In part 1 of our Tell Me Why podcast with Dr. Haneen Jarrar, Maria Botros explores with the child psychologist the different neurodevelopmental disorders and their physiological causes.
At the age of 6-7 we start developing ‘executive function skills’ in our frontal lobe, but children with ADHD may not, says Dr. Haneen
Dr. Haneen: Children sometimes develop self-esteem issues or social anxiety as a result of their ADHD
Three areas of functioning to look into when you want to know if a child has ADHD: home life, social life, and school life
Dr. Haneen: Based on research, time in nature, undirected play, and screen time all affect the development of the frontal lobe
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At the age of 6-7 we start developing ‘executive function skills’ in our frontal lobe, but children with ADHD may not, says Dr. Haneen
Dr. Haneen: Children sometimes develop self-esteem issues or social anxiety as a result of their ADHD
Three areas of functioning to look into when you want to know if a child has ADHD: home life, social life, and school life
Dr. Haneen: Based on research, time in nature, undirected play, and screen time all affect the development of the frontal lobe
Read the full story here:
See more videos at https://gulfnews.com/videos
Read more Gulf News stories here: https://bit.ly/2HLJ2km
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00:00There's ADHD, so attention deficit hyperactivity,
00:03the child is hyperactive.
00:05And there's ADD, attention deficit,
00:08which means that if the child is given a Lego,
00:10they can focus for hours,
00:12but homework is really difficult
00:14because it's a non-preferred activity.
00:16And these are two different areas of the brain.
00:30All right, Dr. Hanin Jarrar,
00:32child psychologist is with me in the studio.
00:35How are you?
00:36I'm doing very well, thank you.
00:37I love that you're with us in the studio.
00:39And I love that we're going to talk about today's topic,
00:41which is attention disorders in both children and adults,
00:46because I feel like I've seen more and more adults,
00:49you know, getting diagnosed with ADHD
00:52or other, you know, attention deficiency disorders,
00:55or deficit disorders, sorry.
00:58And I feel like it's one worth mentioning
01:00because there could be a fix to it
01:04that is long-term and that is beneficial to the individual.
01:09It's just a lot of people are unaware of these fixes.
01:13But before we get started, I want to get to know you first.
01:15Tell us about yourself and tell us about
01:17how you got into this field, what you do,
01:20who you work with, that kind of thing.
01:22So I always loved kids.
01:25I'm a firstborn.
01:26So I was very naturally loving taking care of children
01:30and being in that role was very natural for me.
01:33I wanted to be a pediatrician.
01:36I loved spending time in the OR with my uncle.
01:39So I would spend summers in the OR with my uncle.
01:43One summer, they had a visiting pediatric heart surgeon.
01:48And after the heart surgery,
01:50I was spending so much time with the individuals post-operation,
01:55like talking to them and telling them how they feel.
01:58And this specific heart surgeon looked at me and said,
02:00you know, if you ever want to get into medicine,
02:02you can't be that involved.
02:04Maybe psychology is more your thing.
02:06I was like, psychology?
02:07No, he's like, you're so interested in how people felt
02:10after the operation more than the operation itself.
02:14And so that stuck in my mind.
02:15I went into med school,
02:17but I was finding med school really challenging.
02:19It was so boring, long hours.
02:21You can't have a social life.
02:23You're stuck in the library.
02:25I hated chemistry.
02:26I failed chemistry miserably.
02:29And children being my, you know,
02:32my area of interest and my love and my passion,
02:36I became more and more specialized in the area of children
02:39and early development.
02:41So I don't see children beyond 13 years of age.
02:44My area of interest is that early developmental milestones
02:47and early years and the psychology in these very early years
02:51up to the age of 13 when the teenage brain pops in.
02:54Oh yeah, which is a whole, like, it's a different ball game.
02:57Yeah, we're not going to even get into that.
02:59But yeah, I agree.
03:00Those foundation years are critical.
03:03And there isn't, like, I have never met a psychologist
03:07who has not said that these determine,
03:10these years determine how an individual turns out.
