ALL ABOUT YOUR HEALTH!

Upper gastrointestinal Bleeding (GI-Bleeding)

-This is bleeding that occurs in the upper gut, stomach and/ or the duodenum (this is the first part of the small intestine).

-What do you have to look out for if you suspect that you are having upper GI-bleeding?

Here are some signs:

• Most obvious one is if you vomit blood: this can be red or dark brown resembling the colour of coffee.
• Black, tarry stool: now here we must caution, because someone taking iron medication or medication containing iron tend to also have black stool. For such people this wouldn’t be a sign of bleeding.
• Dizziness and/ or Fainting: this is due to loss of blood.
• Weakness and getting tired too quickly: also due to blood loss.
• Heartburn: now warning this is a very general symptom that occurs to many of us. That means this alone doesn’t ascertain that one has an upper GI-Bleeding.
• Nausea: also, a very general symptom, but mostly occurs in combination with vomiting blood.
• Symptoms of shock

-What should we understand by this? This is when one loses a large amount of blood that the body suddenly goes into a shock mode:

-What to look out for when in shock?

• Sudden drop of blood pressure
• A very fast pulse rate
• Not urinating at all or very minimal amount of urine in the cause of the day: this is caused by reduced amount of blood flowing to the kidneys, hence causing an acute kidney failure.
• Unconsciousness

-If this happens seek medical attention ASAP!

-Now that we know what signs to look out for, lets dive into the various causes of upper GI-Bleeding.

• Peptic ulcers  ̴40%: this are sores on the deeper lining of the intestinal tract. These sores can occur in any part of the intestine. When the deeper lining is destructed by too much stomach acidity or infections or medication, it can be so severe to the point of damaging blood vessels running underneath the intestinal lining hence causing GI-Bleeding.
• Causes: H-pylori infections, anti-inflammatory drugs (Ibuprofen)
• Gastric erosions ̴20%: this are sore on the upper lining of the stomach. This can occur due to alcoholism, frequent us of medication such as ibuprofen,

-Signs of gastric Ulcers: heartburn, indigestion, or reflux.

• Varices bleeding  ̴15%: these are swollen or large blood vessels that develop in the gut and the stomach mostly due to a chronic liver disease such as Liver cirrhosis. They develop when the normal blood flow to the liver is blocked either due to scaring or a blood clot, hence causing blood to flow in smaller blood vessels, that in normal circumstances, can only transport blood in small amounts. When the blood in these vessels increases, there stands a risk of them busting open, hence upper GI-Bleeding.

-Stomach acidity can increase due to factors such as: bacterial infections or medication like Ibuprofen taken for a longer period without taking PPI’s (PPI are drugs meant to reduce the acidity produced by special stomach cells).

• Gut and stomach tumours: When the stomach lining is weakened or a penetration of the tumour through a blood vessel.
• Mallory Weiss tear: This is a tear that occurs along the gut due to prolonged vomiting or coughing. The Lesions caused can bleed so much that an intervention would be necessary to prevent excessive blood loss.

Prevention and Treatment of upper GI-Bleeding

Avoiding excessive consumption of alcohol

Avoid excessive smoking.

Early and thorough treatment of bacterial infections caused by H-Pylori

By prolonged use of anti-inflammatory drugs supplementary use of PPI’s (These are medication to help reduce stomach acidity).

In cases of bleeding, seeking immediate medical attention with interventions such es endoscopic haemostasis

Lower Gastrointestinal Bleeding (GI-Bleeding)

Now let’s jump into the lower part of the GI-Tract and look at the signs and symptoms, evaluate causes, and look at the interventions.

Lower GI-Bleeding is occurring in the lower gut. Lower gut is considered to start from lower small intestine and the whole large intestine till the rectum.

Let’s have a look at some signs and symptoms:

General symptoms:

• Pale Skin due to blood loss
• Feeling weak or getting tired quicker than normal, even after doing work that requires less amount of energy.
• Heart palpitations
• Fainting
• Dizziness

Specific Symptoms for lower GI-Bleeding:

• Red blood mixed with stool or layering on stool.
• Uncommon: black stool when the bleeding is located at the lower small intestine (medical term Ileum or caecum).
• Increased stool frequency: blood sometimes acts as a laxative in the lower GI-tract.

