< BACK TO: Parenting & Education

Paying attention, The National 31.03.2009

Hyperactivity can be a by-product of growing up but it can also be a sign of a neurobiological disorder that affects three to five per cent of school-age children. Jo Wadham reports on ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) has long attracted controversy. This stems from the fact that the diagnosis of ADHD is subjective and the patients are most often children, causing sceptics to suggest that they are being labelled with a disorder instead of simply a “difficult” personality. But for families who experience it first hand, having a child with ADHD can be a desperate situation. Without a programme of treatment, the child may be shunned by peers and let down by the education system.

It is generally agreed that ADHD, and the related condition, attention deficit disorder (ADD), are neuro-biological disorders, affecting around three to five per cent of all school-age children. In a classroom of 25 pupils, there is likely to be at least one child with ADHD. While most diagnoses are of children, sufferers sometimes manage to cope for decades with the condition and it is not picked up or treated until later in life.

Candice Render, a psychotherapist at the American Center for Psychiatry and Neurology in Abu Dhabi, explains that children with ADHD typically “can’t stay on task. They don’t pay attention, they have poor concentration and don’t follow directions well. They may be the class clown to mask the fact that they don’t understand what is going on.” Other symptoms can include making careless mistakes with homework and being disorganised, forgetful and hyperactive.

They may exhibit impulsivity and blurt out answers before questions are completed, speak tactlessly and interrupt frequently. Much of this sounds like the common characteristics of any child’s behaviour, but as Render points out: “A four to five year old should know how to sit and follow directions, to follow the group.”

A diagnosis will only be made once it has been established that there is a pattern of ADHD behaviour for longer than six months at home and in the classroom, discounting the problem being with the setting rather than the child. “There may be a bully at school or not enough sleep at home,” says Render. She estimates that about a third of the children she sees do not have ADHD. “It’s not cut and dried, nor should it be. When you are talking about labelling a child, you have to be sure you are doing it for the right reasons.”

The causes of ADHD are not clear. It is thought to be a largely inherited condition, although other factors may play a role. A Danish study in 2006 found a link between premature birth and ADHD. It has also been suggested that smoking when pregnant can increase the likelihood of the unborn child developing the condition. Diet has also been thought to play a part, which has led to the banning of certain food colourings in the UK.

Approximately two thirds of those diagnosed will also suffer from a learning difficulty or related mental health issues, including bi-polar disorder and obsessive-compulsive disorder. Christine Hunt’s son, Alexander, 12, has been diagnosed with ADHD and oppositional defiance disorder. “It started when he was two years old,” Hunt remembers. “We had to take him out of nursery. He wasn’t sitting with the others, he was wandering off, causing problems for the teachers.”

Alexander attended two different mainstream schools in Abu Dhabi, but both experiences ended badly. “We would go up to school on a weekly basis,” says Hunt. “His whole primary schooling was a failure”. When he left, “he was completely broken. He didn’t mix with other kids”. Alexander is now thriving at a boarding school that has experience in teaching children with learning difficulties. “It’s been nothing but positive. They explain things to him rather than punish him. There was all this negativity before. Now they point out the negativity but explain how to get to the positive side of things. The teachers tell me he has a promising future at school. It is so lovely to hear this after ten years of difficulties.”

There is no cure for ADHD, but with medication and therapy, the sufferer can learn to cope with the condition. Treatment begins with therapy, but it is equally important to educate parents and teachers. This is one of the reasons why the American Center for Psychiatry and Neurology is currently running a series of seminars for parents and teachers at certain schools in Abu Dhabi.

If therapy alone does not seem to be helping the child, then there is medication. Dr Yousef Abouallaban, a psychiatrist and the director at the American Center for Psychiatry and Neurology, says that there are three drugs available to ADHD sufferers in the UAE. Ritalin and Concerta are two of the most widely-known medications. They are classed in the US as Schedule II controlled drugs, the same classification as barbiturates and methadone. Abouallaban says a new drug, Stattera, originally used as an anti-depressant, may also be prescribed and is the one he prefers. “It is not a controlled substance, it has a safer side effect profile overall and is effective for 24 hours, compared with Ritalin which lasts three to four hours, and Concerta which lasts for eight hours”. These drugs can be very effective in calming children with ADHD and, together with therapy, can enable them to succeed at school, make friends and relieve pressure on family life.

All three drugs may have unpleasant side effects. Ritalin and Concerta may cause stunted growth and suppressed appetite. Concerns about such stimulants causing heart failure in those who have heart disease have lead the US Food and Drugs Administration to insist on a black box warning on their labels regarding the risk of sudden death. As a result, children usually undergo tests to check they have normal heart function before beginning a course. There is some concern about the long-term effects of children taking these drugs and research currently seems to suggest that short-term use is most effective. The medication is usually taken for at least six months.

For Diana Boulos’s son, taking medication has been a turning point in his life. “I tried every alternative method I could find,” says Boulos. She adjusted his diet, used behavioural modifications, and gave him Omega-3 supplements for more than a year. Medication has made her son’s condition manageable and dramatically altered his experience at school. “The confidence thing is a big issue for these kids. If you are working with a good doctor, you don’t over-medicate. You change the medication levels over time, until it is just enough to get him to focus. It takes the edge off; it doesn’t change his personality and you minimise the side-effects.” Boulos holds up Albert Einstein and the swimmer Michael Phelps as role models for her son as people who have succeeded despite ADHD. “I think these kids are geniuses in disguise.” Other famous ADHD sufferers include Steven Hawking, Jim Carrey, Robin Williams, Michael Jordan and John F Kennedy.

Left untreated, ADHD can lead to a host of other problems. By the age of 10, the child may suffer from low self-esteem, have poor social skills and exhibit challenging behaviour. As an adolescent, this may result in the child being excluded from school, having mood or conduct disorders, and getting caught up in high-risk behaviour. A US study in 1998 showed that 46 per cent of untreated ADHD sufferers did not complete high school. Another piece of research showed they were twice as likely to be drug abusers.

If your child is experiencing behavioural problems that are hindering their achievements at school or socially, there is help available. One study suggests that half of ADHD sufferers no longer meet the diagnostic criteria after three years of treatment. As Render says: “No one wants their child to be difficult. Once they come to see us, having been dealing with it alone for a few years, some people breathe a sigh of relief that there is effective treatment available. It doesn’t have to be for the rest of their lives.”

Comments are closed.