Breaking the stigma around ADHD

GILLIAN KLAWANSKY

Attention issues. Socially withdrawn. Difficult. Children with ADHD are covered in so many labels that it’s often hard to see beyond them. And for parents, the labelling process is no different, said Jaye. From becoming a nervous wreck to an insomniac, Jaye initially found her child’s ADHD diagnosis hard to handle.

A medical doctor with diplomas in allergology and child healthcare, Jaye holds a Master’s degree in childhood neurodevelopment. The topic of her thesis was ADHD.

At the workshop, she shared her expertise with parents who find themselves bombarded with information about their child’s ADHD diagnosis. Among South Africa’s general population, there is a 10% prevalence of ADHD. This exceeds the international average, which is about 6%. What’s more, studies show that gender might influence diagnosis, with boys four times more likely to be diagnosed.

“Parents of ADHD children find it very difficult when a diagnosis is made,” said Jaye. “We’re not coming with blood results or a brain scan, we’re looking at the child and their behaviour, and based on that, making a diagnosis.” There are no typical or physically observable features that indicate that a child has ADHD. To make a diagnosis, Diagnostic and Statistical Manual (DSM-5) criteria are used, which evaluate whether patients display a certain number of symptoms.

Before 2013, a much more limited group of patients could be diagnosed through DSM-5.

“Previously, children needed to be under seven to be diagnosed. This has now been extended up to the age of 12,” said Jaye. “Symptoms may now also manifest in adolescents and adults.” There is now also a broader definition of ADHD. “Previously, they said there needs to be a clinically significant impairment. That’s also changed in that now we’re saying it needs to reduce the quality of academic, social, or occupational functioning. That’s why we’re seeing so many more ADHD children because we’ve opened up the diagnostic parameters.”

The number of preschool children being diagnosed doubled between 2007 and 2016.

“We’ve also found that many of these preschoolers are now getting medication which in the past was never the case,” said Jaye. She mentioned a study showing high rates of recovery within three years when children between three and a half and four years old were medicated. Each case needs to be assessed individually.

Children entering primary school are diagnosed with ADHD more often and receive more treatment than their older peers, said Jaye. “Seventy percent to eighty percent of adolescents who had ADHD in childhood may still face social, academic, and emotional challenges,” she said. At this age, there is also the issue of decreased compliance with treatment, as teens often don’t want to take medication.

“We’re dealing with bigger issues if the ADHD isn’t sorted out – things like depression, anxiety, and low self-esteem, especially among the risk group of adolescent girls.”

Adults suffering from ADHD are often completely disorganised and easily distractible, and relationships are often a problem. “They’re not like typical ADHD children, they won’t be running around and jumping all over the place, they just always seem edgy and tense,” said Jaye.

ADHD medication has become a controversial topic. “Parents are worried about giving kids medication, and we want to have a solid diagnosis when dealing with the brain. Doctors know that medicine is changing, and we need to be humble enough to acknowledge this. We also need to provide parents with the facts and research about the medication, and explain safety and side effects.” In terms of treatment, she said, a combination of medication and behavioural therapies have been found to be most effective.

Jaye explained how ADHD medication works. In ADHD sufferers, she said, messages don’t filter through the brain because dopamine, essential for message transmission, is released but then sucked back up. “Therefore, no dopamine can go into receptors and electrical signals can’t be sent. Dopamine isn’t going where it needs to, and therefore ADHD children don’t hear instructions.”

Methylphenidate in the form of ritalin or concerta therefore works by blocking transmitters so that dopamine can’t be sucked back up. This leaves more dopamine in the synaptic cleft, which allows messages to be sent.

“Parents know medication will help the child to become a successful adult, they know that it will increase the likelihood that the child will finish school and that it will control ADHD behaviour,” said Jaye. “Yet, the majority of parents in a recent study said that in spite of this, they’re worried and think the side effects outweigh the benefits of the medication.”

While she acknowledged the side effects, including loss of appetite, sleep issues, and social withdrawal, she argued that these either normalised or could be managed. Regarding the common concern about whether we’re turning our children into drug addicts with ritalin, Jaye said the answer was a resounding no. “There is no danger of drug dependence if it’s used as prescribed. If we give ADHD children ritalin, we’re in fact lowering their risk of becoming drug addicts.”

In terms of a cure, there is a window of opportunity between the ages of six to nine, and perhaps earlier, which is why early intervention is key. “Yet, we still see that 60% of child ADHD patients go on to be adults with ADHD,” said Jaye.

Let’s get rid of the stigma, she concluded, reflecting on her daughter’s progress. “ADHD doesn’t define my daughter, it’s just a part of who she is.” When kids have ADHD, let’s help them. If they need medication, give it to them. Help them to become successful adults through effective interventions.