03:13And again, we always hear the saying
03:16of children are sponges
03:17and it's those years that matter the most.
03:19And I love that you work with that specific age
03:23or that age group because it's what makes a person.
03:26And I think it's crucial.
03:28And I think with assistance,
03:29kids can actually turn their lives around
03:32and they can actually beat all the odds
03:34that were told to them at a young age.
03:36It's funny that you mentioned
03:37that you wanted to become a pediatrician
03:38because I wanted to become a pediatrician as well.
03:40I love kids.
03:41But then when I knew that, okay, there's a lot of like,
03:46I mean, it's graphic, it's a graphic field.
03:49And the fact that with, I mean, the blood,
03:52the, you know, the surgeries, I can't tolerate that.
03:54So I was like, okay, I'm out.
03:56Like, I'm just going to do this.
03:56That never bothered me, the long library hours.
04:00That's what bothered you.
04:00Like that, I can't.
04:01Like, I don't mind blood.
04:03I don't mind an open heart.
04:05A child with an open heart didn't bother me.
04:07But the long hours in the library with no social life
04:10and that, I couldn't do that.
04:12And chemistry, the chemistry I couldn't do.
04:15Yeah.
04:15So my advisor was like, if you can't do chemistry,
04:18you can't do med school.
04:19Oh, of course.
04:20Yeah.
04:20Yeah.
04:20Pharmacy.
04:21Cause it's all.
04:22Yeah, of course.
04:22Absolutely.
04:23My parents and my whole family all come from a medical background.
04:27And to me, I was in awe.
04:28I was like, good for you guys.
04:30It's not for me.
04:31I'll spread the knowledge.
04:32I'll bring in guests, talk to them about it.
04:34They'll share their knowledge.
04:36And I will just sit here.
04:37You said you work with kids.
04:38And the topic that we're discussing today
04:40is attention deficit or hyperactive disorders.
04:45Can you tell us a bit more about that?
04:47So I don't really like to use the term disorder
04:51because that insinuates there's something wrong with you.
04:56And I never like to break that to a child or a teenager ever.
05:00I'm here to tell you there's something wrong with you
05:02and I'm here to fix you.
05:03I don't like that because we're all very different.
05:05And human brains are developed in a really different way.
05:09So when you're neurodivergent,
05:13it just means that your brain is really good at some things,
05:16but might find some things really difficult.
05:19And if these things that your brain finds difficult
05:22get in the way of life,
05:24we are here to support you and give you coping mechanisms
05:26just so you can function in this society
05:28that's not really built for everybody.
05:31And it's society's fault.
05:32Society should be more inclusive.
05:34Jobs should be more inclusive
05:36for people who have neurodivergent brains.
05:39So this is how I like to talk about it.
05:41Not really as a disorder that needs to be fixed,
05:44but a type of a different brain that is also very unique.
05:48Most of the people that the scientists,
05:50the people that have gotten us to the moon
05:52are actually people who are neurodivergent.
05:55So if we isolate them from society and say disorder,
05:59what are we left with really?
06:00Right.
06:01So what happens is the human brain,
06:05when it's born, when a baby is born,
06:07the brain is not fully developed.
06:09It's actually a third of its actual size.
06:12The frontal lobe, which is a very important area of our brain,
06:16is one of the areas that is very underdeveloped in babies.
06:19So if you think about it, a baby can do what?
06:22Can cry, poop, sleep.
06:24That's it.
06:25Can't speak, can't stand, can't do anything.
06:28As the years go by, the frontal lobe develops.
06:31So the baby starts talking, walking.
06:34And then around the age of six,
06:37we start developing something called executive function skills.
06:40What are those skills?
06:42Time management.
06:44Impulsivity control.
06:46Managing to hyper focus on non-preferred activity.
06:52Ability to empathize with other social skills.
06:56Ability to regulate my emotions.
06:58These are called executive function skills.
07:01You're not born with these skills.
07:02You develop these skills with time.
07:05So what happens with kids with ADHD
07:08is that at this threshold, the six to seven,
07:11that's why we say wait till six,
07:13because before that, the frontal lobe is not developed.