Now that we know what to look out for let’s see what causes bleeding of the lower GI-Tract

1. Haemorrhoids: these can be large or small lumps of blood vessels located on one’s rectum that tend to cause bleeding especially due to hard stool like during obstipation. Many people suffer from this, so there’s no need to feel ashamed. Signs are:

• Bright red blood layered on stool.
• Itchy anus
• Feeling pressed even after defaecation
• Mixture of mucus and blood on the toilet paper after wiping your bottom
• Lump around the anus or on the end parts of the rectum.
• Pain after defaecation

2. Angiodysplasia: these are abnormal blood vessels that can form in any part of the GI-Tract. This means they can cause an upper or a lower GI-Bleeding depending on where they located.
3. Rectal varices: these are collateral blood vessel formed on the lower GI-Tract due to hypertension caused by Liver cirrhosis. Now would you like to know what Liver cirrhosis is? Then please read our previous articles to get more informed.
4. Ischaemic colitis: this occurs when blood flow to a certain part of the large intestine is temporarily reduced by narrowing of the blood vessels supplying blood to that part of the intestine. Meaning limited oxygen to the digestive cells, hence limiting its functions. Theis can be caused by low blood pressure. Signs are:

• Pain like cramping of the stomach. This can be a sudden pain which comes and goes.
• Bright red blood in your stool or passing blood without stool.
• Nausea and diarrhoea

5. Colorectal Cancer: Now this is a topic on its’ own but just to highlight some of its common signs:

• Change in stool: that means there are time one has diarrhoea and other times one is obstipated. This occurs especially when the tumours are so big that they are covering a large part of the intestinal lumen.
• Bleeding
• Anaemia

6. Colon polyps: these are small clumps of tissue cells that form on the intestinal lining. Most of them are benign. Meaning that they are harmless. BUT over time some of the polyps can change their genetic code to malign tissue, meaning they become cancerous. Most Polyps don’t cause any symptoms as they are harmless, up until they start bleeding, or they become so big that they also occupy a large space of the intestinal lumen causing a change of bowel habits (diarrhoea to obstipation).
7. Diverticulosis/Diverticulitis: these are small bulges on the lining of the intestine, where stool can get stuck. The pouches formed by the bulging can be inflamed and cause infections. They are mostly found on the lower left of the large intestine; hence most symptoms of abdominal pain are also located there. Signs are:

• Lower left abdominal pain
• Nausea and vomiting
• Fever
• Constipation
• Bleeding

8. Chronic inflammatory bowel disease (CIBD): Now these is a term for 2 very large diseases which we will discuss in a whole segment of its own. But to bring some perspective into this term, it stands for 2 conditions: Crohn’s disease and ulcerative colitis.

• Crohn’s disease: is an CIBD characterised by inflammation of the both the large and/or small intestines. The inflammation can start at any part of the intestine and mostly starts at between the age of 15 to 35 years.
• Ulcerative colitis: is a CIBD characterised by inflammation that mostly starts in the lower part of the large intestines then spreads upwards. Of course, there exists some abnormalities where the inflammation starts at the last part of the small intestines.
• The most common symptoms for both are: frequent diarrhoea (up to 10 to 15 times a day, rectal bleeding, abdominal pains, and weight loss

Whoo! Now that we know all these causes let’s have a look at what interventions we have:

1. Doing an emergency endoscopy when one has relevant blood loss, or general endoscopy (here we have colonoscopy or proctoscopy, depending on which one is needed).
2. By heavier blood losses that can’t be stilled using endoscopic measures then the solution is surgery.
3. For Colorectal cancer, Diverticulitis and CIBD depending on how the therapy regimes are your doctor should advice on the method of intervention.

