Articles on childhood psychiatric disorders

Symptoms of Learning Disabilities in Children

Dr. Vykunta Raju K. N, Neurologist
DefinitionDisorder of one of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an impaired ability to listen, speak, spell, read, write, think (e.g. planning) or to do mathematical calculations (not due to mental retardation [MR] or sensory deficits [e.g impairment in hearing, vision etc].Common Elements in the Definitionsü  Brain dysfunctionü  Uneven growth pattern/psychological processing deficitsü  Discrepancy between potential and achievementExclusion of other causesTypes of Learning Disordersü  Dyslexia– Difficulty in reading ü  Dysgraphia– Difficulty in writingDyscalculia– Difficulty in mathematical abilitiesEtiology - Often genes + disorderTobaccoAlcoholHead InjuryOtherMales predominateFamilialUp to 5-10% of "seemingly normal" schoolchildren have this hidden disability. Dyslexia affects 80% of all those identified as learning-disabled. SpecificLD is now believed to be a result of functional problem with brain"wiring" rather than an anatomic problem and is genetically inherited.Preschool children Language delayPronunciation problems Slow in acquiring vocabulary Difficulty in rhyming words Trouble with learning numbers, alphabets, days of the week, colors and shapesSchool-going children             Presenting problems-more commonly with school performance-difficulty is in one particular subject Slow to learn the connection between letters and sounds Confuses basic words (run, eat, want) Makes consistent reading and spelling errorsTransposes number sequences &confuses arithmetic signs Poor spelling, slow reading Has difficulty in left right coordinationHas difficulty in tying shoe laces, organizing pencil box. Comprehension of these children is often superior to isolated decoding skills Reading Disorder(Dyslexia)  There is generally a combination of difficulties in the ability to compose written texts as evidenced by grammatical or punctuation errors within sentences, poor paragraph organization, multiple spelling errors, and excessively poor handwriting. This diagnosis is generally not given if there are only spelling errors or poor handwriting in the absence of other impairments in written expression.SlowComprehension defectsVocabulary limitationsLimited experienceFigure notations – complex and denseDirecting– dense, readability very high, in high distraction  positionSlowVocabulary limitationSpellingPunctuationOrganizationExperienceHandwriting– poor readabilityNote takingReading is very difficult ( + x )MultiplestepsPoor tool useSelf confidenceAnxietyWrittenOralEtiologyCourseFamilialCourseIQReadingrateStandardscoresComprehensionSpellingStandardscoreCan person read what they have writtenImpaired vision and hearing Attention Deficit Hyperactivity Disorder(ADHD) Mental Retardation Pervasive Developmental Disorders Communication Disorder Lack of opportunity, poor teaching Normal variations in academic achievement Anxiety Poor studying skillsConsensus ClinicalCriteria (CCC) for Diagnosis of Learning Disorders -adapted from DSM IV-TRIQ85 or more No vision impairment No hearing impairment Presence of adequate opportunity for learning with proper motivation GLAD score below 40%, at two levels below the child’s current class level Difficulty in reading / writing / mathematics that significantly interferes with academic functioning.Along with GLAD, Bender Visuo-motor Gestalt Test will be used to assess motor coordinationOnset during infancy or childhoodMost show a delay or impairment in developing functions and most undergo a steady course. Outcome depends on the severity of the disability, the age or grade when remedial education is started, the length and continuity of treatment, presence or absence of associated emotional problems, and parental and school supports. With appropriate remedial education and provisions,most children with LD can be expected to achieve academic competence and complete their education in a regular mainstream school. However, some children may still be unable to cope up and need to continue their education in special schools.1. Management of Primary Problem Remediation and AccommodationBehavioural & Psychological treatmentAllowing extra time A separate quiet room for taking tests   Alternatives to multiple choice questions Providing access to syllabi and lecture notes Tutors ‘talk through’ and review the ‘content’ of reading material Tape recorders and recorded books Allowing use of computers with spell checkersCalculatorRead problemWordprocessingSpell checker (right-click)NotesPhotocopiesInstructor OutlinesNote takerFolder for each subjectWhere are the classesLibrary– contact personScheduleSupportServiceCourse load – start slowDisability certificate. Extra time to write examinations, grace marks, supplemental writer during their examinations and also the facility of integrated as well as inclusive education. TheNational Trust for the Welfare of Persons with Autism, Mental Retardation andMultiple Disability, 1999, recommends promotion of inclusive education. The Sarva Shiksha Abhiyan (SSA, 2000), pledges to “ensure that every child with special needs, irrespective of the kind, category and degree of disability, is provided education in an appropriate environment".

