MHA Webinar Episode 48:Attention Deficit Hyperactivity Disorder (ADHD) Uncovered:

0:00 Guys, a very good afternoon to all of us. You are most welcome to today's edition of our mentally virtual seminars. And today we have an interesting topic to discuss. Attention deficit hyperactive disorder from recognition to real life management for mental well-being. We are not just talking we are not just going to talk about the symptoms. You are going to know that this condition affects mental health in the first place. relationship, education,

0:45 daily living and all that. We are going to talk about that as well. Then most importantly, what we can do to support and manage the condition. So at the end of the day, we'll be able to recognize the common signs of ADHD. We'll be able to understand its impact on mental health and lifestyle as well as daily living. Then we'll get to learn some practical strategies of how to support and manage the condition. So this is what we are going to do. It's a very it's a very interesting topic >> and

1:31 everything. >> Let me share with you our usual housekeeping rules. Um please let's try as much as possible at all times to switch off our microphones. Let's try as much as possible so that it does not distract our facilitators most importantly and others. Secondly, we are going to discuss mental health. So let's try to be empathetic and sensitive when we get opportunity to make a comment, make a question or make an input. And the issue about confidentiality also works here. Uh any information that you pick here, let's try to put it to good use not to

2:17 harm or abuse any person. Sorry. And finally, those of us joining us for the very first time and are not aware that mental health authority has a helpline that you can call in for psychological first aid. Uh we do have a helpline and the number is 0800 678 678. Let me repeat the number. 0800 678678. This is a tollfree line to our helpline. You can call at any time to get some

3:02 psychological first aid and uh maybe a possible referral depending on your case. At this point uh permit me to introduce our facilitators for today. We have some distinguished fine ladies to help us in discussing the matter at hand and I'll first introduce Dr. Mrs. Peggy Aidu. She is a specialist psychiatrist with the West African College of Physicians and the Ghana College of Physicians and Surgeons. She works at the ACA psychiatric hospital and is very passionate about mental health especially issues to do with children

3:50 and adolescent. Dr. Aument is an alumni of SOS HGIC class of 2004 and has gone through the process to where she is now. She's a part-time lecturer and is involved in the training of medical students from University of Ghana and Family Health Medical School during their psychiatry rotations. She also supervises resident doctors, medical officers, house officers and physicians assistants in her team. She currently serves as the vice president of child and adolescent mental health society of Ghana. She is also the

4:35 head of public relations and the deputy clinical coordinator at the Ara psychiatric hospital. A Christian happily married with children with three children. With a round of digital applause, let's welcome Dr. Mrs. Aidu Acrements. Let's see the digital applause. Good one there. Good one there. Thank you. >> Fantastic. Dr. Akerman, how are you today? >> I'm doing well. Good afternoon to everyone on the call. Good afternoon,

5:22 Christine. >> Thank you. Thank you. Next is Dr. Christine Marble Pier. She's a licensed clinical psychologist in Ghana. Works at Mission Clinic and Mission Pediatrics in Ara and her PhD from Clark University in Massachusetts and has gone through all the process rough. She also specializes in educational psychology assessments for students who need access arrangements for national international examinations including students with HD

6:08 and specific learning disorders such as Lexia and Dalulas being Dr. Pierre and the team admission clinic also provides expert consultation, workshop and sness on staff and student wellbeing and special education support for schools. She's a mother of two girls in her spare times loves to create art, arts and read. Ladies and gentlemen, I present to you Dr. Christine Babier. A round of applause round of applause for her. >> Thank you. Thank you. Thank you. Thank you very much, Dr. Arthur. It's a pleasure to be here. >> It's good to see you. How have you been? >> I've been well. I've been well by God's

6:55 grace. >> Good, good, good, good. It's good to have you. It's good to have you. So, my first question goes to my participants, my dear participants. Uh we have 127 now. So, let's get into the chat box. And this is the question. What one word or phrase comes that comes to mind when you hear ADHD? What one word or phrase comes to mind when you hear ADHD? Let's hear what what comes to mind. I read them out.

7:41 Juliet say chaos. Wow. Hyper. Anita says hyper. A says petri. Eric says stop. Uh inattentive, too much energy, aggression hyperactivity distraction unstable restless mind, hysteria, super active everywhere. >> [snorts] >> High energy, too distracting, hyperactivity. Let's keep it coming. Let's hear the words. Easily distracted, unpredictable,

8:31 special educational needs. Low attention span. Differently able. Uncontrollable overwhelm. Poor attention. Superactive. More energy. Always wanted to be noticed. Okay, let's keep it coming. Vulnerable on the go.

9:16 Okay. Attention seeker. Indifferent executive function problems. Hyperactive learners who can't sit at one place. Okay. All right. I think that at this point we get the picture of what all of us are thinking when we hear the word HDHD. Another Christina says proactive. So it's quite interesting. You know all of us have different thoughts. Somebody

10:03 said motor disorder gifted find it difficult to relax or remain still. We all have different things that comes to our mind when we hear ADHD. So let me start with you Christine. >> Okay. >> What are what are the core signs of ADHD in children and adolesccents? Both of you are specialists in children, adolescence and adults. So I I'll I'll let you deal with the children and adolescents and I'll let Dr. Kremet deal with the adults. >> Okay. Okay. >> Okay. >> Sure. All right. Thank you once again for having me. It's very interesting to see the honest responses that are coming

10:51 up. And I'm sure we all notice that the hyperactive part is usually the one that people remember the giddy giddy and the energy and the overwhelming. But with ADHD there actually three types of ADHD. So I'll go through the the core symptoms. Um one for inattention. So when we say attention deficit and hyperactivity disorder, there's the inattention symptoms where we are looking at the the the core things that make it difficult for the person or the child to pay attention for a long time or for an adequate amount of time. Then there's

