🎙 Transcript

ENGLISH AND ARABIC

Understanding Paediatric ADHD: Signs, Diagnosis and Support

Guest: Dr. Dalal Elsori

00:00
I'm Melissa. And I'm Lea and we are busy mums, company founders and all round early learning nerds. Welcome to our podcast, Growing Little Humans. Kids aren't born with a user manual, so each week we'll try and cover many topics that you guys encounter and worry about each and every day while you're raising your little humans. Today we are delighted to have Dr. Dalal Elsori join us. Dr. Dalal is a highly experienced consultant, developmental and behavioral pediatrician.

00:30
After completing her pediatric fellowship in the US and earning her American Board of Pediatric Subspecialty Certification in Developmental and Behavioral Pediatrics, Dr. Dalal returned to the Middle East in 2022 to practice in Abu Dhabi. Over the years, she has worked closely with families and communities to raise awareness of developmental disorders and improve care for children with neutralizabilities. With a special focus on early childhood development,

01:00
Dr. Dalal's areas of expertise include diagnosing and managing conditions like autism spectrum disorders, speech and language delays, learning difficulties, ADHD and more. Hi Dr. Dalal, thank you so much for joining us today to talk about ADHD. Hi guys, thanks for having me on and happy holidays to everybody. Thank you so much. So let's just jump right in and can you just explain to us what is ADHD and what is the difference between children and adults?

01:29
Absolutely. So ADHD, what does that stand for? It's actually short for Attention Deficit Hyperactivity Disorder. So this is just one of many neurodevelopmental disorders. It manifests in childhood. It's quite prevalent. So about 10 % of the population are diagnosed with ADHD. It's typically characterized by two main core set of symptoms, I would say. Inattention,

01:59
is one of them, so the lack of focus, and hyperactivity or impulsivity is the other one. I just want to take that one step further. We further categorize ADHD into three main types, and I don't think many families or caregivers know too much about this. The three main categories we focus on are depending on which symptom predominates. So from the name, attention or hyperactive. So

02:27
is the predominating feature an attention problem? So attention deficit is the primary or predominating symptom. Or is it the hyperactivity or impulsivity that's the primary symptom? Or is it a combination of both? So ADHD inattentive subtype, ADHD hyperactive impulsive subtype, or ADHD combined. So it's a combination of both. And you just kind of asked Melissa about how does it affect children versus adults?

02:58
It does affect both and we have similar symptoms in both. However, in childhood, you have to keep in mind that one of the primary concerns we hear is that we're not doing well at school. So academically, there's a decline in school performance, in academic performance. One of the main reasons for referrals, it affects families just as it does with adults. But this time it affects siblings, parents, the family dynamic as a whole.

03:27
Not only that, but it also affects a child's social skills. So this isn't a social communication disorder per se, but kids with ADHD do have trouble having and maintaining friendships and relationships. So it affects all aspects of the child's life. And what are some of the early warning signs or symptoms that parents can be looking out for, Dr. Dalal, that might show that their child has ADHD?

03:55
So that's a really good question. So we just talked about kind of how we categorize ADHD. We look more into or dive more into those symptoms. So when we talk about attention difficulties, these children typically have trouble sustaining attention, keeping attention to tasks. They're easily forgetful, easily distractible. So these are under the umbrella of the inattention symptoms. And then you have your hyperactive and impulsive symptoms

04:23
the more kind of negative or quote unquote obvious symptoms. What are those? So those are kids that kind of have trouble sitting in their seat. They're kind of fidgety. You have to. Absolutely. They're described as being driven by a motor. The mom says, he or she is so talkative. I can't get a word in. Very argumentative at times. Has very much difficulty sitting.

04:50
In the place I asked him to sit, similarly at school, we have trouble getting this child to sit down. He frequently needs to walk around and take that movement break. In addition, you have those negative behaviors most of the time, the defiant behaviors, not really following rules. They're kind of everywhere. So these symptoms can start very early on and they can become more severe over time.

05:16
And so these signs that we're talking about, do they differ from boy to girls? Do there's certain signs that we see more prevalent in boys? And also, I hear that it is more prevalent in boys. So very good point, actually. It is. It is. So it is more prevalent in boys than in girls, almost double the prevalence in boys than in girls. However, those statistics may not actually just mean that boys have a higher chance of developing ADHD because it goes back to

05:46
How do they present? When I describe to you how they present differently, you kind of get the gist of why the prevalence is a little bit higher in boys than in girls. When we talk about symptoms, however, I just want to make one thing clear before we go into symptoms. Symptoms are very similar and core symptoms are the same and you can find them in boys or girls. However, what predominates is what makes that difference in prevalence or some of that difference in prevalence. In boys, we talk about more externalizing symptoms or features.

06:16
What are those? These boys are more hyperactive, impulsive. They again have the more obvious negative behaviors that parents and schools really have a problem with. If you can't pay attention, right, it's an issue, but you're not distracting others. You're good. You're good. You have an issue. We're gonna try and solve that, but you're not as distractible and not distractive to others around you.

06:42
and you're good in the house, you're just a little bit, you're not paying that much attention. So externalizing symptoms. With girls, it's more the internalizing symptoms. So they have more of that inattention. Problematic, but not as obvious, which is why a lot of girls get missed with regards to diagnosis until later on in early adulthood, adolescence, not much in childhood. So you have that different in which symptoms predominate. The core symptoms are the same, but the predominating symptom

07:11
is inattention in girls, hyperactivity, impulsivity and behavioral issues in boys. So you can see how that contributes to the number difference, the prevalence difference in boys and in girls. It's easier to detect it in boys. Absolutely. They'll come in with the boys and say, oh, he's just so naughty and he just doesn't want to follow these rules. And we say, the sister or the cousin probably has an element of ADHD. She's just quieter to herself, more inattentive.

07:40
doesn't really pay much attention. Both have declining academic performance, but these symptoms are more problematic to society, to the families, than with Earl's. obvious, exactly. So how would a parent know what is just normal age-appropriate behaviour? Because obviously there's times where children start to, I say, test the waters on certain ages. So how would a parent know that that is not just age-appropriate behaviour versus ADHD? So how do we know that this is...

08:10
just kind of skewing a little bit away from normal behavior versus a disorder, attention deficit hyperactivity disorder. Some level of inattention hyperactivity is expected in all children, especially infants, toddlers. And it all depends on kind of the threshold of how much the family can handle in the school. So it differs. That fine line between normal behavior and abnormal, the way we can...

