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Understanding ADHD

Text by Mariam Akabor. Photography Shutterstock

Source: This article was taken from the April 2011 issue of Living & Loving Magazine

Attention deficit hyperactivity disorder is a condition associated with negativity.

An ADHD diagnosis doesn’t necessarily mean that your child will be unruly or wild.

Dianne’s* daughter Lucy* was just four years old when a teacher notified Dianne of Lucy’s behaviour. Lucy had pulled out all the flowers in the flowerbed, she had bitten her fellow classmates, and thrown chairs around. It was the first time anyone had suggested to Dianne that Lucy may have an impulsive disorder.

“We put her in school after she turned two and we found that she managed to keep her teachers running around all day long. Lucy was able to build puzzles that were beyond her age group’s capability, and her vocabulary astounded her teachers. She never enjoyed nap time, and in the end they’d let her read quietly while the other kids slept,” Dianne says. Dianne decided to follow the school’s advice, and have an assessment done on Lucy. Shortly after, Lucy was diagnosed with Attention Deficit Hyperactivity Disorder, commonly known as ADHD. Most parents have heard of this disorder, which seems to be clouded with negativity and misinformation.

ADHD 101

It was in England in the early 1900s that doctors first suggested that behavioural problems in children could be attributed to genetics, and not bad parenting. One hundred years later, researchers at Cardiff University found the first direct evidence that ADHD is a genetic disorder and that children with this condition are more likely to have missing or duplicated segments of DNA.

Dr Shabeer Jeeva, an ADHD specialist psychiatrist from Johannesburg, who was diagnosed with the disorder himself, is passionate about his subject. “A lot of people talk about ADD and ADHD as if they’re two different things, reserving ADHD for those kids who are hyperactive and ADD for those who aren’t. However, both are simply generic terms for Attention Deficit Hyperactivity Disorder, and don’t really describe the type of ADHD a person has. They’re often used interchangeably by teachers, doctors and parents, which can confuse some people,” explains Shabeer.

There are three types of ADHD:

1. ADHD, Inattentive type – A child with this type of ADHD struggles to pay attention to detail and becomes easily distracted or forgetful. The child has trouble processing information and may seem dreamy, shy or withdrawn. Most people refer to this type of ADHD as ADD.

2. ADHD, Hyperactive-Impulsive type -A child with this type of ADHD will mostly show symptoms of hyperactivity or impulsivity, such as fidgeting, having trouble staying in her seat, talking excessively, being “on-the-go”, interrupting others, having trouble waiting for her turn, and so on.

3. ADHD, Combined type – This type of ADHD occurs when a child has symptoms from both of the other ADHD types, including inattention as well as hyperactivity and impulsivity.

“A child can be diagnosed with ADHD from as young as four years old, which is early onset ADHD,” says Shabeer. Unlike other medical conditions which require physical tests, ADHD is diagnosed after an intensive assessment is done, based on a detailed history of the child. Shabeer emphasises that there needs to be a multimodal holistic approach to treatment. A child with mild symptoms of ADHD can manage with a low-carbohydrate, high-protein diet, exercise, behaviour modification and school support. But if the symptoms are moderate or severe, she would need medication.

In Lucy’s case, Dianne followed through with the treatment options that were recommended to her. Lucy’s diet and routine were changed, and she started medication. She also became involved in various tension-releasing activities at school, including swimming, ballet, netball, chess, piano and choir.

ADHD in the Classroom

Jane Jarvis, an educational psychologist from Grahamstown and co-author of the book. The Manual That Never Came With Your Child, explains, “Some children with ADHD can concentrate extremely well in certain situations but not in others. When the teacher wants the child to focus on mathematics, the child is concentrating on someone walking past the classroom, or on sharpening pencils instead. It’s not that the child isn’t concentrating; she’s just concentrating on something different. Needless to say, this causes lots of problems in the classroom environment.”

Jane explains that it’s important to realise that children with ADHD are often the most debilitated learners in the classroom because their learning style doesn’t match the teaching style.

