ADHD Case Study: Real-Life Example of Attention Deficit Hyperactivity Disorder in Children
Patient Information
Name: Rishav Rane
Age: 8 years
Gender: Male
Background: Rishav is an industrious and inquisitive child. He was a student of Class 3 at a reputed catholic school when diagnosed with ADHD. He comes from a middle-class family in Nagpur, Maharashtra, and lives in a nuclear family with working parents.
Family History: No family members in the past have been detected with ADHD or neurological disease.
History or Cause
Rishav became increasingly inattentive and restless from the age of 5. His parents also noticed that he was struggling to follow instructions given at home. Initially, they ignored these symptoms, considering them a hyperactive personality. However, when the school teacher constantly reported against his disruptive behaviour in school, his parents became concerned. Rishav became very talkative. He could not focus on the class lessons, interrupted the teachers during the class and did not complete the given tasks. He also used to become restless while waiting for his turn in group activities.
By the time Rishav reached the age of 7, his symptoms had become more intense. His impulsive behaviour alienated him from making friends. This made him look down upon himself and increased his emotional distress. He often made comments like, “Why am I not good?”, “I can never do things in the right way.” Academically, his grades began to decline sharply. Rishav’s attention span for homework has reduced. Frustrations and emotional outbursts became a normal reaction each time he was corrected.
He did not show any signs of emotional trauma. However, the domestic environment was inappropriate considering his neurological conditions. It consisted of irregular schedules and less time for refreshment, which triggered his inability to manage attention and emotions.
Diagnosis
In the first quarter of 2023, Rishav’s parents came to Jagruti Rehabilitation Centre to help Rishav manage his symptoms. He was immediately referred to our child psychiatry department. The team performed a complete assessment of his symptoms through a multi-step diagnosis process. It helped examine the nature of his symptoms and make the most accurate diagnosis of his condition.
They used the following assessment tools for diagnosis.
- Diagnostic Interviews: Conducted with Rishav, his parents and teachers
- ADHD Rating Scale IV: Performed on Rishav’s parents and teachers
- The Conners Comprehensive Behaviour Rating Scales (Conners CBRS): Conducted on Rishav to get a complete overview of how Rishav functions in different settings
- Cognitive Testing: Performed on Rishav to examine his executive functioning and his span of focus to assess attention span and executive functioning
- Behavioural observation: Conducted on Rishav over multiple sessions
The following diagnoses were made:
- Primary Condition: There is a combined presentation of Attention Deficit Hyperactivity Disorder (ADHD) in Rishav
- Secondary Concerns: Negative interaction with peers and inability to succeed in structured tasks multiple times have developed mild anxiety in Rishav.
The results of the diagnosis brought to light that Rishav had significantly high symptoms that satisfied the DSM-5 criteria for ADHD. Prominent symptoms included inattention and hyperactivity-impulsivity.
Treatment
The professionals at Jagruti Rehab created a multilayered personalised plan for Rishav’s treatment. The primary aim was to provide Rishav and his family with a highly effective long-term ADHD management strategy. Cognitive, behavioural, academic, and emotional development were the primary focus of the treatment. It also included the continuous involvement of the parents.
Rehabilitation Programme
Duration: The rehabilitation program was divided into 2 stages.
- Stage 1: Structured clinical sessions for the first 3 months.
- Stage 2: Comprehensive care and follow-up treatment for the final 6 months.
Key Components:
Week 1–2: Creating a bond with the patient and offering Psychoeducation
- Bond therapies: Conducted various therapies based on games to help Rishav open up, build trust and create a bond with the therapist.
- Psychoeducation for parents: Parents were taught about all the aspects of ADHD, and in-depth discussions were conducted on Rishav’s condition through various psychoeducation sessions. These sessions also helped them learn how to manage Rishav at home.
Week 3–6: Behavioural & Emotional Regulation
- Cognitive Behavioural Therapy: Cognitive Behavioural Therapy (CBT) personalised according to Riushav’s needs was started during this time to help him enhance his skills for self-awareness and coping with ADHD symptoms.
- Reward-based Therapy: Reward-based therapies were set into motion to help Rishav build positive behaviours and complete tasks on time.
- Behaviour Management Training: Rishav’s parents were engaged in the Triple P Positive Parenting Programme. The program was conducted once a week to help Rishav’s parents learnt the tricks to control Rishav’s behaviour.
Week 7–10: Social Skill Development and Academic Assistance
- Remedial education: Skill development education sessions were initiated during this phase of the treatment. It aimed to enhance Rishav’s attention span, working memory and skills in lining up tasks.
- Social skills coaching: Various role plays, storytelling, and group interaction sessions were conducted with Rishav to help him gain social skills like turn-taking, empathy, and communication.
- Individualised Education Plan (IEP): Worked with Rishav’s school authority to design a personalised Individualised Education Plan (IEP) based on Rishav’s academic requirements.