08:39
discriminate between the two is we'll say, how is it affecting daily life? Is it affecting school performance? Severe enough to affect school performance. So grades are dropping, school is complaining. Life is just not fun at home. It's not bearable. It's severe enough that I have to plan going to the grocery store. I have to plan before I take the kids to the mall. At home, life is a mess and I just can't deal with it.

09:09
So the more severe and the more they're affecting quality of life, be it at school or at home, then we jump from normal behaviors to disorder. Threshold is different though. Some parents have much lower threshold and they'll come in and say, I just can't deal with this. And schools will be like, no, we're good. We're good. We can deal with this. So that's why we always compare two settings, especially in kids with ADHD. You never rely on just reports of family or parents in the home or caregivers in the home versus just at school.

09:38
We need that comparison. That's actually essential in the diagnosis of ADHD. And people don't know that. That we need to see the difference between school and home. We're building a whole picture of who the child is because we talk about this a lot is that, you know, as a teacher myself, I'd say to parents, we don't see that at school, but they're seeing at home. you know, children sometimes do behave differently in a different setting. that's really interesting. Absolutely. Absolutely. And if parents aren't have got to that point in their...

10:06
they're suspecting there could be an issue. What are the steps that a parent should take if they think they do need to see is there something wrong here? So always voice your concern. A parent or caregiver should feel safe enough to voice their concern. Start off with your general pediatrician. Ease of access. You go in there just like any checkup for any child. My main concern is some of these behaviors. A general pediatrician should be able to guide you.

10:35
with normal versus abnormal. Your concerns are legitimate regardless, especially if someone else is voicing that concern, like school. So voice that concern, let someone else who's in the field guide you to normal versus abnormal. A general pediatrician, if they're kind of on the border, they're not too sure, they'll refer you out and say, go get checked by this specific specialist. Voice your concern as a parent or a caregiver.

11:03
You are the voice of this child. So a pediatrician first and then the pediatrician will suggest the best professional to continue the conversation. I'll tell you, the threshold for referrals from general pediatricians is super low. So believe me, if you have a concern, you'll be referred out. easy to be referred. Very easy. This isn't the US and this isn't other countries where it does take a lot of time to get in to see your specialist in the UAE specifically. You will be referred out.

11:31
Absolutely. And from what age do you, is it possible to even diagnose? Because I've heard that, particularly with ADHD, that they don't like to diagnose too young. So what age do you think it is safe to diagnose? So I hear a lot of different opinions and answers of parents who have seen people before they come to see me. And it all depends on kind of where you practice. I follow the guidelines of the American Academy of Pediatrics. I trained in North America.

12:00
And my practice is based on what I was taught in developmental and behavioral pediatrics. If you want to follow those guidelines, American Academy of Pediatrics, we can diagnose ADHD anywhere between the age of four, minimum age of four to 18. And this sometimes shocks families. What do you mean? He's not six, he's not seven. That's fine. Management might differ.

12:26
but we can make a diagnosis as early as four years old. However, because of the awareness now, the increased awareness, which is great, we see a lot of people talk on social media platforms about ADHD, developmental disorders have become a hot topic throughout on social media, on Instagram, TikTok, on YouTube videos. Some parents come in overly anxious. I'll give you an example. A mother, very educated mother who came in to see me, who has a nine month old.

12:54
and is convinced this nine month old infant has ADHD. We're seeing this a lot. You're shocked, but we see this a lot. A nine month old, an 11 month old, a one year old, where we really truly, we're seeing overly anxious parents. It's nice to grasp those symptoms and fire the warning signs early on, but there's also another side to this, another spectrum to this overly anxious parent. A nine month old, I always tell them,

13:23
Let the nine month old be a nine month old. Let's look at core developmental milestones, but doesn't pay attention, overly active. He's nine months, he should be. And hasn't developed that focus. Right, right, right. So what role does the early diagnosis, how does that support ADHD effectively? As with all developmental disorders or neurodevelopmental disorders, early intervention, better outcome. Earlier diagnosis gets you into earlier intervention.

13:51
which leads to better outcomes and what we call it prognosis, so future outcomes. The earlier we can diagnose, the earlier we can manage you, get you into behavioral therapy, get you the help that you need, get schools involved, and target those problematic or challenging symptoms earlier on so we can have a better outcome.

14:10
And I think I've spoken to Lee a lot about this, parents that have had that early intervention by the time their children are getting to formal schooling, there's steps and routines and things in place to be able to support the child in the home and then we can obviously have that consistency of care within the school environment. Exactly, absolutely, absolutely. Dr Delal, I feel like we skipped a step.

14:32
When can you tell us how, when you do a diagnosis, what's involved in diagnosing a child? Yeah, so I'll start by saying, or I'll start this answer by saying who can diagnose first and then we can talk about the steps. there's a huge question mark culturally in society in general, who's gonna diagnose this?

14:58
I'll give you an example. So in the U.S. where I trained, a general pediatrician is well equipped to give a diagnosis of ADHD. And this is not the case here, probably regionally within the Gulf region and the UAE. A general pediatrician in the U.S. is trained to pick up basic ADHD. One step further, they can manage ADHD. We won't see your clear cut basic ADHD in our practice. It takes 12 to 18 months to see us sometimes.

15:27
You're not going to wait 12 months. You're going to go in and see your community pediatrician, your primary care pediatrician, who's going to get you going. Any complex issues or issues that can't be resolved by a general pediatrician then get referred out to us. Now let's talk about here specifically in the UAE. Who can diagnose ADHD here? I can say with confidence that 95 % of general pediatricians are not too comfortable giving that diagnosis, despite them being very well trained.

15:56
They're not too comfortable because the practice is different. We're used to referring out. Access to care is easier to hear and this is a blessing that we have in the country. you'll have a general pediatrician who's your first step typically and they'll see that, okay, there's an issue referral. Who are they referring to? They're either referring to a developmental and behavioral pediatrician and these are pediatricians, pediatricians, not psychologists. They're general pediatricians who have done training.

16:25
in developmental, neurodevelopmental disorders and behavioral disorders. Typically early childhood. So these are your preschoolers, your early childhood. We do see kids a little bit older, but then we overlap with child psychiatry and pediatric neurology. So we've talked about different specialists, developmental and behavioral pediatricians, child neurologists and child psychiatrists who can diagnose. I'll add one more specialty to that.

