How do you know your child suffers from ADD or ADHD? Are Ritalin and its cousins fashionable drugs for parents and teachers who're unable to control active children, or are they miracle cures? Will hyperactivity disappear as a result of omega-3 and -6 supplements and dietary adjustments?
BY YVONNE BEYERS for YOU Pulse magazine
If you've been worrying about an unruly child, this guide might help you understand things better. It contains up-to-the-minute information based on the latest international research and studies.
Does your child suffer from ADD or ADHD?
STEP 1: Understand the important background information
A quiet dreamer and an overactive child may suffer from the same problem. This is how it works: according to the latest international findings, attention deficit problems may manifest in three main symptoms. These are:
- Struggling to concentrate or sustain concentration
The main symptoms may occur on their own or in combination so there are basically three groups:
- Attention distraction without hyperactivity (ADD). This usually affects girls who're likely to be quiet dreamers such as Anneke.
- Attention deficit with mainly impulsivity and hyperactivity (ADHD). This usually manifests in very active boys such as Peter.
- A combination type where the child has definite problems with concentration and is also impulsive and hyperactive.
The problems don't end here. On average 40 per cent of children with ADD or ADHD also have reading and learning problems, depression or other problems.
Step 2: Know the symptoms
Answer the questions on:
Does your child:
- Struggle to pay proper attention to finer details and often make unnecessary mistakes doing homework and tasks around the house?
- Struggle to concentrate on one task?
- Often not pay attention or listen when you talk directly to her?
- Struggle to complete school assignments, duties around the house or a series of tasks, even though she understands what she should do and is not rebellious?
- Behave in a disorganised and muddled way?
- Avoid or hate tasks where she has to think a lot?
- Lose things required to complete a task, such as pencils, books and equipment?
- Become easily distracted by things that have nothing to do with the task at hand such as a dog barking, a cellphone ringing or the sound of music?
- Become forgetful when it comes to routine tasks?
If you've answered "yes" to six of these questions your child may be one of the "quiet dreamers". Quiet dreamers are disorganised and often live in a world of their own. They struggle to plan ahead and complete tasks.
Now answer these questions on hyperactivity and impulsivity:
Does your child:
- Forever fidget or have constantly busy hands or feet? Struggle to remain seated in the classroom?
- Run around, climb and clamber more than other children?
- Struggle to take part in any activity without screaming or talking at the top of his voice?
- Find it difficult to remain silent or talk softly while playing or doing something?
- Act as though he is being propelled by a battery?
- Talk incessantly?
- Spontaneously give answers before questions have been asked?
- Struggle to wait his turn or take turns at all?
- Often interrupt conversations or games by beginning to talk or forcing himself on others?
If you've answered "yes" to six of these questions your child may suffer from attention deficit disorder with hyperactivity and impulsivity. These children often pose a danger to themselves because they act so impulsively. (The last three questions refer to impulsivity.)
If you've answered "yes" to the same number of questions in each section your child's lack of concentration and hyperactivity are equally prominent. He probably fidgets constantly and does everything except what he's supposed to be doing.
Six "yes" answers or if you are in doubt mean you should take your child to a specialist rather than ignore the condition.
If you're concerned but have answered "no" to most questions your child is probably an introverted quiet type.
Step 3: Help the specialists
There is no such thing as a single or simple test for ADD or ADHD. When you decide to see specialists - who should be a child psychiatrist or paediatrician in collaboration with a clinical psychologist - they should evaluate and examine your child in your presence.
Attention deficit disorder is complex and the diagnosis is based on a specific and thorough medical examination and evaluation. ADD and ADHD are about chemical imbalances in the brain that have to be adjusted. The complex diagnosis cannot be made by a clinical psychologist or teacher alone. Not even general practitioners have the expertise to do so.
- Did the first signs manifest before your child's seventh birthday?
- Have at least six of the symptoms been present for a minimum of six months?
- Are the symptoms visible in at least two places, for example at home and at school?
- Do the symptoms affect your child's school achievements or his interaction with friends or other people?
Step 4: Be more observant
If your child has one of the following problems treatment and teaching methods may be used to help him:
Learning problems. Reading and learning problems and dyslexia are six times more prevalent among children with ADD or ADHD than among other children.
Oppositional defiant disorder and disruptive behaviour disorder. Your child may act destructively, oppose authority, argue a lot with you or his teachers, lose his temper easily, taunt others or refuse to obey rules.
