An interaction with Dr. Sonia Malhotra

I was formally examined and diagnosed wit ADHD and Dysgraphia at Children First, an institute in Delhi that specialises in providing mental health and developmental services to children and adolescents. After undergoing a number of tests, my parents and I were counselled by Dr. Sonia Malhotra about some of the things we should do to deal with ADHD and Dysgraphia.

There is a lot of material on the internet regarding ADHD and Dysgraphia but very little that has an Indian perspective. Therefore, I thought it a good idea to seek Dr. Malhotra's opinions on these subjects.

Please tell me a bit about your background. It would help my readers to know where you studied and what drew you to this field.

I am Dr. Sonia Malhotra. I have done M.D. in Psychiatry, with almost 10 years of experience of exclusively working in child and adolescent psychiatry. I work with Children First, a child and adolescent mental health institute in Delhi and Gurgaon. I have always been passionate about working with children, and my field gives me the opportunity to live my passion each day!

What are ADHD and dysgraphia?

These are neurodevelopmental disorders, that are a result of different 'wiring' in the brain circuits that are needed for foundational academic skills and executive skills of daily living like attention, activity levels, impulse control, emotional control, reading, writing, comprehension, calculation etc. The occurrence of these disorders is multifactorial and there is no single cause that can be pointed out for the same. Since they are disorders of the inter-related areas of the brain, they frequently co-occur as well (almost to the tune of 50-60%).

What do you think are some “red flags” that parents or teachers can watch out for in determining if kids need a formal diagnosis or evaluation for a learning disability like ADHD and Dysgraphia?

Whenever parents/ teachers see that, in spite of best of efforts and age appropriate intelligence, a child is not able to perform and sustain basic tasks that are expected from children of that age, it is always a good idea to get a psychoeducational assessment done. Usually these issues start showing up after the age of 5 years. However, sometimes children manage to cope extremely well with the differences in their functioning and performance, and hence, the difficulties may arise only after reaching a senior class like 9th standard and above.

Could you also give a brief overview of how you diagnose these conditions, and what kind of assessments or tests are typically used?

There are clinical criteria (ICD-11 and DSM-5) that are used to diagnose these conditions clinically. But a diagnosis is not just about matching the symptoms- it is also about clinical observation and the severity of impact of these difficulties in a child/ young adult's day to day life as well as academic performance. For assessments, there are standardised tests which are approved for use in children and adolescents, selected on the basis of criteria such as age, major areas of concern, level and type of performance of the child etc.

I coped without a formal diagnosis and accommodations for years in which I have been called lazy, unmotivated... etc. Isn’t there any formal structured assessment that can be made available, even compulsory to schools to screen children with these issues?

There are only formal assessments that can be done by RCI-registered clinical psychologists. Unfortunately, the training of administering these tests is not a part of the curriculum for degrees needed to become teachers and professors and are taught in the Psychology branch only. These tests also need a clinical insight into the symptom presentation. Hence, it is not likely for schools/ teachers to be able to perform any screening/ tests.

Are there any genetic causes or environmental triggers that make people more prone to learning disabilities or is it entirely by chance?

It is not a chance occurrence. It is multifactorial in nature, with an impact from factors like genetics, environmental causes, pre-/ peri-/ post- natal causes, medical causes, social causes etc. Hence, there is hardly any preventive approach that you will find for these illnesses, since there is no single cause that can be ruled out.

Do these disabilities often occur together - like ADHD and Dysgraphia? Like if you test positive for one, is there a greater chance that you may have another?

Since they are neurodevelopmental disorders that also arise from close-by/ same brain areas, their co-occurrence is very high (50-60%). However, one does get to see cases with singular diagnosis also. But yes, chances of having one if you have another are pretty reasonable.

In your experience are there any subjects or career choices that children or adults with these learning disabilities like ADHD or Dysgraphia should avoid or actively pursue?

Subject/career choices do not only depend on your ability/ way to perform (which is impacted by these disorders). They are also dependent on your strengths, likings, passion and skill sets. Hence, there are no such clear boundaries of what children with ADHD and/ or learning difficulties can or cannot do. It is not a disability or impairment - it's just a different way of doing things!

Can a person outgrow their ADHD / Dysgraphia? And are there any lifestyle changes or therapies that can help manage symptoms of ADHD or Dysgraphia?

One learns to cope with their differences. Over a period of time, with experience, therapies and lifestyle changes, it is possible to lead a next-to-normal life in spite of the presence of these difficulties. I don't know what outgrowing/ perfect/ normal life looks like, because I don't think anyone has it anyway.

In addition to extra time or the use of a scribe/laptop, do you think there is some additional support that should be provided to help students with ADHD or dysgraphia succeed in school, both in and out of the classroom?

There are some very well researched accommodations that all boards and universities have prescribed for children with these diagnoses. Depending on what the assessment reflects, those accommodations are put in place which will help that particular child the most. Likewise, for life beyond academics, therapy spaces help children realise their strengths and potentials and develop strategies to deal with their differences in day-to-day living.

I would like to reiterate that Neurodevelopmental disorders like ADHD, ADD, Learning Difficulties are not disabilities. These are subtle differences in wiring of the brain that leads to changes in the way the individual's brain learns. It doesn't rob the brain of the capacity to learn. Hence, belief in one's self, acceptance of one's differences and a positive attitude towards the future is the most important foundation over which a happy and satisfying life can be built.