Week 11–12: Preparation for Transition & Maintenance
- Reduced clinical sessions: Foxcussed on maintaining consistent behaviour at home and reduced on-site clinical sessions.
- Personalised behaviour strategies: Rishav’s parents were provided with some behavioural strategies specially designed to manage Rishav’s manners and attitudes. They could use it in real-life scenarios.
- Classroom management techniques: Rishav’s teachers were provided with classroom management techniques that they could use to sustain Rishav’s progress.
Medical Intervention
Psychiatrists at Jagruti Rehab conducted medical trials on Rishav for 1.5 months using non-pharmacological methods. After a thorough examination of the results of the trial, they prescribed Methylphenidate, a stimulant medication with low potency. The aim was to increase Rishav’s cognitive function and help him control his emotions. The specialised doctors monitored his progress through weekly sessions and adjusted the dosage of the medicine based on his needs. Rishav’s response to the medicine was phenomenal. His focus on any given task increased significantly while his hyperactivity reduced. The following therapies were involved in Rishav’s treatment for ADHD:
- Cognitive Behavioural Therapy (CBT)
- Play Therapy
- Behaviour Modification Therapy
- Parent Management Training
- Social Skills Group Therapy
- Academic Remediation
Improvements / Recovery Timeline
| Timeline | Key Milestones |
|---|---|
| Week 1–2 | Rishav’s typical behaviours were noted while the therapist created a bond with him. |
| Week 3–4 | Classroom disturbances reduced significantly, and Rishav’s interaction with his parents enhanced. |
| Week 5–6 | Emotional outbursts became notably low, and Rishav completed three out of 5 homework assignments without parental assistance. |
| Week 7–8 | Classroom activity participation and engagement with classmates increased. |
| Week 9–10 | Teachers appreciated Rishav for his improved focus. |
| Week 11–12 | Rishav maintained his positive behaviours and demeanour at home and school with minimal assistance. |
| Months 4–6 (Outpatient) | Rishav’s progress in recovery from ADHD continued. He was advised to continue with medication at a stabilised dose. Outpatient sessions were reduced to just once a month. |
Related: ADHD Child Case Study
Our Success
Impact on Rishav’s Life
The experts of Jagruti Rehab offered personalised and structured therapy that included medical and therapeutic intervention for 3 continuous months to help him and his family manage his ADHD symptoms. During this time, Rishav ‘s progress was remarkable. He began to enjoy school again, started focusing on his tasks, gained interest in his studies and started making friends in his class and building better rapport with his classmates - progress never observed by his parents and school teachers before. Changes were observed in his personality as well. His negative self-talk was reduced, and his self-esteem increased rapidly. He became more patient, started sitting through an entire lesson without interruption, and completed all his task assignments on time.
Impact on Family and Community
A positive shift in the family dynamics was observed during and after the 3-month Rishav’s ADHD treatment. The emotional bond between the parents and the child strengthened, and interpersonal conflicts, especially regarding the right way to deal with Rishav’s ADHD symptoms, were reduced significantly. They became confident in their abilities to deal with the challenges concerning Rishav’s ADHD and found better ways to manage it apart from punishment or frustration. Teachers appreciated Us- Jagruti Rehabilitation Centre for the collaborative approach to managing Rishav’s neurological concerns. The biggest success of our therapy was the award Rishav received in his school’s annual award ceremony - it was for the student with “The Most Improved Behaviour.”
Future Steps
Rishav is now in stage 2 of our Rehabilitation Program. He comes to our Jagruti Rehabilitation Centre once a month for counselling sessions. His OPD care includes, but is not restricted to:
- Monitoring his progress in ADHD and adjusting medications accordingly.
- Follow-up of Rishav’s behavioural improvement through counselling sessions.
- Intermittent assessment of the Individualised Education Plan (IEP) in cooperation with his school.
- Active engagement of Rishav’s parents in the ADHD parents group to share, learn and exchange various issues and their solutions with parents of children with similar issues.
Conclusion
This case study from Jagruti Rehabilitation Centre brings out the significance of early diagnosis of ADHD can bring a radical change in their lives. Here, specialists at Jagruti adopted a multilayered and personalised rehabilitation program using therapeutic sessions, medications and collaboration of parents and school teachers to manage ADHD. It highlights that ADHD is not incurable; with the right support system, children like Rishav can beat the challenges, lead a normal social life, and perform well academically. If you notice your child showing signs of ADHD, don't wait to seek professional assistance. At Jagruti Rehab, we offer structured programs for the treatment of the disease after performing a complete assessment. Each program is personally designed to meet the unique needs of the patients.
If you suspect your child might be showing signs of ADHD, don’t delay in seeking help. Jagruti Raha's Child and Adolescent offers comprehensive assessment and tailored treatment programmes designed to meet every child’s unique needs.
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