Childhood ADHD & conduct disorders

Raising children is difficult. But raising difficult children can be flat-out life altering! Here, DR TRISHA UPADHYAYA of Osler Health International shares how to recognise some of the key characteristics of common behavioural disorders in children, including ADHD, conduct disorder and oppositional defiant disorder – and how you can act on any concerns you might have.

Child challenges

Behaviour and emotional dysregulation are normal for children as they go through different phases of physical, mental, emotional and social development. Of course, there are also mental and behavioural problems that can affect children. They may coincide together, with other emotional problems, mood disorders or family circumstances aggravating their condition, explains Dr Trisha.

At Osler Health International’s Star Vista clinic, she provides primary care to patients of all ages, including children right from birth. The following list comprises the most common behavioural disorders she sees in children.

#1 Conduct disorders

Often called antisocial behaviour, conduct disorders are a group of disorders with varying difficulties in controlling aggressive behaviour, self-control and impulses. They are the most common mental and behavioural problems in young people worldwide. Typical behaviours of a child with conduct disorder include:

• refusal to obey parents or other authority figures
• lack of empathy towards others
• lying or stealing without any sign of remorse or guilt when caught
• being aggressive towards animals and other people
• involvement in more violent physical fights, often with the use of weapons
• showing behaviours such as bullying, physical or sexual abuse
• refusal to follow rules
• breaking the law
• tendencies to run away from home

#2 Oppositional defiant disorder (ODD)

Oppositional defiant disorder (ODD) is a milder form of antisocial behaviour that’s mostly seen in younger children. Some characteristics of ODD may include:

• getting easily annoyed, irritated or angered
• arguing with authority figures and refusing to comply with their requests
• refusal to obey rules
• deliberately annoying others
• blaming others for their mistakes or misbehaviour
• low self-esteem

#3 Attention deficit hyperactivity disorder (ADHD)

ADHD is the second most common neuro-behavioural disorder in children and is primarily diagnosed by three main symptoms: inattention, hyperactivity and impulsivity. These ADHD symptoms lead to an impairment in the functioning of children in many different settings. Children with ADHD may struggle with:

• concentration
• sitting still during movies, meals or in the classroom
• completing tasks and getting ready for school
• forgetting instructions or what they were doing
• losing things and having unintentional accidents
• peer relationships and even parent-child relationships
• being bullied or easily influenced for thoughtless acts
• road safety and other types of danger awareness; this usually necessitates high levels of adult supervision

While there are no single causative factors for these disorders, there are certain associated risk factors, says Dr Trisha. For instance, boys are more likely than girls to suffer from behavioural disorders. Additionally, the likelihood of developing behavioural issues is higher for children with learning difficulties, low birth weight or premature birth, and in families where domestic violence, poverty, inappropriate parenting skills or substance abuse are problems, she says.

Disorder or phase?

No doubt, as parents, a child’s challenging or peculiar behaviour can be worrisome – even all-consuming. But, just because your six-year-old son throws caution to the wind doesn’t necessarily mean he’s got a condition. Even if your toddler gets aggressive with the dog, it doesn’t mean she has a conduct disorder.

So, how do you know if it’s an actual disorder that needs further assessment or just a passing phase? Dr Trisha says it can be difficult for parents, teachers and even healthcare professionals to judge whether a behaviour is atypical or a significant problem. She recommends paying attention to different features of the behaviour in question, including its frequency, how long it has been occurring and what kind of impact it’s having, particularly in the child’s relationships with parents, siblings, teachers and peers.

She says it’s also helpful to take note of the setting in which the behaviour occurs. “Is it only at home, or does the behaviour occur regardless of the setting the child is in?”

How your GP can help

“If you’re concerned about your child’s behaviour, you should consult your family doctor who knows you, your child and your family well. They can perform an initial assessment and refer you to the appropriate healthcare professionals for the next steps,” says Dr Trisha.

“Diagnosis and care for a conduct disorder or ADHD takes time and requires specialised medical, psychological, speech and language assessment and follow-up. A GP can coordinate and provide this extensive care as early as possible.”

In fact, she believes that early diagnosis and management are key in helping to support children through their younger formative years, and throughout adolescence and beyond.

“Individuals who suffer from these disorders and aren’t given the right care tend to grow up to be antisocial adults, often with deprived, underprivileged and destructive lifestyles,” says Dr Trisha. “Recognising behavioural disorders early on means that more immediate guidance and care can be provided to your child, you and your family, teachers and schools.”

The management of behavioural disorders, she adds, is multi-faceted. It involves parental education on how to communicate with children effectively, family-based therapy and specific therapy for children such as cognitive behavioural or anger management. A doctor may also recommend the use of certain medications, particularly to help with some troubling impulsive behaviours.

Osler Health International
• #02-27/02-34 Raffles Hotel Arcade, 328 North Bridge Road | 6332 2727
• #B1-27 The Star Vista, 1 Vista Exchange Green | 6339 2727
osler-health.com

This article first appeared in the September 2022 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!