In this blog I will discuss our experience at NIMHANS, Bengaluru and diagnostic approach followed there and thin line of difference between Attention Deficit & Hyperactive Disorder (ADHD) with Expressive Speech Disorder (ESD) vis-à-vis Autism Spectrum Disorder (ASD).

A. Diagnostic Issues

From the day we got the initial diagnosis of Simi as a case of Pervasive Developmental Disorder (PDD), we contacted many Doctors to make sure about the correct diagnosis. But every time we got contradictory information and nobody could able to tell us the exact problem of Simi and we did not get answers to many of our questions. The obvious reason, there was lack of awareness about Autism Spectrum Disorder (ASD) those days.

As per the advice of some friends, we decided to take Simi to National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru for further assessment and diagnosis.

B. Diagnosis at NIMAHNS

We visited NIMANHS during 1st week of December 2005. We were advised to stay there for about 22 days at Child Psychiatric Centre (CPC) and Simi was put under observation by team of doctors under the team leader Dr Sekhar Seshadri.
In CPC so many other children and adults (who had come for treatment) were staying along with their parents/caretaker. All were there under observation.

The initial observation by Doctors on Simi was as under:

“Child is presented with increased activity, restlessness, distractibility, inattentive and impulsivity. Till age of 4 years child had poor receptive and expressive speech that improved significantly with inputs from parents. At the time of presentation child had adequate receptive language with deficit in expressive speech”

The routine at CPC was packed with various activities keeping Simi (along with other inmates) engaged with academic, behavioural, speech therapy, activities relating eye hand coordination, group activities for social skill etc.

At the end of each day, the team of doctors used to take the feedback from all the assistants engaged with Simi and also from us.

Dr Sekhar Seshadri used to take the feed back from all the Doctors and from us and discussed with us about the further course of action.

During, the interaction with Dr Seshadri, he enquired about whether Simi was given any medication as he was of the opinion that Simi might be a case of ADHD with ESD which is having the traits very much similar to ASD.

According to him while the main differences between ADHD and autism are the types of disorder; causes of meltdowns; the ability to speak; communication difficulties; routine and structure; and interests and attention, they are similar in terms of being incurable neurological conditions.

Symptoms of both ADHD and autism can be managed with therapy and medication, although some people with autism might find therapy more beneficial while some people with ADHD might find medication more helpful.

Besides having the tendency to talk too much, people with ADHD may “not notice how their words affect other people” and “interrupt others” whereas people with autism may find it difficult to express “their emotions and thoughts,” have trouble understanding common everyday expressions, avoid eye contact, recoil from physical contact such as hugging or a touch on the shoulder, focus on one topic of interest and “not respond to or initiate to social interactions.

Since Simi was having deficit in expressive speech, finally, at NIMHANS, she was diagnosed as having ADHD with ESD and not Autism and was advised to take Medicine ATTENTROL 18 MG (twice in a day) along with behavioural and speech therapies.

C. Impact of Medication:

We gave medication as prescribed above for more than three years and found some improvement in her hyperactivity but not up to our expectations. But this helped Simi to be more stable so that her mother could able to give more input in her academic front. She could able to sit in her classroom and do her class work/ complete her home work but under rigorous supervision of her mother.

The medication continued till 2009 when we shifted to Delhi for change of my Job. After reaching Delhi we again visited AIIMS and other Doctors including Dr Veena Kalra. Dr Kalra advised us to stop the medication – Attentrol and accordingly we stopped the same.

In my next blog I will discuss about the schooling issues at Delhi NCR and other challenges we faced.

TO BE CONTINUED………
Author: Srinibash Mishra