Introduction to the Meeting: Attention Deficit Hyperactivity Disorder (ADHD)
Peace be upon you, esteemed guests, in this meeting we previously announced titled: "Attention Deficit Hyperactivity Disorder (ADHD)... Diagnosis and Misdiagnosis" or what is known as (Miss Diagnosis). In this meeting, we will discuss the symptoms of this disorder, and the common mistakes that occur in its diagnosis, whether by not noticing some cases, or on the contrary, overdiagnosis; is every increase in a child's activity considered a disorder? What are the other conditions whose symptoms resemble this disorder known as differential diagnosis (Differential Diagnosis)? And what are the appropriate treatments?
This meeting is hosted by Dr. Yusuf Muslim, holder of a PhD in cognitive-behavioral therapy and the general director of the "Kalima" Center for Cognitive Behavioral Sciences, to share with us his practical experience spanning over 22 years in the field of psychological assessment and treatment.
The Importance of Accurate Diagnosis
This lecture comes as a result of the real need of people and the frequent inquiries about the topic of ADHD. Mastering accurate psychological diagnosis is the key to mastering treatment later. What appears before us as behaviors may actually be "symptoms" of an internal problem and not just voluntary behavior.
Imagine a child who feels like there is a "motor" running inside him and is required to be calm; this child suffers in silence because people think that what he does is bad manners, while the truth is that it is internal disorders that move him and not his will or desire.
The Story of "Hassan": An Illustrative Model of Symptoms
Hassan is a 9-year-old child, a third-grade student, who always receives warnings and reprimands at school. He is always told: "Hassan, why can't you calm down? Why can't you pay attention? Why do you distract your classmates?" At home, he is asked to go and do something and then gets distracted and forgets, so he is punished for his forgetfulness.
Even while watching television, he cannot sit still; he fidgets, plays with his legs, or bites his nails. In social situations, he may interrupt adults while they are speaking impulsively, making others describe him as "impolite." With his friends, he faces difficulties because he always wants to be in charge and does not accept mistakes easily. Hassan does not choose to be this way; rather, these behaviors happen to him "involuntarily" as a result of the disorder.
Main Axes for Diagnosing ADHD
The disorder is divided into three main axes, and it is required for the child to have (6 points out of 9) in each axis for diagnosis:
First: Axis of Inattention and Concentration
Children here are not completely unable to concentrate, but they cannot "sustain" it. The most prominent points of this axis are:
- Not paying attention to details and making many mistakes in school assignments.
- Difficulty sustaining attention, especially in tasks that require mental effort (while they may concentrate in video games because it is a different type of non-taxing concentration).
- It seems like he does not listen when spoken to directly.
- Difficulty following long instructions and completing routine tasks.
- Weak organizational skills and avoiding mentally taxing tasks.
- Frequent loss of personal items (books, pens, jackets) due to mental distraction.
- Easy distraction by any external stimulus and frequent forgetfulness.
Second and Third: Hyperactivity and Impulsivity
Hyperactivity is shown through:
- Constant fidgeting and moving hands and feet while sitting.
- Leaving the seat in situations where sitting is expected (such as in class).
- Excessive running or climbing in inappropriate places.
- Difficulty playing quietly (they tend to prefer noisy physical games).
- Excessive talking (sometimes described as "lathering more than shampoo").
As for impulsivity, it is shown through:
- Hurrying to answer before the question is complete.
- Difficulty waiting for one's turn.
- Intruding on others and interrupting them in their conversations or games.
Diagnostic Errors and Differential Diagnosis
There is a percentage of up to 20% of misdiagnosis. For example, children suffering from "tonsillitis" or breathing problems do not get enough oxygen, leading to behavioral symptoms that resemble ADHD, such as excessive activity and lack of concentration. Once the respiratory problem is treated, these symptoms disappear.
It is also necessary to differentiate between ADHD and:
- Learning disabilities: such as dyslexia, which may cause distraction resulting from frustration with the academic material.
- Autism spectrum disorder: although there is sometimes an overlap, autism has its own symptoms related to social communication and repetitive patterns.
- Psychological problems: such as anxiety or depression in children, which may manifest as "agitation," continuous movement, and discomfort.
Psychological and Social Effects of the Disorder
When the child with ADHD is not understood, those around him (parents and teachers) resort to punishment and constant blame, which leads to complicating the problem and the emergence of defensive behaviors or behavioral deviations:
1. Negative Self-Concept
The child begins to see himself as a "not good" or "unloved" person because he is constantly criticized. This feeling sometimes drives him to intentionally engage in bad behaviors (defiance or "acting out"), or try to gain the acceptance of peers in wrong ways, such as becoming the "class clown" or volunteering to annoy the teacher to make his classmates laugh.
2. Behavioral Deviance and Impulsivity
Due to high impulsivity, the adolescent with ADHD may be attracted to "risky activities" or bad company to find the acceptance he has lost in his family. The situation may develop into lying to avoid punishment, or even theft and aggression as a way to assert himself in unregulated environments.
Treatment and Management Strategies (8 Main Axes)
Dealing with ADHD cases depends on a comprehensive protocol that goes beyond just medication:
- Engagement in Life: Encouraging the child to participate in sports activities, understanding his tendency to switch activities due to quick boredom.
