Monday, March 31, 2014

Does my child have ADHD?

There has been a sharp increase in kids getting diagnosed with Attention Deficit Hyperactivity Disorder. Many medical professionals believe that it existed in high percentages even before but the primary healthcare professional wasn't aware of it and hence did not refer the child to an expert. There are others who insist that the percentages are high because of overdiagnosis or wrong diagnostic criteria applied to high energy kids.

A host of factors including  low birth weight,  intake of alcohol or smoking in pregnancy, neglect and abuse, ingestion of toxic substances or food coloring , sustained and repetitive sensory bombardment by electronic gadgetry and media, lack of unstructured free play has been blamed. Whatever the cause, we are looking at ADHD and ADD in gigantic proportions. 

So, as a parent what should we look for if we suspect our child of having the disorder? When should a parent seek professional help?
1. If your child shows activity levels higher than what is seen in kids of his age
2. If the increased activity is serving no purpose. Eg. Running from one student to another without a specific goal such as conversation or borrowing school supplies, instead just touching them.
3. Picking up everything they see to touch and play.
4. If the activity levels interfere in doing his developmental tasks such as Sitting down for dinner at a restaurant, reading a bed time book, making and sustaining peer level friendships.
5. If your child is easily distracted by the slightest sensory input in a very structured environment.  E.g. Getting distracted by another child coughing during a structured activity in a classroom.
6. If he fidgets and squirms a lot.
7. If your child shows low impulse control. He/ she talks a lot, interrupts people and blurts inappropriate comments.
8. If your child has trouble controlling emotions.
9. Moves from one task to another without completing it
10. Has trouble with directions and multiple instructions.

If you see some of the these signs in your child,  it is time to get an expert opinion. Because the sooner the diagnosis is made, the earlier you can start therapy and remediation. A combination of medication and therapy is prescribed for severe cases though most mild to moderate cases can be treated with behavior therapy, alone.

Monday, March 24, 2014

The joy of learning

I was at the University of Washington campus for the annual event of watching the cherry tree blossoms in all their glory all around the Quad. It was a beautiful sight, indeed. But, far more inspiring were the old heritage buildings beckoning me with their promises of hidden knowledge and unexplored learnings. I wanted to go back to being a student, sitting in a lecture hall with a talented teacher waxing eloquence on the theories of Sigmund Freud and such. I was motivated, inspired and hopeful. The lure of education and learning does that to me.

Hours later, I came home to an email with a powerpoint attachment, very professionally made, with just the right amount of content and hook to intice young teachers, for whom it was meant. It was a delightful way to end my day.

Most of us have graduated and even gone on to do our post graduate studies, often with the sole purpose of landing that dream job that would take care of our existential and utilitarian needs. How many of us have experienced the liberating feeling that comes from learning a new precept without the worrisome assignment//exam, in the near future. I had very ordinary teachers ( barring a couple) throughout my school and undergrad days. I performed well but did not learn much.

It was only later in life when I realised the importance of great universities housing talented teachers. These teachers were inspiring, mentoring and guiding us to find our Chosen path. They motivated and encouraged me to be curious and explore my way through the curriculum. This time round, not only did I do well but I gained a lot of insight into the subject.

Even today, I continue to learn from my teachers. Its just that they have now taken the form of an elder, a parent, a friend, a book. I search for them in every interaction and drink up from their exhaustive reservoir of experiences, knowledge, supervision and advice. I derive clarity from them, I get a new perspective and I grow calmer and more introspective. What more do I want from life?

If there is anything I would wish for my young school going clients, it would be to be blessed with a good mentor, guide and teacher. Everything else will fall into place.

Monday, March 17, 2014

Marriage myths

If you are married and feel disillusioned with the way things are between you and your partner, read on………you will relate to what I am saying. Go back and remember the moment you share your happy betrothed state to a friend. I am sure you were bombarded with a varied mix of definitions of marriage and the (fairy?) tales involved. If you had paid close attention you would surely have fathomed the myths mixed up in that salad of anecdotes and classifications.

Inspite of the abundant collective experience of marriages that mankind has, it is surprising that the myths surrounding it are copious and profuse. Myths…because they seem so real but in reality are just inventions of the fertile mind and heart. Many myths that surround marriage give couples unrealistic expectations. 
Some of the myths can be very misleading and could very well set your relationship up for a lingering dissatisfaction or a disappointing end.