How do you prevent all these you may ask? Now here it gets a little bit tricky because some of these could be genetically caused like colorectal cancer or CIBD. Despite all that, here are some things one could do:

• Eat food rich in fibres, the helps keep stool soft, hence reducing haemorrhoidal bleeds, and diverticulitis. BUT during an acute diverticulitis infection one should avoid foods rich in fibres for at least one month or at least until the infection is over.
• Avoid chronic consumption of alcohol to avoid liver cirrhosis, hence avoiding rectal varices.
• Avoid smoking since chain smokers for years have a higher risk of getting ulcerative colitis.
• Proper management of high blood pressure, exercising regularly.

Diet for GI-Bleeding

Understanding the cause of the diagnosis is always necessary to adapt nutrition in patients with gastrointestinal bleeding.

Generally, foods rich in iron are recommended as one can lose a lot of iron during bleeding especially if it is extensive. It is also advised to eat small meals more often while your digestive system heals. Some lifestyle adjustments are also necessary, that is restricting alcoholic drinks, smoking, caffeine (coffee, regular tea, chocolate), mints (peppermint and spearmint), garlic, onions, fried, greasy, or spicy foods, high acid foods such as citrus fruits and juices, bubbly drinks, tomato products if one engages in them. Alcohol and smoking should be avoided as they increase stomach acids and lead to ulcers which worsen the bleeding. The general idea with food is to avoid foods that cause either heartburn, nausea, or diarrhoea.

Examples of recommended foods are red meat, shellfish, poultry, eggs, beans, raisins, whole-grain breads, and leafy greens.

For more informative Reads…. keep it Doki’s Advice.

Disclaimer: This article is majorly for public Education. As a medical practitioner reading this, you are obligated to know more than these basics.

Consider your nerves as fine electrical fibres that conduct impulses to various muscles and organs leading to coordinated muscle and organ functions.

Now consider your Brain as the control centre of all these wires consisting of complex circuits and connections.

A Seizure is an abrupt non synchronised electrical disturbances and conductions.

Before we go FAR, we want to make it Clear that not everyone who has suffered a Seizure has EPILEPSY.

EPILEPSY is defined as a chronic neurologic disorder with predisposition of epileptic seizures.

So careful: People having EPILEPSY as a diagnosis will always have recurrent seizures at points of their lives.

BUT NOT Everyone who has a Seizure has EPILEPSY. Confusing as it is; not all seizures =Epilepsy. (Read it again carefully)

Classification of Seizures.

1.General Seizures: Electrical disturbances in the whole brain.

2.Partial Seizures: Disturbances in one part of the brain.

CAVE: partial seizures can transit to general Seizures.

General Seizures:

Under this Category we have.

a) Tonic-Clonic Seizures: with muscle stiffness and Jerking.

b) Absence Seizures: No jerking involved, just a transient loss of awareness: Affected just stare absent mindedly.

c) Atonic seizures: loss of muscle strength.

d) Myoclonic: Rhythmic muscle jerking without stiffness.

Partial Seizures:

a) complex partial: Loss of consciousness and awareness.

b) Simple partial seizure: No loss of Awareness.

Causes of Symptomatic Seizures:

• Traumatic Brain Injury.
• Strokes
• Intracranial surgeries.
• Metabolic disturbances (low blood sugar low calcium, sodium…)
• Acute infections of CNS like meningitis.
• Alcohol withdrawal
• Recreational drug use.

There are stimuli that also trigger seizures these may include:(These can be observed on people with or without epilepsy)

• Sleep deprivation
• Flashing lights
• Some genres of music
• Hormonal Changes.

Again, be reminded: Not all seizures mean the affected have Epilepsy:

MANAGEMENT OF SEIZURES:

Disclaimer: As a clinician reading this, you will need much more knowledge than this.

Why is this important?

In as much as most seizures last for 2-3 mins on average,

epileptic Seizures past 5 mins are known as status epilepticus and might cause irreversible brain damage if not intervened and broken, it could also lead to death.

This is how to conduct yourself when a victim suddenly develops a seizure in your presence:

Easier said than done:(not necessarily in this order, but have a structure)

1.Stay calm, observe the nature of the seizure. Note the beginning of the seizure and immediately alert the paramedics, since it’s not predictable how long a seizure lasts.