16:52
that usually in this part of the world can give a diagnosis, child psychology. So a psychologist is also added to that list. But general pediatricians, generally they will not give that diagnosis. They'll refer out. How does that process look like in order to make a diagnosis? So we rely a lot on the report of parents in schools. So not only the parents report or the caregiver report. When you come in and you're giving me certain symptoms,

17:20
I need to know how many settings do we have where these symptoms come up. So school is a huge part of what we do. Parents are a huge part. What you tell us is what's important. We examine the child and we observe the child, but we take in all of those symptoms and kind of the challenges that the parents in the school are reporting. We'll give out questionnaires that are based off of something called the DSM-5 criteria. This is the diagnostic and statistical manual.

17:50
for mental health or mental disorders. This is a rule book, I might say, that we follow that have symptoms of inattention, hyperactivity, and impulsivity. If you score a certain amount or number of these symptoms and it's affecting your daily living, then we go ahead and we give the diagnosis. It's as easy as that, or as parents would say. It's not...

18:15
a computerized system, even though there is some computer-based testing, but we as the American Academy of Pediatrics trained physicians, we follow our basic rule book. We pay attention to what parents are reporting, what schools are reporting, and based on our questionnaires and our scores, we can go ahead and make that diagnosis. We can take it one step further. If we see that there are learning challenges, which are common in children with ADHD, refer to your educational psychologist or a clinical psychologist to do a full neuropsych evaluation.

18:45
However, we don't need them for a diagnosis. We need them to see if there are learning challenges. Okay, great. So, okay, so there's a lot of people can be involved in that process, which is fantastic. once a child is diagnosed with ADHD, what interventions and treatment, what are the next steps? What are the next steps? Depending on the age of the child, we have a combination of steps we can take or management strategies. Our base relies on behavioural therapy. Your behavioural therapy is typically done by a clinical psychologist.

19:14
or behavioral therapists, and these are psychologists, who will work with families. Key word is families, not just children. We're not trying to change a child's behavior. We're trying to change your approach as a parent or caregiver with this child. So we work on the family as a unit on behavioral modification strategies, how to deal with those challenging behaviors. Where do we come in? It's super important, isn't it, to involve the parents? Because if the parents are...

19:42
not dealing with the child in the best way for that child, then they'll be basically triggering behaviour, essentially. Absolutely. And at the end of the day, who's going home with that child? The psychologist? Absolutely not. The psychologist will probably see you once or twice a week. You're going to live with the child in the home environment. We're relying on you to pick up on those behavioural strategies and replicate those in the home in order for the child to succeed. So that's one part of it. School is another part of it. The third part of it as physicians.

20:12
those that are trained and specialized, medication management, which is not for everybody. And again, there's a lot of thought process that goes into our management decision-making, but medication does play a role. It does play a role. And we as developmental and behavioral pediatricians, child psychiatrists, and most pediatric neurologists are well-versed in prescribing ADHD medications to help. It's just an aid to augment kind of the basic

20:40
picture of the symptoms that we're targeting. But behavioral therapy, psychotherapy, call it whatever you want to call it, those behavioral management strategies are your core. And then we come in to augment kind of this management plan. And so how do educators, where you're talking about what everyone's role in regarding managing the ADHD, what are the educators' role in managing that within the school environment? Yeah, so I think we've harped on the importance of the education system and schools.

21:09
in multiple stages, even with the diagnosis, with the reporting. So when it comes to kind of management in general, schools and special education departments and inclusion departments are well-versed, and I think parents underestimate the school systems here. They're well-versed in putting in basic accommodations, classroom accommodations, to help these children. So basic accommodations like, for example, moving a child from the back of the classroom to the front to reduce distractibility, giving movement breaks.

21:39
Giving organizational factors like files or folders that you can help the child organize so they're not forgetting schoolwork or tasks or homework. Giving short and simple tasks using more visual aids to keep the child less distracted. Giving frequent check-ins for the child. Again, the list goes on with basic accommodations. One step further than that is coming up with something called an Individualized Education Plan, an IEP. This is put in place by the school.

22:07
with collaboration with families, as well as with clinics, with educational psychologists, with us as developmental and behavioral pediatricians, to come up with goals, behavioral goals, academic goals, for this child to thrive. And these IEPs are frequently revised to make sure that we're giving the child all the aid and support and help that they need to thrive within the school setting. And so the school plays a very vital role in what we do.

22:35
We cannot manage it by ourselves at the clinic. Families cannot manage it by themselves at home. The school plays a huge, huge role in what we do. I feel like we could talk about this all day, Dr. Delar. Oh, absolutely. It's so interesting. I think, you know, to wrap up, what can you recommend any resources for parents at home, especially, I think, especially a parent that may suspect, you know, their child

23:04
Could it be showing some symptoms? Are there any resources that they can access? And we will then share those in the show notes. And of course, we'd love to include your information so that if people that are UAE located know how to contact you as well. Sure. So I'll start off by saying a lot of what you get from social media platforms is helpful, but don't rely too much on

23:32
kind of non-recognized or under-recognized sources. So we have a lot of people that come in who are quite convinced with certain sources online, YouTube, TikTok, specific Instagram videos. We're open to hearing all this, but don't resist too much of kind of the guidance that we're providing. We base it off evidence-based medicines versus hearsay. So my neighbor's son did well on this specific supplement. This is the one that I want. You can...

24:00
100 % verbalize that and discuss that with your provider, but be open to kind of getting guidance. It's 2024. There's so many different podcasts you can get on based on reviews, but I would say, regardless of what source you're going to go for, discuss this with your psychologist or clinician before you go forward with educating yourself in certain books or podcasts or YouTube videos.

24:27
We rely primarily on the American Academy for Pediatrics or American Academy Guidelines for Child and Adolescent Psychiatry. They have beautiful recommendations on their website. The CDC has beautiful recommendations on their website. It's not based on hearsay. It's based on evidence-based medicine, which is what we want to kind of rely on the most. rely on your clinic that you're working with, your psychologist to look up.

24:55
support groups or networking availabilities within your kind of local community. And that's something we can help with depending on which center you go to for your assessment or your evaluation. And in addition to that, bring up kind of which podcast you're listening to, because we always want to learn what are you listening to, what's being said on these podcasts. But there's so much out there that I always recommend discuss with your psychologist or your provider.

25:23
And then based on that, we can look through kind of what you're listening to or reading, and we can give you feedback accordingly. At end of the day, we're all about evidence-based medicine, so we follow our guidelines quite strictly. And so these are the main sources I rely on, but I'm open to hearing about all different types of sources or resources that people have. School. School is a huge part of you being part of a community that's supportive, because the school knows to guide you.

