Often misdiagnosed, plagued by myths and misunderstanding, and even sometimes claimed to be an “invented condition”, attention-deficit hyperactivity disorder (ADHD) and its treatments continue to cause controversy. But ADHD is a very real condition that affects many children and adults, and should be managed to limit the negative impact it can have in their daily lives.
What is ADHD?
ADHD is a chronic developmental neuro-behavioural disorder found in both children and adults. It is characterised by excessive activity, poor concentration and organisational skills, distractibility, low tolerance for frustration or boredom, a greater tendency to say or do whatever comes to mind (impulsivity) and a predilection for high-intensity activities. ADHD is estimated to affect as many as 1 in 10 children globally, and boys seem to be more prone to the condition than girls. In South Africa, the prevalence is even higher, affecting 2-16% of the school-age population, according to the South African Journal of Psychiatry.
Very active or ADHD?
Developing children are normally very active and often inattentive, so how do you know whether your child has ADHD? According to Dr Brendan Belsham, a child and adolescent psychiatrist in private practice in Johannesburg with a special interest in ADHD, this depends on the degree to which there is impairment in the daily functioning of the child. An appointment with a healthcare provider is recommended should all of the following apply:
- Hyperactivity or inattentiveness is affecting the child's academic or social functioning or causing much distress to the child, and is affecting his/her self-esteem.
- There are a sufficient number of symptoms present in more than one setting for at least six months.
- There are no other causes for the hyperactivity (such as sleep deprivation).
Belsham stresses that ADHD cannot be diagnosed with an electroencephalogram (EEG).
Who is qualified to diagnose ADHD?
Any of the following doctors can diagnose ADHD:
- A child and adolescent psychiatrist;
- A neurodevelopmental paediatrician; or
- A paediatric neurologist.
Belsham recommends including the general paediatrician and general practitioner in the diagnosis process, but make sure to choose healthcare practitioners who are knowledgeable about this condition.
What treatments have been proven effective?
“Generally speaking, prescribed medication is the mainstay of treatment for ADHD, and in terms of the published literature it is by far the most effective therapy,” says Belsham. The choice of stimulant versus non-stimulant medication depends largely on the child, the effect you want to achieve with the medication, and the side effects that concern you the most.
Heidi Lathy, an educational psychologist with extensive experience in working with children with ADHD in a school setting in Johannesburg, agrees. “Where it is indicated, medicine works quickly and effectively and does not accumulate in the body.”
According to both Belsham and Lathy, other forms of therapy won’t address the core symptoms of ADHD but may assist with addressing associated problems. These include:
- Behavioural therapy: to teach kids (and parents!) coping skills. “In particular, parent management training (for example, the New Forest Parenting Programme) is an evidence-based treatment that can be effective for associated symptoms, such as defiant or oppositional behaviour,” says Belsham.
- Play therapy: helpful for other emotional or social issues the child may have.
- Occupational therapy: for associated problems such as sensory difficulties, fine motor control, or muscle tone.
- Alternative therapies: these rely mostly on anecdotal evidence, says Lathy, but good sleep habits, a healthy diet and fish oil supplements are beneficial for anyone. “If it’s not harmful (such as colloidal silver), there may be a psychological component to it that seems to be working. I would, however, rather go with evidence-based medication.”
Although an estimated one million South African adults are affected by ADHD, most children with ADHD grow into well-functioning adults. Many achieve higher-level education and build successful careers. The correct treatment, as well as a structured, clear, organised environment, can help a child with ADHD become a well-balanced teenager and adult.
Get the support you need
- The South African Depression and Anxiety Group (SADAG) has launched an ADHD helpline. Phone 0800 55 44 33 toll free or visit www.sadag.org.
- The Attention Deficit and Hyperactivity Support Group of Southern Africa (ADHASA) has been assisting people living with and those affected by ADHD for more than 20 years. Visit their website at http://www.adhasa.co.za or phone 011 888 7655.
- What’s the fuss about ADHD by Dr Brendan Belsham is a book for parents of children with ADHD that explores the controversies surrounding the condition, and presents the relevant science in a way that is accessible and readable.