2.Do not try to physically stop a seizure.

3.Secure the Surroundings to ensure no further injuries occur.

4.Loosen tight clothes such as Ties and belts.

5.If it’s a person with known history of seizures (a family member for instance) check their emergency kit, if there is an acute seizure pill/spray/ injection.

6.When the Seizure ends and the patients are still in the post seizure sleep, secure the airway using the stable Side recovery position, In case of a foaming mouth, this manoeuvre should be done as soon as possible.

Diet for epilepsy

The most well-established dietary therapy for epilepsy is the ketogenic diet (high fat, adequate protein, low carbohydrate).  Other diets with great potential for managing epilepsy are the Atkins diet (high fat, high protein, low carbohydrate), a diet enriched in polyunsaturated fatty acids, and a diet with overall restriction of calorie intake.

The modality of work of the ketogenic diet is through the anticonvulsant effect of fasting/ starvation as protein digestion becomes the primary source of energy and not the carbohydrates thus tricking the brain that it is starved. In the ketogenic diet, the body produces ketones through the process of ketosis. The ketones then inhibit the release of glutamate which is an excitatory neurotransmitter and produce GABA which is an inhibitory neurotransmitter. The ketones also prevent degradation of GABA and thus lead to better seizure control through the combined effect of GABA and inhibition of release of glutamate. It is effective in all people, but more effective in toddlers and school going ages. It helps in all convulsions, but more specific about 50% of patients treated with the ketogenic diet exhibit 50% or more reduction in seizure frequency.

Examples of foods that make the ketogenic diet are: dairy (cheese, plain Greek yoghurt, cottage cheese), unsweetened plant based milk, seafood (fish and shellfish), green leafy vegetables (salad greens, cooking greens and herbs), peppers (small hot peppers, jalapenos, bell peppers and poblanos), summer squash, avocadoes, cauliflower, turnips, poultry, meat (preferably grass-fed due to higher content of omega 3 fatty acid and conjugated linoleic acid), nuts and seeds, berries (especially raspberries and strawberries), dark chocolate and cocoa powder, olive oil, butter and ghee, unsweetened tea and coffee and unsweetened sparkling water etc.

Keto diets can be restrictive at first and can have some side effects: dizziness, digestive changes, increased cholesterol etc. Of essence is to ensure a variety of foods are eaten so as to meet the daily requirements. At the beginning, it also important to keenly monitor carb intake and discontinue the diet if side effects are severe.

Some vegetables should be avoided while on the ketogenic diet, the main reason being that their carb amounts are high. These are: potatoes (Irish and sweet potatoes), onions (especially in large amounts), certain winter squashes (such as acorn squash and butternut squash), corn and beets.

The Atkins diet is also a low carb diet with high protein and fat intake. In essence, the Atkins diet is quite like the ketogenic diet. The difference is that with the Atkins diet, you gradually increase your carb intake while with the ketogenic diet, the carb intake remains very low.

NB: Before starting any diet it’s important to seek medical advice just to be sure that the diet you plan undertaking won’t further affect your health.

We sure shall do another Article on Seizures and Epilepsy. It’s a broad topic.

According to WHO data in 2020 Deaths caused by liver diseases in Kenya were about 13,400 or 5.09% of the total deaths. With an age rate of 57.44 deaths per 100,000 of the population, ranking Kenya at number 6 in the world.

