to cope with these and other types of stressful events. Over a period of days or weeks, majority of us are able to return to our normal activities. This is called Normal Reactive Depression.Normal Reactive Depression is different from Medical Depressive Illness.Normal Reactive Depression requires no treatment. Just assurances, supportive empathy and encouragement would be useful. It does not affect day to day activities and routine life. People bounce back within a few days.Medical Depressive Illness is not a normal variation of mood. The symptoms of this disease last for weeks and months and the person suffers a lot affecting their regular pattern of living.It is the illness in the brian's nerve circuits that affects or changes our thoughts, moods, behavior, activity, attitude, habits and personality from what we normally are. Some neurotransmitters like Serotonin, Norepinephrine and Dopamine are less in quantity in some parts of the brain leading to dysfunction of the brain's neural circuits. If one has depressive disease, they are often unable to perform daily activities as before. They may not care enough to get out of bed or get dressed, much less work, do errands, or socialize. During this phase, the depressive illness fluctuates with few normal days of functioning and mood. One may feel better on few days of the week but then the depressive symptoms prevail on most days and gradually the number of days of depressive illness increases. When one meets their doctor, they usually complain of:Headache, back pain, body pains and pains in other parts of the body especially hands and legs.Weakness despite eating well especially in the hands and legs.Tiredness despite doing regular work.Sleep disturbances - difficulty in falling asleep or dissatisfaction in sleep.Decreased appetite.Gastric problems like acidity, constipation and bowel problemsOther psychological symptoms include:Feeling sad or depressed.Loss of interest in job - leading to decreased efficiency,changing jobs and in some job loss; loss of interest in housework - leading to unclean, unkempt house, delays in washing clothes and dishes and cooking food; loss of interest in day to day activities like brushing teeth, bathing, wearing non-ironed clothes and lacking interest in appearance.Feeling tired most of the time despite doing regular or less than regular work leading to postponement of regular work, delayed bill payments and procrastination.Lack of enjoyment or pleasure in activities than before leading to dropping of hobbies, avoiding socialization, going out or watching movies.Feeling lazy, lethargic and being slow leading to postponement of work.Decreased concentration leading to memory problems and forgetfulness leading to poor academic performance or accidents.Decreased confidence, self esteem, self worthiness or feeling inferior to others.Become indecisive, fickle-minded, dependant, unable to organize, plan etc.Thoughts that other people are bad, thinking bad about themselves or ignoring them and will not help them.Thoughts of worthlessness, being a burden to family members, unworthy of love of near and dear ones.Thoughts that the world is a bad place, full of negativity etc.Thoughts of guilt, self hate and frustration.Thoughts that current situation will not improve in future, hopelessness, helplessness and thoughts of being alone in the whole world.Decreased initiation, motivation or enthusiasm than before.More irritability, anger, explosive behavior than before.Sleep disturbances like difficulty in falling asleep leading to internet surfing or watching TV ( channel surfing), waking up early or late, wanting to sleep more and feeling dissatisfied with the sleep.Appetite disturbances( change in eating habits) - not interested in eating or eating more than usual or even late night snackingAll these thoughts lead to sleep medication abuse, alcohol misuse, headaches/backaches (unexplained/no clear medical cause) and pain killer abuse, antacid abuse etc.Ideas, thoughts, plans of wishing to die, suicide harming oneself, suicidal attempts in severe patients.Treatment includes medicines and counseling or psychotherapy including other treatments like Cognitive behavior therapy, supportive therapy.MEDICATIONSAntidepressants are generally prescribed.Treatment is provided by psychiatrists who are medical doctors who have completed specialized training in depressive disorders and treatments.Antidepressant medications are not sleeping pills or addictive in nature.They have to be taken initially at a small dose with gradual increases in doses under supervision of a psychiatrist for about 6 - 9 months on the dose to which they respond.In those who have been suffering from the depressive disease for a long time or repeatedly, the medication have to taken for at least 2 years or longer as advised by the psychiatrist.People with depressive disease can safely be treated in a series of outpatient visits.Hospital care may be necessary for people with more serious symptoms and is required for those who are contemplating suicide or cannot care for themselves.

Gadgets and Technology: Boon or Curse?

Dr. Ravindar Varakala, Audiologist
Technology has become so synonymous to all our lives today that we have even crossed that stage when we discussed whether it is a boon or bane. However, when it comes to our children, it is probably worth thinking a bit deeper and seeing if it’s affecting their development and behavior.Children born today are technology savvy almost right at birth. Kids as young as 18 to 24 months use mobiles and tabs with great ease. Though they learn a couple of things there too but overuse of it can lead to some behavioral issues like Attention Deficit, Hyperactivity Restlessness and Aggression.Researchers have found that the negative impacts of gadgets and electronic media outweigh the positive. Some of the significant impacts of gadgets on children’s brain development and behavior are as follows:Not good for the brain: Overexposure to gadgets has been linked to Attention Deficit, Hyperactivity Disorder (ADHD), cognitive delays and impaired learning. Language delay for toddlers: According to American Academy of Pediatrics (AAP), severe language delay is seen in children who are overexposed to gadgets.Less active play equals delayed development: Kids under the age of 12 spend more time in front of a screen rather than playing  outdoors. This restriction in movement results in delayed motor development.Not good for bedtime: The late-night glow of laptops and mobile phones are depriving children a good night sleep.Not good for school: Being sleep-deprived doesn’t only affect child development but also their performance in school.Terrible child aggression: A study by the National Institutes of Health found that the increase in use of modern technology can break the old boundaries of family, values, behavior and children’s well-being.Kids suffer mental illness: A study of more than 1,000 children between the ages of 10 and 11, found that children who spend longer than two hours in front of a screen or another entertainment medium are more likely to suffer psychological difficulties.Gadgets cause tantrums: Kids throw tantrums because they get over attached to gadgets and can’t emotionally handle themselves when these devices are taken away from them.As parents, you can practice a few things to prevent your kid from being enslaved to technology. Here are a few tips:De-addict yourself: Kids always grow on the model of imitation. When they see their parents glued to their mobiles, they also develop a strong desire to explore the same. Limiting the use of mobile and tab in front of kids can go a long way in dissuading away from them.Sing, act, dance: Bond with your child by singing those rhymes that he enjoys watching on the tab. Sing those rhymes, stand up and act and dance.Read books together: Invest in some interesting story books with big and colorful pictures. Not only would it help develop reading habit in the kid, will build his language skills and cognitive development as well.Play interactive games: Encourage him/her for interactive and outdoor games that would lead to his/her social and physical evelopment.Restricted screen time: If you are busy with some house or office work and want to seek refuge in the digital medium to engage your toddler, allow access only for a limited time period.Last but not the least, don’t worry about keeping your child away from gadgets until he/she is five. It will not make your child any less gadget-savvy when he/she grows up. It will still come naturally to this generation as they are born after the advent of gadgets.