Psychiatric Drugs: Myths and Facts

Dr. Aditya Gupta, Psychiatrist
There are several myths regarding psychotropic medications in our society. Through this article I will try to break few of them, to aware the public and remove stigma. Each myth will be followed by the associated fact.Medications will change my personality/ make my brain weak - Medications work to correct what is wrong. It doesn’t change who you are nor make you weak.Medications are addictive – with the exception of few, psychotropics cause little if any physical dependency. If taken under medical supervision safely tapering off them is possible.Medications are for weak people, who can’t deal with everyday problems. – psychotropics are not stress reducers, they correct genuine disorders. Far from being a sign of weakness, it takes considerable strength to admit that you have an illness.Psychiatrists give drugs to everyone who comes to them, I only need counseling.–Psychiatrists are the only health professionals who are trained to evaluate all biological, psychological and social factors involved with an illness. They are trained in psychotherapy as well as medication treatment and know which method to apply and when. Have faith in your doctor.Why do I need to see a psychiatrist, can’t my physician/neurologist prescribe for me? –Psychiatrist is the only specialist in mental illness and in medications used to treat it. You wouldn’t expect your orthopaedician to operate your eyes, nor should your physician be expected to know everything about prescribing and monitoring psychotropic medications.Psychotropics are effective but not some magic bullets. Recovery from severe mental illnesses often takes weeks or months, but the results are worth the wait.

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.

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

Bipolar Disorder- What Is It? (Symptoms)

Dr. Milan Balakrishnan, Psychiatrist
What Is Bipolar Disorder?Bipolar disorder, also commonly known as manic depression, is a brain disorder that causes shifts in a person’s mood, energy, and ability to function. The symptoms of bipolar disorder can result in damaged relationships, difficulty in working or going to school, and even suicide. There are generally periods of normal mood as well, but left untreated, people with bipolar disorder continue to experience these shifts in mood. The good news is that bipolar disorder can be treated, and people with this illness can lead full and productive lives.What Are the Symptoms of Bipolar Disorder?Bipolar disorder can cause dramatic mood swings—from high and feeling on top of the world, or uncomfortably irritable and excited, to sad and hopeless, often with periods of normal moods in between. The periods of highs and lows are called episodes of mania and depression.MANIC PHASE• Feeling on top of the world. A sensation of sheer and utter happiness that nothing—not even bad news or a horrifying event or tragedy can change.• Sudden or extreme irritability or rage. While mania is often portrayed as a pleasurable experience, that is not thecase for many people with bipolar disorder.• Grandiose delusions. Individuals believe that they have special connections with God, celebrities, or political leaders.• Invincibility or unrealistic beliefs in one’s abilities. The person feels that nothing can prevent him or her from accomplishing any task.• Hyperactivity. Scheduling more events in a day than can be accomplished; inability to relax or sit still.• Excessively risky behavior. Reckless driving, outlandish spending sprees, foolish business investments, or out-of character sexual behavior.• Uncontrollable racing thoughts/rapid speech. Ideas that abruptly change from topic to topic expressed in loud, rapid speech that becomes increasingly incoherent.• Less need for sleep.DEPRESSED PHASE• Intense sadness or despair. The person feels helpless, hopeless, and worthless.• No interest in activities they once enjoyed.• Loss of energy, fatigue.• Sleep difficulties. Either sleeping too much or not at all.• Changes in appetite. Either a noticeable increase in appetite or a substantial weight loss unrelated to dieting.• Difficulty concentrating, remembering, making decisions.• Thoughts of death or suicide.PS. 30th of March is World Bipolar Day. Birthday of Vincent Van Gogh who committed suicide due to the disorder. Follow #WBD2016 #Mumbai on Twitter.

