Ask a Doctor

Questions commonly asked by parents, by children with ADHD, ADD, Autism and/or Sleep Disorders.

There are many ways in which unrequited emotional turbulences can present in children, and I have been a witness to all of them over a period of two decades as a neurodisability doctor. This would present in the form of severe pain anywhere in the body (headache, limb pain, abdominal pain), loss of consciousness – intermittent or prolonged, loss of vision, weakness of limbs, bizarre seizures- none of which might fit with common sense, neurological -anatomy correlate or with your examination findings. Investigations invariably come back with a blank!

I had a very sensible neurologist as my supervisor who I observed explaining to the child and the parents most sincerely and empathetically that he vehemently agrees that the difficulty the child experiences is real for sure, but has no medical explanation or any medical basis by investigations carried out.

ADHD is a dopamine deficit disorder.

When someone is deplete in Dopamine, one finds ways to pump it into the areas of brain needing it desperately to keep your attention intact on the environmental stimuli and your inner environmental needs (conscience, morality, daily chores, routines, hygiene etc..).

Eating, rewarding with positive comments/ gifts, sex, any thrilling activity as well as physical activity pumps in your innate dopamine. That’s the sad reason why children remain hyperactive to keep their focus on tasks and activity of daily living intact. Not because they want to be naughty, but actually they are trying very hard to focus on what you are instructing them. I recognise the same pattern in parents when I’m giving a ‘long talk/ advice session’ on ADHD strategies, when they start to jerk their legs in a fidgety manner as if trying hard to listen (and I know where the chikd’s ADHD has come from).

This is effectively used in class rooms as movement breaks, fidgety toys, wobble cousins etc etc where some activity- discreet or obvious keeps this action in brain going.

Hence a run three times up and down the stairs before doing homework, walking to school or staggering physical activity with mental activity promotes learning episodes.

ADHD is a blessing. But unfortunately if left unbridled, it can turn a curse.

The abundant energy and the tireless drive one has is incredible. When everyone is tired, this hero has the enthusiasm to carry on.

He is called the soul of party – comical, full of fun and the clown, keeping everyone laughing and entertained, even if he harbours sadnes in private.

He is always full of original ideas as he thinks out of the box. He however might not be there to complete the project, as often others take over the lead (something that he doesn’t really get mind)

He speaks out courageously for the underprivileged, the discriminated, the marginalised (as he just can’t tolerate injustice) unlike the rest- and openly campaigns for them, even the ones on the receiving end. He not surprisingly wins enemies as a result, but can’t fathom why they dislike him.

He would always be there for friends.. going out of his way to support, stimulate and encourage them to achieve their maximal potential. But he understands they cannot be accessible all the time once they are riding the crest of success as he understands that obviously they are busy and his pride will not let him ask them for help.

He has an amazing wide circle of friends for whom he will be there anytime any where- but he cannot count the number of close ones on his hands, the ones who could trust and would turn up when he really needs them,

He wishes every one good, with not a sinew of ill will in him they all know, but can’t forgive him for his annoying habit of ‘’things slipping from his mind’. They don’t understand why he can’t get to a meet in time, buy gifts or send a card for their birthday like they do!

Most of all although he keeps them in splits in their private circle, they look away to avoid him as he can prove a source of perpetual embarrassment by his loud voice and antics..

And sadly he knows all this, but just doesn’t have any control on it.

The youngest I had to start treatment was 3 years of age after all intense sensory therapy, psychosocial management failed.

This was to prevent killing of gold fishes, pushing down his little infant sister down the stairs, running away and disappearing in the malls/ London tube station, waking up at 5 am opening the front door and digging holes in the garden to pee in it, being EXCLUDED from nursery after nursery (mum gave up her work). Basically preventing endangering himself or others. Medications helped!!!

ADHD presents in diferent forms- and in the each domain examined there is a wide spectrum of presentation, In as assessment , normally level of inattention, impulsivity and hyperactivity are examined- with a possible addition of emotional dysregulation and sleep dysregulation coming soon. It’s the variety in which each of these domains presents with, that makes every person with ADHD different – and our clinics so exciting

How does one make a diagnosis of Autistic Soectrum Disorder? I shall try to elaborate my thoughts in as simple words as possible.

To have a diagnosis of ASD- one should have on one hand a definite evidence of socio-communication disorder along with on the other hand an extra-ordinary and overwhelming need to engage in certain behavioural patterns, activities and interests (often misinterpreted as OCD)

So, what is a socio-communication disorder (SCD)? We normally use the tools of communication (Non-verbal and verbal) and interaction to reciprocate exchanges of emotions within a social context (socio-emotional reciprocity). This is the basis of establishing any social relationship.

Verbal communication is the effective use of words and Non-verbal communication is use of eye contact, facial expression, hand gestures and body postures to express our thoughts, feelings and desires. Interaction (as I understand) is basically sharing….. of thoughts, space, objects, codes of conduct, societal conventions, rules, regulations etc…. We use the above as a two-way process to express ourselves and also to understand what others are trying to express in a reciprocating manner- and that’s how a dialogue progresses to a long- term relationship, be it with parents, siblings, teachers, classmates or with the Society at large. Sadly if one has SCD, everything as far as communication or interaction Is concerned, it is all one sided and on the persons agenda -and due to lack of understanding or interest in the other side of dialogue, things do not progress to long term relationships with ease.

