Is your ADHD teenager ready for hostel?

ADHD teens with appropriate life skills can live independently

Does your teenager with ADHD have the life skills to survive in hostel? She did well in her 12th board exams and scored high in the CET. To attend the engineering college of her choice she has to move from home to a hostel in another city. Given her difficulty organising her daily schedule, would she be better off doing the same subjects at the local engineering college? The answer would depend on her personality and the life skills she has acquired.

ADHD teenager personality types

Teenagers with ADHD are of 3 character types: the optimistic, the terrified and the lost. They are placed into these categories depending on their productivity and anxiety (either too much or too little).

• The optimistic teen does not worry. He is excited about the independence that college life will bring, but may not realise that freedom comes with responsibilities (financial, social and personal). If he's still disorganised at home he will be more so in hostel where the distractions are multiple and there is no guiding hand.
• The terrified teen is intensely anxious. She needs reassurance and help in planning the future step by step. If she still waits for you to clear her way round a difficulty she will hesitate to seek help when she is in hostel.
• The lost teen displays a lack of energy and positive view towards life. He is easily depressed and defeated. He has to be repeatedly reminded and encouraged to do what needs to be done. If you still have to push him to get work done he's unlikely to function well from hostel.

Life skills for teenagers with ADHD

ADHD hinders development of the  coping and self-management component of life skills due to inattention and impulsivity. Adolescents with ADHD need to focus on three aspects of this component for transition to independent living away from home.

1. Motivation is first – there has to be the will to achieve. The ADHD teen needs clear goals and has to evaluate them objectively — are they achievable? Clear short-term, mid-term and long term goals are necessary – persistence is required. If a particular course is not available in the local colleges, can he take the initiative to locate an alumnus from school who is pursuing the same elsewhere? He must make a list of pros and cons  – then make a choice – and not procrastinate.
   
2. Time management is a big challenge for most students with ADHD. They should not take on too much initially. ADD adolescents should concentrate on their classes, keep track of assignments, and organize daily notes. They should use a planner to schedule daily activities. A large calendar on the wall for upcoming assignments, project submissions, and exam dates is a big help. The teenager with ADHD needs to get to know her limits, then push them a little at a time to see if more is achievable. She should set some daily routines – get up at the same time everyday, have healthy, regular meals (this is often neglected when staying away from home), and do the laundry.
   Attendance at classes is non-negotiable (all colleges insist on a minimum attendance). The teenager with ADHD must ensure she takes her medication on time and follow-up regularly for refills. When taking a break she should do something that has a limited time span. For example she could read a few pages of a book, watch TV for 15 minutes, or chat with a friend for 10 min.  She must make time for the additional administrative tasks college entails: paying her college fees, creating and sticking to a budget, making time to go to the ATM. These tasks should be entered in the weekly planner.
3. Self-understanding and awareness of strengths and challenges is the key to making intelligent choices. The ADHD adolescent should not hesitate to seek help, from teachers, friends and the counsellor specially if falling back in his schedule. Strategies for learning and study skills training with the counsellor are helpful.

The ADD teenager, like any other adolescent, is transitioning from dependence on the family to increasing adult independence. The life skills he acquires would dictate the ease of this transition. Teenagers with ADHD who have acquired the necessary life skills would be better able to cope with the transition from home to hostel without adversely affecting academic performance.

References

1. Economic and Social Commission for Asia and the Pacific. Life Skills Training Guide for Young People. United Nations. 2003 (Accessed 08-Nov-2014)
2. ADDitude. The Real Whirled: 8 Essential Life Skills for ADHD Teens. Accessed 25-Nov-14.

Work style and employee selection

Use work style assessment to hire the best - and avoid the rest

Work style is a combination of personality traits that are relevant and specific to the workplace. Work style is highly predictive of job performance and employee behaviour. Differences in working style explain how people with similar knowledge, ability, goals, and desire to perform differ in the actual performance of their jobs. In today's complex business environment talent selection is critical and is at the top of a manager's list of priorities. Selecting employees for job-relevant personality traits improves job performance in the organisation.