- Family Awareness: Parents are the "eyes and ears" at home, and their understanding of the disorder is half of the treatment.
- Changing Self-Concept: Working on changing the child's negative beliefs about himself and reinforcing his strengths.
- Stress Management: Teaching the child how to deal with stressful situations that increase his agitation.
- Problem-Solving Skills: Training him in simple skills to organize priorities.
- Assertive Communication: Teaching him how to express his needs and rights firmly without aggression or acting out.
- Self-Regulation: Training the child to "self-talk" while performing tasks (for example: he pronounces the steps of solving a problem aloud), which helps him be aware of his mind and reduce impulsivity.
- Delaying Gratification: Training him to be patient and tolerate temporary discomfort instead of immediate reaction.
Clinical Diagnosis and the "Coincidence Syndrome"
Dr. Yusuf explained an important term: the "Coincidence Syndrome", where symptoms resembling ADHD may coincide due to environmental circumstances (such as family problems, bullying at school, depression), while the root cause is not a neurological disorder.
Therefore, accurate diagnosis is not achieved in "ten minutes," but requires:
- Contextual diagnosis: Understanding the child's environment and family relationships.
- Multiple sources: Obtaining assessments from parents and school (in different academic subjects).
- Cognitive ability tests: To measure memory span and analytical ability, as it has been found that more than 50% of those with ADHD have a very high intelligence level.
Q&A Section
Is there a relationship between electronic devices and the disorder?
There is no conclusive scientific evidence that electronic devices "cause" the disorder, but spending a long time in front of screens increases the severity of existing symptoms and leads to a decline in the desire for traditional learning.
What about drug treatment?
Drug treatment (such as Methylphenidate) is considered a "mainstay" in severe cases that disrupt life functions. The medication helps the child functionally with focus and activity control, and does not necessarily mean lifelong continuation; it can be gradually withdrawn when behavioral and functional skills improve.
Does the disorder disappear in adults?
Symptoms persist in about 20% of those affected until adulthood. Affected adults may experience work scatter or marital relationship problems, but they often compensate with their high intelligence. The topic of "ADHD in adults" deserves a special session due to its importance and impact on social roles.
Final advice for parents
We must differentiate between "symptoms" and "behavior." What parents may perceive as a lack of manners is often a symptom of a disorder that requires treatment and understanding. The real cost is not in the treatment price, but in the "cost of not treating," which may lead to the loss of the child's academic and social future.
Continued Q&A Section
Is there a relationship between ADHD disorder and enuresis?
Through practical experience, there is no direct or necessary connection between the two issues; each follows a different diagnostic path, although anxiety resulting from poor handling of the child with hyperactivity may sometimes lead to secondary behavioral problems.
Do anti-epileptic drugs cause similar symptoms?
Yes, in some cases, anti-epileptic drugs or the presence of epileptic foci (excessive charges) may lead to attention scatter or irregular activity. Therefore, it is necessary to conduct a brain mapping (EEG) in cases where the doctor suspects a neurological overlap, to ensure that the diagnosis is not just a "symptom similarity."
The importance of the integrated diagnostic team
Accurate diagnosis does not depend on a single test (such as the TOVA test); the TOVA test is a computer tool that measures response and concentration for 20 minutes, and it is a good predictive tool but not sufficient alone to confirm the diagnosis. The ideal diagnosis requires a team that includes:
- The psychiatrist: To evaluate the organic and drug condition.
- The psychologist: For behavioral and cognitive assessment and intelligence tests.
- The occupational therapist: To assess sensory integration, motor, and functional abilities.
The Perspective of the "Islamic Psychological Concepts School" in Dealing with the Disorder
Dr. Yusuf discussed the importance of building a psychological theory based on Islamic heritage (such as the literature of Ibn Qayyim and others), where the human being is viewed through three dimensions: capacity, will, and responsibility.
Legal Responsibility and Accountability
Regarding the child with ADHD:
- Before puberty: The child is not legally responsible in principle, and his high impulsivity makes him more deserving of understanding and treatment rather than punishment.
- After puberty: The human being remains responsible unless he loses insight or reason (such as cases of madness or schizophrenia). The person with ADHD may find it "difficult" to control his impulses, but he remains aware and responsible for his actions. God Almighty holds servants accountable according to the abilities He has given them, and our role is to help them acquire tools for "self-control" to reduce the severity of these impulses.
Conclusion and Recommendations
ADHD is not a "lifelong sentence" of failure, but a neurological nature that requires an understanding environment. Many creators and successful people (doctors, engineers, artists) are affected by this disorder, but they have been able to channel their high energy and intelligence into positive paths.
Final messages for parents:
- Look for the cause: Before punishing your child for his movements, make sure his sleep, breathing, and vitamin levels are healthy.
- Diagnosis is a trust: Do not accept a quick diagnosis in a single session; ask for a comprehensive and contextual evaluation.
- Medication is a means, not an end: Medication helps in "controlling the wave" so that the child can learn behavioral skills, and it is safe if used under precise supervision.
- Positive reinforcement: Look for the "bright side" in your child; they are often helpful, creative, and have leadership energy if directed correctly.
We thank Dr. Yusuf Muslim for this enrichment and promise you upcoming sessions on "ADHD in Adults" and "Atheism as a Psychological Phenomenon" from the perspective of the Islamic Psychological Concepts School.
End of summary.