Leading causes of death in Kenya as per worldlifeexpectancy.com sept/2020

1. Stroke: 11,453 deaths
2. Influenza and pneumonia:16,263
3. Coronary Heart diseases:8,626
4. Liver diseases:9,658
5. TB:14,162
6. HIV/AIDS:15,048
7. Road accidents:10,723
8. Malaria: 9,116
9. Diabetes mellitus:4,072
10. Hypertension:3,183
11. Lung diseases:3.084
12. Cervical cancer:2,441
13. Prostate cancer: on this date no Data
14. Kidney diseases:3,216

Liver cirrhosis is a condition where the liver becomes scarred and damaged over time, which can prevent it from performing its important functions. Let’s break down these functions in a simpler way:

• Detoxification: The liver helps remove harmful substances like drugs, alcohol, and ammonia from the body.
• Metabolism: It converts certain hormones and substances into forms that the body can use. For example, it activates a thyroid hormone called T4 into its active form, T3.
• Cholesterol production: The liver produces cholesterol, which is important for various functions in the body.
• Blood sugar balance: It helps regulate the amount of sugar (glucose) in the bloodstream by removing excess glucose and storing it as glycogen.
• Bile production: The liver produces bile, a substance that aids in the digestion of fats.
• Protein synthesis: It creates important proteins like albumin, which is crucial for maintaining proper blood circulation, and factors needed for blood clotting.
• Blood filtration: The liver filters the blood, removing toxins, by-products, and other harmful substances.

In liver cirrhosis, the liver’s ability to perform these functions is compromised due to the scarring and damage it has undergone.

Liver cirrhosis can have various causes. Here are some common ones:

• Excessive alcohol consumption over many years can lead to liver cirrhosis.
• Virus infections can also cause liver cirrhosis, such as:
• Hepatitis A: Contracted through contaminated food or drinks, especially seafood, or direct contact with an infected person. However, it usually doesn’t lead to cirrhosis as most people recover fully and develop lifelong immunity.
• Hepatitis B and C: Transmitted through sexual intercourse with an infected person, sharing needles, or from mother to child during pregnancy or delivery.
• Hepatitis E: Ingestion of contaminated water containing fecal matter from infected individuals. This type of hepatitis is typically self-limiting and doesn’t usually result in cirrhosis.
• Hepatitis D: Often occurs as a co-infection with Hepatitis B.
• Non-alcoholic steatohepatitis (NASH): This condition is characterized by the buildup of excess fat in the liver and is commonly seen in individuals with diabetes mellitus.

Liver cirrhosis can be classified as either:

• Compensated: This is when one suffers from cirrhosis but has no acute symptoms like the one’s that will be discussed below.
• Decompensated: This is when the listed below symptoms occur.

The signs and symptoms of liver cirrhosis can vary, but here are some common ones:

1. Loss of appetite
2. Weight loss and muscle wasting
3. Nausea and vomiting
4. Itchy skin and jaundice (yellowing of the skin and eyes) due to elevated levels of bilirubin in the blood.
5. Appearance of tiny red lines on the skin
6. Hair loss, particularly noticeable in men who lose their chest hair.
7. Swelling of the legs, ankles, and feet (oedema) caused by fluid retention.
8. Abdominal swelling due to the accumulation of fluid known as ascites.
9. Frequent or prolonged bleeding due to a deficiency of clotting factors produced by the liver.
10. In advanced stages of cirrhosis, complications may arise, including:

• Vomiting of blood due to bleeding from enlarged blood vessels in the gastrointestinal tract.
• Increased pressure in the portal vein, leading to the diversion of blood flow into smaller blood vessels that may rupture under high pressure.
• Kidney failure, liver failure, the development of hepatocellular carcinoma (liver cancer), and ultimately, death.

It’s important to note that liver cirrhosis is a serious condition that requires medical attention and treatment.

The treatment and interventions for liver cirrhosis include:

