ADHD Diagnosis Challenges in India: A Call for Culturally Relevant Approaches

About 5% of children and teenagers worldwide have ADHD, a brain disorder that makes it hard for them to act and learn like others. It impairs the ability to focus, maintain self-control, and sit still, often involving academic, social, and home life. This post delves into the complexities of diagnosing ADHD in the Indian context, highlighting the limitations of current diagnostic criteria and proposing culturally sensitive alternatives.

Why the Current Diagnostic Criteria Fall Short

The diagnosis of ADHD relies on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11), primarily developed based on research conducted in Western countries. These criteria may not adequately apply to Indian children due to significant cultural, educational, and environmental differences. Several vital reasons underpin the flaws in the current diagnostic criteria:

Educational Disparities : The DSM-5 and ICD-11 require symptoms to manifest in at least two settings, often home and school. However, in India, issues like limited access to formal education, large class sizes, poor infrastructure, and insufficient teacher training can hinder educators’ accurate symptom observation and reporting. Lack of Objective Measures : To meet these criteria, the symptoms must cause severe problems in how they get along with others, do in school, or work. Unfortunately, standardized, objective assessment tools to gauge this impact might be lacking in the Indian context, compounded by low awareness, stigma, and resource limitations. Categorical vs. Dimensional Approach : The current criteria adopt a categorical approach, assuming ADHD is a distinct disorder with clear boundaries. Recent research indicates that ADHD exists on a continuum of severity and comorbidity, potentially causing underdiagnosis in children with milder symptoms or comorbid conditions like anxiety, depression, or learning disabilities. Western-Centric Model : The Western-centric model of child development and behaviour underpinning these criteria does not adequately capture the diversity and complexity of the Indian context. Behaviours indicative of ADHD in the West may be deemed normal or culturally acceptable in India, and vice versa.Exploring Alternatives

Given these limitations, it is imperative to develop culturally sensitive and context-specific tools for ADHD diagnosis and management in Indian children. Some viable alternatives include:

Locally Developed Rating Scales : Utilize locally developed or adapted rating scales that account for the nuanced variations of ADHD symptoms and impairment in Indian children, such as the INCLEN Diagnostic Tool for Attention Deficit Hyperactivity Disorder (INDT-ADHD). Dimensional Approach : Shift towards a dimensional approach that considers the frequency, intensity, duration, and impact of ADHD symptoms across different domains and settings. Comprehensive Assessment : Implement a complete assessment process that includes detailed history taking, mental state examination, physical examination, neuropsychological testing, and screening for other related disorders, ensuring a holistic approach to diagnosis and treatment. Collaborative Approach : Encourage a collaborative approach involving the child, parents, teachers, and other professionals in diagnosing and managing ADHD, fostering consistent and coordinated support across various settings.

ADHD is a significant concern among Indian children, yet the existing diagnostic criteria may not be suitable for this population. Developing culturally sensitive and context-specific assessment tools is crucial to enhance the identification and treatment of ADHD, ultimately improving the quality of life for affected children and their families. Culturally relevant approaches are the key to addressing the unique challenges presented by ADHD in India.

Sources:

Link to Indian PediatricsLink to Indian Psychiatric SocietyLink to NHS on ADHD DiagnosisLink to NICE (UK)