I am whole when I am with him……She completes me....Together we are a whole: Haven’t you heard this many times? If you do not perceive yourself as a whole self sufficient stable entity, you will go looking for someone who will make you feel (feel being the operative word) whole. Isn’t that too big a burden for your partner to carry? If s/he is busy making you feel whole, then how is s/he to feel fulfilled in your company. What are you adding to the alliance as his/her partner? Find yourself first and you could be two wholes in one relationship. Now, that is a good marriage.

I only need love: Really???!! Most couples will tell you that the overt gestures of love disappear in a few months of the marriage. And even the covert ones aren’t enough to sustain the relationship. What good is a partner who stays up with you when you are sick and misses his professional deadlines the next day because he did not get enough sleep…worse it’s a trend. Will love pay the rent and put the kids into college (well, I am assuming you are going to have kids)? Love is never enough. You need trust, stability, dependability, faith, honesty, reliability and so much more for a successful happy marriage.

Never take your partner for granted: I admit I am guilty of believing this one myself and would take offense to my partner taking me for granted. But, it is still a myth. If I cannot take my I-will-love-you-even-with-your-morning-breath soul mate for granted then who am I supposed to count on in my hour of need? With overly individualistic family members, unreliable maids and vacillating body mass, he is the only enduring truth in my life. I say, you should take the middle path and lean on your partner when you need to……without allowing it to become an everyday occurrence.

Marriage will make me happy: No marriage can make you happy. The unhappiness that probably you feel now is a function of your mental perceptions and conclusions that you draw in a given scenario. Unless you change your point of view, the sadness/frustration/disappointment will remain. Change your glasses, look anew at the source of your feeling and happiness will be right at your door. As a bonus, you will be rewarded with happiness in your relationship.

Gods and their feet of clay: I have heard my friends boast about how perfect their partner is. They even say so to their other halves in a misguided attempt to compliment them. The truth is all of us have our imperfections….small blemishes and big flaws. That is what makes us human….. and unique as well. To have a partner deny that and look at you as a demi-god can be powerful….. for a second, but too big a responsibility, the next. I mean, it involves being mature and right all the time. How many of you will survive this label……will you act out against it or meekly accept a role that is not you….can never be you? And, more importantly, will the marriage survive it. See your partner for who he/she is and love the human quirks and idiosyncrasies that are uniquely his/her.

Happily ever after: The fairy tale ending is just that …a fairy tale. In real life there are chores at home, traffic jams, office and family politics, bills and EMIs, cranky kids…..the list goes on. Any marriage based on the precept of Cinderella and her Prince will bite the dust. A more realistic way of looking at a marriage is that, now you have a partner to share that load with and find solutions for. You will have happy times and there will be challenges along the way. If you are pragmatic about it, you will have a better shot at a good marriage.

Don’t make a big deal out of sex: We live in an age when sex is discussed more easily, is depicted very often in movies and is talked about openly ….. but I have often seen it dismissed as just sex. In the marriage, sex or its lack therein can mean disappointment, stress at work, physical and mental fatigue, anxiety, hurt and so on. Examine any change in the sexual rhythm and communicate with your partner about it. Just that dialogue could set it right. Sex is very important in a marriage. Never forget that.

Kids will bring us closer: I have heard this one so many times, its no longer funny. Anyone who has kids can tell you that the arrival of a child though very joyous an occasion can be tiring and tedious and catch your marriage by the coat tails. The feeding cycles, diaper duty and house chores can keep you too busy to even notice your partner…forget feeling close to him/her. Most couples I know and see in my clinic call those days a roller coaster of emotions interspersed with thunderous arguments and vociferous accusations. If you are planning on starting a family, do so with a healthy dose of reality. Your relationship will now function on a different plane and as is the case with every new job, it will take some time for things to settle down. Till then keep the faith 

There are many other myths floating around….supposedly based on empirical evidence. That itself should alert you to their presence. Every marriage is special and unique and so are the two people involved in it. Empirical evidence in this scenario is bound to be flawed.
Enjoy the fact that you have found someone special to share your life with. Don’t downgrade your relationship by subjecting it to the generalities and fables at hand. By doing so, you have everything to lose.

Reproduced from Gaurai Uddanwadiker's article- Complete Wellbeing August 2012

Saturday, March 8, 2014

Happy Woman's Day

Its International Women's Day. I saw atleast a million generic messages congratulating me for being the gender I am or thanking me for what I a difference I have made in their lives. I don't know if I should be thankful or dismissive of this gratitude showered on my sex.

I feel unaffected by this yearly hoopla around celebrating women and their womanhood because on other 364 days, I find a complete lack of regard for her. And I am not even talking about severe cases where abuse, violence and total disregard for her personal space and person is the norm. I am talking about how women are taken for granted in seemingly happy, well adjusted families.