11:38 also the hyperactive or the impulsive symptoms which have more to do with the physical, the movements, the ones that is easier to notice. And so in diagnosing, you can diagnose someone with a predominantly inattentive presentation where they have they're not paying attention as hard, but they're not hyperactive. And you can diagnose someone with predominantly hyperactive. So it's rare, but you can have cases where they can pay attention, but they have to move. They have to fidget phys fidget. They their body has to be on the go, but they're listening, but they are moving. And then you have the third type

12:24 where is combined. Their attention and their hyperactivity are both a challenge. So looking at the inattention symptoms, one of them is that the person has a very difficult time paying close attention to details or they make mistakes. And so with children, you'll notice that when you're looking at their classwork, there's a lot of avoidable errors, minor minor mistakes. Sometimes even writing is like they didn't even finish writing the word and then they moved on or they didn't finish the sentence. So that giving close attention to detail is one of the symptoms we look for. Then we look for difficulty sustaining attention. So that's a short

13:11 attention span. At one minute they're looking here then 2 minutes for some children even 60 seconds immediately their attention is on something else. So they're not able to for instance focus on the teacher. the teacher is standing there talking for a 35 minute class, they're not able to sustain their attention and focus. And for another of the inattention symptoms is that when you are talking to them, they don't seem to be able to listen when spoken to directly partly because of that in attention and their mind keeps going in and out. So they themselves they'll tell you that I I zoned out. They sent me to the room to

13:58 go and get the bag and get the pen from the bag. When I got there, I didn't know what I was doing there cuz halfway through the instructions, I had zoned out. So not being able to listen or follow through um on instructions. Then there's difficulty with organizing um their tasks and activities. So you find that they they can be quite disorganized where they they lose things a lot. So their water bottle, their homework, sometimes even their their shoe. One boy will come and say he's can't find his shoe and the parent is wondering how did you lose your shoe? But they because their attention is in and out. They forgotten that oh I put it

14:45 here and then I walked away and I did something else. And then they are also easily distracted. So it's hard for them to block out the distraction. So those are some of the inattention symptoms. Then for the hyperactivity, that's the one that we all see where even if they are not usually they they're moving, they they're jumping, they're running. Their favorite time of the day is break time when they can just let all the energy out. But with some of the children, especially with girls, they might not be so energetic, but you will still see that they fidget a lot. So maybe they're chewing their pen or

15:30 they're always playing with their hair or they're rocking back and forth in the seats, but it's just hard for them to be still or they leave their seat. Some of the children will tell me they'll ask to go to the washroom like five times one class cuz it's the only way they can get up and move. Um then there's also um just being on the go. Talking talking is another of the symptoms. Talking excessively often times if you do the clinical interview well it will come up that yeah she likes talking or he likes he can go on and on. then you change some something you say will bring him another idea then he can just talk unless you interrupt him. So talking excessively. Then there's the

16:16 impulsivity part of sometimes they act before they think, right? So they might interrupt you. They'll blurt out answers in class even though you haven't called them when they raise their hand. They have difficulty waiting their turn. And that can sometimes cause fights or conflict, especially on the playground because as soon as their idea comes, they do it. If you annoyed them and they want you to stop, they might immediately hit you because they are they are impulsive and it's harder for them to to filter the thoughts and make the right decisions. So those are the the core symptoms for inattention and for hyperactivity. So I'll let I'll let Peggy take up the

17:03 adults the adults presentation. >> All right, Dr. Peggy. In fact, I mean at this point explaining these symptoms everybody and everybody on the call is thinking h person could be [laughter] that child could be h that child could that that boy could be. Well, there's the issue about misdiagnosis as well and most of us maybe doing some misdiagnosis at this point because we are just thinking h that anyway we get to the point of misdiagnosis why it happened that way but Dr. I beg you. Let's let's hear about the adults. Let me see if I am one. >> Okay. So, like Christine um explained um so

17:50 adults can actually have any of the types. Um so, it could be the predominantly inattentive. Um you can still have some adults who are hyperactive but um in my little practice um most of the time the adults with the hyperactivity may not even show up for an assessment but you find adults who are also very fidgety. So you are you have a work colleague who is always touching the table playing with his pen you know always trying to write on a sheet of paper. So they do things like that. And when it comes to um some of the impulsive thing they can make um certain bad decisions. So um they acting before they are thinking like has been explained. So in terms of spending so

18:36 money spending by time they realize they've done things they can't really tell what they did or even maybe oh I'm tired of this job let me just resign. By time they realize they've already resigned. Like bad choices with jobs they're changing that. And sometimes this also affects their relationship. When it comes to the inattentive bit, you'd realize that um just like the children who struggle to focus when they need to actually focus, the adults also have um similar things. So when it comes to work, so difficulty, you know, finishing a task. So they start this task, they they're not able to do it. when it comes to organizing themselves for work, for home, for other activities, it becomes a bit difficult um um organizing if they have to they

19:22 may miss even maybe paying bills because everything is scattered. They're not um able even household um chores and things can also um become a problem when they let's say maybe like a work meeting or something. They start and you realize this person has zoned out. Maybe you have a colleague you work with. You think the person is taking notes but by the end of the meeting you go and you ask um could you share your notes with me and you realize that um the person actually only heard the first >> h did not focus you know and sometimes it can be very hard and um cuz they will they can miss deadlines they need to go for this appointment they've literally missed that appointment because they

20:09 forgot. Some can also misplace their things. So those who come, I'm I'm not saying that if you come to work and you're always looking for a pen. But if I see if you were my colleague and every time you came to work, h your pen is missing. It would raise my cuz sometimes they may lose their things, they never have this or they think they packed it, but they actually did not pack it. So these are a few things um that um you can see in adults that have ADHD. And sometimes they may even come with um the consequences of it or maybe the squirly let's say because everybody is saying oh you are always you are lazy you are missing appointments it may affect their esteem and may affect relationships that they are in as well. Yeah, thank you.