Work style and job performance

Individuals differ in job performance despite having similar task abilities. The personality traits the individual brings to the organization along with abilities, interests, education, and experience, are responsible for this difference. Personality traits are a major contributor to variations in job performance. The unique personality an individual brings to the workplace is visible as working style - a combination of work habits and self-regulatory ability. Work style has two aspects - work habits and self-regulation.

Work habits are patterns of behavior that people learn over time that can facilitate or interfere with job performance. They include characteristic motivational responses such as choices for the amount, intensity, and duration of effort to expend. They explain why you would give the job to Neha in certain situations and to Riya in some others.  Work habits include characteristic responses that are not necessarily motivational in nature. This is seen when Rahul, your sales representative who has been trained in the best way to deal with an angry customer and has shown the ability to do so,occasionally reverts to pre-training habits of reacting with hostility.

Self-regulation is the thinking process that allocates attention, time, and effort toward attaining a goal. Self-regulation protects an intention from distraction. Priya’s characteristic tendency may be to exert as little effort as possible, but she may choose to go against that tendency in response to the new bonus structure that rewards productivity. Habits influence behavior despite intentions to behave otherwise because they require very little attention. To implement an intention that goes against habitual tendencies and distractions, one must engage self-regulatory or volitional mechanisms. This self-regulatory construct of working style is very important because it is strongly related to personality.

Modern psychometric tools that accurately measure human potential have been proven to

1. enhance overall productivity
2. reduce employee attrition
3. reduce overall hiring costs significantly.

Work style assessment measures traits such as initiative, integrity, persistence, leadership, stress tolerance, analytical thinking, and interpersonal skills. Higher performance can be obtained across all jobs if one hires employees who are highly conscientious and emotionally stable. Other personality traits (Extraversion, Agreeableness, and Openness to Experience) result in higher performance depending on whether these traits are relevant to the actual job activities.  Hiring right mitigates short- and long term damage to the business from a very bad hire. Work style assessment generates a profile of personality traits that can be matched with requirements for successful performance in a particular job.

References

1. Bouton M, Moore M. J Med Pract Manage. The cult of personality testing: why assessments are essential for employee selection. 2011 Nov-Dec;27(3):144-9.
2. Jeff W. Johnson. Toward a Better Understanding of the Relationship Between Personality and Individual Job Performance. In: Personality and work : reconsidering the role of personality in organizations. Murray R. Barrick, Ann Marie Ryan, editors; foreword by Neil Schmitt. John Wiley & Sons, USA. 2003. Pg 83-120

ADHD Diet - practical family meals

Practical ADHD diet for the family

ADHD Diet

A high-protein, low-sugar ADHD diet can help improve ADHD symptoms in children. Parents of children with ADHD are overwhelmed with dietary advice that is often time-consuming and disruptive to the household. However, this need not be so. Research shows it is feasible to incorporate an ADHD diet as part of an ongoing ADHD treatment program. Medication with behaviour modification is the backbone of ADHD treatment. A practical diet can be incorporated into the family routine to supplement ADHD treatment.

High Protein

Foods rich in protein - poultry, fish, eggs, beans, nuts, soy, mutton and low-fat dairy products (milk, paneer, cheese) - may have beneficial effects on ADHD symptoms.

Protein-rich foods are used by the brain to make neurotransmitters, the chemicals released by brain cells to communicate with each other. Protein can prevent surges in blood sugar, which increase hyperactivity. Giving your child protein for breakfast will help his body produce brain-awakening neurotransmitters. Combining protein with complex carbohydrates that are high in fibre and low in sugar will help your child manage ADHD symptoms better during the day.

Low Sugar

Eating simple processed carbohydrates, like white bread and jam, is almost the same as feeding your child sugar! Sugar surges are shown to increase inattention in children with ADHD. The body digests these processed carbohydrates into glucose (sugar) so quickly that the effect is virtually the same as eating sugar from a spoon.

For children with ADHD symptoms serve breakfasts and lunches high in protein, complex carbohydrates, and fibre — like cereals, dalia, upma with vegetables and nuts, and a glass of milk. Peanut butter on a slice of whole grain bread would also be good. The sugars from these carbohydrates are digested more slowly, because protein, fibre, and fat eaten together result in a more gradual and sustained blood sugar release. The result? A child can concentrate and learn better at school.