• Lifestyle changes: It is crucial to make certain lifestyle modifications to manage liver cirrhosis effectively. These include avoiding alcohol consumption, quitting smoking, maintaining a healthy weight (especially in cases of obesity or overweight), engaging in regular exercise, and getting vaccinated against hepatitis A and B.
• Medication: Medical treatment for liver cirrhosis should always be discussed and prescribed by a healthcare professional. Some medications commonly used in cirrhosis management include:
• Diuretics: These medications help relieve swelling (oedema) and ascites by promoting the removal of excess fluid from the body.
• Beta-blockers: Drugs like propranolol can be prescribed to reduce portal hypertension, which is high blood pressure in the portal vein that supplies the liver.
• Antibiotics: In case of bacterial infections, antibiotics may be administered to prevent or treat complications.
• Diabetes treatment: If diabetes coexists with cirrhosis, appropriate management of blood sugar levels is important.
• Laxatives: Laxatives may be prescribed to help with the treatment of hepatic encephalopathy, a condition caused by the accumulation of ammonia in the bloodstream due to impaired detoxification by the liver.
• Endoscopic treatment: In cases of variceal bleeding in the gastrointestinal tract or stomach, endoscopic procedures can be performed to stop the bleeding. This may involve the use of techniques like banding or sclerotherapy to close off the bleeding vessels.
• Liver transplant: In severe cases where the liver is extensively damaged and other treatments are ineffective, a liver transplant may be considered. This involves replacing the diseased liver with a healthy liver from a donor.

Diet for cirrhosis

Therapeutic role of nutrition in liver cirrhosis has been known for many years and as such, nutritional status was one of the criteria observed in the initial prognostic tests for liver disease.

Being malnourished is also very common in people with cirrhosis with about 20% of people with compensated cirrhosis being malnourished and more than 50% of people with decompensated cirrhosis. When dealing with liver cirrhosis, being malnourished is a risk factor for succumbing to the disease. So, to enable better coping, reversal of malnutrition to a state of good nutrition is key.

In general, a diet that ameliorates or prevents the symptoms of liver cirrhosis as described above is a good diet for management. This is for example a diet that prevents high pressure in veins, a diet rich in albumin etc.

Some of the diet recommendations are:

• Eat little and often to prevent the body from being stressed and breaking down the proteins in your muscles.
• Eat more calories and protein because when cirrhosis happens, your liver is not able to store glycogen which the body needs so you compensate by eating more.
• Reduce salt to help manage fluid retention and bloating (ascites and oedema) as salt can worsen fluid intake and swelling in the liver.
• Managing hyperglycaemia (high blood sugar) and diabetes as liver plays a major role in managing blood sugar but then with cirrhosis, the capacity is impaired.
• Supplements for people with or at risk of bone disease (osteoporosis) because factors that contribute to bone loss need to be reduced when with cirrhosis
• Coffee intake as coffee helps in breaking down fats.
• High intake of fruits and vegetables

It’s important to consult with a healthcare professional for an accurate diagnosis, appropriate treatment options, and ongoing management of liver cirrhosis.

And as always keep yourself informed at Doki’s Advice

In Sub-Sahara Africa, about 9.5% of children and adolescents

are reported to have a psychiatric disorder such as (depression, post-traumatic stress disorder, anxiety)

As the Kenyan population has grown research showed that the estimated ratio of one psychiatrist is to a population of about half a million people, with most psychiatrists practising in the capital, Nairobi.

The World Health Organisation reports that mental health problems affect 10 – 20 % of children and adolescents worldwide. In addition to that half of all mental illness begins by age 14.

Common childhood conditions include:

1. Autism

Autism or autism spectrum disorder is an umbrella or various disorders:

1. Classic autism,
2. Asperger’s syndrome (AS): Mostly don’t have learning disabilities but some may have learning difficulties, don’t have a delayed Speech, mostly have difficulties with their social skills.
3. pervasive developmental disorder (PDD): Mostly applies to children that don’t meet the criteria or either autism or Asperger syndrome.

Condition characterised by:

• difficulties with social interaction and communication,
• repetitive behaviour: like wanting to watch the same movies every day for months and months or playing the same game over and over.
• In Infants: absence or delayed speech, lack of interest in others,
• unprovoked aggression which when not dealt with early can be a major problem in adulthood, don’t engage in pretend play, inability to concentrate,
• atypical behaviours like having challenges transitioning from one activity to another,
• an increased focus on details
• unusual reactions to sensations
• Decreased need for sleep and frequently waking up during the night
• A minority of children may develop good musical, mathematical or visual abilities
• Sensomotoric Symptoms: increased joint laxity, hypotonia, clumsiness, loss of ability to execute or carry out skilled movements or gestures and toe walking. Self-injuries like biting and head banging.
• Have a higher risk of developing seizures by the time they are adults.