20:56 >> All right. Thank you for for what you said so far. I'm pretty sure that for an adult with an ADHD, they are very disappointed. If that person disappoints you, you're very normal, [laughter] >> very normal. They can be very disappointing because I mean the person is not paying attention to do what he to do. Very disorganized. I mean, so they can be very disappointing I think. So now well so I have two people. I'm thinking that these people these people they they have this condition but maybe I maybe misdiagnosing them. So so Christine tell us why is it why do

21:42 we often miss such a condition or misdiagnose? So, so instead that like we are some of us the the how the one word thing that we just did somebody said Petray somebody said stop somebody you know we we cannot pinpoint or figure out that there's a problem but we label that person where does it happen that way particularly among girls and women. >> Yeah. So even before I go into why the misdiagnosis or the assumptions made I think it's important for us to

22:29 understand that this is actually a developmental disorder right it's a a different way in which the brain functions specifically the front parts the preffrontal cortex. So we're not just looking at the child or the adult and then looking at their symptoms and say okay okay okay all of this normally with ADHD these things should have been recognized from from childhood. So it's not that oh when I suddenly had to live on my own because I was 20 something then I became disorganized and I started disappointing people. It's starting from before 12 years old. we are seeing these symptoms um and the things are actually getting

23:16 in the way. So it's affecting school, it's affecting their family relationships, it's affecting friendships. And when they are adults, as you were saying, I've had cases where they couldn't sustain a job, you know, because they couldn't complete tasks and they themselves were disappointed in themselves because they're thinking, I'm trying, I'm trying, but for some reason I just can't do what needs to be done. Um, and a lot of times it's it's developmental because it's genetic. About 80% of the time is genetic. You have cases too where it's the if if a a person is born premature for instance and the the complete development of the

24:02 brain doesn't happen in utro then you find that they have a harder time with these functions with that part of the brain. So now to answer the question of the the misdiagnosis, the truth is to work with somebody especially with the hyperactive side of their ADHD, it can be tiring, right? Especially when you're thinking about the the little children, the ones that they won't sit down, say sit down, 2 minutes later they are hopping and jumping and it's like often times the caregivers in charge of them think it's deliberate. This is defiance is intentional. But when you take your time

24:47 too much, [laughter] >> but then after a while you realize and often times it's the sometimes it's the parents who come first and say, you know, I think he's trying or she's trying, but she just can't she just can't seem to control herself or she forgot and she was crying about it that mommy, I'm sorry, I forgot. And so it's not it's different from a defiance behavior. It really is a a difference in the way their brain is such that remembering and focusing and sustaining their attention is hard for them. And then in girls, they found that for girls, more often

25:34 than not, they have that inattention type more than the hyper hyper type. And it's partly because of the the socialization from very very young boys. Oh, as for boys, yeah, that's how they are. They jump, they play football. So, society allows the males to be a bit more hyperactive. The girls tend to present more as inattentive. So they are sitting there in class. They are staring at you, son, but the thing is not going inside. They are thinking of yesterday when they were playing with their dollies and they are not focused at all. So often times you'll find that the boys will get the negative reaction

26:20 from teachers. They will be labeled as he's not listening. Whereas the girls will go mis misdiagnosed or unnoticed. They'll say, "Oh, she's fine. She's fine. She's a good girl. I don't know why she's not getting the answers correct. Let's just try harder." So, they're not picking up on the fact that this girl's attention span is very, very short and she's missing. And then, so they're not giving them the very simple interventions that are easy to do in school. >> Good. Great. So we'll come to the intervention. That is the most important part. [laughter] >> I wanted to add on. >> Okay. Please do. >> Yeah. I wanted to add on a bit about the

27:07 um girls often being misdiagnosed. Um so sometimes um you find that some girls compensate for their inattention. So they may think that oh like so she the person is actually struggling but she knows that I may forget I may lose this. So she compensates by overpreparing or doing things. So you may think that oh this girl is maybe a perfectionist or you know some way but she's actually trying to mask what she's going through. And there are times where people also may confuse it for other conditions. Maybe think that oh this person is depressed that's why they are not actually concentrating or doing things or does this person have anxiety that

27:53 she keeps blanking and things like that. Or they may even label the person as just being lazy that oh this person is not motivated or has low motivation to do things. But it's not really them. It's the way um the brain is wired differently um to do to organize and stay focused. >> Yeah. >> Okay. >> Okay. Thank you. So talking listening to both of you I remember um so how would we where would we place those kind of girls that we normally call them? They everywhere [laughter] playing they are everywhere. Where would we place them? Are they also misdiagnosed or they think

28:39 that they are they are they are okay because they everywhere they can't sit they can't pay attention fighting playing everywhere they are there climbing everything that a boy does they're also doing it where do we place them >> that's a very it's a there are so many factors to that to that question so it's a very very good question because on one and you'll assume that okay this girl is hyperactive she's one of the hyperactive um ADHDs but one with ADHD there's a reason you go to a professional to get diagnosed because children have energy right so it's not just any energy that is ADHD

29:27 sometimes they grew up with brothers you know sometimes they've learned that the more noise I make the more attention I'll Yet, it doesn't necessarily mean they can't control it. So, a professional has to be able to do a proper assessment and say, "Oh, this one there is really a an inability to control their impulses. That's why she's such a tomboy." So, that's one aspect of it that in in doing the diagnosis, it has to be very thorough. There's also um other presentations that somehow sometimes look like ADHD both with boys and girls. So for instance, when somebody has trauma, if they have PTSD,

30:14 post-traumatic stress disorder, they become hyper vigilant. And in little children, you'll see that it's like they can't sit still, but it's because of something they've been through, some trauma that has put them on edge. So that so that for instance, if they hear a loud sound or there's some noise going on somewhere or they remember something, suddenly they'll jump up. They have to move. They have to they just can't be calm and still. And so you might see that and think, "Oh, this one, dear, is ADHD." It might not be. It might be trauma. It might be anxiety. It could be a whole host of other things. So, it's very important to sort

31:01 of differentiate and make sure that we are we're diagnosing it properly. And then the third thing I'll say is you could have for instance a girl who is very energetic but is not affecting her school work is not really affect there's no negative impact. She's able to wait for break time and then you see the real energy but then during school she's she's listening and she's doing the work. So just the fact that she has energy again doesn't necessarily mean that is ADHD. It has to be that is we say is impairing their functioning is getting in the way