A typical Indian girl from an educated middle class family is raised with the same expectations as her brother. She is expected to study well and find herself a satisfying career that allows her to provide for herself. The focus is on academics and not so much on learning household activities. She is free to pursue her dreams while being provided with material means to do so. All is great till this point.

Then she reaches the marriageable age....and parents suddenly do a volte face. She is now expected to take an interest in cooking, traditional religious activities, and wear age appropriate clothing (read non western clothing!)  If she chooses her own partner (God forbid), she will also have to go through an acid test of being vetted by his family and other sundry well wishers. Her past life will be put under the microscope before she is approved of. An arranged marriage, in addition to the scrutiny, will mean being subjected, a few times, to rejection in the marriage market for a seemingly present flaw in her physical appearance.  The compromises and adjustments will continue after marriage, too. After all she is the one entering the new family. She has to change. The concept of making her feel welcome or giving her time to adjust to the new way of life is not under consideration.

The husband, now, has the responsibility of keeping his parents happy and their wishes fulfilled, his wife's dreams/ family be damned. So more changes for the girl woman. All this while, she is trying to work her way into a good career. Managing the balance of running a house, different expectations from the new adopted family, her own desires from these new relationships, her career aspirations is supposed to come easy to her. Any outburst, any bout of anger, any expression of  unfettered thought is dissected, judged and commented upon or filed under a stereotype. In all fairness, many partners lend an ear to their wives. But, they too continue to sit on the fence, lest they hurt either their families or their wives. All the promises of support, protection and giving happiness made during the marital rituals are forgotten in the name of family harmony. The girl women is alone fighting her battles , often keeping her priorities aside to keep the new family happy.

Parenthood brings more challenges for her. Raising the children is primarily her responsibility. Vaccinations, illnesses, school activities are her domain for which she makes changes in her work schedule. The mother is better capable of handling and raising the child......maternal instinct and all that!!! The father is busy earning the money for the family's comfort and security. By this time , the woman has made so many compromises in her career that she can never provide for the family as well as her husband or climb back on in the driver's seat, professionally. Those who chose to continue at full blast in their professional lives are accused of neglecting their children. Its a no win for her.

This is the ground reality of today's young middle class woman in India and till this unconscious, unintentional neglect of her inner self continues, celebrating her womanhood for a day is meaningless.

Monday, March 3, 2014

Structure and Routine

I cannot emphasize enough on Structure and Routine in a child's life. Structure is about having a planned day, divided into meal times, study times, structured play times, unstructured leisure and sleep times. Routine is all about doing these things at a specific time, in a specific way.

Let me explain further. Infants, toddlers, young children and adolescents have a very high need for exploration fueled by their natural curiosity. This tendency allows them to learn new things through experience and master some age appropriate skills (playing peek-a-boo teaches a toddler about object permanence, searching for toys teaches the preschooler figure ground perception, learning numbers at school allows him to count his toys, taking part in sports teaches a teenager team spirit etc). But like any exploratory activity, it has risks of the unknown (will my mom who is hiding behind the chair come back? or will I ever find my favourite toy in the toy chest? or will my classmates laugh at me if I don't say the numbers in the right order, will I become a laughing stock with the girls if I don't score a single goal). It may seem like an insignificant thing to an adult but it causes unconscious anxiety and fear in the kids. The automatic response to anxiety (or any stress) is to seek to decrease it.

Feeling safe and protected brings down the anxiety. As parents we provide that through hugs, reassurance and love but it also makes them dependant on us. And, we may not be around all the time. Mom and Dad have to go to work, the kid needs to go to day care or school where the teacher may not have the time to attend to every child. The resultant anxiety could manifest into clinging behavior, frequent crying or temper tantrums, defiant behavior, truancy, experimentation with addictive substances etc.

The only way to decrease this anxiety and help the child cope with the daily struggles of navigating the complex world is by providing the safety net of sameness of routine and structure. Knowing that Mom will pick me up from school after lunch, Dad will read me a story at bedtime, we will have a meal together every night or that I will go for swim lessons every weekend after breakfast can be very reassuring to a child.

Predictability is encouraging and adds to the reserve strength to deal with the other unpredictable inevitabilities of life.

Sameness breeds security, develops confidence to explore new things and take risks. The presence of routine and structure is like a launch pad for the child to learn new things, understand his strengths and explore his potential. Does it then mean that if we have structure and routine in our lives, we will raise confident and successful kids? No. But we will certainly raise kids who are confident enough to try new things, who seek resolution of their stress in adaptive routines and who will focus on reaching their potential.