07:17We start noticing that, wait a minute, the child's seven.
07:20Everyone in the classroom can sit,
07:22can focus on non-preferred activities,
07:25but the child cannot focus as long.
07:28The child is hyperactive.
07:29Their body cannot sit still for long periods of time.
07:33The child cannot manage their time.
07:35So if you say, John, go upstairs and get dressed and come down,
07:39John will get lost upstairs.
07:42The child cannot regulate their emotions.
07:44So they still might have tantrums at the age of seven.
07:47The child might have difficulties in social cues
07:49or social understanding or ability to withstand
07:53losing a game, for example.
07:56And so as a result, the child will start feeling
07:59that there's something off.
08:01I'm being told off a lot.
08:02I'm getting a lot of comments,
08:04a lot of feedback on my behavior.
08:06So there's self-esteem issues that start developing.
08:09Anxiety, social anxiety about social situations
08:11because I'm always late or extreme or too emotional
08:15or under emotional or missing social cues.
08:19So social anxiety might start.
08:21How do you know that your child is just being active
08:25or if they actually have an issue?
08:28I usually ask,
08:31there are three areas of functioning that I look into.
08:34Social life, home life and school life.
08:38Is this level of activity affecting any of those?
08:42Is she so active that she's getting so told off at school
08:46or is she so active that it's okay?
08:49Is she so active that at home she's being told off,
08:52she can't sit, she can't eat, it's affecting her functioning
08:55or is she getting by?
08:56Is she so active like in social life,
08:59in birthday parties when everybody's singing
09:03and sitting together and she's off on the trampoline
09:05or is she getting?
09:06So if this difficulty is affecting functioning,
09:11that's when I get concerned.
09:13If it's not, then the child is able to cope.
09:16Okay.
09:17And what are the different types of,
09:21I don't want to say disorder anymore.
09:23It's okay.
09:23You can say whatever you want.
09:25So like these attention,
09:27Difficulty.
09:28Tampering or difficulty.
09:30So one, because the thing is the DSM,
09:35the Diagnostic Statistical Manual that we didn't write.
09:39That's a whole other topic of who writes these things
09:42and how they get affected.
09:45We as clinicians, we have to go by those rules.
09:47Right.
09:47So you didn't come up with this ADHD.
09:50This is so we can understand what we're talking about.
09:53So according to the DSM, there's ADHD.
09:56So attention deficit hyperactivity.
09:59The child is hyperactive and there's ADD, attention deficit.
10:03So it's just, there's no hyperactivity,
10:05but there's a real difficulty on focusing
10:07on non-preferred activity,
10:09which means that if the child is given a Lego,
10:11they can focus for hours,
10:13but homework is really difficult
10:15because it's a non-preferred activity.
10:17Okay.
10:17And these are two different areas of the brain.
10:19So that's why we look at non-preferred activities.
10:22Okay.
10:22So there are two types.
10:23It's the ADHD and the ADD.
10:26There was a time when, you know, studies came out
10:28and they said, oh, they're essentially the same thing.
10:30This was just an old terminology.
10:32Is that even true?
10:34They are because there's a lot of overlap.
10:36Okay.
10:36But for ease of therapy,
10:38because usually what happens after assessments
10:41is that you get therapy, you get intervention.
10:43Right.
10:43Because these things can change.
10:45So if the child is so hyperactive
10:48that they can't sit and focus,
10:49there are therapies put in place to help
10:52to grow the frontal lobe
10:55so that this child can sit and focus better.
10:58Okay.
10:58So with therapy, it's easier to make this,
11:02what are we working on?
11:03Are we working on hyperactivity or focus?
11:06Are there sensory issues?
11:08Are there social skills difficulties?
11:09And that's how you then plan the therapy
11:11for the child moving forward.
11:12Okay.
11:13Usually with the school as well.
11:15Okay.
11:15Is there a reason at a young age
11:17that the frontal lobe hasn't developed?
11:19Like, are there any factors?
11:21That's a very good question.
11:23Yeah.
11:23So as humans from research,
11:27what are the things that develop the frontal lobe?