Intervention:

• Early and intensive remedial education that address both behavioural and communication disorders.
• Occupational and physical therapy to address specific deficits
• Ongoing counselling and support of parents

Tips for Parents:

• Learn as much as possible about ASD.
• Provide consistent structure and routine for your child.
• Seek professional help for specific concerns.
• Connect with other parents to children with ASD.

General therapy:

• Children who do not yet use words can be helped using alternative communication methods such as sign language, communication boards, picture exchange, and other forms of augmentative communication.
• Applied behavioural analysis (ABA):

E.g.:

Prior: The teacher says “It’s time to clean up your toys” at the end of the day.

Behaviour: The student yells “no!”

Consequence: The teacher removes the toys and says “Okay, toys are all done.”

How could ABA help a child learn a more appropriate behaviour in this situation?

Prior: The teacher says “time to clean up” at the end of the day.

Behaviour: The student is reminded to ask, “Can I have 5 more minutes?”

Consequence: The teacher says, “Of course you can have 5 more minutes!”

With continued practice a child will be able to replace an inappropriate behavior with one that’s more appropriate.

2. Attention deficit/hyperactivity disorder (ADHD):

This is characterised by: impaired attention, hyperactivity, impulsivity or a combination of these symptoms.

Diagnosis criteria:

Impaired attention

often:

• fails to give close attention to details, makes careless mistakes.
• has difficulty sustaining attention in tasks or games.
• does not seem to listen when spoken to directly.
• does not follow through on instructions and fails to finish schoolwork, chores, or duties.
• has difficulty organizing tasks and activities.
• avoids, dislikes, or is reluctant to engage in activities that require mental effort.
• loses things easily.
• easily distracted by external stimuli.
• forgetful in daily activities.

Hyperactivity and impulsivity:

Often:

• fidgets or taps hands or feet, or squirms in a chair.
• cannot stay put in situation that require stillness.
• runs about or climbs in situations where it is inappropriate or complains of restlessness.
• unable to play or engage in leisure activities quietly.
• “On the go” and acting as if “driven by a something”.
• talks excessively.
• gives answers to questions before their completion.
• has difficulty waiting his or her turn.

It’s associated with low rates of high school education and poor peer relationships,

Children who are disruptive and hyperactive are more likely to be identified and diagnosed as opposed to ADHD-children without these behaviours.

ADHD frequently presents with other conditions such as: learning and language disorders, oppositional behaviour, conduct disturbance, anxiety, depression and coordination disorders.

Tips for Parents:

• school intervention like cognitive behaviour therapy (CBT) with a therapist.

– In CBT your thoughts, feelings, physical sensations and actions are deemed connected, and that negative thoughts and feelings can trap you in a never-ending cycle.

-The aim of CBT is to help break down all the overwhelming issues into small parts that one can deal with easily

• behavioural strategies in form of parental management (Triple P/Positive parental programs): this promotes positive parental relationships in order to reduce behavioural problems eg:
• -creating safe and interesting environment for example for their play time
• -Having a positive learning environment: giving an ear when your child is interested in learning something new
• -use assertive discipline: set clear boundaries, rules and consequences, while encouraging/ praising good behaviour
• -Having realistic expectations:
• -taking care of yourselves as parents: like taking time off and getting help from family and friends
• Psychostimulants: this can only be prescribed by your psychiatrist

Intervention:

Behavioural therapy: this enhances motivation using rewards and other consequences and providing models and opportunities for social learning.

-Parental training in behavioural management teaches parents to shape their child’s behaviours with the use of simple behaviour modification and social learning theory like teaching parents how to communicate about their emotions, promoting positive parent-child interaction skills.