Depression. These children often have violent tantrums. They are also often sad and weepy, don't mix easily with other children, don't want to eat, are derogatory about themselves and often have problems sleeping.
Anxiety. About one third of children with ADD or ADHD also suffer from anxiety.
Tourette's syndrome. About 75 per cent of children with Tourette's also have ADD or ADHD. Tourette's characterised by repetitive, involuntary mannerisms such as a continuous contraction of facial muscles (facial tics) or the sudden utterance of sounds or swearwords.
My child has ADHD/ADD. What now?
What treatment works?
Medicines such as Ritalin aren't the only answer and it's important to know what else can make a real difference.
Omega-3 and -6 supplements can make a difference in up to 40 percent of children. Dietary adjustments help about 20 per cent of children to a degree. Medicine helps 70 to 80 per cent of children with ADD or ADHD. But a child also needs emotional support from parents and a clinical psychologist because the disorder impacts at school, family and social levels.
An educational therapist will also be able to help a child with learning problems. The child requires a set routine to learn to organise his brain and things around him. Parents and the family often have to make great sacrifices to help with this.
There is unequivocal scientific proof that ADD and ADHD are caused by a faulty mechanism in certain parts of the brain. Children with these disorders have limited availability of two neurotransmitters (dopamine and noradrenalin).
The deficiencies occur specifically in the parts of the brain that regulate impulsiveness and concentration. As a result the children struggle to concentrate or control impulsive behaviour.
The medicines help to normalise the levels of those transmitters. They are not used to scramble messages in the brain but to try to make them normal, just like diabetics use insulin injections to supplement their own insufficient insulin levels.
One of the medicines is Ritalin, which helps specifically to restore the dopamine level in the brain. The effect of Ritalin lasts four hours, that of Ritalin LA six to eight hours and that of its cousin Concerta 12 hours. All three contain methylphenidate, which acts as a stimulant.
Strattera was recently approved in South Africa. It is not a stimulant and improves the concentration span. Its effect lasts 24 hours. Some children with a combination of symptoms need more than one medicine.
Tofranol is not a stimulant and can help some children. Some of these medicines may have side effects such as stomach- or headache, lack of appetite and emotional outbursts when the medicine has worn off.
"Medicine is not a cure but an aid. Children with ADD or ADHD will benefit from techniques which help them organise their thoughts and lives," says Dr Adri van der Walt, a Cape Town paediatrician.
Why do we fear Ritalin?
Professor André Venter, national chairman of Panda (Paediatric Neurology and Development Association) and head of paediatrics at the University of the Free State, writes:
Many parents are uncomfortable with the notion that their children require psychiatric medicine to help them get through the school day. They ask, "Don't you suppress your child's naturally boisterous personality by giving him medicine such as Ritalin to make him less active?"
Not to mention the bad publicity Ritalin has garnered over the years - on the one hand because doctors often prescribe it too readily and without sufficient motivation, on the other because it is indeed a controversial substance. It's a stimulant and moreover classified as a schedule 6 drug because it's sometimes abused. It may have a few unpleasant side effects such as loss of appetite and insomnia.
What's more, Ritalin is sometimes sold illegally on school premises because it's a stimulant. It's sometimes used as a rave drug. Obviously Ritalin (and its cousins, such as Concerta) may not be prescribed casually. However, research has shown that children who have had Ritalin prescribed are not more likely to become drug addicts.
The contrary is probably more likely: children with serious ADD or ADHD that remains untreated may become more susceptible to the drug culture at a later stage because they struggle to adapt socially.
One important new reservation about Ritalin is that it is dangerous for some children with latent heart disease. That's why a specialist should evaluate your child and refer him to a cardiologist if necessary.
Obviously one is careful to administer a drug that seems to interfere with a child's brain. But what is worse: the medicine or the anxiety, fear, self-doubt and isolation of someone with ADD or ADHD?
Or even becoming a maladjusted adult if the child's learning problems aren't addressed immediately?
Ritalin, just like any other medicine, should be prescribed with the utmost care. If it doesn't work, or if the side effects are worse than the problem itself, talk to your doctor. But it's not a crime to try to improve your child's life and make it easier.
This article was compiled with the assistance of Professor André Venter, Dr Adri van der Walt and many scientific papers. It is an edited version of an article that originally appeared in the September 2007 edition of YOU Pulse / Huisgenoot-POLS. The current edition is on sale now.
More questions on ADHD