The Case for ADHD: Jan 07 issue

THE CASE FOR ADHD
Claire Morrow examines the Attention Deficit controversy
Q: How many kids with ADHD does it take to change a light-bulb?
A: Let’s ride our bikes!
Of course children like to ride bikes (a great mystery), and they are rarely called upon to change light-bulbs. But what happens to the kids in the joke when they are old enough to change light-bulbs? “OK…here I am…I’m at the shop…I’m going to buy light-bulbs and milk…great…I can do this.” By some miracle the adult with ADHD has their bank card with them and it’s not maxed out.
Gleefully arriving home – stopping briefly at the neighbour’s to pick up the spare keys so they can let themselves in (stepping carefully around the pile of junk in the hallway) – with bread, eggs and all the things to fix that crack in the wall and…no light-bulbs.

Everyone has those “senior moments” from time to time, and most of us can say “oh, that happens to me too”. But for some people it happens…a lot. Too much. Even if you haven’t been paying attention, you could hardly have failed to notice that there is a condition called Attention Deficit / Hyperactivity Disorder. It is the most common psychiatric diagnosis in children (in adults, depression is the most common) and it receives the kind of media attention that your average cancer charity would kill for. Not normally positive media attention though. Not your Here-are-the-warning-signs-see-your-doctor-now-for-help- thanks-to the-miracle-of-science kind of publicity, as a general rule. More your bad-kids-or-bad-parents-you-be-the-judge kind of attention. Children do not have ADHD because their parents smack them, or don’t smack them, because dad’s not around, because they’re poor or because they eat too much sugar/wheat/dairy products.
True, the odd child who is badly behaved, impulsive and super-active may be misdiagnosed with ADHD when there are in fact “problems at home”. But a good, thorough assessment would rule that out. An ADHD diagnosis is usually made very, very carefully with the involvement of several specialists, teachers and parents. One cannot simply front up to the family doctor, complain about the child and get a pill to make it go away.
Attention Deficit / Hyperactivity Disorder is primarily a disorder of attention. It comes in 3 flavors – hyperactive, inattentive and mixed (one scoop of each). The primary symptoms revolve around the ability to focus, concentrate, remember, control impulses and do what needs to be done. Inattentive type (with the clumsy diagnostic label “Attention Deficit/Hyperactivity Disorder – without significant hyperactivity”) results in a daydreamer who may not be diagosed until later because their inattentive style is hard for them, but doesn’t disrupt the class. Hyperactive type…well, we know hyperactive when we see it. A hyperactive child is not merely a colossal pain in the backside to take care of (babysitters-won’t-return syndrome) – they need extra time, love, humour, consistency and attention from someone who understands them. And to be protected from themselves – because impulse control is poor, they are not deliberately doing foolish things, they are just so focused on getting their ball that the “don’t go on roads” bit drops out of their mind. Which is very normal at 2 and 3 years old, not so normal in an 8 or 10 year old. And these kids have to grow up.
Although it used to be thought that children grew out of ADHD, increasing numbers of adults are now being diagnosed with the condition. You do not catch ADD at 30, of course, it is a pervasive, perhaps lifelong neurological condition. Adults with ADHD are either people who were diagnosed as children or who – later in life – hit upon some hope-fully friendly person who said “Could you have ADD?”
You might get through school because your parents are supportive, and you are yourself very bright, even though you constantly lose the things you need for your assignments. Maybe even with good marks. But when you enter the less structured, less supported, more competitive environment of work or university, things start to fall apart. Many adults with ADHD have been under the impression for most of their lives that they are lazy, stupid, space cadets. If one of their children is diagnosed with ADHD suddenly the light-bulb (which they have finally re-membered to buy) goes on – “They can’t have ADHD…I was exactly the same as a child…still am like that…and I don’t…unless…?” (ding!).
Some people object to ADHD on religious grounds – Scientologists for example do not believe in psychiatry at all. Others are worried about “labeling” children. Children are smarter than you think, in that case. Labeling a child as “A wonderful, artistic sensitive lit-tle person who happens to have ADHD, a neurobiological condition which sometimes causes her to have problems that we can work out together” is a whole lot better than the labels a child will apply to themselves if they don’t have a clear understanding of why they have trouble in class, forget things, and ‘drift off”. You don’t want a label; “stupid”, “space cadet”, “thoughtless”, “lazy”, “bad”. If not enough information is given about what’s happen-ing and why, these are the labels children with ADHD come up with by themselves (with a little help from their friends).
Correctly diagnosed ADHD is caused by insufficient dopamine in the brain. That is all. The synapses in the brain need dopamine. If you have enough dopamine, then taking amphetamine will make you have too much and you will become edgy, difficult and anx-ious. Too little and you have ADHD. Stimulant medications such as amphetamines (and drugs such as ritalin are no more closely related to ice or speed, than codeine is related to heroin) increases the amount of dopamine in the brain – focus improves. At any age, Attention Deficit Disorder is managed, not cured. It can be managed through cognitive behavior therapy (using a day planner, timers, alarm and so forth), and some people find special diets help a little (if they have food intolerance in addition to their ADHD). There are (aren’t there always?) a great number of unproven treatments, exercise has proven to be fairly helpful. Newer medications are not as well established, but there are long-acting and non-controlled medication treatments now available. Medication, particularly the stimulants, far and away outperforms any other treatment. Just as no one expects the severe diabetic to control their sugar level without insulin, children and adults with ADHD have some control and can exert some effect on their behavior, but medication does have a significant place in treatment.
If you think you may be an adult with ADHD or you would just like to know more about the condition, you can find information and a self assessment scale at: http://www.addresources.org . As always; exercise more, and see your doctor if chronic lateness, underachievement and disorganization persist. Oh yes, make a list. Lists help a great deal. Light-bulbs.