25:52
with regards to which children have similar challenges to your child and get you in touch with those families. So your school and the clinic that you're working with are a huge part of your support group. Where can people find me? So I actually said this to Melissa the other day. I'm at a quite exciting time of my career right now. And I'm in a transitional phase where I'll be joining Modsly Health.

26:14
in Abu Dhabi starting January so people can contact the clinic and make appointments with me at Maudsley Health. I do have an email as well, professional email that I'll provide that you can reach out to me for any further questions and I'm happy to take any questions as well. Thank you so much. It's been a very informative session and congratulations on your new role. Thank you. That's just amazing. Thank you for joining us Thanks for having me. Thanks for having me. appreciate it. Thank you. And here come the legals.

26:43
podcast is purely brought to you for educational and entertainment purposes. We are just two hectic mums and we are certainly not licensed therapists. This podcast is not intended as a substitute for the advice of licensed or qualified professionals and if you do need some help please seek out some professional advice.

00:00
I'm Melissa. And I'm Lea and we are busy mums, company founders and all round early learning nerds. Welcome to our podcast, Growing Little Humans. Kids aren't born with a user manual, so each week we'll try and cover many topics that you guys encounter and worry about each and every day while you're raising your little humans. Today we are delighted to have Dr. Dalal Elsori join us. Dr. Dalal is a highly experienced consultant, developmental and behavioral pediatrician.

00:30
After completing her pediatric fellowship in the US and earning her American Board of Pediatric Subspecialty Certification in Developmental and Behavioral Pediatrics, Dr. Dalal returned to the Middle East in 2022 to practice in Abu Dhabi. Over the years, she has worked closely with families and communities to raise awareness of developmental disorders and improve care for children with neutralizabilities. With a special focus on early childhood development,

01:00
Dr. Dalal's areas of expertise include diagnosing and managing conditions like autism spectrum disorders, speech and language delays, learning difficulties, ADHD and more. Hi Dr. Dalal, thank you so much for joining us today to talk about ADHD. Hi guys, thanks for having me on and happy holidays to everybody. Thank you so much. So let's just jump right in and can you just explain to us what is ADHD and what is the difference between children and adults?

01:29
Absolutely. So ADHD, what does that stand for? It's actually short for Attention Deficit Hyperactivity Disorder. So this is just one of many neurodevelopmental disorders. It manifests in childhood. It's quite prevalent. So about 10 % of the population are diagnosed with ADHD. It's typically characterized by two main core set of symptoms, I would say. Inattention,

01:59
is one of them, so the lack of focus, and hyperactivity or impulsivity is the other one. I just want to take that one step further. We further categorize ADHD into three main types, and I don't think many families or caregivers know too much about this. The three main categories we focus on are depending on which symptom predominates. So from the name, attention or hyperactive. So

02:27
is the predominating feature an attention problem? So attention deficit is the primary or predominating symptom. Or is it the hyperactivity or impulsivity that's the primary symptom? Or is it a combination of both? So ADHD inattentive subtype, ADHD hyperactive impulsive subtype, or ADHD combined. So it's a combination of both. And you just kind of asked Melissa about how does it affect children versus adults?

02:58
It does affect both and we have similar symptoms in both. However, in childhood, you have to keep in mind that one of the primary concerns we hear is that we're not doing well at school. So academically, there's a decline in school performance, in academic performance. One of the main reasons for referrals, it affects families just as it does with adults. But this time it affects siblings, parents, the family dynamic as a whole.

03:27
Not only that, but it also affects a child's social skills. So this isn't a social communication disorder per se, but kids with ADHD do have trouble having and maintaining friendships and relationships. So it affects all aspects of the child's life. And what are some of the early warning signs or symptoms that parents can be looking out for, Dr. Dalal, that might show that their child has ADHD?

03:55
So that's a really good question. So we just talked about kind of how we categorize ADHD. We look more into or dive more into those symptoms. So when we talk about attention difficulties, these children typically have trouble sustaining attention, keeping attention to tasks. They're easily forgetful, easily distractible. So these are under the umbrella of the inattention symptoms. And then you have your hyperactive and impulsive symptoms

04:23
the more kind of negative or quote unquote obvious symptoms. What are those? So those are kids that kind of have trouble sitting in their seat. They're kind of fidgety. You have to. Absolutely. They're described as being driven by a motor. The mom says, he or she is so talkative. I can't get a word in. Very argumentative at times. Has very much difficulty sitting.

04:50
In the place I asked him to sit, similarly at school, we have trouble getting this child to sit down. He frequently needs to walk around and take that movement break. In addition, you have those negative behaviors most of the time, the defiant behaviors, not really following rules. They're kind of everywhere. So these symptoms can start very early on and they can become more severe over time.

05:16
And so these signs that we're talking about, do they differ from boy to girls? Do there's certain signs that we see more prevalent in boys? And also, I hear that it is more prevalent in boys. So very good point, actually. It is. It is. So it is more prevalent in boys than in girls, almost double the prevalence in boys than in girls. However, those statistics may not actually just mean that boys have a higher chance of developing ADHD because it goes back to

05:46
How do they present? When I describe to you how they present differently, you kind of get the gist of why the prevalence is a little bit higher in boys than in girls. When we talk about symptoms, however, I just want to make one thing clear before we go into symptoms. Symptoms are very similar and core symptoms are the same and you can find them in boys or girls. However, what predominates is what makes that difference in prevalence or some of that difference in prevalence. In boys, we talk about more externalizing symptoms or features.

06:16
What are those? These boys are more hyperactive, impulsive. They again have the more obvious negative behaviors that parents and schools really have a problem with. If you can't pay attention, right, it's an issue, but you're not distracting others. You're good. You're good. You have an issue. We're gonna try and solve that, but you're not as distractible and not distractive to others around you.

06:42
and you're good in the house, you're just a little bit, you're not paying that much attention. So externalizing symptoms. With girls, it's more the internalizing symptoms. So they have more of that inattention. Problematic, but not as obvious, which is why a lot of girls get missed with regards to diagnosis until later on in early adulthood, adolescence, not much in childhood. So you have that different in which symptoms predominate. The core symptoms are the same, but the predominating symptom

07:11
is inattention in girls, hyperactivity, impulsivity and behavioral issues in boys. So you can see how that contributes to the number difference, the prevalence difference in boys and in girls. It's easier to detect it in boys. Absolutely. They'll come in with the boys and say, oh, he's just so naughty and he just doesn't want to follow these rules. And we say, the sister or the cousin probably has an element of ADHD. She's just quieter to herself, more inattentive.

