Indefinitely lost in dreams

Children with learning disabilities are often termed as slow learners. They need special attention and help

 By Luavut Zahid

Your child can not concentrate in school, and doesn't seem to even want to try. He's always lost in some imaginary world or the other and has friends that you cannot see. He is extremely impulsive and at times severely hyper, to the point of annoying and infuriating everyone around him including you. This is not because your child is the very devil incarnate; in fact, he may have a brain disorder which causes him to act the way he does. Attention Deficit Disorder (ADD), also known as Attention Deficit Hyperactivity Disorder (ADHD) when there are additional evidences of hyperactivity and impulsiveness is a neurological disorder that mostly strikes children, but is also known to affect adults. Currently around 3-5% of the world's population has this disorder.

The real cause of ADD is at present unknown. Research is still being conducted on that front, however, geneticists have concurred that is it a genetic disorder and can be passed down from parent to child. Some studies suggest that the risk for ADD is greater in males and they are three times more likely to have the disorder. It has been discovered in many children with ADD that their brains, later in life, show abnormalities and structural differences; these abnormalities can be caused by a mother smoking or consuming alcohol or narcotics during pregnancy. At times children who have been exposed to high levels of lead also display ADD symptoms.  

The disorder, at the moment, can only be controlled; not cured. Identifying an individual with ADD is not all difficult. In children the most common symptoms are distractibility, difficulty with concentration and focus, short term memory loss, procrastination, problems organizing ideas and belongings, tardiness, impulsivity, and weak planning and execution. However, it is important to mention that not all children exhibit all of the above mentioned symptoms; some may only experience a combination of a few of these.

The main classification is between two groups i.e. those with poor attention and those who are hyperactive and impulsive. The tricky part is knowing who really is affected with ADD since almost all people demonstrate all of the above mentioned symtoms to a degree at some point or the other. The key is to note whether these symptoms are interefering with their ability to function as a whole. That is one of the problems in diagnosing the disorder. It is difficult because children do not have to deal with stressful situations where they would exhibit their symptoms clearly. Children with learning disabilities are often termed as slow learners. They need special attention and help.

During school life, children with ADD tend to have significant problems with their schoolwork. Such children need special attention and often benefit from one on one classes and care. Such children will have difficulty with planning, remembering things needed for school, getting their homework done on time etc. Often such children become extremely agreesive towards their peer groups and become social outcasts.

ADD can often cross into a person's teenage from their childhood and in rare cases is known to progress into adulthood as well. Some studies suggest that 60 percent of all children who have the disorder retain it throughout their lives. If not controlled at the appropriate time, the disorder can turn anyone's life topsy-turvy. People who have ADD have been known to perform poorly at school and work, they have weak social relationships and suffer from depression along with low self esteem.

An important fact is that people with ADD are not of lower intelligence or stupid. They may be highly intelligent but unable to truly express themselves which is why in most cases where they receive no real help they remain underachievers although they have the potential to be much more than that. 

The disorder goes hand-in-hand with many others. At times it can be caused by one of these disorders or can cause them itself. Some of them are Oppositional Defiant Disorder (ODD) where the person sucumbs to negativity and exhibits hostile behaviors towards all around him including family and friends. ODD is said to be prevalent in almost 50 percent of people diagnosed with ADD. Due to feelings of low self esteem and constant failures at work and school such people become antisocial and pessimistic. The conditions progress to the point where they begin stealing, fighting, destroying property, harming people and animals etc. along with this; depression and the anxiety disorder is another dangerous problem that these individuals might encounter.

Another problem is the treatment and medication for ADD. Some drugs such as Topamax which were previously thought to have minimal side effects have now been known to further cause brain damage in people instead of alleviating the problem of ADD. Persons who have been administered such drugs run the risk of having psychotic breakdowns and seizures in the future.

