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Diagnosing ADHD
New research provides fresh insight into the causes of ADHD, and offers parents alternative and holistic treatment options
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Lance*, father to now 11-year-old Aiden*, was doubtful when his son was first diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) at the age of nine. Three years later, the Johannesburg-based father still finds himself vacillating over the issue. “There are times when I look at my son’s behaviour and think that he definitely has ADHD. But then I stop and think that I behaved like that as a child, so did I have ADHD? Then there are the other times when I watch him and I think to myself, there is no way he has ADHD.” Despite sometimes doubting the diagnosis, Lance has now accepted his son’s condition and he ensures that Aiden gets the correct treatment.
The treatment is diverse, and is applied to all aspects of Aiden’s life. As Lance explains, “Treating a child with ADHD is not just about putting him onto medication.” Instead, he encourages other parents to examine the child’s emotional state, as well as the food they are eating and the amount of exercise they are getting.
ADHD is one of the most debated disorders, with everyone wanting to offer an opinion if your child appears to be heading towards a positive diagnosis. There are those who will blame your child’s diet or offer a “miracle” cure, while others will say the condition does not exist, suggesting that your child is just disruptive and needs a good hiding.
Like many parents, Lance was frustrated by the way in which his son was diagnosed.
“Initially Aiden was treated by a GP whose experience of ADHD was severely limited.” He was given a prescription for Concerta (a drug similar to Ritalin) and Lance watched as the Aiden he knew slipped away; his personality and appetite taken by the medication. There was also no subsequent improvement of any kind in his concentration or schoolwork. “Diagnosing a child with ADHD is a long process and it’s important to do it right. Teachers are not experts,” says Lance.
Aiden was eventually diagnosed by a number of people using the popular Conners’ Rating Scale (an instrument that uses observer ratings and self-report ratings). His school reports, school work, general behaviour and concentration levels were all taken into account before the treatment started. This time he was given Strattera, a drug used to treat ADHD in children over the age of six. Unlike Ritalin, Strattera does not stimulate the central nervous system and is not scheduled as a controlled substance. But, as with Ritalin, there are often negative side effects.
Fortunately, in Aiden’s case, the treatment worked well and along with a carefully controlled diet largely free of artificial ingredients and inclusive of omega oils, Aiden now appears to be thriving. Lance’s immense concern and love have also gone a long way to improving Aiden’s condition. “Love, security, positive attention and a healthy diet are all essential elements to raising a happy, healthy child,” he says.
Causes of ADHD
Although no-one knows for sure what causes the disorder, the Adhasa support group reports that “it is neurological – meaning that there is an imbalance of certain neurotransmitters; it is biochemical – meaning a deficiency in Prostaglandin’s E1, E3 (PE1, PE3); and it is an 80 percent genetic condition.” Like any mental condition, there is no blood test or brain scan that can prove beyond a shadow of doubt that someone has ADHD. So we rely largely on research scientists to keep us informed and, together with their findings, new understandings emerge and adjustments in thinking shift as new treatments are found. Some interesting research, conducted recently by Alina Rodriguez from the Institute of Psychiatry at King’s College London, suggests that stress during pregnancy may be a contributing factor. (Stress, in terms of this particular study, included depression, bereavement or the breakdown of a relationship.) The study involved more than 1 700 children and tracked them from pre-birth to primary school. Neurologists found a link between antenatal stress and what is known as “mixed-handedness” (where the right or left hand is used to perform different tasks) as well as a link to behavioural problems in children, with ADHD being the most common.
Rewards, not drugs
Recently, interesting research, which spanned an entire eight years, suggests that people with ADHD have a compromised “reward pathway” in the brain. Led by the renowned Dr Nora Volkow, a research psychiatrist in the USA, this study explains why attention deficits in people with ADHD are most evident in tasks that are considered boring, repetitive and uninteresting. Volkow’s findings suggest that ADHD sufferers have fewer dopamine receptors and transporters in the mid-brain area – the area responsible for the “reward pathway”. She suggests that an intervention to make tasks more engaging and rewarding would have significant results.