07:40
doesn't really pay much attention. Both have declining academic performance, but these symptoms are more problematic to society, to the families, than with Earl's. obvious, exactly. So how would a parent know what is just normal age-appropriate behaviour? Because obviously there's times where children start to, I say, test the waters on certain ages. So how would a parent know that that is not just age-appropriate behaviour versus ADHD? So how do we know that this is...

08:10
just kind of skewing a little bit away from normal behavior versus a disorder, attention deficit hyperactivity disorder. Some level of inattention hyperactivity is expected in all children, especially infants, toddlers. And it all depends on kind of the threshold of how much the family can handle in the school. So it differs. That fine line between normal behavior and abnormal, the way we can...

08:39
discriminate between the two is we'll say, how is it affecting daily life? Is it affecting school performance? Severe enough to affect school performance. So grades are dropping, school is complaining. Life is just not fun at home. It's not bearable. It's severe enough that I have to plan going to the grocery store. I have to plan before I take the kids to the mall. At home, life is a mess and I just can't deal with it.

09:09
So the more severe and the more they're affecting quality of life, be it at school or at home, then we jump from normal behaviors to disorder. Threshold is different though. Some parents have much lower threshold and they'll come in and say, I just can't deal with this. And schools will be like, no, we're good. We're good. We can deal with this. So that's why we always compare two settings, especially in kids with ADHD. You never rely on just reports of family or parents in the home or caregivers in the home versus just at school.

09:38
We need that comparison. That's actually essential in the diagnosis of ADHD. And people don't know that. That we need to see the difference between school and home. We're building a whole picture of who the child is because we talk about this a lot is that, you know, as a teacher myself, I'd say to parents, we don't see that at school, but they're seeing at home. you know, children sometimes do behave differently in a different setting. that's really interesting. Absolutely. Absolutely. And if parents aren't have got to that point in their...

10:06
they're suspecting there could be an issue. What are the steps that a parent should take if they think they do need to see is there something wrong here? So always voice your concern. A parent or caregiver should feel safe enough to voice their concern. Start off with your general pediatrician. Ease of access. You go in there just like any checkup for any child. My main concern is some of these behaviors. A general pediatrician should be able to guide you.

10:35
with normal versus abnormal. Your concerns are legitimate regardless, especially if someone else is voicing that concern, like school. So voice that concern, let someone else who's in the field guide you to normal versus abnormal. A general pediatrician, if they're kind of on the border, they're not too sure, they'll refer you out and say, go get checked by this specific specialist. Voice your concern as a parent or a caregiver.

11:03
You are the voice of this child. So a pediatrician first and then the pediatrician will suggest the best professional to continue the conversation. I'll tell you, the threshold for referrals from general pediatricians is super low. So believe me, if you have a concern, you'll be referred out. easy to be referred. Very easy. This isn't the US and this isn't other countries where it does take a lot of time to get in to see your specialist in the UAE specifically. You will be referred out.

11:31
Absolutely. And from what age do you, is it possible to even diagnose? Because I've heard that, particularly with ADHD, that they don't like to diagnose too young. So what age do you think it is safe to diagnose? So I hear a lot of different opinions and answers of parents who have seen people before they come to see me. And it all depends on kind of where you practice. I follow the guidelines of the American Academy of Pediatrics. I trained in North America.

12:00
And my practice is based on what I was taught in developmental and behavioral pediatrics. If you want to follow those guidelines, American Academy of Pediatrics, we can diagnose ADHD anywhere between the age of four, minimum age of four to 18. And this sometimes shocks families. What do you mean? He's not six, he's not seven. That's fine. Management might differ.

12:26
but we can make a diagnosis as early as four years old. However, because of the awareness now, the increased awareness, which is great, we see a lot of people talk on social media platforms about ADHD, developmental disorders have become a hot topic throughout on social media, on Instagram, TikTok, on YouTube videos. Some parents come in overly anxious. I'll give you an example. A mother, very educated mother who came in to see me, who has a nine month old.

12:54
and is convinced this nine month old infant has ADHD. We're seeing this a lot. You're shocked, but we see this a lot. A nine month old, an 11 month old, a one year old, where we really truly, we're seeing overly anxious parents. It's nice to grasp those symptoms and fire the warning signs early on, but there's also another side to this, another spectrum to this overly anxious parent. A nine month old, I always tell them,

13:23
Let the nine month old be a nine month old. Let's look at core developmental milestones, but doesn't pay attention, overly active. He's nine months, he should be. And hasn't developed that focus. Right, right, right. So what role does the early diagnosis, how does that support ADHD effectively? As with all developmental disorders or neurodevelopmental disorders, early intervention, better outcome. Earlier diagnosis gets you into earlier intervention.

13:51
which leads to better outcomes and what we call it prognosis, so future outcomes. The earlier we can diagnose, the earlier we can manage you, get you into behavioral therapy, get you the help that you need, get schools involved, and target those problematic or challenging symptoms earlier on so we can have a better outcome.

14:10
And I think I've spoken to Lee a lot about this, parents that have had that early intervention by the time their children are getting to formal schooling, there's steps and routines and things in place to be able to support the child in the home and then we can obviously have that consistency of care within the school environment. Exactly, absolutely, absolutely. Dr Delal, I feel like we skipped a step.

14:32
When can you tell us how, when you do a diagnosis, what's involved in diagnosing a child? Yeah, so I'll start by saying, or I'll start this answer by saying who can diagnose first and then we can talk about the steps. there's a huge question mark culturally in society in general, who's gonna diagnose this?

14:58
I'll give you an example. So in the U.S. where I trained, a general pediatrician is well equipped to give a diagnosis of ADHD. And this is not the case here, probably regionally within the Gulf region and the UAE. A general pediatrician in the U.S. is trained to pick up basic ADHD. One step further, they can manage ADHD. We won't see your clear cut basic ADHD in our practice. It takes 12 to 18 months to see us sometimes.

