Giving all their attention




GREG, 7, loves playing soccer, hurling and taking his Doberman, Belle, for walks.

Last year, he found it difficult to concentrate at school, was failing at literacy, and began to hurt other children unintentionally as he ran past them in the playground. In the doctor’s surgery, he loved climbing on the furniture and was unable concentrate for long enough to complete a jigsaw or build a tower of blocks.

“He was full of craic and fun and people enjoyed him, but we didn’t want him to be the class clown. We had him assessed privately because of harmless comments from people like, ‘He’s mad, where did you get him from?’ It gets to you when you hear it all the time,” says Greg’s mother, Lorna Pearson.

When Greg was diagnosed with Attention Deficit Hyperactivity Disorder at 6, she was relieved.

“As a parent, you don’t want to hear there’s anything wrong with your child. People asked me was I upset but to be 100% honest, I was relieved. I had the wording on paper to say it wasn’t his fault, and that was worth its weight in gold.”

ADHD is a complex disorder of the nervous system, characterised by three core symptoms — hyperactivity, impulsivity and inattention. It is the most common neurobiological condition in children around the world and there are 60,000 young people under 18 in Ireland diagnosed with ADHD.

Last week, researchers writing in the British Medical Journal stated that changes to the diagnostic criteria for ADHD could lead to an increase in children being misdiagnosed as having mild and moderate ADHD. The changes include an increase of the maximum onset age for ADHD symptoms from seven to 12 years, and a change in the definition of ADHD to include more behavioural examples. However, there hasn’t yet been a large increase in ADHD diagnoses in Ireland.

“In Ireland, there’s been a slow development of services. We see lots of kids who have been in trouble right throughout primary school and no-one looked to see what was wrong there,” says Dr Eithne Foley, child and adolescent psychiatrist with the HSE.

“There’s an awful lot of undiagnosed ADHD here, but now that the CAMHS services are more developed and teachers and SNAs are also increasingly becoming educated about ADHD, it’s being diagnosed more.”

ADHD symptoms manifest in behaviours which include an inability to sit still or concentrate in class, a tendency to blurt out answers, and having no real sense of danger.

“Their symptoms impact on their ability to learn to maximum capacity and to build and maintain relationships with peers and teachers. They get constant negative feedback and the child starts to get a sense that they’re a ‘bold child’. It all starts to impact on self-esteem as they get older,” says Dr Foley.

Although a lifelong condition, many interventions are available. These include behavioural strategies, alternative and complementary therapies, and medication.

Last year, the HSE spent almost €2.5m on medications to treat ADHD, with the highest spend on a single drug being on Methylphenidate (also known as Ritalin). But not everyone responds to Ritalin. Shire pharmaceuticals recently launched a drug in Europe (known as Vyvanse in the US), a single daily dose prodrug stimulant which has longer lasting effects than Ritalin.

“It gives us another option for treatment in the over-6s who have had side effects or who have not responded to Methylphenidate,” says Dr Foley.

“The response can last through school and homework time and evening time. For example, you don’t want the medication to wear off during soccer training and sports activities. The advantages are that it’s a single daily dose and it lasts longer in the system than what’s already available.

“We get a lot of people fearful of the medication and wondering if their child will end up dazed, but they won’t be. The most common side effect is a decrease in appetite, which is resolved within a few months. With all medications, there are benefits and side effects. You need to balance whether the benefits outweigh the risks.

“Not everyone needs medication. But often, once the parents try it, they never want to go back.”

Dr Foley emphasises that parents can trial a medication and decide to stop it at any time. They can also decide to limit medication usage to weekdays only. She also advocates a multi-modal approach to treatment, with behavioural strategies, psycho-education and medications used in conjunction with each other.

Lorna and her husband decided to try a non-pharmacological approach with Greg.

“He has asthma and I thought he already had enough medications going through his system. We found alternative therapies and went with it. We decided it’d be great if it works and if not, at least we tried,” says Lorna, an early childcare worker.

“I just want to give Greg the best opportunity to succeed, and if he’s still struggling later on in school, I’m open to medication. Some of the symptoms suppress themselves, but they’ll always be there. They can come out at times of stress. He might need to be medicated at exam time.”

When Greg received his diagnosis, she informed the school, organised weekly after-school grinds, and started to give her son daily fish oil supplements. She also began Johansen Sound Therapy with Greg, an auditory integration therapy which involves listening to specific music for certain periods of time, as well as a series of daily exercises.

“We’ve been doing it for a year now and I’m not 100% sure whether it helped his learning ability but his social skills have improved. He’s able to play in groups and turn-take now. He can go out on the road and play. It’s not all about learning. At the end of the day, I’m happy when he has friends.”

Greg’s co-ordination and balance has improved, he has a reduced fear of heights, and there have been improvements in behaviour and concentration at school, she added.

“Behavioural strategies aren’t magic but they do help. A structured, stable environment [at home and at school] will lead to less symptoms,” agrees Dr Foley, who recommends practical strategies for a child with ADHD.

These include the use of reward systems and kitchen timers to encourage concentration, ensuring the child has a quiet space for homework and teaching a child to follow routines and schedules.

For secondary school students, she recommends helping the child with organisational skills, which includes teaching them to simplify their daily schedule, colour coding timetables and books, and having a school bag with pockets for books and lunch.

ADHD is ultimately treatable, says Dr Foley, who advises concerned parents to contact their GP for a referral to Child and Adolescent Mental Health Services.

“Greg will always have ADHD and I hope he will learn to cope with it. My hopes for him are that he’ll be happy and healthy and look back in 20 years and say ‘Mum, you did everything you could for me,’’ says Lorna.

“He’s our pint-sized action man and he lights up our lives every day.”

* There is a series of six webinars on ADHD starting on Nov 18, presented by Professor Amanda Kirby from the University of Wales, aimed at teachers and parents. Each webinar costs from £35 (€41) and lasts for one hour.

www.patoss-dyslexia.org or www.hadd.ie


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