Clinical practice can be challenging in Bangladesh, and more so if you are a psychiatrist. Your patient cries, shows anger and signs of distress.
And here you are, sitting with a curious face and non-judgmental attitude and trying to understand the explicit and implicit issues with the patient.
So, when a child of seven years entered my chamber, took two highlighters just to throw them away, jumped on the bed just to get down immediately, and ran amok, I was worried whether the child might get hurt.
I was curious, however, about the attitude of the parents. “Doctor, my child simply does not listen. He cannot sit still, does not concentrate on his studies, and is constantly getting complaints from school. He is just a naughty kid.”
For many parents and clinicians alike, this is a familiar story. A child who is constantly moving, interrupts others, forgets instructions, or struggles to complete schoolwork may quickly be labelled as “naughty,” “lazy,” “stubborn,” or “undisciplined.”
Parents fail to recognize it for what it is, and ultimately, children are subjected to repeated scolding or even physical punishment in an attempt to correct their behaviour.
But in some cases, these behaviours may reflect a neurodevelopmental condition known as attention-deficit/hyperactivity disorder, or ADHD.
ADHD is not simply about being “too active.” It is a condition in which difficulties with attention, impulse control, and/or hyperactivity are persistent and developmentally inappropriate, and they interfere with everyday functioning.
At the same time, it is important to remember that not every active or inattentive child has ADHD. A child who occasionally loses concentration during homework does not necessarily have ADHD.
Children naturally have variations in attention, energy, and behaviour. However, when difficulties persist over time, occur in more than one setting such as home and school, and significantly interfere with learning, relationships or daily functioning, professional assessment may be warranted.
There is another important reason not to jump to conclusions. Sleep problems, anxiety, depression, learning difficulties, family stress, and excessive screen use can also affect a child's attention and behaviour. A proper assessment therefore requires more than simply checking a list of symptoms.
Calling a child “bad” or giving a “smack” does not teach self-control. It may instead damage the child's confidence and relationship with parents and teachers. Children with attention or behavioral difficulties often benefit more from clear expectations, predictable routines, positive reinforcement, and appropriately structured tasks.
For example, instead of yelling at a child, parents can set a specific and realistic goal: “For the next 15 minutes, let's complete these two pages.” Breaking larger tasks into smaller steps can make them easier to manage.
Schools also have an important role. Leadership, communication, discipline, and ultimately their world view is largely shaped by how they interact at school.
A child who repeatedly leaves his seat or fails to complete assignments should not automatically be treated as a disciplinary problem. Clear and brief instructions, reasonable breaks, structured classroom routines, and positive feedback may help such children participate more effectively.
A child’s problem must be communicated with their parents without labels; labelling will automatically make parents more frustrated in an already tiring battle.
Treatment is multi-faceted. Depending on the child's needs, it may involve behavioral interventions, parent-focused strategies, educational support and, when clinically appropriate, medication.
The goal is not simply to make a child “quiet.” The goal is to improve attention, self-regulation, learning, and overall functioning.
Most importantly, an ADHD diagnosis does not mean that a child's future is determined by the disorder. With appropriate assessment, support and treatment, children with ADHD can develop their abilities and lead productive and fulfilling lives.
So, the most important change we need is a change in the question we ask. Instead of asking, “Why is this child so naughty?” we should sometimes ask: “What is making this child struggle, and what kind of help does the child need?”
Understanding the reason behind a child's behavior may be the first step toward changing that child's future.
Dr Imdadul Magfur is a psychiatrist and psychotherapist, Sylhet MAG Osmani Medical College and Hospital.