3. Oppositional defiant disorder (ODD):

ODD is a diagnosis appropriate only when the below behaviours occur to such a degree that they interfere with academic success, peer relationships, familial relationships, or other major areas of life

Risk factors that can lead to development of ODD:

Children who:

• struggle to regulate their emotions and are prone to emotional outburst have tendencies to later be diagnosed with ODD.
• Have a difficult temperament living in an unstable home.
• Have overly authoritative or permissive parents that create a transactional parent-child cycle.
• Go through maternal aggression.
• Experience inconsistent discipline.
• Have unsafe upbringing environments.
• Undergo prenatal nutritional deficiencies.

Symptoms: over a period of at least 6 months and the cause of these behaviours should not be caused by other factors like trauma or abuse:

• Arguing with adults or authority figure
• Aggression toward peers
• Deliberately annoying others
• Spitefulness
• Vindictiveness
• Being easily annoyed or hostile

Intervention/ tips for parents:

• Parent-child therapy: to help understand why their child is acting out, or how parenting strategies may be contributing to the problems and how to change parenting styles to address a child’s behaviour more effectively. For example:

-praising good and positive behaviour rather than strict punishments for unwanted behaviours

• Collaborative problem-solving: working together to help a child learn how regulate their emotions and help parents to learn how to deal with unmet expectations
• Play-based therapy: parents and children between the age of 2 and 6 years to decrease the occurrence of ODD later.
• Medications: in case of comorbidity e.g., ADHD and ODD (can only be prescribed by a psychiatrist)

4. Conduct Disorder (CD):

Behavioural and emotional disorder characterised by disruptive and breaking societal rules.

Symptoms: behaviour present with 12 months

• Don’t care about feeling or right of other people.
• Enjoy causing harm, lying or manipulation.
• Hurting animals.
• Don’t care about social norms of good behaviour.
• Frequently lying for no reason.
• Stealing for the fun of it.
• Extreme bullies: both emotionally and psychologically.
• Pickings fight, destroying property.

Risk factors:

• Maternal smoking during pregnancy
• Living in poverty
• Living with parents with substance abuse or criminal behaviour
• Exposure to physical or sexual abuse
• Exposure to domestic violence
• Family instability
• Children who experience harsh discipline
• Parents with a cruel or rejecting attitude

-High comorbidity with ADHD or ODD

Tips for parents:

• Giving clear instructions and following through with appropriate consequences when needed.
• Recognizing and praising your child’s good behaviours and positive characters to promote good behaviours.
• Family and individual therapy: which may involve social skills training, parent-child interaction therapy and parent training.
• Getting treatment for one’s own physical and mental health issues, if one suffers from one

*These tips may seem like easy and basic but when dealing with opposition/conduct disorder they don’t come that easy. That means they require routine, practise, and a lot of patience while still showing consistent, unconditional love and acceptance towards your child.

5. Post-traumatic stress disorder (PTSD):

Mental disorder after exposure to traumatic events.

Either:

• Directly experiencing the traumatic event
• Witnessing the event as it occurs to others
• Learning that a traumatic event occur to a parent, caregiver/guardian.

Symptoms:

• Recurrent or distressing memories of traumatic events
• Recurrent distressing dreams where its contents are related to the traumatic event
• Dissociative reactions in which the child feels or acts as if the traumatic event is reoccurring.
• Intense or prolonged distress at exposure to internal or external triggers that resemble aspects of the traumatic event
• Avoidance of activities or places that arouse recollections of traumatic events
• Avoidance of people or conversations that remind of traumatic events
• Reduced interest or participation in activities such as play
• Socially withdrawn behaviours
• Reduction of positive emotions
• Irritable behaviour and anger outbursts sometimes with little or no provocations
• Concentration problems
• Sleep disturbance
• Dissociative symptoms like: Depersonalisation/derealisation: feeling like observing yourself from outside your body

Tips for Parents:

• Creating a feeling of safety for your child
• Helping your child speak about his / her feelings and experiences directly or through art or play
• Teaching your child coping and relaxation mechanism
• Reduce external triggers where possible
• Individual and family therapy to help your child cope with stressors and assist you to help your child.

Disclaimer: Always seek medical attention before beginning any new medications for your child or as soon as you notice any symptoms within the span of 6 months.

For more keep it Doki’s Advice….