31:48 of life and what they supposed to do. So one critical aspect is to make sure that that situation is impairing their daily life significantly then that is the first red flag that needs to okay so Dr. Kment so what are the consequences of of missing this this this diagnosis what happens if we we as parents we as guardians we miss this Yeah. Um thank you. So um missing a diagnosis um for ADHD can have um various or not even giving the help they

32:33 need can have um various outcomes and noticeably if obviously a child is in attentive they don't get help for it then academically they can't thrive. So it may it may lead to them you know having um academic failure struggling in school some can even have can be repeated cuz we we've seen people that they thought oh this person is not pulling their weights but it was just that they are making mistakes in their work they are not completing tasks so obviously they couldn't move ahead and for some people if we were to stretch it they may even be able to drop they may drop out of school when it comes to um some of the um labels that we put on people. So this

33:21 child is born, this is that. Sometimes we shame people, children in public and it can have an effect on them. So it can affect their self-esteem. Um they may and these things for other mental health problems. Um when it comes to the hyperactivity and the um impulsivity um accidents are very common. So you can have a child who is running all over the place jumping because sometimes they're perceived they're not able to perceive danger. I've had children with burns. Um some have actually fallen from a story cuz they weren't being supervised. They were just going all over climbing and they climbed over and they fell. fractures,

34:08 other things like that could happen if um ADHD is not diagnosed and treated. Um as well um for the impulsivity sometimes you know because the impulsivity simply means like you know you are acting before you think. So oh somebody may say oh let's try this let's do this. So very risky things they can do it could be with their behavior even with substance use you know and sometimes um they can have um burnout there. There's also um some um behavioral problems like some conduct problems which can either coexist with the ADHD or because of you know a child um being told you are stubborn, you delete your work, I'm going to beat you and they become

34:54 obstinate. You know it's a whole myriad of things that um can happen when we don't diagnose and especially when we don't treat um ADHD. So, and obviously the impact on family and relationships. Some mothers are, you know, ashamed to take their children out. There's one mother who told me, I just want my child to be able to sit through a 6-hour flight. So, because of that, this child does not go on vacation because they can't handle the child on land. So, how much more handling the child in the air? So, sometimes it can lead to all these family stresses. Parents are always fighting saying that oh you didn't train the child well. There's a lot of things that um happen

35:39 interpersonal conflicts with parents with a child strain relationships all that can happen when we do not um treat recognize and treat ADHD. >> Thank you. Dr. W would you like to add something or she's done justice to it? I think she's done a lot of justice and she mentioned and I'll just add on to the I see a lot of lower lower self-esteem as they get older because they are trying but not able to and then the world around them is judging them for being inadequate. Um very often this lowered self-esteem and anxiety and depression becomes

36:26 um a comorbidity with the ADHD um if it's not if it's not diagnosed and then just family family upheaval. So, family conflict because you know the parents have this idea of who they want their child to be and they know that this child is capable but they still don't seem to be achieving the the target. And I've seen that it can be such a change when they realize, oh, this is ADHD. It's not that they're just being naughty. So then there's a peace of mind for the parents and a a shift in how they they are approaching it. So it's

37:14 not that they give up. It's like oh it's ADHD there's nothing we can do but then they shift their approach on how to to support and help the the individual. >> So now we we have a better understanding what is HD. We know the science clearly. inactive and proactive and a combination of both what they all are. We know the consequences if we are unable to if we miss the diagnosis or we misdiagnose. Okay. Now let's do a little bit of biology here so that we'll get a deeper understanding. Let's get an understanding of what is happening in the brain. In the brain so [snorts] that their

38:02 behaviors and attitude would understand it much better. What is going on Dr. Maybe ask what is going on in the brain of somebody who has HD? >> What is going on? >> Okay. So as we mentioned earlier the the main part of the mind of the brain is the preffrontal cortex. So that part of this brain is in charge of what they call executive functioning. An easy way to understand that is picture a CEO of a big company. They're sitting in their office and things are coming through. There's a lot of information they have to sort through. Hey somebody said this. you saw this

38:48 thing, you have to decide quickly what am I going to do with this information? Should I file it away? Should I put it away? Should I respond to it? And then you have to decide what you do. So with those with ADHD, this part of the brain is less developed. And so for instance when the information is coming in that hey your friend shouted your name and the teacher is talking at the same time and somebody is pulling your uniform at the back. All the information is coming in and it's so much harder for them to one make decisions on what to do what the best course of action is. um two to focus their attention and then

39:35 to stop the impulsivity and so we often sometimes say that it's like the CEO has gone on vacation kakar so it's like everything is coming in and anything is coming out and so that that delay in the preffrontal cortex is what we then see as this inattention another way to understand what's happening in the brain is we all have a forgotten the name it's like a default mode for when we are resting and we're daydreaming and the typical person when it's time to focus they can turn that off and then okay it's focus time but they found when they look at the brain of someone with ADHD

40:21 it's like the daydreaming resting part of the brain is still active even while they are trying to focus and so you have this sort of they're in and out. The focus is not as clear and and and succinct as somebody who is neurotypical and can just say I'm going to focus I'm going to block everything out. Um and the research has shown that with ADHD it's about when you are trying to think of age maturity they're about 30% of the age behind. So for instance, if they are 10 years old, you take 30% of this like they they're

41:07 more like 7 years old. When it comes to the stopping your impulses, making the right decision, paying attention, calming yourself down. >> Yeah. >> Thank you. Um, would you like to >> Yes. So um like Christine said um I mean that's the area of the brain that um has the um issue with um in addition to that sometimes there's some um dysregulation of certain chemicals as well which are responsible for the attention for the you know I'm sure those who have read

41:54 would have read about dopamine about no epinephrine but we're not going to do we're not going to make it like that. But those >> they are involved. So to like the networking of the brain and the signaling of the brain um all these um things that so the they're not the we're not having um effort in that area. notice that the prefrontal cortex of um would have fully developed um late adolescence into like mid20ies, you know, that's when everything. So to have a problem with that part of the

