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    “Why is my child hyperactive!”



    Why is my child hyperactive and always on the move?

    Most children before the age of 5 are and should be expected to be somewhat active, with a tendency more often than not to move around. This is how they are constructed, with a curious mind, keen to explore. This is how they learn, often through accidental learning as they stumble upon things as they rush their way around. Experiential learning is the key way through which they absorb facts through their various senses of touch, taste, sight, hearing and movement. If they stay still, stuck only on one thing, the world passes by and opportunities escape them.

    Having said that, it is also important that they can slow down when there is a need, in order to be able to attend to an important task and able to complete a task suitable for their age. They should be able to sustain enough attention and interest to learn about the activity their hands are on or the story that is being vividly told. As they grow older, attention should improve as awareness improves. Past the age of 5-6, then prolonged attention is expected, starting with an average of a minute of well sustained attention per year of life. This then extends in leaps and bounds as they enter Primary School and a child should then be able to sustain half hour of good attention at a go. With some structure in the environment and support from people around them, this should extend further, to eventually reach independence for work and some degree of self organization by mid primary school.

    What then might be the reasons why a child cannot stay on task or might be rushing around all the time, moving from toy to toy at a young age, have difficulty sitting to listen at Circle time in preschool and then not being able to sit still in class for the entire period or become independent for work even later on?

    There are several reasons that can give rise to reduced attention and it is not always an attention deficit disorder that needs to be the diagnosis.

    Perinatal issues or events around birth could contribute. It is known that premature infants are at risk for attention issues, as are babies born with some degree of perinatal stress, especially if oxygenation was compromised at birth. Thankfully, this is not so common.

    Early exposure to screen time has also been shown to lead to poorer attention as an older toddler or child with reduced ability to engage and socialize. Guidelines have thus been issued to avoid access to screen time prior to the age of 2 and reduce screen time even up to the age of 4. Essentially, the lesser the better is the norm.

    A structured environment is important in assisting a developing child attain an understanding of order and routine. This should in no way be a rigid set up. However, it helps the child acquire a feel of time and a sense of duration. It aids self regulation and develops organizational skills.

    Hearing and vision are two often taken for granted faculties in a child. Whilst there is universal newborn screening these days widely available, not every parent takes this up. It is needed that any form of hearing impairment be picked up by 3 months with the necessary intervention be in place by 6 months. Otherwise, speech and language development is affected. It is also not only complete hearing impairment that affects expressive and receptive skills. The intact range of hearing spectrum is important. The same applies for visual abilities. Full tracking of the visual range and acuity are important. Any impairment of the hearing or visual faculties would impact attention.

    Any child with poorer speech and language skills and / or communicaton skills will have poorer than expected attention. It is important that milestones for speech and language skills be thoroughly explored in any child with a supposed short attention span. If a child cannot understand, he or she will not attend.

    The other thing to consider of course would be the medical health. Simple things like eczema can reduce attention. If a child is itchy and uncomfortable all the time, the poor child’s attention will be affected. If the child’s nose is running or blocked all the time, how would attention be good. Specifically, those with allergic rhinitis should be explored for the possibility of obstructive sleep apnoea, which invariably means disturbed sleep with poor brain rest. This results in daytime sleepiness and / or hyperactivity.

    Poor muscle tone would also cause a child not to be able to sit still. Likewise, those with sensory processing issues will also not sit still. These need to be explored as well.

    When all of the above have been looked at and not found wanting and then child has reached close to the age of 5, then exploration for the possibility of an attention disorder should then be seriously considered.

    In preschoolers identified with attention issues, behavioural training is the cornerstone of management. In the school goers with attention issues, the confirmation of an attention disorder involves both school and home evaluation and management warrant a combination of medication which is the cornerstone, and behavioural training as well as education support.

    Proper assessment and evaluation is critical for any child with poor attention and / or hyperactivity of a degree sufficient to affect normal daily living and functioning. Best outcomes are achieved if all care providers are involved and early identification is successful.