نص باللغة الإنجليزية حول اضطراب فرط الحركة وتشتت الانتباه (ADHD)

00:00
أنا ميليسا. وأنا ليا. نحن أمهات مشغولات، مؤسسات لشركات، ومهووسات بالتعلم المبكر. مرحبًا بكم في بودكاست "تنمية البشر الصغار". الأطفال لا يُولدون مع دليل استخدام، لذا نحاول كل أسبوع أن نغطي العديد من المواضيع التي تواجهونها وتقلقون بشأنها يوميًا أثناء تربية أطفالكم.
اليوم يسعدنا أن تستضيف معنا الدكتورة دلال السري.
الدكتورة دلال استشارية متمرسة جدًا في طب الأطفال التطوري والسلوكي.

00:30
بعد إكمال زمالة طب الأطفال في الولايات المتحدة والحصول على شهادة البورد الأمريكي للتخصص الدقيق في طب الأطفال التطوري والسلوكي، عادت الدكتورة دلال إلى الشرق الأوسط في عام 2022 لممارسة عملها في أبوظبي.
على مدار السنوات، عملت عن قرب مع العائلات والمجتمعات لزيادة الوعي باضطرابات النمو وتحسين رعاية الأطفال ذوي القدرات المختلفة، مع تركيز خاص على تطور الطفولة المبكرة.

01:00
تشمل مجالات خبرة الدكتورة دلال تشخيص وإدارة حالات مثل اضطرابات طيف التوحد، وتأخر النطق واللغة، وصعوبات التعلم، واضطراب فرط الحركة وتشتت الانتباه (ADHD) وغيرها.
مرحبًا دكتورة دلال، شكرًا جزيلًا لانضمامك إلينا اليوم للحديث عن اضطراب فرط الحركة وتشتت الانتباه.
مرحبًا بكم جميعًا، شكرًا لاستضافتي وأتمنى لكم عطلات سعيدة.
شكرًا لكِ. دعينا نبدأ مباشرة. هل يمكنك أن تشرحي لنا ما هو اضطراب فرط الحركة وتشتت الانتباه؟ وما الفرق بينه عند الأطفال والبالغين؟

01:29
بالتأكيد. اختصار ADHD يعني اضطراب نقص الانتباه مع فرط النشاط.
وهو واحد من العديد من الاضطرابات النمائية العصبية، ويظهر عادةً في مرحلة الطفولة.
يُعتبر اضطرابًا شائعًا نسبيًا، حيث يتم تشخيص حوالي 10٪ من السكان به.
تُميز أعراضه الأساسية بنوعين رئيسيين: قلة الانتباه، وفرط النشاط والاندفاع.

01:59
نقوم أيضًا بتقسيم اضطراب فرط الحركة وتشتت الانتباه إلى ثلاثة أنواع رئيسية، وهو أمر لا يعرفه الكثير من الأهالي ومقدمي الرعاية:

النوع الذي يغلب عليه نقص الانتباه.

النوع الذي يغلب عليه فرط النشاط والاندفاع.

النوع المختلط، حيث تظهر أعراض النوعين معًا.
سأعود لسؤالك يا ميليسا حول الفرق بين الأطفال والبالغين.

02:58
الاضطراب يؤثر على كليهما، مع أعراض متشابهة، ولكن عند الأطفال، يبرز أثره بشكل كبير في الأداء الأكاديمي، إذ نلاحظ تراجعًا في التحصيل الدراسي، مما يؤدي غالبًا إلى الإحالة للتقييم.
كما يؤثر على ديناميكية الأسرة، والعلاقات الاجتماعية، حيث يواجه الأطفال صعوبة في تكوين صداقات والحفاظ عليها.

03:55
ما هي بعض العلامات أو الأعراض المبكرة التي يمكن أن ينتبه لها الآباء والتي قد تدل على إصابة الطفل باضطراب فرط الحركة وتشتت الانتباه؟

04:23
من أعراض نقص الانتباه: صعوبة الحفاظ على التركيز، سهولة التشتت والنسيان.
أما أعراض فرط النشاط والاندفاع، فهي أوضح مثل: عدم القدرة على الجلوس بثبات، كثرة الكلام، الحركة المفرطة كأن الطفل "مدفوع بمحرك"، العناد، ومخالفة القواعد بشكل مستمر.

05:16
هل تختلف هذه الأعراض بين الأولاد والبنات؟ سمعت أن ADHD أكثر شيوعًا بين الأولاد.

05:46
نعم، بالفعل هو أكثر شيوعًا عند الأولاد تقريبًا بنسبة الضعف مقارنةً بالبنيات.
لكن طريقة ظهور الأعراض تختلف:

الأولاد يُظهرون أعراضًا خارجية (فرط نشاط واضح وسلوكيات اندفاعية).

البنات غالبًا ما يظهرن أعراضًا داخلية (قلة الانتباه)، ولهذا قد يتم تشخيص البنات في مراحل متأخرة مثل المراهقة أو حتى البلوغ المبكر.

07:40
كيف يمكن للوالدين التمييز بين السلوك الطبيعي المناسب للمرحلة العمرية وبين أعراض اضطراب فرط الحركة وتشتت الانتباه؟

08:10
السؤال المهم هنا هو: إلى أي درجة يؤثر السلوك على الحياة اليومية؟

إذا كان السلوك يؤثر سلبًا وبشكل واضح على الأداء المدرسي أو الحياة الأسرية اليومية، ويتسبب بمشاكل مستمرة، عندها نتحدث عن اضطراب وليس مجرد سلوك طبيعي.

لذلك يجب التقييم في أكثر من بيئة (المنزل والمدرسة) لتكوين صورة كاملة عن سلوك الطفل.

10:06
إذا شعر الأهل بوجود مشكلة، ما هي الخطوات التي ينبغي اتخاذها؟

10:35
يجب على الأهل التعبير عن مخاوفهم بوضوح.
الخطوة الأولى تكون بمراجعة طبيب الأطفال العام، والذي يستطيع أن يميز غالبًا بين السلوك الطبيعي والمشكوك فيه.
وفي حال كان هناك شك، يتم تحويل الطفل إلى اختصاصي آخر (مثل طبيب أطفال تطوري أو طبيب نفسي للأطفال).

11:31
هل هناك عمر محدد يمكن فيه تشخيص ADHD؟
سمعت أن بعض الأطباء يفضلون عدم التشخيص في سن مبكرة.