Supplements

Additive-free and oligoantigenic or elimination diets are time-consuming, disruptive to the household, and impractical. They have no proven role in ADHD treatment. Iron and zinc are best supplemented in children with known deficiencies. Omega-3 fatty acids supplements may be tried in some children with ADHD.

Greater attention to a healthy diet while omitting food that predisposes to ADHD symptoms, is perhaps the most effective and practical ADHD diet.

References

1. Millichap JG1, Yee MM. http://pediatrics.aappublications.org/content/129/2/330.long The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. 2012 Feb;129(2):330-7. doi: 10.1542/peds.2011-2199. Epub 2012 Jan 9.
2. Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. http://jad.sagepub.com/content/15/5/403.abstract?ijkey=d7ce9f17e13e896d1e6b00f2684ad29523c1c5a9&keytype2=tf_ipsecsha ADHD is associated with a “Western” dietary pattern in adolescents. J Atten Disord. 2011;15(5):403–411
3. Wender EH, Solanto MV. http://pediatrics.aappublications.org/cgi/ijlink?linkType=ABST&journalCode=pediatrics&resid=88/5/960 Effects of sugar on aggressive and inattentive behavior in children with attention deficit disorder with hyperactivity and normal children. Pediatrics. 1991;88(5):960–966.
4. Yehuda S. http://pediatrics.aappublications.org/external-ref?access_num=3305401&link_type=MED Nutrients, brain biochemistry, and behavior: a possible role for the neuronal membrane. Int J Neurosci. 1987;35(1–2):21–36

Corex cough syrup - no more OTC opioid dependence

Reducing codeine supply forces Corex users to the spiral of change

Corex Cough Syrup opioid dependence

Codeine cough syrup is no longer available over-the-counter (OTC) without a prescription. Record keeping by the dispensing pharmacist is now mandated by a new government notification. This one legislation will aid relapse prevention in abstinent Corex cough syrup addicts. Many former codeine addicts have relapsed after visiting their dispensary for another medication; the pharmacist casually offers opioid containing Corex cough syrup and provides a visual cue to trigger craving and retard their progress through the stages of change.

Codeine cough syrup addiction is fuelled by dispensaries that distribute litres of codeine in the form Corex Cough Syrup and other brands like Mits Linctus. The key ingredient in these ‘cough syrups’, Codeine, is derived from opium and is an addictive substance. Codeine containing cough syrup abuse made its entry to India in the 1990s and since then has contributed to the steadily increasing opioid dependence case-load.The estimated number of opium users in India is well over 5 million with codeine being a major oral source. Opioid dependence in a de-addiction centre increased significantly from 37 to 52% over the last three decades.

Relapse prevention at the pharmacy

Codeine dependent individuals are exposed to visual cues of Corex and other codeine containing cough syrups at every visit to the dispensary. Modification of addictive behaviours involves progression through five stages of change - precontemplation, contemplation, preparation, action, and maintenance. Individuals cycle through these stages many times before termination of the addiction. During relapse individuals regress to an earlier stage of codeine use. Stimulus control - avoiding or countering reminders of codeine use - is a key process for relapse prevention on the spiral of change. Cutting off easy access in the dispensary aids stimulus control and helps prevent relapse to codeine use. The common sight of multiple discarded codeine cough syrup bottle on stairwells would also disappear (see image).

Codeine cough syrup abuse prevention

1. Pharmacy-based approaches help in minimising the harm associated with OTC medicine abuse, and supporting and treating affected individuals.
• Removing products from sight
• Alerting or counselling customers to the abuse potential of products is effective.
• Refusing sales without a prescription
• Suggesting customers contact their doctor
• Supplying only limited amounts.
2. Raising awareness of the addiction potential of codeine cough syrup is necessary for both the public and the prescribers (many doctors are unaware of the ingredients that go into Corex and other cough syrups).
3. Preventing access is the domain of the government.  Regulating and monitoring codeine prescription and dispensing is a welcome step. The finance ministry is now attempting to enable tracing of batches of codeine containing cough syrups  to their suppliers in a bid to control smuggling of Corex and other codeine containing cough syrups.