42:40 brain that normal um children and adolescents also don't have it fully um um developed. It it can be like a a double blow because we know that as children are developing um decisions and things like you learn over time and as you learn problem solve and you're able to organize and everything that part of the brain develops. But in ADHD there's a problem with that part. So then the struggle is even more for um the children. So it's a it's an interplay of the brain. So think about dec and um other things. Yeah. So that's what I would add to it. And I I say that it's not like the person is not

43:27 intelligent >> is it's signaling and wiring is struggling. Yeah. Well, I mean if the the executive function is impaired, you would expect that there is problem with basically everything basically everything because that is where all the information goes and it needs to be processed and needs output. So if there is a problem with that place don't go don't go away Dr. Kmet. Um so let's talk briefly about HDHD and mental health conditions. What is the connection for example anxiety and depression? How is HDD connected to this?

44:15 >> Okay, thank you very much. So um ADHD I think I mentioned earlier that it could occur alone or it could occur with other conditions. So somebody who has ADHD may develop anxiety and depression later which may not be related to the ADHD but the experience of living with ADHD can also put you at a risk of developing um this we've explained that you know um children are suffering or struggling failing at what they are doing despite all their efforts and criticisms may calm and they are from being disorganized being

45:00 etc. Maybe their friends are even rejecting them or they having fights with their because it's like you're always in our picking out things, you're playing noisily, we won't include you in our group and all those things can actually predispose um some to have anxiety or depression. So people who children who have ADHD have a high um um anxiety and depress um ADHD being a neurodedevelopmental condition can co- occur with other um neurodedevelopmental conditions as well. So you may have a child who has ADHD and who has autism as well. A child who has ADHD who has epilepsy as well.

45:48 So these are some of the um co-orbidities and obviously we've talked about not treating if the person starts using substances and things that also can be a co-orbidity but anxiety and depression are quite um common and I'm sure Christina and I see if it's in some of the children that um we see. Yeah. Thank you. All right. >> Okay. While while he's coming. >> Okay. I'm I'm I'm here. >> So, thank you very much for that explanation. So it looks like more or

46:34 less this when it comes to mental health as aside the the genetic and the comorbidity more more of them is on the social front because they are not performing well in class. They are not behaving well in class. So their classmates are not relating well with them. do not want to play with them and that affects their self-esteem and predisposes them to anxiety and depression and all that. Great. Now to the big question which is why we are all here the management of this [snorts] problem. One question is already in the chat box. My dear participants, please uh drop in your comments as well as your questions and uh after this run I'll take a look

47:22 at them. So um Christine, what are the main treatment options treatment options for HDHD? Okay. So, for ADHD, the gold standard, especially if it's moderate to severe ADHD, is a combination where you want to combine what they call the behavioral interventions with the medication or pharmacological therapy. So ideally for moderate to severe the best result is when you're adding medicine and there's medicine which Peggy can speak to to behavioral interventions. So I'll talk a bit about the behavioral things the strategies.

48:08 The idea is that you're trying to help the child or the adult to learn to filter. Remember I said how it's like everything is coming in and it's it's too much. So whatever comes out comes out. You're trying to help them to filter all the information and you can do that by one structuring their environment. So number one is routines. Um, I cannot emphasize enough how simple but effective having consistent and daily routines is for a child or even an adult with ADHD because the the brain then has to do a lot less, right? Because they know, okay, when I wake up in the morning, it's not that, oh, I

48:55 could decide to go to the washroom or I could go on the tablet for a bit or I could have breakfast. There's too much information. You just have the routine of first we do this then we go to the next step and then after a while you don't even have to think about it. It becomes habit. The same thing in the school setting. If they have a clear routine of when I get to school I put my bag away. I sit at their desk. I do the entry exercise. I take a break. I do this. Once they get used to the routine and it does take time for them to get used to a routine. Um but once there's somebody there to make sure it's consistently applied, you start to see um some management or some some calming

49:41 in the behavior. For some of them, you need visual charts. So you as the adult or the partner or their you know their coach or therapist might see it in your head that ah this is a routine. We talked about it. I reminded you. But sometimes they need a visual reminder. So for children sometimes we print out and and if they are not reading age we just put pictures there so that they can see that this is what I need to do and then they can check it off. Another effective intervention is because their attention span is short. It's best to um chunk work. So we minimize we reduce the amount of time

50:30 the person has to focus on one thing for. So take the example of classwork. If they doing maths for instance and it's 10 questions a neurotypical child can just sit down and do all 10 questions and come and say teacher finished. For a child with ADHD, the likelihood that after question one, something will distract them is very very high or they'll forget what they're doing. So then you chunk it and say, "Okay, after question one, you bring it. I'll check then you go back question two or you do maybe two or three questions at a goal." They found that because the ADHD brain fatigues with attention, just having a short break, even just 3 to 5 minutes, and as

51:18 they get older, even just 2 minutes can refresh the brain so that that mental fatigue goes down and then they are able to refocus again. So, chunking with breaks in between is very helpful. There's something called the Proodoro technique. So that one is a is like a well-known technique where they say 25 minutes of work and then um like 5 to 10 minutes of break then 25 minutes of work then break. So chunking the work in that way is helpful. Um there's also selfawareness. So when we start therapy or behavioral interventions with a child if they are old enough a very important

52:05 first step is to make them aware of what their mind is doing and not in a judgmental way. So it's not that oh that's what you dare you can't pay attention grow. It's just that your mind works differently and in fact I I often use this example of I met a very successful adult male who has ADHD and he says his ADHD is actually the reason he's successful because his brain was always making associations. So he'll see something and he'll say [clears throat] that's a very good business idea. if I talk to this person and we connect so his brain is always jumping but that's what's nobody else mind is doing that and that's what's gotten him his money and his success so with children we tell