There are still a few ways to deal with the disorder. Other than medication, the ketosis diet can be followed which is said to have good results. It is basically a low carbohydrate diet which aims to synthesis the lipid ketone which the brain burns in order to utilise energy and reserve glucose. In this way depletion of the body's protein store in the muscles is avoided. However, at present the ketosis diet is still under research and schools of thought vary on whether it is effective or not. Although in some cases it has been said to drastically reduce symptoms of ADD.

People who have ADD need therapy and constant support. And by support one should know that they do not just need support in their daily lives but need emotional support from those around them. It is because such individuals have such a negative outlook and low opinion of themselves that they need to be continuously told that they can in fact do things on their own and they can do them right. Negative feedback and criticism will only make matters worse for such people.

Parents of such children need to take care to watch over their school work and help them whenever needed. Before using any medication, a proper note has to be taken of the side effects of the drug and the long term effects of the same. People that the ADD sufferer is in constant contact with need to be briefed about his/her condition so that they do not act in a discriminatory way or negative way towards the individual since it could have dire consequences for the person.

At the end the only thing to remember is that although incurable, ADD can be controlled. Which basically means people who have been suffering from the disorder can and most likely will lead very normal and successful lives only if they are given the chance to do so.

Combating clinical depression

The word 'depression' is a common way of expressing sadness, but in truth it is a very serious medical disorder

 By Ifra Asad 

You moan as you hear the alarm clock signalling the end of your restful sleep. You squint as the glare of the sunshine hits your eyes and you grumble as the birds' screeching hits your ears. Today's really not a good day, you think. And you decide not to get out of bed at all.

While some people would call this a Tuesday, for others, it holds a darker, grimmer meaning. There's a fine line that divides clinical depression from sadness, or just plain morning blues. In this case; diagnosing it is the crucial part. The word 'depression' today is a common way of expressing sadness, but in truth the word itself is a very serious ailment that has only recently been recognised as a medical disorder. It's important to understand the symptoms in order to differentiate it from plain sadness. These include:

•        a tearful disposition that lasts days, weeks, months, or maybe even years

•        a loss of interest in certain activities

•        a change in appetite; leading to change in weight

•           changing sleeping patters; insomnia (inability to sleep) or hypersomnia (too much sleep)

•           fatigue, lethargy, loss of energy everyday

•        a feeling of self-loathing, worthlessness, guilt

•           inability to make decisions, frequently changing one's mind

•        loss of concentration

•           persistent thought of suicide or death; a suicide attempt

•        a feeling of emptiness, and inability to feel emotion

•        fear of abandonment accompanied by feelings of isolation and loneliness.

There is debate as to whether these are the causes or the effects of depression, but the fact remains that any form of clinical depression can be dangerous. Its causes are foggy at best to the victim, but doctors have uncovered two sides to it: biological and psychological. According to doctors, depression is inherited; 40% in women and 30% in men. However, inherited genes of depression do not imply that one is destined to be depressed; other factors also come into play. It has also been seen hat people without any history of depression in their family fall victim to it. Current research focuses on the serotonin, norepinephrine and dopamine systems. The alteration of behaviour due to antidepressants suggests the brain chemistry's involvement in depression.

Psychological causes of depression are the usual ones that we hear of that trigger the start of this illness: an unwelcome change in life, relationship troubles, financial concerns, academic demands, social isolation, chronic illness, recent bereavements, neglect, rejection, or sexual abuse. The negative effects of childhood trauma can manifest themselves in the form of these breakdowns later on in life. A low self-esteem, helplessness, rape, assault, health problems or addictions are some other causes. The inability to deal with stress can lead to the feeling of hopelessness, which can spiral into this perpetual state of melancholy.

It's not all bad, however. Depression can be cured in various ways; medication, therapy, or just plain talking it out with someone can help a great deal. The right dosage along with the right combination of antidepressants is very effective; results can be seen in three to eight weeks. For chronic depression, medication is to be taken continually for the remainder of the victim's life; for moderate to severe depression, patients are advised to continue their medication for at least four months.