It’s possible to have both an over and an under-diagnosis of ADHD. Cynthia*, mom to eight-year-old Matthew*, says she was first notified that her son had ADHD when he was six years old. “His teacher said he wasn’t concentrating in class and was always fidgeting and kicking his legs.” So Cynthia took him to a psychologist who, after one consultation, diagnosed Matthew with ADHD Hyperactive-Impulsive Type and said that he needed to be medicated. It was only a few months later that Cynthia realised that her son had been misdiagnosed.

“Many children who don’t have ADHD are diagnosed with it, and many who do have it, aren’t diagnosed at all or it’s only picked up much later in the schooling system. As a result, they develop many gaps in their learning,” says Jane.

Jane explains that it’s important to realise that children with ADHD are often the most debilitated learners in the classroom because their learning style doesn’t match the teaching style. Like other children with difficulties, they need – and are entitled to – some accommodation in their learning style (fun tasks, variety, and delayed repetition) to help them, and they’re often deprived of this because of their “hidden handicap”.

So, do our schools accommodate ADHD learners adequately? Many teachers in public schools have received additional training with regards to recognising symptoms of ADHD in students. However, private assessments and medication are costly, and many parents can’t afford these. The waiting lists at government organisations are often long and children can wait for months to be assessed. While they wait, valuable education time is lost and these children fall far behind their peers.

The “R” Word

Many parents automatically assume that their child has to take methylphenidate (known by the more common trade name of Ritalin) if she’s been diagnosed with ADHD. Due to the negative stigma surrounding this schedule seven drug, it’s easy to understand why parents feel this way. However, misconceptions need to be rectified. “The reason for its scheduling is that it works on the ‘feel good’ centres of the brain and like any medication – even cough mixtures – it can become addictive if abused,” Shabeer explains. “To date, there are no reported cases of an ADHD patient’s addiction or serious drug dependence with Ritalin.

However, if it’s used by a person who doesn’t have ADHD, it can become habit forming because, as a stimulant, it causes a massive boost of energy.” According to studies, the use of stimulants by a person with ADHD actually protects them from becoming drug addicts. An untreated ADHD person has a 75% chance of substance abuse compared to 18% in a non-ADHD person. But when ADHD is treated, the risk drops from 75% to 25%.

Dianne and her husband have accepted Ritalin as part of Lucy’s treatment. “Some family members weren’t happy that we chose to medicate Lucy, and felt that we were drugging her into a zombie-like state to appease her teachers. However, on Ritalin, we’ve noticed that she doesn’t become aggressive and she’s able to relax and think out a situation before taking action.”

Matthew’s mom, Cynthia, was terrified when her son’s personality changed overnight once he was on Ritalin. “He was tired all the time and barely spoke, whereas before taking Ritalin, he was full of life. He also began experiencing severe chest pains.” That’s when Cynthia decided to stop Ritalin treatment, without informing Matthew’s school of her decision. Eighteen months later, Matthew is functioning well without Ritalin, and has had no complaints from his teachers. “He was so easily misdiagnosed and, to this day, his teacher believes he still takes Ritalin,” says Cynthia.

In eight-year-old Rachel’s* case, her mom Melissa* refuses to follow the school’s suggestion of subjecting her daughter to Ritalin. Rachel has been diagnosed with ADHD Inattentive Type and can be dreamy and stubborn, but Melissa feels that there are other ways, besides medication, that can help her child function. Instead, she gives Rachel omega fatty acids and vitamins daily, and works around her daughter’s moods. For example, Melissa finds it easier to pick Rachel up from school and allow her to finish her homework in the car, parked outside the school. More often than not, Rachel completes her homework without any struggle, as there are fewer distractions.

Some common side effects of Ritalin include decreased appetite, headaches, stomach aches and insomnia. These are all treatable, according to Shabeer, but he stresses how important it is for parents to inform their doctor of any other long-term medication that their child is on. In an attempt to decrease side effects, Ritalin is available in four different release mechanisms: Ritalin (immediate release), Ritalin SR (sustained release), Ritalin LA (extended release) and Concerta (controlled release).

So, do the pros of Ritalin outweigh the cons? “Most definitely!” says Shabeer. “Because the child is finally able to control impulses and focus, this improves self-esteem. Medication also lessens the chances of developing co-morbidities like anxiety and depression. Although no cure exists for ADHD, symptoms can be reduced with a combination of medication and behavioural therapy.”

*Names have been changed.

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