Case Studies
What follows is some of the typical problems that are seen in the clinic. Though all exmples are based on real patients, I have changed some details to protect their identities.
Vishal is 9 yr old and studies in
fourth standard. He gets in trouble all the time at school and at
home.
Teachers say that he is very restless
and energetic. He does not sit still in the class and tries to chat
up other children around him. If he is made to sit alone, he keeps
making noises and disturbs the class. Once when asked to stand
outside the classroom as a punishment, he went for a walk and was
found two hours later in school playground, playing with stray dogs.
He is okay in his studies and looses
marks mainly due to untidy work and not reading the instructions properly.
At home parents have tried various
methods to discipline him, he gets physical punishment as well. But
all this has not made any significant changes in him.
When he is playing with other children
in the housing complex, his energetic shouts and screams can be heard
from a distance. He has lots of friends and they call him "daredevil"
because he is not afraid of anything and can get in and out of
dangerous situations easily. He is the fastest rider of the bike in his group and can do
wheelies. He can climb the 10 foot tall garden wall to retrieve ball and has even
tried to climb sewage pipes to get into a balcony.
Nobody invites him home to play due to
his tendency to knock things over.
Vishal's parents wanted to know how to
"make him behave properly". They were sure that they are
responsible for spoiling him as they pampered him a lot till recently
and being the first grandchild in the family he has received lot of
attention from grandparents as well. They were considering a day
boarding school for him as a way of disciplining him.
After a detailed discussion with them
and Vishal's school it was clear that Vishal gets bored easily and
can not concentrate on any task for more than 20 minutes. He can not
control his impulsive behaviour and lands in trouble all the time.
Provisional diagnosis of ADHD (
attention deficit, hyperactive disorder) was made and we ordered blood
tests like haemoglobin, thyroid function tests. School medical exam
had already ruled out any problem in hearing and sight.
To monitor his progress we decided to
use scors from Vanderbilt scales at the time of diagnosis and at 6 months.
Now came the most difficult part of
treatment. Over the time, as detailed assessment took place, parents
were encouraged to read up information on ADHD. They had lots of
questions about medications, their side effects and long term
prognosis for Vishal.
After a discussion it was decided that
Vishal will take medications, we will collaborate with school to
facilitate learning with some specialised techniques in the classroom
and parents will attend 5 sessions to learn proper disciplining methods.
After 3 months into treatment and with
lot of support from school, Vishal has managed to integrate with
class. His time outs are now rare phenomenon and he has bagged a
medal in relay race at annual sports day.
At home things are a bit slow to
improve but Vishal is sure on his way to less troubled growth.