Nature's vengeance

Unexpected help in relapse prevention by restricting supply has also come in the form of mother nature. Opium growers in Mandsaur, MP are ruing the increasing numbers of nilgai (Boselaphus tragocamelus) that have developed opioid dependence after chance grazing in farms that were once grassland. The nilgai now run amok and destroy swathes of poppy fields in search of their fix.

References

1. Debasish Basu, Munish Aggarwal, Partha Pratim Das, Surendra K. Mattoo, Parmanand Kulhara & Vijoy K. Varma. Changing pattern of substance abuse in patients attending a de-addiction centre in north India (1978-2008). Indian J Med Res 135, June 2012, pp 830-836
2. Richard J. Cooper. J Subst Use. Over-the-counter medicine abuse – a review of the literature. Published online Oct 3, 2011. doi: 10.3109/14659891.2011.615002. Apr 2013; 18(2): 82–107.
3. Gary Reid and Genevieve Costigan. Revisiting ‘The Hidden Epidemic’ A Situation Assessment of Drug Use in Asia in the context of HIV/AIDS. The Centre for Harm Reduction, The Burnet Institute, Australia. 2002. 
4. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992 Sep;47(9):1102-14.

Mental Health and Academic Performance in Children

10yr window to treat mental health problems affecting academic performance

Mental health & academic performance

Mental health has a direct impact on academic performance in children. Neglected childhood psychiatric disorders like ADHD and Learning Disorders adversely affect the child’s academic performance and educational attainment. Poor educational outcomes affect the child’s health, employment, and status as an adult. This is especially so for psychiatric conditions that are seen at 7 years and persist beyond 16 years of age.

Mental health disorders in children have a greater impact on academic performance than chronic physical illness. The presence of a single mental condition results in morel board exams failures and backlogs. This association is more than for chronic illnesses of the neurological, lung, heart, or digestive systems. Physical impairments are not associated with exam failures. More than half the teenagers who fail to complete their secondary education have a diagnosable psychiatric disorder. Mental health problems in childhood impede academic performance as the student is unable to take advantage of learning opportunities at school and at home.

Poor academic performance may be a marker for mental health problems in childhood. We screened secondary school students performing poorly at academics for mental health disorders. 2/3 of these children had at least one mental health disability. ADHD and Depression were the most common mental health disorders in this population. One third of the children had more than one mental health disorder. Our study showed that screening children who had poor academic performance would help in the early identification of treatable psychiatric disorders. This in turn would improve academic performance and subsequent adult outcomes.

Mental health problems in children negatively impact physical health, employment and social status as they grow into adults. These adverse health, employment and social status outcomes are especially seen in those children with psychiatric disorders at age 7 that persist to age 16. There is a large window of opportunity between ages 7 to 16 during which psychiatric disorders can be addressed to prevent adverse outcomes in adulthood.

Mental health problems in childhood have a higher impact on academic performance than chronic physical conditions. Psychiatric disorders account for a large chunk of school failures in children. Poor academic performance in children may be a marker for the presence of undetected mental health problems. Treatment of childhood disorders like ADHD improves academic performance. There is a decade window between the ages of 7 and 16 years to prevent adverse impacts on physical health, employment and social status by treatment of mental health problems that are resulting in poor academic performance.

References

1. Case, Anne, Angela Fertig, and Christina Paxson. "The lasting impact of childhood health and circumstance." Journal of Health Economics 24.2 (2005): 365-389. 
2. Stoep VA, Weiss NS, Kuo ES, Cheney D, Cohen P. What Proportion of Failure to Complete Secondary School in the US Population Is Attributable to Adolescent Psychiatric Disorder? Journal of Behavioral Health Services & Research, 2003, 30(1), 119-124.
3. Neville Misquitta, Sayyara Ansari. Prevalence of ADHD, Depression and Dysgraphia in School Children. 15th IACAPAP. New Delhi. 30-Oct-2002