Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in children, estimated to affect 3-5% of school-aged children, particularly boys. It is characterized by difficulty in paying attention, difficulty in controlling behavior, and hyperactivity.
Western Concept of the disease
For most children, no etiology is identified. Both genetic and environmental factors play a role. Studies have identified abnormalities in dopamine transporter and thyroid receptor beta genes in some patients. Some of the identified risk factors of the disease are: –
- Brain injury
- Exposure to environmental (e.g., lead) during pregnancy or at a young age
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
Examples of inattentive, hyperactive, and impulsive behavior included within the criteria for the diagnosis of ADHD are listed below.
l. Early distraction by extraneous stimuli
2. Often makes careless mistakes in schoolwork or other activities
3. Often has difficulty sustaining attention in tasks or play
4. Often forgetful in daily activities
5. Does not seem to listen to what is being said to him
6. Often fails to finish schoolwork or other chores
7. Daydreams become easily confused and move slowly
8. Difficulty in processing the information as quickly and
accurately as others
l. Runs about or climbs excessively in situations where it is inappropriate
2. Fidgets with hands and feet and squirms in seat
3. Talks nonstop
4. Has trouble sitting still during dinner, school, and storytime
5. Has difficulty doing quiet tasks or activities.
1. Has difficulty awaiting turn in games or group situations
2. Blurts out answers to questions
3. Often interrupts conversations or others’ activities
For making the diagnosis, the behavior must begin before 7 yr of age, be present for at least 6 months, be pervasive (present in at least 2 different settings) and impair the child’s ability to function normally. The symptoms should not be secondary to another disorder. Three subtypes are known:
Predominantly hyperactive-impulsive. Most symptoms (6 or more) are in the hyperactivity-impulsivity categories, and less than 6 symptoms of inattention are present.
Predominantly inattentive. The majority of symptoms (6 or more) are in the inattention category and less than 6 symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree. Parents or teachers may not readily recognize these children as having a problem.
Combined hyperactive-impulsive and inattentive. These children have six or more symptoms each of inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
Diagnosis is primarily clinical, using a thorough clinical interview of parents and the use of behavior rating scales. Physical examination includes direct observation of the child and ruling out chronic systemic illnesses that affect a child’s attention span. Neuropsychological evaluation using standard tests of general intelligence and educational achievement help to exclude learning disorders or mental retardation.
Early diagnosis and intervention are mandatory to check the symptoms of ADHD.
In such cases, the child can be trained into a position where he can lead creative and fruitful adolescence and adulthood.
But in most cases the symptoms are lifelong, they can be given mild relief.
The condition is usually considered under the spectrum of diseases called Unmada wherein the functional elements of the body called doshas are impaired in the mental plane, giving rise to abnormal behaviour.
ADHD is usually considered as the Vata predominant variant of Unmada. In conditions where the child excessively interferes in others’ activities or hurts them, and shows an excess of anger, the association of pitta is also to be considered.
Ayurveda Treatment- Internal and External
The Ayurvedic management of the condition shall be employed as follows: –
To clear the metabolic waste and to facilitate proper assimilation of the medications and diet, two steps are done before the main therapy.
To dislodge the metabolic wastes,
- Oleation or controlled fat administration is done.
As the cleansing procedure,
This is followed by pacifying therapeutic modalities, namely
- Siro abhyanga
- Medhya Drugs internally (Should formulations be mentioned?)
The behavioral management of ADHD should begin with educating the parents about ADHD and helping them in setting realistic goals of treatment. The treatment involves a combination of behavioral therapy and medications.
Useful behavioral strategies include:
(i) clear and explicit instructions to the child about desirable and non-desirable behavior
(ii) positive reinforcement of desirable behavior by praise or small tangible rewards
(iii) punishment strategies like a verbal reprimand, nonverbal gestures or ‘time out’ for undesirable behavior and
(iv) extinction technique, i.e. systematic ignoring of undesirable behavior
(v) providing a well-structured and organized routine for the child at home as well as school. At school, giving brief and consistent instructions to the child, clear and consistent response to the child’s behavior, seating in an area with few distractions, and allowing the child to change activities and move about periodically is helpful.
Foods that can be used: –
Foods that are rich in proteins, complex carbohydrates, and omega-3 fatty acids.
- Lean meats,
- Fortified cereals,
- Cold-water, fatty fish such as sardines, tuna, and salmon,
- Fish oil
- Corn syrup
- Products made from white flour
- White rice
- Potatoes without the skins.
Postures and meditations are to be advised in such a way that they drain the energy and tension that is present in excess in the child. They must also increase the focus of the attention of the child. The following be useful.
- Pranayamic Breathing
- Downward Facing Dog posture (Adhomukha svanasana)
- Tree posture (Vrikshasana)
Tips for Apunarbhava.
- Use of Medhya Rasayanas (Drugs promoting intellect)
- Continuation of behavioural therapy
- Daily yogasanas and pranayama
ADHD is a neurobehavioral condition with a very large social impact. The presentations of the disease can be effectively reduced by Ayurvedic treatment. But the therapy alone is not sufficient. It requires strict observance of dietary regulations. In that case, the recurrence of the disease shall be reduced to a considerable extent.