11:31Number one, time and nature.
11:34So we know from research
11:35that the kids that spend more time in nature
11:37have a more developed frontal lobe
11:39than the kids that don't.
11:41Active play and undirected play.
11:45So the kids that have more undirected play in their day
11:49have a more, have a better frontal lobe.
11:51What does undirected play mean?
11:53You just play whatever you want.
11:55Okay.
11:56Screen time.
11:57Oh, absolutely.
11:59The more screen time your child gets,
12:00the smaller the frontal lobe is going to be
12:02because it's the opposite
12:04of what the frontal lobe needs to develop
12:06because the frontal lobe
12:07needs to develop frustration tolerance.
12:09With games, you get frustrated,
12:12you go to the next level.
12:13The frontal lobe needs to develop impulsivity control.
12:16With games, it's not there.
12:18The frontal lobe needs activities
12:20to develop focus and concentration.
12:22With games, everything is so fast.
12:23And so if you have a child neurodivergent,
12:27zero screen time,
12:28because this is the opposite
12:29of what develops a frontal lobe.
12:31Right.
12:32And then we have lots of social interaction,
12:36like real social interaction.
12:39Sunlight, time and sunlight,
12:42and movement, moving the body.
12:43Okay.
12:45If you look at these six factors
12:46and you look at how our modern world is designed,
12:50you will see that more and more children
12:53are spending less time in nature,
12:54less time outside,
12:56less time with, you know, friends.
12:59So do we have any stats on how many kids,
13:02like the percentage of kids
13:04that are affected by ADHD or ADD, sorry?
13:09One in every three boys,
13:14this is the stats from the US,
13:15I don't know if there are any stats here in the UAE,
13:18is diagnosed with some form of either,
13:22you know, we call them neurodevelopmental disorders.
13:25Right.
13:26Either ADHD or autism spectrum disorder.
13:29And one in every four to five girls.
13:33So statistics are high.
13:35Wow.
13:36Yeah.
13:37And I feel like after corona
13:41and after all of these different factors
13:44have come into play, it's even higher as well.
13:47So we know that with kids that, you know,
13:50might have these difficulties, we seek help.
13:52But what can a parent do in these situations?
13:55And then the follow-up is,
13:56what can teachers do as well in the classroom
13:59when they know that they have a kid,
14:01you know, with these difficulties
14:03and that might not, you know,
14:05have the neurological, you know,
14:07functions that another child might have?
14:10Yeah.
14:10So I always say,
14:12understanding, scaffolding, and praise.
14:18So what does understanding stand?
14:20Like, I understand that my child's
14:22not doing this to tick me off.
14:24They can't.
14:25It's not that they won't.
14:26It's they can't.
14:27So when you get that as a parent,
14:29your whole perception to something shifts.
14:33Okay.
14:33So if I'm asking him repeatedly to put his shoes on
14:36or to get ready in the morning and he's not,
14:39what can I do as a parent to help him or her?
14:43That's the second one, scaffolding.
14:44What does scaffolding mean?
14:46It's a term that teachers use a lot.
14:49If your child is here, this is their level.
14:51And if they're a level one
14:54and you want to get them to level three,
14:56you got to build a kind of a staircase for them
14:59at one and a half, 1.75, 2, 2.5 until they reach three.
15:04If you keep expecting a three,
15:06come on, come on, come to me at a three
15:08and they're at a one and they can't get to you
15:12and they keep failing.
15:14It's our role to build this bridge for them
15:18slowly but surely.
15:19So if your child can put their shoes on
15:20but can't tie their shoelaces
15:22or if your child can get upstairs
15:24but can't seem to start the activity,
15:27then there's a lot of things that you can do
15:29as a parent to help them get there.
15:31We use lots of visuals with anyone who has difficulties
15:35in focus planning and organization
15:37and even adults with ADHD,
15:39you will find that they need to put a lot of timers,
15:42a lot of reminders to get them to do
15:44and they're fine with it.
15:45Like, yeah, I have ADHD, I need like five timers to remind
15:48because this part of your brain that says,
15:50come on, Maria, get up.