12:00
بحسب إرشادات الأكاديمية الأمريكية لطب الأطفال (AAP)، يمكن تشخيص اضطراب فرط الحركة وتشتت الانتباه ابتداءً من سن أربع سنوات وحتى سن 18 سنة.
قد تختلف أساليب العلاج حسب العمر، لكن التشخيص يمكن أن يتم مبكرًا.
مع انتشار التوعية مؤخرًا، أصبح بعض الآباء قلقين بشكل مفرط ويطلبون تقييم أطفالهم الرضع! (مثل طفل عمره 9 أشهر)، وهنا نؤكد أن الحركة وعدم التركيز أمر طبيعي في هذا العمر.

13:51
ما أهمية التشخيص المبكر؟

التشخيص المبكر يسمح بالتدخل المبكر، مما يؤدي إلى نتائج أفضل على المدى الطويل.
بالتدخل المبكر، نتمكن من تقديم العلاج السلوكي والدعم المناسب، سواء في البيت أو المدرسة.

14:32
كيف يتم التشخيص بالتفصيل؟

14:58
أولاً: من يمكنه التشخيص؟
في الولايات المتحدة، طبيب الأطفال العام يمكنه تشخيص ADHD.
أما في منطقتنا (الخليج)، غالبًا ما تتم الإحالة إلى اختصاصي كطبيب أطفال تطوري أو طبيب نفسي.
التشخيص يعتمد على تقييم شامل لسلوك الطفل في أكثر من بيئة (المنزل والمدرسة)، وجمع تقارير من المعلمين والوالدين، وإجراء اختبارات تقييمية.

هل تود أن أكمل بقية النص أيضًا؟
أكمل لك الجزء المتبقي بنفس التنسيق لو أردت! 🌟 هل ترغب أن أصيغه أيضاً بطريقة رسمية تناسب النشر أو دليلًا للأهل؟

هم ليسوا مرتاحين كثيراً لأن الممارسة هنا مختلفة. نحن معتادون على الإحالة إلى مختصين. الوصول إلى الرعاية أسهل هنا، وهذه نعمة نتمتع بها في هذا البلد. عادةً، لديك طبيب أطفال عام كخطوة أولى، وعندما يرى أن هناك مشكلة، يقوم بالإحالة. إلى من يحيل؟ يحيل إما إلى طبيب أطفال مختص بالنمو والسلوك، وهؤلاء أطباء أطفال أكملوا تدريبًا خاصًا، وليسوا علماء نفس.

16:25
هؤلاء أطباء أطفال تلقوا تدريبًا إضافيًا في الاضطرابات النمائية العصبية واضطرابات السلوك، وعادةً ما يتعاملون مع الأطفال في مرحلة الطفولة المبكرة. نحن نرى أحيانًا أطفالاً أكبر سنًا، لكن حينها نبدأ في التداخل مع طب نفس الأطفال وطب الأعصاب للأطفال. تحدثنا عن تخصصات مختلفة: أطباء الأطفال التطوريون والسلوكيون، أطباء أعصاب الأطفال، وأطباء نفس الأطفال الذين يمكنهم تشخيص الحالات. سأضيف تخصصًا آخر هنا.

16:52
في هذه المنطقة من العالم، يمكن لعلماء نفس الأطفال أيضًا تقديم التشخيص. ولكن بشكل عام، أطباء الأطفال العامون لا يقدمون التشخيص؛ بل يحيلون إلى مختصين آخرين. كيف يبدو هذا المسار للوصول إلى التشخيص؟ نحن نعتمد بشكل كبير على تقارير الأهل والمدارس. ليس فقط تقارير الأهل أو مقدمي الرعاية. عندما تأتون وتعرضون أعراضًا معينة،

17:20
نحتاج إلى معرفة في كم بيئة تظهر هذه الأعراض. لذلك، المدرسة جزء كبير مما نقوم به. والأهل أيضًا جزء كبير. ما تخبروننا به مهم جدًا. نقوم بفحص الطفل وملاحظته، لكن نعتمد أيضًا على الأعراض والتحديات التي يبلغ عنها الأهل والمدرسة. نقدم استبيانات مبنية على ما يُسمى بدليل التشخيص الإحصائي DSM-5.

17:50
وهو دليل التشخيص والإحصاء للاضطرابات النفسية. يمكننا أن نسميه "كتاب القوانين" الذي نتبعه، والذي يصف أعراض قلة الانتباه، وفرط النشاط، والاندفاع. إذا سجل الطفل عددًا معينًا من هذه الأعراض وكان ذلك يؤثر على حياته اليومية، عندها نعطي التشخيص. بهذه البساطة... أو كما يعتقد البعض.

18:15
ليس نظامًا محوسبًا بالكامل، رغم وجود بعض الاختبارات المحوسبة. ولكن كأطباء مدربين وفقًا للأكاديمية الأمريكية لطب الأطفال، نحن نتبع قواعدنا الأساسية. نعتمد على تقارير الأهل والمدارس، واستنادًا إلى استبياناتنا ونتائجها، نقوم بالتشخيص. يمكننا أن نخطو خطوة إضافية: إذا لاحظنا وجود تحديات تعلم، والتي هي شائعة عند الأطفال المصابين باضطراب فرط الحركة وتشتت الانتباه (ADHD)، نحيل الطفل إلى أخصائي نفسي تربوي أو إكلينيكي لإجراء تقييم نفسي عصبي كامل.

18:45
ولكننا لا نحتاج إلى هذا التقييم لإجراء التشخيص، بل لمعرفة إذا كانت هناك تحديات تعلم.

19:00
حسنًا، إذن هناك العديد من الأشخاص الذين يمكن أن يشاركوا في هذه العملية، وهو أمر رائع. بمجرد تشخيص إصابة الطفل باضطراب فرط الحركة وتشتت الانتباه، ما هي التدخلات والعلاجات والخطوات التالية؟

19:14
اعتمادًا على عمر الطفل، هناك مجموعة من الاستراتيجيات أو طرق الإدارة التي يمكن اتباعها. الأساس لدينا هو العلاج السلوكي. عادةً ما يتم تقديم العلاج السلوكي من قِبل أخصائي نفسي إكلينيكي أو معالج سلوكي. والكلمة المفتاحية هنا هي "العائلة"، ليس الطفل وحده. نحن لا نحاول تغيير سلوك الطفل فقط، بل نحاول تغيير طريقة تعامل الأهل أو مقدمي الرعاية مع الطفل.