Apart from medication, therapy sessions with a psychiatrist can help minimize the negativities. Informal interviews that allow one to explore their feelings and get intimate with their own self help a person recover. This is known as psychotherapy, and the most studied form of psychotherapy for depression is known as cognitive behavioural therapy. This type of therapy helps people learn healthier behaviours; the most effective treatment is said to be a combination of medication and psychotherapy.

So, today was a bad day to get out of bed in the morning. That's fine, as long as that excuse lasts just today. If you feel this lack of motivation lingers, and is accompanied by the above mentioned symptoms, be warned, and get help.

Don't be scared!

Agoraphobia is the fear of being in places where escape might be difficult or help is not available

By Fatima Zakir

AYou may have heard or even seen people scared of the world around them. They may fear going out to places they don't know and may even avoid strangers. We might just ignore such symptoms claiming to it be attention seeking behaviour or put it down to some psychological problem. Yes, it sure is a disorder known as 'Agoraphobia'.

Agoraphobia is the fear of being in places where escape might be difficult or help is not available. It accounts for the majority of phobias. Places avoided by those with agoraphobia include most places outside of their known and secure environment including open spaces, driving a car, standing in queues, walking through crowds, and going through tunnels. Being exposed to these situations often results in physical symptoms of distress. They may eventually be able to travel outside their home only with a trusted person, on a limited basis.

Although the severity of the anxiety and the extent of avoidance behaviour are variable, this is the most incapacitating of the phobic disorders and some sufferers become completely housebound; many are terrified by the thought of collapsing and being left helpless in public. The lack of an immediately available exit is one of the key features of many of these agoraphobic situations. Most sufferers are women and the onset is usually early in adult life. Depressive and obsessional symptoms and social phobias may also be present, but do not dominate the clinical picture. In the absence of effective treatment, agoraphobia often becomes chronic, though usually fluctuating.

Diagnosis

All the following criteria should be fulfilled for a definite diagnosis:

* The psychological or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms, such as delusions or obsessional thoughts.

* Anxiety must be restricted to (or occur mainly in) at least two of the following situations: crowds, public places, travelling away from home, and travelling alone.

* Avoidance of the phobic situation must be, or have been, a prominent feature.

Differential diagnosis

It must be remembered that some agoraphobics experience little anxiety because they are consistently able to avoid their phobic situations. The presence of other symptoms such as depression, depersonalisation, obsessional symptoms and social phobias does not invalidate the diagnosis; provided that these symptoms do not dominate the clinical picture. However, if the patient was already significantly depressed when the phobic symptoms first appeared, depressive episode may be a more appropriate diagnosis.

Treatments

As with many other mental disorders, agoraphobia treatment typically includes a combination of medication and psychotherapy.

Medications

Antidepressant and anti-anxiety medications are commonly used to treat agoraphobia and panic symptoms. Among antidepressants, the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine and sertraline are recommended. Other types of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) also are sometimes used to treat agoraphobia. But TCAs and MAOIs tend to have more side effects and more serious side effects than SSRIs.

Anti-anxiety medications, also called benzodiazepines, can help control symptoms of anxiety and panic attacks. These may include alprazolam, clonazepam and others.

Psychotherapy

Several types of psychotherapy or counselling can help agoraphobia. Several research studies have shown that cognitive behaviour therapy may be the best for agoraphobia. Behaviour therapy shows positive results too. It involves changing unwanted or unhealthy behaviours through desensitisation, sometimes called exposure therapy. This technique helps you safely confront the places and situations that cause fear and anxiety. A therapist may accompany you on excursions to help you remain safe and comfortable, such as trips to the mall or driving your car. Through gradual practice, people with agoraphobia learn that the fears don't come true and their anxiety goes away with time.

If you have trouble leaving your home, you may wonder how you can possibly venture out to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer initial appointments at your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through e-mail. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed.

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