Attention Magazine October 2018

WE’RE ALL FAMILIAR with that distracted, uninterested fellow who just did not sit still in school. He was annoyingly chatty and quite often failed his examinations. We presumed him clueless, lacking the desire to study. In Pakistan, many of these children leave school at an early age. Some become entrepreneurs. Others continue the traditional educational route with little success. When they fail to accomplish the outcomes society deems desirable, many become dissatisfied. They often end up argumentative, problematic, and begin lying or deceiving to get guardians and educators to leave them alone. This conduct brings about additional issues for them at home, in relationships, at school, and later at work. Many struggle emotionally, socially, and financially.

To help such individuals, Kazim Trust was established in 2008 in the city of Karachi, one of the largest cities in Pakistan. Its core purpose was to reach out to as many children with ADHD as possible, and to change perceptions about ADHD and learning difficulties. Kazim Trust is dedicated to creating awareness in Pakistan and to help educators and parents improve the lives of these children. Operating on a not-for-profit basis, it has helped many children through screening services, workshops for educators and parents, and dynamic internship programs. Before going into more detail about the organization, let’s consider the overall situation of mental health in Pakistan.

Mental health in Pakistan

Mental health in children is an overlooked subject worldwide, even in developed nations. In Pakistan, awareness is building gradually, but the situation of mental health institutions is dark and far from the mark. There are not nearly enough psychiatrists and psychologists in the country. There are approximately two to three psychiatrists per one million people in the urban centers; they are nearly non-existent in rural areas. Existing hospitals and healthcare institutions are poorly utilized due to the social stigma associated with mental illness. The general misconception is that mental illness is caused by curses and evil spirits.

Developing mental health awareness for children requires serious attention, since half of the country’s population is under the age of 18. There are limited trained personnel in the field of child psychiatry. Out of 3,729 outpatient mental health facilities in Pakistan, only one percent are just for children and adolescents. To add to this, the stigma attached to being a parent of such a child further complicates the matter.

The idea of a child suffering from a mental disorder is so unfathomable, undesirable, and shameful for the parents that they opt to avoid treatment for their children. This results in delaying a child’s admission into a special school, rendering the child vulnerable to severe comorbidities. If the child is already anxious, for example, a plethora of ADHD-related difficulties will add to the anxiety. Parents may feel free from humiliation, but it is at the cost of their child’s mental health.

Brave parents who opt to support their child despite the social stigma begin a quest to find a renowned professional from a thin selection. There are few institutions where specialists can assess, determine, and treat children with psychological issues. There are only a handful of special schools; in Karachi, for example, there are only three institutions working on ADHD. Educating parents about ADHD treatments and behavior interventions is of pivotal importance, since once correctly diagnosed, most children respond well to medication and behavior modification techniques. The parents’ availability and consistency in discipline are key, however. Parents must also follow up closely with a specialist who can monitor the progress of the child’s treatment and the occurrence of any additional issues.

Founded to empower the children

In a developing nation like Pakistan, where numerous children don’t go to school, it is considerably difficult to set up programs for these children. When Kazim Trust was established in Karachi ten years ago, its core purpose was to help as many children as possible and to raise awareness about ADHD. The organization has established a network of referrals to provide and maintain a global standard of care. Its psychologists and therapists work closely with other professionals at Pakistan’s leading medical institution, the Aga Khan University Hospital, and the Institute of Clinical Psychology, among others.

Kazim Trust has established a network of psychologists working with different organizations–hospitals and other nonprofits–that participate in its panel discussions, trainings, and workshops on all kinds of psychosocial and academic problems related to ADHD. These are usually attended by healthcare professionals, special educators, psychologists, and university students enrolled in these areas of study.

Believing that ADHD should never restrict the academic, social, and psychological development of any child, the organization holds regular workshops for parents, teachers, and other health professionals. These programs are an effective way to provide participants with skills to identify and manage symptoms. Teachers are trained to identify symptoms of ADHD, to employ screening tools, and to refer students for assessment and therapy. Additional programs are held to promote awareness in the wider community. These events are conducted at the Trust headquarters and at more than 300 schools across Karachi. Though based in the city, the organization serves other regions as well and is expanding its network of schools.

One of the most important networks the Trust creates is that of the parent, the teacher, and the child. Experience shows that without this triad, the child simply gives up over time. Our psychologists work hard to uphold and reinforce this triad–which is a difficult thing to do, as both parent and teacher try to enforce their own rules on the child instead of working together.

Over the past ten years, the Trust has helped over 2,000 children and over 5,000 parents and teachers in Karachi. We have an active database of 800 children who are currently getting therapy with us. This includes children from every kind of socioeconomic status, educational background, culture, and ethnicity.

Kazim Trust has a simple mission: Empowering children who learn differently. While the mission sounds simple enough, it is anything but that. Given the resistance we face, we have a long way to go. To realize this vision, we must expand our network even more, raising awareness in every school throughout the country.

Farah Aftab, MS, and Hafsa Rafique, MS, are clinical psychologists who work with Kazim Trust in Karachi, Pakistan. Visit kazimadhdtrust.org to learn more.