52:51 them that look your mind works differently it's not necessarily a bad thing but you need to be aware of it so that you can start to notice yourself when you are becoming distracted when you're in school and you realize that hm how [clears throat] did I get here how come I'm talking to y'all and I'm not paying attention So that selfawareness we spend quite a bit of time doing different activities to help them notice that oh look your attention is gone. Then we use visual timers. So this is teachers and parents can use visual timers as well. And what you do is you help them to learn what their baseline attention span is. So you get a timer either on these days you can just go on

53:38 Google and search for timer and something will pop up but you say okay we're going to do this unit of work um and I'm going to watch you and see the point at which you go off. So you set the baseline maybe for some children it might be 2 minutes for some is 10 minutes for some is it's 12. So you say, "Okay, so right now your baseline is this. We're going to work on expanding it so that your attention span lasts for longer." And because the brain is a muscle, the more you work it, the stronger it gets. Just like you go to the gym or you find weights and you lift it and then you become ble, you can work the the muscles, specific parts of your

54:24 brain so that they become better as paying attention. So then with that visual timer, you see right now your baseline is 3 minutes for instance, we're going to work at 7 minutes of continuous work. Then you have the visual timer there. You're showing them when they go off, you say 7 minutes is not up. Let's get back to work. And with that consistency, they found that and with that self-awareness, individuals can start to redirect themselves and manage themselves. when it's quite severe or even moderate, usually it won't work just by itself. With the milder ones, they they find their own way and they might not even need medication.

55:10 And then lastly, I saw that somebody asked about these working the exercises, you know, on the internet. There's a lot of games and things about moving. I think one of them is moving two different lines at the same time to work your ADHD brain. The truth is that what they do know for sure is that yes, there's something called working memory holding multiple things in your head at the same time that is connected to ADHD. So that if you are training your working memory, you are more likely to be able to pay attention. What however they found is that whatever

55:57 you use to train it. So for instance, if if you are using um if you're using an activity like simultaneously following lines on a page, you become better at that specific thing, but it doesn't always generalize to being better at focusing. And so the activities we we then do with the child instead will be things like following instructions. So if we know this child is not able to follow instructions, well, we do games and activities where it's like, okay, you're on a mission and

56:42 you have four steps to complete before the mission is complete. Step one, go to the drawer, find the blue bag, take the bag to the corner, and so you've given them four steps of instructions, and it's almost like a competition to see if they'll remember it and be able to complete it. So, there are activities like that where you try to approximate it to the problem they're having in real life, whether it's in the classroom or at home, and then you practice that over and over. So those are some of the behavioral interventions. Thank you very much. Thank you very much

57:30 Christine. I mean describing some of these interventions. I'm thinking these are simple things that parents we could learn some of them and incorporate them into the lifestyle of our children for them to be able to at least close that gap. Okay. Thank you very much for that explanation. Dr. Peggy, um let's talk about schools. What's what what advice would they give to schools? What what what support system What support system can schools um create to support such individuals and their families?

58:15 >> Okay. So, I think before I talk about the schools, I'd like to mention medications cuz I' I've seen a few people ask about medication like Christine said for >> So, so before you go Try well not to mention any medication. Of course, all your medications are by prescription but try [laughter] not to mention any medication. We encourage professional help seeking here. So try not to we all understand Dr. Christine mentioned that when it's moderate to severe it's combination of medication and behavioral interventions. She did well

59:01 by explaining this intervention that we can adopt medications. >> It is not for us here to decide. So please go on. >> So I I think I'll just mention the two um main groups of medications that we use but um like you mentioned they >> prescription Yes. prescription medication and um even for what we use as the first line. So we would say stimulants versus non-stimulants. I would group them that way. For the stimulants, most of them are controlled substances. So you can't even on this call go and buy. We need to write the prescription. We need to

59:46 stamp. Somearmacies will take our professional um certification numbers to make sure that um we have actually prescribed. And occasionally you get a call from a pharmacist saying, "Oh, I saw this prescription. I want to make sure that it is from you." So the stimulants are what we use as first line. Then if maybe there's a contra indication or maybe it's not working or um the side effects the person can tolerate, we may move to the non-stimulants. The non-stimulants seem to um they tend to take a longer time to work as compared to the stimulants. And um they also have we have different groups that we use but um they are effective but to um it takes some time

1:00:34 for it to build up and work compared to the stimulants which are are first line. I think that is um nowadays we're getting a lot of come and say oh I think I have ADHD I think I have ADHD. um some of them we found were was not ADHD at all was something else but some people also came with a purpose of getting some stimulants medication for various reasons that I'm not sure if we can discuss that's the note on medication um so I'll go on to um what can be done in schools I think Christine mentioned certain things about like you know um giving work um breaking

1:01:19 um letting them continue, giving them instructions in steps. So a brief instruction to do this, to do that and um for me um sitting arrangements in class is quite important especially for um those who are inattentive and get easily distracted. Sometimes we've had children who are sitting by the window and maybe the school is close to a road so they they actually can see the multiple cars that go they even know the cars that come compound because whilst you are teaching they are looking for people's parents and they'll be telling this person oh your father has come your mother has come so sitting arrangement is quite important they have to be seated in low distraction areas. So if

1:02:04 you think that sitting by this person who is talking um will distract them, you move them away to somewhere that they can actually focus. So taking the breaks um using timers greeting has mentioned then the visual schedule is also quite important. So you let the things for them um and sometimes you can allow breaks for that child because if you don't allow the break the child will come and say I want to wee wee I want to do that I want to do that and it's better to have that consistent routine that you are giving to the child and that can help um in previous years we've had collaborations with um or we've had requests from schools so Ghana education service for their BC for their actually

1:02:50 making accommodations for children with ADHD and other um special needs. So exams can be extended so a bit more time so that you can have the adequate breaks that you need. Um they they can do things to help you thrive in your exam. So letting you um do it at your pace or there are other people even for other special needs that they have specific accommodations whether you want to talk or you want to type or other things. So I think increasingly um that is also a and so if for there there are some teachers on the call that need accommodation for your children you can either therapist or le with your head

1:03:38 um the health workers that um the children work with for us to also if it means a letter or something to help guide them um we do that. So that's um the bits for the school. Yeah. All right. Thank you very much. I mean, so at this point, clearly parents, guardians, and schools can do a lot can do a lot to change the lives of our children experiencing HD. Of course, seeking professional help is very important. Okay. So, I have one final question for each of you, but before that, let's go into the chat box. And uh there are a few questions there. Let's try to respond them. I'll plead with you

1:04:23 to be straightforward and punchy to this question so that we can respond to as many as muted. Okay. So the first one is coming from Hana. She has written you a letter. Hannah, you have written You have written a letter to them. It says, "Doctors and me, thank you for explaining about the different symptoms in both children and adults in Ghana. Have you found it easier or not to prescribe medication for HD?" I think they've answered that.