Now, on the other hand one must also have evidence of the need to be obsessive (inside the head) about certain thoughts/ patterns/ routines/ structures or rituals and compulsively carry it out- to the extent that it becomes a hindrance to ‘normal’ functioning. If this is also added onto socio-communication disorder, the diagnosis of Autistic Spectrum Disorder gets established.

Coming to the second bit of the condition in a little bit more detail: Currently there are 4 categories within DSM-5 of which one needs to have only 2 to fulfil (along with SCD to to make ASD diagnosis).

The need to repeatedly carry out certain purposeless motor activities, repeat unusual words, dialogues/ bits of dialogues or a

The inflexible insistence to stick to same routines, structure to the day, ritualistic behaviours, routes taken, patterns of thinking- and an undue distress to any attempts at change to any of them.

Very limited and fixed interests- Going through same game, book, films, TOPICS of conversation, collecting ‘useless’ objects (hoarding!) – again any attempts to divert is met with severe resistance.

This is a recent add on, but that was always there as a described difficulty. Hypersensitivity or hypo-sensitivity to sensory stimuli. This means an unusual reaction to tastes/ consistency of food, feel of texture of clothes, smells, loud noises, pain and temperature

All this can lead to immense anxieties of all forms- due to the need to confirm by self and by the environment they live in.

I could elaborate on finer details of the above, if anybody needs. Please feel free to contact me here on Quora. There are such brilliant responses here on this forum, but the DSM5 had not been explained, hence my little contribution. Hope this is helpful

There is no scientific basis for any of the food avoidance theories yet, although I have regularly come across parents who swear by several diet restrictions.

Many have spent thousands of pounds following a strict diet prescribed by a particular school of thought. Sadly, over the years I have learnt that none of these diets have brought the desired outcomes. This might be amelioration of some disabling behavioural patterns to full cure. Some children have come close to a certain level of malnutrition before I have clearly spelt out my concerns. This has again been by tactfully exploring what parents thought about their child’s growth and nutrition through growth charts and other means. Often this ‘light bulb momenr’ leads to withdrawal of the spartan regimen imposed upon the totally oblivious child.

I have never adversely commented on these fads to parents as I strongly believe that the ‘fire of hope’ should never be extinguished within any human being, This is what keeps us moving forward in life.

Socio-communication Disorder is a possibility- where a person has difficulties in synchronising communication (non verbal and verbal) and sharing conventions, codes of conduct, things, space, thoughts with people – and therefore can’t make meaningful two-way dialogues or long term relationships thereafter.

If the person had unusual stereotypic inflexible rigid behavioural patterns (rituals and routines) with an inordinate need to stick to certain topics, activities and interests that it hinders ‘normal’ day to day life with it- then he falls within the Autistic Spectrum.

However, I believe that m many of us do have many of these features off and on in our lives. But, when it becomes so acutely hindering that it scuttles any meaningful friendships or relationships, progress in learning, establishing a vocation or career, then it clearly becomes a disorder!!

There are several neurodevelolmental disorders that are equally debilitating or causing seious erosion of self esteem.

Developmental co-ordination Disorder (Dyspraxia of the past) is perhaps one of those silent hidden disability that does not get the due prominence that it ought to. It is present as a co-morbidity in 50% of children with ADHD and around 60% with ASD. The prevalence of the condition in general population has never been estimated but must definitely be even more than ADHD and ASD.

Basically these children are born clumsy and remain behind their peers in attaining gross motor skills and hand function. They cannot run, hop, kick a ball, throw or catch one like other children, cannot ride a bike like their mates. Their handwriting is appalling as are cutlery skills with immense difficulties in learning to cut their own food. They do not know how to button up, do their zips or shoe laces. It’s shameful when you cannot catch up with your mates in the play ground, PE lessons, class room or swimming sessions.

They are ridiculed, called lazy, faulted, sidelined, bullied.. and they grow up smiling their pain away….. often turning the class clown with a display of their clumsiness to be a part of the tribe that would not accept the differences. They have such low self worth and confidence in themselves that they learn not to participate in any activity for fear of failure and to prevent hurt or bring shame to their beloved ones. ‘I can’t, I cant’ becomes the mantra of survival.

They grow into individuals with low self esteem, immature social skills, high levels of anxiety.

Autistic Spectrum Disorder often gets diagnosed early in life- earliest around 2 years, when one can map acquired milestones of communication (verbal and non-verbal) against expected.

