ADHD Demystified

Not too surprisingly, Attention Deficit Hyperactivity Disorder (ADHD) is one of the most studied areas of child health. Yet despite all of the research available, it’s clouded in myth and stigma, with many parents fearing that a diagnosis of ADHD will sound a death knell for their child’s academic performance and career prospects. But this just isn’t the case anymore.

What is ADHD?

There’s an area at the front of the brain called the orbito-frontal cortex, and it’s here that our self-control resides. In children with ADHD, this area either doesn’t develop as fast as it does in other children, or in extreme cases, never develops at all.

This isn’t simply theoretical. If you compare PET scans (a type of brain scan) of a child with ADHD and a child without, the reduced metabolism in the orbito-frontal cortex is apparent even to a layman. Children with ADHD struggle to concentrate. They have extremely short attention spans – if something isn’t immediately entertaining or engaging, they’ll lose interest, making them great at Xbox, terrible at homework, and murder on road trips.

Their lack of impulse control means they’ll behave like little terrors. Where other kids might consider something and then decide against, a child with ADHD will act without hesitation. Their condition also prevents them from learning from mistakes – no matter how many times you tell them not to do something, they’ll be unable to resist if the urge takes them. This also makes them significantly prone to accidents. We aren’t talking about children who simply don’t behave themselves – these are children who can’t, even if they want to.

Root causes 

At this time, we can’t say with absolute certainty what causes ADHD. We do know that moms who smoke or eat fish while pregnant have statistically more ADHD kids than those who don’t, and that the condition manifests more in premature babies than those carried to full term.

An increasing amount of evidence is pointing at a genetic explanation. There isn’t a single ADHD gene, but rather a combination of genes that, if present, produce ADHD. Put simply, it looks like an inherited condition.

It’s estimated that around six percent of the current adult population has ADHD. If one parent suffers from it, or had it growing up, there’s a 30 percent chance that a child of theirs will develop it. And if both parents have it, that risk rises to 80 percent – a compelling statistic. If one twin is diagnosed with ADHD, there’s a 75 percent chance that the other suffers from it too.

How do we fix this?

There isn’t a cure for ADHD yet, but there are ways of managing it. A holistic approach is best – good parenting strategies and diet play important roles.

There’s some evidence that children who eat healthily (fewer processed foods and additives) find it easier to concentrate at school. This is also true for children without ADHD, so it’s considered a best practice rather than a specific treatment.

Right now, our best approach is to manage the symptoms with medication,which in most cases gives children with ADHD – and, by extension, their families– their lives back.

Some parents are reticent about medicating their children, and that’s understandable, especially given that the word Ritalin has basically become a swear word. But it’s by no means the only option out there, and a competent health professional will be able to advise you on the best course of treatment for your child.

“Ritalin is no longer the gold standard for treating ADHD,” says Dr Michelle King, a psychiatrist and early childhood intervention specialist working in Polokwane. “It can be effective, but we have a much better selection of medications available today than when Ritalin was first introduced. No two children are alike, so which medicationis right for a particular child has to be assessed on a case by case basis.”

Is ADHD really so widespread?

The short answer is that it probably isn’t –it’s estimated that less than eight percent of children have the disorder. The reason why it appears to be overdiagnosed may have to do with diagnoses being made by professionals who don’t have specific experience with ADHD, but another explanation is surfacing with a darker shade of ethical grey entirely.

In October 2012 the New York Times published an article drawing attention to a growing phenomenon of doctors making diagnoses of ADHD in order to prescribe medication for off-label uses – specifically, school performance. The same drugs that make it possible for an ADHD child to function at all give kids without ADHD a significant academic edge. To them, they offer improved focus, the ability to concentrate for longer, and some studies indicate they may temporarily raise IQ scores. In other words, these drugs make your kids smarter.

Naturally, prescribing medications for academic boosting is both unethical and completely illegal – it’s the scholastic equivalent of sports doping. But some parents feel compelled to give their kids the edge whatever the cost, and if they can find a tame GP, it’s easy to see how this behaviour spikes the apparent prevalence of ADHD.

Does my child have it?

Don’t jump to conclusions. “I always recommend that parents have their children’s ears and eyes tested first,” says Dr King. “If a child doesn’t appear to listen, it could simply be that they don’t hear well. If they’re struggling at school, maybe they’re actually struggling to see.”

It’s also impossible to diagnose ADHD before a child is at least four years old. “Toddlers are busy,” says Dr King. “Before the age of four, the brain is still forming, and what may seem to be a hyperactive child could just as easily be explained by the normal exuberance of being a child.”

But once you’ve ruled out the basics, if you’re still concerned, or if teachers are raising the issue with you, it may be time to seek a professional opinion. If your child genuinely has ADHD, it could be the best thing you ever do for them.

ADHD myths busted 

As quickly as ADHD became a buzzword, it gained stigma. Some of the biggest misconceptions include: 

You're a bad parent 

• Your child blurts out socially inappropriate things, so you clearly haven't set boundaries for them or taught them manners- shame on you. This is patently untrue, because a child with ADHD literally has no impulse control. 

They just need to focus

• Except they can't, even if they understand why they should. Their brains won't let them. Shiny things automatically take precedence over boring things. 

They'll grow up to be junkies

• Because most ADHD therapy involves some sort of stimulant, your kids are doomed to be crackheads. But the evidence shows that ADHD sufferers who receive treatment are far less likely to abuse drugs than those who don't. 

They'll grow out of it

• There's some evidence that, with treatment, the symptoms of ADHD can decline in adolescence. But around 60 percent of sufferers will continue to battle the disorder into adulthood, which can manifest in dangerous driving, serious debt caused by impulse shopping, and difficulty holding down a job.