ADHD should be treated before learning disorders, say experts

Eight-year old Sarita’s mother would buy 12-15 water bottles before each academic year. Her child would lose a bottle each month. She can hardly sit in class without distracting others around her and getting punished for the same. She would blurt out answers aloud and talk out of turn in class.

When Sarita was brought to the BYL Nair hospital and tested for learning disability, her IQ was low, indicating that she is a slow learner and therefore could not be tested for learning disorder.

“But the child was showing all signs of having attention deficit hyperactivity disorder (ADHD). We decided to put her on medication, occupational therapy and swimming,” said Dr Alka Subramanyam, psychiatrist from Nair hospital.

ADHD is a behavioural disorder caused by neuro-chemical imbalance in the brain. Globally, around 30 percent of the children suffering from learning disorders also have ADHD.

After a year’s time, the child’s IQ increased and then she could be tested for learning disorder. She was diagnosed with dyslexia, dysgraphia and dyscalculia. “Once the ADHD is taken care of, the child becomes receptive. However, the acceptance that ADHD should be treated as medical disorder is not there yet,” said Dr Subramanyam.

Dr Subramanyam has had children coming to her with learning disability and ADHD without undergoing any treatment or occupational therapy before. “In many ADHD children, the LD testing doesn’t show results,” she said.

She handled one such case three months ago, when a 15-year-old girl came to her. She was a quiet day dreamer and was simply unable to concentrate. During her exams, even a pencil falling could distract her to the extent that she would take nearly 5 minutes to get back to her train of thought. She was diagnosed with Attention deficit disorder (ADD) and was given medication for it.After a few months, she was tested for LD and her IQ rose, and she was showing clear learning disorder.

“In ADD, the information processing system is defective and the right impulses don’t reach the brain. The LD programme can be much better received after medication,” said Dr Rajendra Barve, clinical psychiatrist.

While many psychiatrists have this approach, the special educators who train children with learning disorder disagree and say that medication should be the last resort.

“Children with ADHD should first be administered occupational therapy, sensory integration so that their learning needs are met..If the child is improving, medication is not required,” said Deepika Aggarwal, special educator.

Dr Bhagwan Bandekar, occupational therapist from Education and Training Centre, Airoli, said, “One needs to modify the environment the child studies in to get their attention. First preference should not be medication.”

Dr Barve rubbished this approach and said, “These are half baked ideas. Pragmatism is more important in such situations.”

(Names of the patients have been changed)