Learning About Learning Disabilities

Geeva Kamal raj
WHAT IS LEARNING DISABILITY ?Learning disabilities is a broad term which might look very different from one child to another.One child may struggle with reading and spelling, while another loves books but can’t understand math.Still another child may have difficulty understanding what others are saying or communicating out loud.The problems are very different, but they are all learning disorderNOW YOU ARE PROBABLY WONDERING WHAT CAUSES LEARNING DISABILITYNot me nor the experts know what actually causes learning disabilities, however, some of the possible causes for Learning disabilities include;Heredity : Learning disabilities often run in the familyProblems during pregnancy and birth : illness or injury during or before birth, usage of drug and alcohol while pregnant, low birth weight, lack of oxygen, premature or prolonged labour.Incidents after birth: head injuries, nutritional deprivation, exposure to toxic substance such as lead.SIGNS AND SYMPTOMS OF LEARNING DISABILITYIt’s not always easy to identify learning disabilities. And because of all the wide variations, there is no single symptom or profile that you can look to as proof of a problem. However, some warning signs are more common than others at different ages. If you’re aware of what they are, you’ll be able to catch a learning disorder earlyPreschool signs and symptoms of learning disabilitiesProblems pronouncing wordsTrouble finding the right wordDifficulty rhymingTrouble learning the alphabet, numbers, colors, shapes, days of the weekDifficulty following directions or learning routinesDifficulty controlling crayons, pencils, and scissors or coloring within the linesTrouble with buttons, zippers, snaps, learning to tie shoesAges 5-9 signs and symptoms of learning disabilitiesTrouble learning the connection between letters and soundsUnable to blend sounds to make wordsConfuses basic words when readingConsistently misspells words and makes frequent reading errorsTrouble learning basic math conceptsDifficulty telling time and remembering sequencesSlow to learn new skillsAges 10-13 signs and symptoms of learning disabilitiesDifficulty with reading comprehension or math skillsTrouble with open-ended test questions and word problemsDislikes reading and writing; avoids reading aloudSpells the same word differently in a single documentPoor organizational skills (bedroom, homework, desk is messy and disorganized)Trouble following classroom discussions and expressing thoughts aloudPoor handwritingThe earlier detected…The better :)Until next time….Love, prayers and good vibes!

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. 

In the Grasp of Anxiety - When Worrying Has Become a Disorder

Ms. Pallavi Tomar, Psychologist
Everyone is familiar with anxiety.It may pop up as a feeling of unexplained apprehension, or a flood of constant worrying thoughts, a sudden burst of panic, or even an intense dread or fear. These feelings are all to situations, things and people perceived as overwhelming, unsafe or threatening. In all its manifestations, it is unpleasant and it is quite natural to want to avoid or eliminate these feelings.But before we move on to discussing anxiety as a disorder, lets understand the evolutionary function of this seemingly out of control beast.The essential evolutionary function of an anxiety response is to prepare an individual to deal effectively with danger and threat. That is why it exists at all.Take a look at a few symptoms and the function they may serve:The feeling of restlessness and increased heart rate may keep us physically prepared for action.Our interpretation of ambiguous information as threatening may actually be aimed at reducing the probability of missing any threats around us.Our mind racing with multiple thoughts of all that which can happen may actually keep us prepared for all possibilities and scenarios.The lack of sleep will allow us to be constantly alert.It propels us, makes us strive, challenges us and pushes our limits. Toss away anxiety and you may lose out a great deal of your motivation, persistence, excitement and caution.So ideally if anxiety is experienced in the right manner, for the right reasons and for the right duration – it is only natural!But how do we recognize the transformation of this natural experience of anxiety into a disorder?There are a few things to consider. Anxiety reactions manifest in three basic forms:As an emotion: The fear, the apprehension, the worry, and the despair.As a thought: Of an impending doom, of things going wrong, of death, of injury.As a physical response: To avoid, to evade, to check, to run, to become immobile, increased heart rate, difficulty breathing etc.In an anxiety disorder, these three basic forms of anxiety may be experienced as difficulties in any of the four below mentioned domains.Intensity – Is the experience of anxiety exaggerated and far too intense than what may be warranted in a situation? Does the individual find it difficult to contain and manage the anxiety? Is the individual finding it difficult to cope with the intensity of the signs and symptoms?Frequency – Are the signs of anxiety experienced too frequently by the individual? Is the individual repeatedly reacting to the same stressor/threat without developing newer ways to cope or deal with it?Pervasiveness – Are the signs or symptoms of anxiety experienced at most times across all situations? Does it seem to be pervading across all aspects of an individual's life?Dysfunction – Is the experience of anxiety impacting the individual's functioning in their personal, professional or social life? Does the individual have to make too many changes to accommodate and cope with the experience of anxiety? Is it affecting others around the individual?If your answer is affirmative to any of these questions, your experience of anxiety may not be serving the evolutionary purpose it is essentially meant for. But before you go ahead and diagnose yourself, I encourage you to talk to a mental health professional about your concern.