What should you expect if you are to effectively detect and manage the complex condition, ADHD?
Lara* struggled with a fussy baby, who became an impossible toddler and then a frustrated preschooler. “Everyone around me said that I should just leave him to develop at his own pace. But having constant battles with your child is soul destroying.”
He underwent speech therapy to address some of the problems before beginning school. However, through Grade R and Grade 1, his situation worsened. The school contacted Lara and her husband daily as he refused to listen to his teacher, was getting into physical fights and falling behind in class. Eventually, assessments by the school psychologist confirmed ADHD.
“Inattention, hyperactivity and impulsivity are symptoms of many underlying treatable medical, emotional and psychosocial conditions affecting children,” according to the Journal of Child Neurology.
“A good clinical history and examination are essential when trying to figure out whether your concerns are in fact ADHD-related,” explains Wendy Vogel, head of Child and Adolescent Psychiatry at Red Cross Children’s Hospital.
Cape Town-based psychiatrist Dr Merryn Young says this means that parents should basically expect a long and multifaceted interview with themselves and their child.
Root of the problem
A medical professional will do a thorough assessment, starting with a detailed history. This includes full developmental and medical history as well as information around inattention, hyperactivity and impulsivity, states Young. Screening should also be done to exclude other conditions, such as executive functioning deficit, or problems, like anxiety or bullying, that better explain the presenting symptoms.
Once an ADHD diagnosis has been made, the practitioner will need to look for co-morbid conditions. These can affect the doctor’s approach to managing the ADHD. “Neurodevelopmental disorders such as autism spectrum disorders, tic disorders and learning difficulties, often occur with ADHD. Also anxiety and mood disorders,” says Vogel.
Meds for life?
If your child needs to start medication, they must first undergo a physical examination, Vogel explains.
If medication is prescribed, there may be limitations and potential side-effects. “Any medication with the potential to do good also has the potential to cause negative effects in some people. Even something as commonly used as paracetamol can have side effects,” says Young.
“Regular follow up (six months minimum) is necessary. A worrying trend is that children seem to go years before having their dosage and side effects reviewed.”
Lara reports great success with multimodal ADHD treatment. This incorporated play therapy, speech therapy, OT, remedial classes and Ritalin. Throughout his Grade 2 year (when he started treatment), the family met regularly with the principal, teacher, HOD, psychologists and speech therapist to monitor his progress. “My child is in Grade 3 this year, and he is happy, focused and learning.”
“Medication should be just a single part of the whole treatment,” says Young. “Other treatments, combining psychological and pharmacological approaches, should also be recommended.”
Help for parents
Parenting programmes – working in groups with children, incorporating cognitive behavioural therapy and social skills training – can be very beneficial. Individual work with the parent/carer and child that focuses on improving memory, concentration and relationships in another helpful tool.
Working with teachers to help them understand ADHD and provide support is also beneficial. Something as simple as paying attention to where the child sits in class, or using visual aids and nonverbal reminders can improve symptoms, says Vogel.
* Name has been changed
The issue with ritalin
The main controversies relating to the safety of stimulants in children with ADHD are their effect on the heart and growth. There have been adverse events specifically in individuals with structural cardiac abnormalities. This is why thorough initial assessment is important, says Young.