1. The document discusses hyperactivity in children and its relationship to Attention Deficit Hyperactivity Disorder (ADHD). It notes that while the term "hyperactive child" is commonly used, hyperactivity alone does not indicate ADHD and further evaluation is needed. 2. ADHD is diagnosed based on whether the child meets criteria for inattention, hyperactivity, and impulsivity. Other potential causes of hyperactive behaviors must also be considered and ruled out. 3. Successful management of ADHD involves a collaborative approach between parents, teachers, and medical professionals using strategies like behavior modification, classroom accommodations, and medication if needed.

1. Is your child Hyperactive?
Hyperactivity seems to be the buzz word these days as more parents and teachers are
worried about hyperactivity than ever before. Professionals working with children are
encountering more children referred for evaluation of hyperactivity.
Given the raising concerns about the possibility of ADHD [Attention Deficit
Hyperactivity Disorder] parents of very young children would like to know if their child
is hyperactive. ‘Hyperactive child’ is not synonymous with ADHD [Attention Deficit
Hyperactivity Disorder]. When a parent or a teacher says that the child is hyperactive,
further information should be obtained about the nature of hyperactive behaviors. If the
child exhibits hyperactivity only in one situation or occasionally gets hyperactive this has
to be explored in detail. To qualify for the diagnosis of ADHD [Attention Deficit
Hyperactivity Disorder], the child must meet several criteria [either DSM 4 or ICD 10]
used by psychiatrists and other behavioral experts. The core symptoms of ADHD are 1.
Hyperactivity [jumping, excessive running, climbing] 2. Impulsivity [engaging in tasks
without thinking of the consequences]
3. Inattention / distractibility.
Attention Deficit Hyperactivity Disorder is diagnosed by gathering information obtained
[from parents, care givers and teachers] from varied sources, clinical observation of the
child, evaluating functional impact on the child due to ADHD symptoms. In addition, the
clinician also evaluates the reasons for hyperactivity in a particular child which could be
due to a host of factors. A number of conditions or base line functions need to be looked
at to understand hyperactivity in a child. A child with hearing or visual deficits can
exhibit ADHD like symptoms. In addition, sleep deprivation, severe anxiety, can mimic
ADHD symptoms. A child having a seizure disorder can exhibit inattention, hyperactivity
during an episode of seizure. Some medications can cause increase in activity levels in
children. A thorough examination by a clinician is necessary before labeling a child with
ADHD.
The impact of ADHD symptoms [attention Deficit Hyperactivity Disorder] varies at
different stages in the development of a child. When the child is very young, physical
hyperactivity [jumping, climbing] can be problematic. As the child enters KG class,
where seating is expected the teachers and parents start to recognize the problem. In
elementary school stage, as the academic & personal expectations from the child are
higher the impact of ADHD [Attention Deficit Hyperactivity Disorder] becomes very
apparent. Some children exhibit only hyperactivity & impulsivity [jumping running,
fidgety, not scanning surrounding s properly] belong to ADHD – hyperactive sub type.
Some children exhibit inattention & distractibility without hyperactivity belong to the
ADHD – inattentive subtype. These children are frequently missed or mislabeled as
‘lazy’. Children presenting with both hyperactivity and inattention belong to the
combined subtype, which is the most common sub type seen in school age children.

2. A child was referred for evaluation of ADHD as she was inattentive, hyperactive and
restless in class. However, a detailed history revealed that the child has frequent cold,
cough and throat infections, for which she ends up on antibiotics month after month. It
was also observed that her hyperactive behaviors were apparent during these times. So
evaluation of ADHD in this child should be done when she is off antibiotics and infection
free. Children with developmental delays [speech delays, mental retardation], learning
disabilities can exhibit hyperactivity. Many at times, parents present with concerns
regarding the child’s hyperactivity either unaware of the delays or without pursuing
interventions for the delays. In these children the primary diagnosis should be made first
and then ADHD which could be an associated condition should be identified and
addressed.
The management of ADHD [Attention Deficit Hyperactivity disorder] includes several
strategies starting with home management, class room accommodations, behavior
modification and medication management under professional guidance. The intensity of
symptoms and their interference in the child’s routine vary from child to child and the
treatment options should be considered with specific needs of the child in mind. Parental
guidance from a professional regarding positive reinforcement, behavior modification
and maintaining structure at home can improve the compliance in a child with ADHD.
Families should seek help from professionals when they are overwhelmed by personal or
family stress or when their own psychological issues interfere in their parenting. Schools
have started recognizing the impact of ADHD on a child’s behavior and performance and
they are guiding parents to seek help. Class room accommodations for these children may
include home work / class work modifications, providing seating accessible to
supervision, daily report card/ communication with parents and a resource room for
remedial sessions can improve academic performance in these children. ADHD can be
managed well by collaborating with teachers, parents, professionals in addition to
working with the child.
Warm Regards,
Dr. Yeseswini Kamaraju, M.D.
Child & Adolescent Psychiatrist.