ADD – background description, diagnosis and treatment
To briefly describe and define ADD is difficult. It is not a black and white disorder and there are a number subtypes. The one component of the diagnosis that runs true is that the disorder disrupts all aspects of a child’s life. The disorder is present at home, at school, at the grandparents and any other carer. A child who is a significant problem at home and causes no concern elsewhere does not have this condition and should not be treated as such. These children can often be identified in preschool. They stand out from the others as a haphazard clumsy defiant impulsive hyperactive child. The experienced preschool teacher is often the best at detection. It occurs in 3 -5 % of children with boys outnumbering girls by about 3 to 1. An example of the kind of questionnaires that are used by professionals is the Connors.
To understand ADD is to get in the mind of an 8-year-old sufferer. At this age life should be simple and exciting. Entrenched in grade 3 and jostling for position in the peer group and family, life is starting to really make sense. The child with ADD is not synchronised like this. The best analogy is that his software is slightly different. From the moment of waking the mind is on a fast moving roller coaster that barely slows to allow instructions and clear thinking to board. Getting ready for school, remembering uniforms, homework, lunch, messages – simple concepts that should not pose a problem are exceedingly difficult. The roller coaster just does not stop to allow the child to take stock. The thoughts fly. Run here, touch that, jump off this, get excited, excitable exhausting. The orders arrive from the parents followed by yelling and cajoling and shouting and punishing. These act like someone grabbing a ringing alarm clock and then letting go again. They briefly halt the roller coaster but will not change its course or structure.
School in this state of mind is disastrous and impossible. Waiting turn, sitting still, keeping quiet is so against the child’s make up and thoughts that he is in a state of misery. There is an urge to bolt. An urge to run that when acted upon can cause clumsiness and damage as the body tries to keep up with the mind. Again the orders, criticisms and punishments come. Writing and reading require massive efforts of will power that last about 4 – 5 minutes until the roller coaster pitches forth. No wonder 30 per cent will have an associated disorder such as anxiety and depression. Happiness and ADD just do not go together.
Speak to a parent of an ADD sufferer and they will relate a journey towards eventual acceptance that their child is different. Many will have tried all sorts of expensive alternative treatments that include diet, skeletal manipulation, behaviour management and vitamin supplements. The causes of ADD are not this simple. If it were then medicine would have found a cure long ago. There is a genetic component that is quite strong. There is an increased incidence in small and premature babies. The condition is made worse if there is associated learning or hearing problems. It is certainly more severe if the parental management is poor. Some sufferers are in fact extremely intelligent but they lack the attention to harness this intelligence. Some have features of autism. Analysing the nervous system of sufferers there appears to be a problem in the development of the inhibitory centre of the brain with altered blood flow and altered biochemistry. The medication that has been used actually stimulates this area of inhibition resulting in a calming effect allowing for better attention and more control of the roller coaster.
Paediatricians and specialists in this field should be the only health care providers who make the correct diagnosis. Evidence is collected from the parents and the school and these look at attention, hyperactivity and impulsivity. (This last can best be thought of as acting without thinking). The path to diagnosis should involve several consultations and consider other factors that affect a child’s attention span such as learning disabilities, sensory impairments, chronic illness, developmental disorders, parenting and family stressors and child abuse and neglect. All these conditions can lead to some of the symptoms of ADD. What is hard is that many of these factors will be in play even when it is clear the child has ADD. Correcting some of these is part of the treatment.
Once the diagnosis is made the treatment is two fold. The first involves correcting some of the parenting strategies that may have unwittingly contributed to the condition and the second is the controversial area of medication.
There is absolutely no doubt that some children with ADD respond quickly and dramatically to the medication. In some instances it is like turning on a switch. It results in a calmer more functional child who is able to complete tasks and perform successful day-to-day activities. Often their writing is clearer they appear calmer and the beauty of all this is that people actually start to like them. Their self – esteem improves and they are happier. This is not universal and the medications involved do not cure. All they do is control. They are non addictive and the main side effects are loss of appetite and insomnia.
The long-term outcome is not clear. Some types of ADD persist into adult hood and although many of the symptoms settle it is clear the adolescent and adult still have the impulsivity and inattention. Those who have no other associated diagnosis and have a reasonable degree of intelligence will improve and can become leaders in their chosen field.
As with many conditions where there are no specific blood tests or X – rays, where professionals base the diagnosis on history from parents and teachers and observations, there are always going to be children who have been wrongly diagnosed. One of the biggest concerns is that parents and health – providers can be guilty of looking for the quick fix. Therefore poor behaviour or problems at home and school will quickly and wrongly result in medication being used. This has been one of the main concerns in the USA where the use of medications for children’s behaviour has dramatically increased over the last few years. Despite this Australia is not following suit.
All these children will have some special skill. Finding this can often be half the battle. One of the things I tell parents is to list the good qualities as often these have been forgotten. The last thing these children need is ongoing criticism. They need understanding and support and at this stage there is very little of either from our society