However, Aspergers is an obsolete diagnosis (from 2014) that hopefully should never be made. These are individuals with lesser cognitive and speech and language impairment – but still do continue to have difficulties in use of tools of communication and interaction to establish establish socio-emotional dialogue and thereby relationships. They have unusual perseverance with certain interests, activities and behavioural patterns that could be seen as a possible hindrance in progressing social and educational achievement. Some also have sensory issues – being too sensitive to smells, tastes, textures, sounds etc. They are often observed as an odd child in the early years – but as they move towards secondary school age, as the differences become apparent to them themselves, behavioural issues can crop up (at home and school) and lead on to a professional diagnosis.

But a large number plod on to adult life without a diagnosis, struggling with people, learning, relationships, jobs, … and yet often end up as heads of corporate organisations or heads of university departments – due to sheer single minded perseverance of that interest, idea, thought that got them there.

The destination and the journey to that position is sadly often lonely if not supported by a loving, kind, considerate family and more so understanding partners and colleagues.

Firstly, it’s not ADD anymore, but termed ADHD- inattentive type from 2014 onwards as per DSM- 5, the diagnostic manual used to define disorders.

That’s because, most patients with the old time ADD also suffer from inner restlessness (if not overt physical hyperactivity) and moreover intense impulsivity affecting their thoughts and actions.

Secondly, we all do have inattention in our lives off and on, and it only becomes a DISORDER when it impairs your life and performance significantly – with evidence of the same from early life onwards.

Having inattention alone might be a symptom of many other conditions that should not be diagnosed by an online questionnaire or consultation.

Please do find an appropriate source for help and support. It’s crucial at this stage of your life, when it awaits you to embrace it fully and wholeheartedly.

As a professional working in this field – assessing, diagnosing, supporting and then transitioning them into adult ADHD services- I am sad that such a myth is being propagated.

ADHD is lifelong genetic condition, inherited from generation to generation. There are five dimensions to ADHD as we all know- poor attention, need to be hyperactive, impulsivity in saying and doing things and two other features acquiring wide recognition poor control over emotions and sleep dysregulation.

One should also remember that with time and age a part of our brain also matures to develope maturity (acquisition of skills to deal with adversities in life that comes our way)- and helps us to circumvent the difficulties described above. We learn from living in an increasingly restrictive society (with increasing age) that it’s not okay to be hyperactive, emotional and impulsive! Hence, people with or without ADHD train themselves to overcome some of these challenges- the ones with ADHD the harder way!

But inattention and most of the other problems linger on with varying magnitude- ALL LIFE TIME. I have observed these symptoms in parents (one or both!) who bring their children to the clinic – be it from deprived or affluent background.

Hence ADHD definitely doesn’t get cured, but symptoms do lessen with time, due to maturity slowly dawning upon them. Remember, I do not do things that I used to do at 5 at10, or at 15 as I age! Same also happens with people with ADHD, ASD or other neurodevelopmental conditions.

ADD is currently called ADHD – inattentive type. This is due to the fact that all children and adults with this condition definitely do have some lingering lifelong impulsivity (inner hyperactivity) causing them to say or do things without giving it a second thought.

It is a genetic condition that transcends generations- but presenting in different levels of severity. In the previous generations it went unrecognised as it was perhaps then accepted as the persons personality quirk (forgetfull) or as expected behaviour (daydreaming in girls).

ADHD alone is prone to make you excessively emotional, which are often to trivial triggers I.e breaking into an uncontrollable flood of tears when watching on TV earthquake victims in Italy. Or on the other hand, a laughter or giggle that knows no end! Both worsened particularly so when the person realises the fact that the drama they are creating by this behaviour is thoroughly enjoyable to them… and most annoying to others!

ADHD has currently three symptoms in its checklist to make a Diagnosis (Inattention, hyperactivity and impulsivity), but with time emotional dysregulation and sleep dysregilation will be added on I am sure

Children may be seen as not being sympathetic when they do not catch the nuances of facial cues, tone of voice and body language due to Inattention. Their impulsivity may cause them to say or do things without giving it a second thought- which itself is sufficient to label them as unkind and inconsiderate.

Actually most are very kind, generous, considerate and loving in nature. They would be happy to chase any utopian ideal or a lofty cause to its end – unless they forget what they were doing, or lose track and pursue some other project instinctively or get submerged under too many accepted responsibilities – as they are most endearingly too eager to please.

Tics are not a part of ADHD as the neurobiological basis is different.

They can coexist with ADHD though like other Neurodevelopmental disorders I.e. ASD, DCD (developmental coordination disorder), specific learning disability ( dyslexia, dyscalculia, dysgraphia etc) specific language impairment etc.

Tourette’s spectrum disorder (genetically acquired like the others) is the likely explanation if it coexists with ADHD- often singly. It can present as involuntary motor tics and vocal tics (together or separately) that can get exaggerated when pointed out, under stress and when relaxed after keeping it all together for a prolonged period. Motor tics are sniffing, blinking, grimacing, shrugs, neck stretches, whole body jerks amongst others. Vocal tics are throat clearing, coughs, squeals etc. Classically it waxes and wanes. Most of the children outgrow the same but for a very small minority it moves into adulthood.

There are other causes for tics- often caused by chronic neurological conditions- that is better unraveled by a neurologist requiring blood tests and perhaps scans.