1:05:11 I find that some of my clients have this huge thing to taking medication for HDHD. How can we encourage clients to do healthy help seeking so therapy will have some bandwidth to teach them some life skills? It feels like for some clients the symptoms are so intense that talk therapy and or mindfulness can't find a place to help. Would you like to comment on this? I think that she she asked a question clearly there was a question in there but you responded to that that her question was I find uh have you found it easier or not to prescribe medication

1:05:59 for HDHD? Well, you are practitioners. I don't know how you understand it but I think I understood it because it's by prescription. So if it's by prescription, how easy or how easy or difficult it is to do that? Maybe as professionals we want to explain that to to us as parents so that parents will not come and disturb professional that they want to see medicine in the list. >> Okay. So let me start this one. >> Uh Dr. what's your what's your what's your take on this? A quick one please. >> Okay. So I think that um in terms of the clients sometimes um it's easier dealing with adults who have ADHD because sometimes they've always known they've

1:06:45 prepared their minds they've come um culturally you know how it is when you want to start medication for people I don't rush to start medication I give parents the chance to um read about the medication the side effects with us all that and somehow discuss with their before they come to a um um um difficult for them to take that decision in in in in in in the moment and the cultural stigma about oh my child is so it means that um this there's always that why for it why does

1:07:31 it mean it's a failure or maybe it's just too stubborn on or too lazy to actually need the medication. They may be pretend the medication. [clears throat] So these are some of the things I think for me it's easier with the older ones or people who have already read or people who are aware before they come for um medications. Some people would have already discussed with their psychologist the need for the medication because the therapy is not working. That makes it easier. So it's not a one it doesn't fit every um situation but it varies depending on who is coming >> situation varies depending on yeah >> to seek the help.

1:08:16 >> All right. Um Bernard Ato says do animal pets have HD? Bernard we are not doing veterary services. [laughter] Please go to veterary services. Let me edit mischievous here. go to veterary service and get your question answered for you. Uh, no but mental condition. >> Sorry, >> it's a human neuro develop mental condition. Yeah, >> it's not for pets. Uh, I don't know why you decided to ask about pets here. No, no, I am >> Yeah. >> Uh, no. Can please can HDHD be treated? I

1:09:01 think that question has been answered. Does HD cause severe headaches? Dr. Hel, yes or no? Does it cause severe headaches? Yes or no? >> It can because it causes mental fatigue and sometimes when there's a lot of things in your head, you get a headache. >> Okay. Samsung, can we get a recording? That mean that you are the first. This is your first time. If it's not your first time, I don't see why you are asking this. Yes, you can get the recording. It's uploaded to YouTube. You will find it there on Monday. Just type in the title of this program. And u your next question is how is this condition treated? H see a lot of ad on Facebook on games on activities to engage in with a child

1:09:47 with this condition. Yes, they've discussed that. Yes, it's all part of the interventions. So, it can be treated with medication and bio interventions. Uh, George, does HD have biological intervention? Your question, but I'm thinking that you think that can biology biology is pharmacy, pharmacy is medicine, phological. Okay. Um uh no please at what age does someone develop at what age please at which age does someone prefal contest develop it's a developmental go

1:10:33 through a developmental process so from childhood to to adult to um please what is the best way of handling a 10 yearear-old with learning difficulty a lot of examples and interventions have been shared. Uh Justin, can this develop later on in adulthood? Maybe due to trauma to the brain and other factors that may affect Yes, it can. Um not your question has been answered. What is the primary cause of HHD is a neurodedevelopmental problem? So it has been mentioned over again Benedict Ben

1:11:20 how safe are these medications how long do they have to take them for? Are there side effects? H Benita don't bother your head with these questions. Seek for professional help and all this will be catered for. At this point you don't have to stress yourself about finding answers for these questions before you seek for help. go in there, seek for that professional help and all other things shall be added onto you. All right. >> Um, is ADHD linked to dlexia? Uh, Christine, yes. No. >> Yes, sometimes. >> Yes, sometimes. Okay, good. Thank you. Is there a correlation between HD and

1:12:06 giftedness and exceptionality? H >> yes or no? >> Is there a correlation? >> Um they can call >> it they can call. Okay. >> Yeah. >> But I don't know whether the person is asking about autism and it's linked to giftedness but they can call okay. ADHD >> HDHD the person can be gifted even though the person is hyperactive. Yeah. So the the correlation there and I think that the giftedness will be managed will depend on how the situation is managed >> to to enhance that potential.

