Grappling with ADHD
This past December, the Health Systems Research Institute of Thailand (HSRI) reported that around 8.1% of prathom 1-5 children (aged 5-10) suffer from Deficit Hyperactivity Disorder (ADHD), which equates to a staggering 374,000 children in Thailand.
“It is a challenge to identify the exact number of children suffering from ADHD, as there are still many children who have not been diagnosed properly,” explained Dr. Samai Sirithongthaworn, the Director of Rajanagarindra Institute of Child Development. “Only a small number of those suffering from ADHD are diagnosed properly.”
“In the past ten years, there has been an increase in the number of parents who are looking for ADHD therapy,” said Vasan Patisen, Occupational Therapist and Director of Mind Brain & Body Child Development Center, “but I can’t really say whether it is the increasing number of children with ADHD or the increasing parental awareness about the disease.”
ADHD has, and continues to be, a controversial disorder and debate continues to rage worldwide as to whether it is underdiagnosed or whether parents, doctors and big pharma are pushing diagnoses as well as medication. The Guardian newspaper described ADHD in 2016 as a “disturbing medial cultural phenomenon”, going on to explain that the term ADHD was only officially coined by the American Psychiatric Association in 1987, being formerly known as hyperkinetic impulse disorder, minimal brain dysfunction, and attention deficit disorder. The paper also claimed that while scientific research in the US suggests that around 5% of children are affected by ADHD, 15% of children have been diagnosed as suffering from ADHD, many being given incredibly addictive pills such as Ritalin and Adderall, both of which are known to trigger dangerous side effects ranging from psychosis to hallucinations. Studies have found that the cost of ADHD in the United States for children and adults range between $143 billion to $266 billion (2010), unfortunately there are no comparative studies in Thailand at this time.
ADHD is riddled with controversy, with some doctors saying that there is no way to accurately diagnose a set of behaviours and that much of the symptoms attributed to it is simply normal childhood exuberance — hyperactivity, impulsiveness and lack of attention. Others, and they tend to be in the majority, claim that with time spent with children, it is clear that ADHD is intrinsically different to ‘just being naughty’.
“Teachers in Thai schools tend to punish bad behaviour instead of trying to understand the underlying causes and this is simply because they don’t have the knowledge to handle such situations.”
“To properly diagnose ADHD you need to understand the symptoms, spend time with the child and not jump to conclusions,” said Vasan. “Our ability to concentrate is likely to decline when we suffer from acute stress. This can happen to anyone, but children suffering from ADHD are those who are unable to hold back as their sensory and motor functions are impaired, caused by a number of things such as biological inheritance, brain chemicals, nutrition, the condition of the mother while pregnant, parental environment and so on. Even spoiling your child can cause ADHD, as not letting them walk, play, or do things by themselves will inhibits their sensory interaction in the world, leading to a form of mental hypersensitivity. Children who are brought up in orphanages often show traits of ADHD due to their restricted upbringing.”
Vasan uses a recent case study to explain, “A is the first child of a middle-upper class family in Chiang Mai. A’s father intended to have his child go to the same school that he did so A was made to take extra classes after school every day and every weekend, totaling around 10 hours of study a day. A was four years old. After months of intensive study, A slowly turned into a furious child, screaming, shouting, hitting his father and unsurprisingly A’s academic performance worsened. Such a case can be found quite often here in Thailand,” said Vasan. “You see, the best thing for kids aged four to eight to do is to play, but when these kids’ main daytime activity being studying, it overloads the logic part of the brain and causes the child’s sensory and motor functions to become underdeveloped which results in stress. I am not saying that extra tuition is a bad thing, but they must be balanced with enough free time and not stack up to take over the whole day, it’s just too much.”
School life can also contribute to the development of disorders such as ADHD. Taking up to six to eight hours a day of a child’s formative life, it can causes stress, especially in children who are already susceptible. In 2017, HSRI published a model that develops support networks for children with ADHD, called the Integrated ADHD Care Model. “Family, schools and medical institutions need to be integrated. Understanding, especially among family members and schools are key, and they have to know what they’re dealing with,” said Dr. Samai as he explained that ADHD can sometimes be hard for family members and schools to diagnose correctly.
“Teachers in Thai schools tend to punish bad behaviour instead of trying to understand the underlying causes and this is simply because they don’t have the knowledge to handle such situations. Whereas in international schools, the teachers tend to offer more of a support system, some even have an occupational therapist on site, and they are more likely to attempt to understand the reasons behind their students’ bad behaviour rather than instinctively punishing the child,” said Vasan.
“Thai classrooms are usually so full that even if a teacher wanted to help, they would have no time to before the rest of the class got out of control,” added Dr. Samai. “So to combat this the Integrated ADHD Care Model aims to set up meetings between parents, teachers and doctors to share experiences and diagnoses in order to further understand children’s struggles,” The project also involves a preliminary test that has been distributed to several schools in Chiang Mai to help identify at-risk children.
“The matter is really too complicated for a simple checklist but it does help at the first step,” continued Vasan. “If a child is diagnosed with ADHD, their situation is not going to change. They will be in the same classroom, with the same teacher and the same classmates. Sadly the underlying threat for kids with ADHD are that they are usually marked as troubled children, then it can in fact make the situation worse as prejudices take over. It is often after grades fall, homework is left uncompleted, kids get in trouble more often — only then will they get a chance to see a doctor or therapist.”
“Doctors and occupational therapists are supposed to work together, but more often than not they don’t communicate so either side is unaware of what the other is doing to combat the symptoms of ADHD. Doctors will turn to pills while therapists turn to developmental therapy to cure the same symptoms, and when combined the desired effects are often misrepresented. Children who are given drugs often take them well into their mid-teens,” said Vasan about the strong and addictive pills often meted out liberally to children.
“We don’t have enough occupational therapist for public services to make it work effectively,” explained Dr. Samai. “The main way to treat ADHD is actually in the hands of the family and teachers. ADHD doesn’t only effect that particular person who carries it but its effects spread to the family and the society around that person too. One study claims that about 80% of criminals in Chiang Mai’s prisons suffer from ADHD. The present number is probably a bit lower, but it’s still a lot,” explained Dr. Samai.
Sadly, without support networks in place, many children end up growing into adults with more permanent mental health problems. Vasan said one of his patients was a 13 years old and incredibly violent. He was saddened to find out that the boy had been physically abused by his father, so as a defense mechanism he developed similar traits to defend himself. As children are scolded or aggressively punished, they grow to inherit some of the negative behaviours from their parents. In the case of the 13 year old boy, Vasan was unable to finish his treatment and support with him after his father took him out of the system – another problem affecting many at-risk children. He concluded that “despite all the work being done to help treat and improve the lives of people suffering from ADHD and similar issues, unless the schools and parents get on board and understand the signs then it’s not going to work.”