Dr Christopher Lucas, associate professor of child psychiatry at New York University School of Medicine, explains that children with ADHD may be able to concentrate for hours on video games, but not at school. Unlike school, which demands sustained attention with no rewards, a video game requires sustained attention with intermittent rewards.
Linda*, mother to now 21-year-old Jack* knows about ADHD and rewards better than most. Jack was four when he was first diagnosed with ADHD. Linda, from Cape Town, was a single mother with a limited income and a child whose behaviour was both stressful and worrying. Jack needed little sleep; he was disruptive in class, found reading and writing difficult and he would enthusiastically begin a project, and then often fail to finish it. On top of this, he was deeply sensitive, making the time-outs and the punishments difficult to endure. Then an insightful psychologist worked with Linda to devise a star chart for Jack. Star charts are controversial things at the best of times – critics warn of a need to motivate from within and not for a reward, while parents, at their wits end, use the chart to restore family peace. So for most families, the star chart has a limited life span, but for Jack and Linda, the star chart was their literal lifeline. “Everything revolved around the star chart – from behaviour to chores, schoolwork to fun-time. He had certain chores he had to complete (this included schoolwork) and three stars out of five earned him a treat of his choice on weekends (such as a video or a sleepover).”
Linda also became firm about things like eye contact, listening to one instruction at a time and speaking slowly and effectively. She is a firm believer in the reward system, but says, “You have to stand fast and not budge for it to work. Jack needed to stay within his boundaries and the star chart took care of that.” This was done as a complementary form of treatment, in addition to Ritalin, which Linda believes was a double-edged sword she had to accept. Had her finances allowed it, she would have sent Jack to a more suitable school, with smaller classes and one-on-one attention. This may have eradicated the need for the Ritalin, which sadly Jack had to take, and the endless teasing he was exposed to at a mainstream primary school.
Now that Jack is out of school, Linda concedes that he may not have completed his schooling without Ritalin. But Linda says she should have changed Jack’s school and sought out a support group. “Very few people understood. They thought he was just naughty and needed a ‘hiding’.”
Support
Erica Stander, who heads up the ADHD Hout Bay support group in Cape Town, stresses the importance of such groups as they form a “melting pot of all those interested and affected by ADHD, whether they be parents, teachers or psychologists specialising in the field”. She says, “Each person plays an important role and support groups ensure that the parent and the teacher have the same consistent approach.” Long-term professional help, which is recorded and monitored, is also critical. This will allow you to apply for extra exam time, for example. “Accept that your parenting is going to be different and try not to worry what other people have to say about it,” advises Erica. Linda knows this all too well. She shows me a few pictures of the now grown-up Jack and I see a beautiful young man; a unique individual filled with promise and purpose, about to start his adult life. Although Linda and Jack’s journey has been far from easy, they have much to be proud of in spite of, or perhaps because of, ADHD.
*Names have been changed
What is ADD and what is ADHD?
Attention Deficit Disorder or ADD is a hangover from the past and technically speaking no longer exists. Attention Deficit Hyperactivity Disorder or ADHD first appeared in the Diagnostic and Statistical Manual of Mental Disorders in 1987, where the term officially replaced ADD. Before that, similar symptoms were referred to as “minimal brain dysfunction” and “hyperkinetic impulse disorder”. Science now recognises three subtypes of ADHD:
- inattentive
- hyperactive-impulsive, and
- combined.
According to Adhasa, approximately eight to 10 percent of the South African population have ADHD. This seems to follow international trends. In the USA, there are suggestions that just over nine percent of the population between the ages of four and 17 have been diagnosed with the problem. Recent studies in rural areas of Limpopo reveal similar statistics.
Is there any support groups nearby? I'm staying in Kuilsriver.