1:12:52 >> Exactly. Um an difference between HD and personality temperament that is your homework for today an go and research is there a difference between HD and personality and temperament I mean we've discussed the we've discussed the symptoms inattention and hyperactive and both of them. So depending on how the person finds him or herself, the conditions and all that parts uh uh the responses of family, friends, schoolmates and all that would contribute to the personality and

1:13:39 temperament of that individual. So another participants and all those No, she's just making noise. Her microphone is on. Mute to that person. >> Please, please let me plead with all of us here. Kindly make sure your microphone is muted. Please. It's very destructive when your microphone comes on. Can't you

1:14:27 turn it off then he comes back on? >> Well, perhaps um Irene Sam is ADHD preventable and treatable. I cannot talk about the preventable but treatable. Yes. Or >> how to prevent it? >> Because it's more likely if the fetus is exposed to toxins, there are some things that pregnant mother can do to try to prevent the likelihood of ADHD. >> Okay. Okay. Fantastic answer. So I read. So the prevention is more in the

1:15:13 behavior during pregnancy. taking in alcohol smoke all sorts of substances can predispose this child to developing HD. So that is one aspect, but it's a neurodedevelopmental condition. So you have to do your best to make sure that no substances get into the system and that will help. Okay. Um Rose how do you actually diagnose someone with HDD? Because I get confused sometimes. My 8-year-old would behave very normal and she's very intelligent and would sometime behave so badly. She sometimes

1:16:01 lack attention, talks a lot and very emotional. Please, which specialist should we seek help from? Okay, you need help because don't confuse yourself. Confusion is not good for your health. Go and seek professional help. And I encourage you to go into any of our facilities across the country. There is a mental health unit there and talk to them. If you want to be clear, you might would want to see a psychologist first. He or she would help you in the next step processes that you need to take. A psychiatrist can also do well, but a psy

1:16:48 psychologist would help you first to address the problem. Uh Monica, good afternoon. House for the good work you are doing to educators to enable us take care of our members. God bless you. God bless you too, Monica Juliet. Does ADHD affect a person's adaptability and flexibility? Affect a person's adaptability and flexibility. This this this is a 50/50 question depending on the case. Depending on the case, depending on the case and if a person have been diagnosed and receiving support

1:17:35 is receiving support, it can it can affect and can I mean it's all about functionality in the daily life. It's all about functionality in the daily life. >> Sometimes they can hyperfocus too. So it's like they don't want to shift their attention from one thing to the next. >> Um, >> okay. So that's where you might see some rigidity. >> Okay. Okay. Um Aia, can I get a recording after the program? Yes, you can. Make Benu Children in the preoperational stage are active always when they are not sleeping. They play, jump, climb, run, etc.

1:18:24 How do we as caregivers differentiate this normal developmental activities from HD? You missed the first part of responding when they were explaining the sentence. You missed that part. Next time come early. Next time come early and you get all the app. But maybe um Christine, would you give him a little app? >> Okay. on them. So that's the where the impairment and functioning comes. So if they playing and they jumping and they're running, they supposed to do that. That's how children learn. So it's and that's why we don't diagnose it unless now it's getting in the way of

1:19:09 they can't stop it to learn or they can't stop it to sit down and eat then it becomes a possible diagnosis. In other words, in other words, bright, in other words, if they are running and everything is impairing the results of their daily function. In other words, they are doing it all right, but their daily function is the outcome is not the way it is supposed to be. Then there is a problem. Then you have to seek for professional help. Uhia Peggy, this is for you. H okay. You

1:19:56 don't have to mention the names of medication, but it would be good to explain a bit more on how the different types work. Well, she did that. I saw this test before she started talking. So, I think she did that. Uh Esquire, Espire Charlotte has asked a question. How do we dist from AD? >> Let me give that to you then. Then Dr. Ement will talk that for us. >> Okay. So we no longer use the term ADD. Um now they've the new DSM and the new manuals have shifted to ADHD with the three types. So ADD was

1:20:43 the inattentive type without the hyper activity. That's where the H is coming from. >> Okay. >> But instead of just saying ADD now, they'll say ADHD inattentive type. ADHD hyperactive ADHD combined. >> Okay. >> So just >> Okay. [snorts] Thank you very much. Uh Balono Monica by the way I'm chatting with you from Ghana and I Monica Labara I'm highly grateful from okay your name sounded as if you are outside Ghana but it's good to let me know that you are chatting with us here okay thank you for coming Mildred Sani

1:21:30 ADHD patients are already stimulated why are stimulants being the first line of medications accurate this is a very good question in But it it crossed my mind sure that these people they're already on the high stimulants. So I'm interested in the in your response. >> So the the group um of that medication is called stimulants because of what it does. So it stimulates the um production of certain chemicals in the brain to be able to calm you. And we've already explained that um the preffrontal cortex um it controls our impulses and our inhibition. But in this case,

1:22:16 they're not able to control it. So counterintuitive is just the name of the group >> of it. But what it actually does is that it stimulates and it raises the level of the dopamine and the norepinephrine to keep um the child attentive and to regulates the impulses. Yeah. >> Okay. Okay. So just just just a trick in the name. >> Okay. Thank you. Um SA where do I assess some of these tests? because even as a licensed clinical psychologist, it's not easy to have access to even buy some of

1:23:02 these tests. Uh you might want to privately chat with Dr. Christine. She might help you privately DM privately chat with her. She might help you. Uh and which assessment tool is best to assess HDA in Ghana children and adults? Uh best for you Christine. Please chat Anton chat with both of them privately. They would help you. You have to declare your profession anyway before they go further with you. Uh okay Dr. Christine clinical interview observation plus questionaire for caregiver and teacher. Example,

1:23:49 Vanderbilt assessment skill, SNAP four, brief two, corner HDHD rating skill. When possible, a working memory performance test can be added. The corner continuous performance test is also good but harder to assess. She has responded uh summer. Okay. again uh Sama again please also is there an established referral system for professionals in Ghana because it's a specialized area you have Christine here do private conversation and this is professional talk

1:24:35 DM her the exchange contact are you a member of the psychological association of Ghana because This this this questions [laughter] your questions. Uh Erica Champon please can ADHD be associated with multiple disability example for a person with visual and hearing impairment. Yes or no? >> Yes. >> Yes. Okay. Is ADHD hereditary? Yes or no? >> Yes. >> Yes. 80%.

1:25:22 >> 80%. Okay. Please. Is it advisable to allow your child with HDHD to go to mainstream school? Is it advisable? >> We're preaching inclusive education. Yes, >> that's right. So that way she gets all all the experiences she needs to to to thrive. Chief Anthony, uh I guess preventive measures are always the best. All right. Uh please is

…