19:42
نعمل مع الأسرة كوحدة واحدة على استراتيجيات تعديل السلوك وكيفية التعامل مع السلوكيات الصعبة.
وهنا تبرز أهمية إشراك الأهل؛ لأنهم إذا لم يتعاملوا مع الطفل بالشكل الأنسب له، فسيؤدي ذلك إلى تحفيز السلوكيات السلبية.
بالطبع! وفي نهاية المطاف، من الذي يعيش مع الطفل؟ الأخصائي النفسي؟ بالطبع لا. الأخصائي قد يراك مرة أو مرتين في الأسبوع. لكنك أنت تعيش مع الطفل في المنزل. نعتمد عليك في تطبيق استراتيجيات تعديل السلوك داخل المنزل لدعم نجاح الطفل.

20:12
هذا جانب. المدرسة جانب آخر. الجانب الثالث نحن كأطباء: إدارة الأدوية، وهي ليست للجميع. وهناك عملية تفكير دقيقة قبل اتخاذ القرار بإدخال الأدوية، ولكنها تلعب دورًا. نحن كأطباء أطفال متخصصين في التطور والسلوك، وأطباء نفس الأطفال، ومعظم أطباء أعصاب الأطفال، نمتلك الخبرة لوصف أدوية اضطراب فرط الحركة وتشتت الانتباه للمساعدة. الأدوية مجرد وسيلة داعمة.

20:40
ولكن العلاج السلوكي واستراتيجيات تعديل السلوك تبقى هي الأساس، ونحن نأتي لدعم خطة العلاج.
وماذا عن دور المعلمين؟

21:09
لقد شددنا سابقًا على أهمية النظام التعليمي والمدارس في عدة مراحل، سواء أثناء التشخيص أو خلال الدعم. المدارس وأقسام التعليم الخاص والتضمين أصبحت متمرسة جدًا في تقديم التسهيلات الأساسية لمساعدة هؤلاء الأطفال. مثل: نقل الطفل من آخر الصف إلى الأمام لتقليل التشتت، تقديم فترات استراحة حركية، توفير أدوات تنظيمية مثل الملفات، إعطاء مهام قصيرة ومبسطة، استخدام وسائل بصرية أكثر، تقديم مراجعات متكررة.

21:39
وهناك المزيد من هذه التسهيلات.
خطوة أبعد من ذلك هي إعداد خطة تعليمية فردية (IEP)، يتم إعدادها بالتعاون مع العائلة، والعيادات، والأخصائيين النفسيين التربويين، ونحن كأطباء متخصصين، لتحديد أهداف سلوكية وأكاديمية لضمان نجاح الطفل. ويتم مراجعة هذه الخطة بانتظام للتأكد من أنها تخدم الطفل بأفضل شكل ممكن.

22:35
إذن المدرسة تلعب دورًا محوريًا جدًا في عملية الدعم. لا يمكننا كعيادات أو كعائلات التعامل مع هذه الحالات بمفردنا. المدرسة شريك أساسي.

23:04
أشعر أننا يمكن أن نتحدث عن هذا الموضوع طوال اليوم يا دكتورة ديلار!
بالتأكيد! موضوع مهم جدًا.
كختام، هل يمكنكِ أن توصي ببعض الموارد للأهالي، خاصة أولئك الذين يعتقدون أن طفلهم قد يُظهر بعض الأعراض؟ سنشارك هذه الموارد لاحقًا في ملاحظات الحلقة.

23:32
بالطبع. سأبدأ بالقول إن هناك الكثير من المعلومات المفيدة على منصات التواصل الاجتماعي، لكن لا يجب الاعتماد كثيرًا على المصادر غير الموثوقة أو الأقل شهرة. كثير من الأهالي يأتون مقتنعين بمصادر من الإنترنت مثل يوتيوب، تيك توك، أو إنستغرام. نحن منفتحون على سماع كل شيء، لكن لا تقاوموا كثيرًا التوجيهات التي نقدمها، فهي مبنية على الطب المبني على الأدلة وليس على السماع فقط.

24:00
على سبيل المثال، أن يقول لك جار أن ابنه استفاد من مكمل معين. يمكنك الحديث عن ذلك مع طبيبك، ولكن كن منفتحًا لسماع التوجيهات المهنية. هناك الكثير من البودكاست الجيد هذه الأيام، لكن مهما كان المصدر، أنصح بمناقشته مع طبيبك النفسي أو الأخصائي قبل اعتماد أي كتاب أو بودكاست أو فيديو.

24:27
نحن نعتمد بشكل رئيسي على الأكاديمية الأمريكية لطب الأطفال، والأكاديمية الأمريكية لطب نفس الأطفال والمراهقين. لديهم توصيات رائعة على مواقعهم الإلكترونية، وهي مبنية على الطب المبني على الأدلة. كذلك، اعتمد على العيادة التي تتعامل معها أو الأخصائي الخاص بك للعثور على مجموعات دعم أو موارد مجتمعية محلية.

24:55
أيضًا، أخبر طبيبك عن البودكاستات أو المصادر التي تستمع إليها حتى نتمكن من تقديم التغذية الراجعة المناسبة. في النهاية، نحن ملتزمون بالطب المبني على الأدلة. هذه هي المصادر الأساسية التي أعتمد عليها، ولكنني منفتحة للاستماع لأي مصادر أخرى ترغبون بمشاركتها.

25:23
ولا تنسوا أهمية المدرسة، فهي جزء كبير من المجتمع الداعم لكم، ويمكن أن تساعدكم في التواصل مع أسر تمر بتجارب مماثلة.

25:52
أين يمكن العثور عليّ؟ كما أخبرت ميليسا مؤخرًا، أنا في مرحلة انتقالية مشوقة من مسيرتي المهنية. سأبدأ بالانضمام إلى مركز مودسلي هيلث (Maudsley Health) في أبوظبي بداية من يناير. يمكنكم التواصل مع العيادة لتحديد موعد معي هناك. وسأوفر أيضًا بريدي الإلكتروني المهني للتواصل مع من لديه أي أسئلة إضافية.

26:43
شكرًا جزيلاً لك. كانت جلسة مليئة بالمعلومات. ومبروك على المنصب الجديد!
شكرًا جزيلاً.
وشكرًا لاستضافتكم لي، أنا ممتنة جدًا.

26:55
(تنويه قانوني):
هذا البودكاست مقدم لأغراض تعليمية وترفيهية فقط. نحن مجرد أمّين مشغولتين ولسنا معالجين مرخصين. لا يُقصد من هذا البودكاست أن يكون بديلاً عن نصيحة المتخصصين المؤهلين. إذا كنت بحاجة إلى مساعدة، يرجى طلب المشورة من مختصين مرخصين.