15:51You have an interview, you have to go.
15:54It's going to take you half an hour to get there.
15:55That means you have to start at 2.30.
15:57That means you have to end your clinic at two.
15:59That part is underactive.
16:01It's there but it doesn't fire as much as it should be.
16:05So we rely on technology.
16:07Right, of course.
16:08It's helpful for something.
16:09Exactly.
16:11And lots of visuals for kids.
16:13So visual schedules, reminders,
16:16so that parents can save their voices.
16:18Same as teachers.
16:18I give the same advice to teachers.
16:20Save your voice because you don't want to be,
16:22John, come on.
16:23John, what did I tell you?
16:24Why are you always making mistakes?
16:26There are other tools that you can use
16:28to help you get the child where they need to be.
16:31Like timers, reminders, visual schedules,
16:35social stories we use a lot.
16:38For this week, we want to work on brushing teeth.
16:41That's all I want to do with you.
16:42I don't want to focus on anything else.
16:45Pick something that is easy and start from there
16:47and then go to something difficult.
16:50Slowly but surely.
16:52And the last thing is praise.
16:53So you do all the work as a parent.
16:56You do the scaffolding, the planning.
16:58Okay, what can I work?
17:00Where can I start?
17:00And then you praise them heavily when they achieve something.
17:05And you have to get support though.
17:07It's hard to be able to do all this by yourself.
17:11So it's always the therapy team is there to help.
17:14Yeah, I love the point of praise
17:16because I feel like a lot of kids with ADHD or ADD
17:19feel like they're underachieving as is.
17:22So it's reassuring to them as well.
17:25Oh yeah, self-esteem really takes a blow in these cases.
17:29Because if you think, I always look at the frequency
17:33of correction versus praise.
17:38So how many times am I correcting my child in the day
17:42versus how many times is my child successful?
17:44It's not because you're a bad parent.
17:46It's because the child has difficulties
17:47in executive function skills.
17:49But the child doesn't know that.
17:50And all he hears is, I'm failing my mom.
17:52I'm failing my teacher again and again.
17:54And this, the self-esteem will take a blow.
17:57And sometimes what we have is the vicious cycle
18:00of oppositional defiance.
18:03So because the ego is only receiving negative comments
18:06and feeling like it's failing all the time,
18:09it starts saying, hey, I must be a failure.
18:12I'm not doing anything right.
18:13I'm not getting my parent's attention for anything good.
18:16So what's the fastest thing to get my parents' attention?
18:19What can I do?
18:20I know, misbehave.
18:22Because misbehavior gets parents' attention really quickly.
18:26So you start having a cycle of I,
18:29the only way to get attention is misbehavior.
18:33And this is reinforced by my core belief
18:36is John is not good enough.
18:37And things like math and homework,
18:40you know what I'm good at though?
18:42Misbehavior.
18:43So I'm going to be known as the naughty child,
18:47as the clown, as the person who makes jokes
18:50because that's what I'm good at.
18:51I'm good at making mistakes apparently.
18:54So we get a lot of cases like they're 12,
18:58they're older and they've just since seven,
19:00they just learned that from school
19:02because they always get corrected.
19:04They're always in timeout.
19:05They're always out, excluded.
19:08This heavily kind of consequence-based way of phrasing
19:14will end up with your child feeling like
19:18the only way I can get recognition if I'm the bad boy.
19:22Of course.
19:22And you get that.
19:23And you will find that when you dig deeper,
19:26this child has a real difficulty
19:28in executive function skills.
19:29They can't focus.
19:30So they found a way out
19:32because they have to be known for something.
19:34They can't be known for being losers.
19:35They want to be known for the bad guy
19:38or there's sometimes they're sportive.
19:39So they become heavily invested in sports
19:42and being the clown of the class, for example.
19:45So that's another comorbid issue
19:48is what we call oppositional defiance.
19:51Again, it's coined as a disorder,
19:53but yeah, we sometimes see it as a comorbid issue.
19:56Like the rebelling side of it.
19:58Yeah.