Debunking the ADHD myths

It’s been portrayed over the years as a made-up condition. An excuse for bad behaviour. The product of poor parenting.

However, ADHD - attention deficit hyperactivity disorder - is a recognised mental health disorder and genes appear to be the largest factor in determining who develops it.

“It is the commonest mental health condition in children,” adds developmental paediatrician Professor Desiree Silva, head of the paediatrics department at Joondalup Health Campus.

The symptoms — which typically include hyperactivity, inattention and impulsiveness — can make it challenging for parents and teachers to manage and children with the condition often encounter negative experiences daily.

“Many of these children become very resilient,” adds Professor Silva. “We know children with ADHD have a harder time with their learning and socially so it’s important we support them and make life easier for them so that they reach their potential.”

While there are many health professionals, teachers and parents who are making a huge difference to the lives of children with ADHD, there are many more who remain ignorant of the condition, who still push tired old myths about its causes and treatments and who treat youngsters with it as if they are just in need of harsher discipline.

However, without the right help, these children are at increased risk of anxiety, self-harm and failure at school.

Professor David Lawrence, a principal research fellow at the University of Western Australia and project leader for Young Minds Matter, points out that the average Australian child with ADHD in Year 9 performs at a primary school level.

The direct link between having ADHD and lower academic results is extremely concerning, he adds.

More investment is needed, he explains, so that children don’t slip through the diagnostic net and so that the education system can offer “the same (level of) structure and support for children with ADHD as there is for other disorders and disabilities”.

He adds: “You can imagine that if a child is in high school and reading at a Year 4 level in Year 7 it is going to be very difficult for them to do the work, which leads to further discouragement and falling further behind and that can lead to demotivation, lack of engagement with schooling and problem behaviours.

“(We want to see) support provided at the time when the problems first emerge because we know that if you fall behind beyond a year in schooling, the research shows it is very, very difficult to bridge that gap ... even with intensive support.”

On the other hand when children are supported, their lives, and those of their families can be transformed, he says.

“The first thing is we want families and teachers all educated about the condition because when they understand it then they know how to support the child,” Professor Silva says.

The fact is, children with ADHD have a different brain structure and different amounts of chemicals in their brain compared with children who do not have ADHD.

“Previously poor parenting was considered the reason the child was the way they were,” explains Professor Silva.

“Parents were blamed and the child was just considered naughty but this is a condition that can make good parenting look poor.

“Also, ADHD rarely exists on its own — you often will have it with other problems.”

Half of ADHD sufferers have learning difficulties, 20-35 per cent have oppositional defiant behaviour, 10-20 per cent have autism, 10 per cent have depression, 20-30 per cent have anxiety and 10-20 per cent have conduct disorder, data shows.

Three basic types of ADHD exist — the predominantly hyperactive type, the inattentive type or the combined type.

Treatment can include advice on home and school strategies, allied support such as psychology, speech therapy, occupational therapy and an ADHD coach, with or without medication.

It is usually spotted in children at the age of four or five and will often show up differently in boys to girls.

And, interestingly, boys are diagnosed about four times more frequently than girls in childhood.

“The girls have essentially had it all along but because they are more the inattentive type they have gone under the radar and this is a problem because they then don’t reach their potential,” Professor Silva says.

Boys, by contrast, typically have the hyperactive type so the condition is often “picked up earlier” because they tend to play up in class.

Dr Lawrence says scientists have estimated 80 per cent of Australian classrooms have a child with ADHD, given it affects one in 14 youngsters.

Already 6 per cent of Australian children have been diagnosed and numbers are rising.

“We still believe, with our work, that you might have the gene predisposing you but something in the environment has triggered it on,” explains Professor Silva, who is also the project director of the ORIGINS Project, a large study which follows 10,000 families over a decade to improve child and adult health.

She says it is already accepted that this complex neurodevelopmental disorder mostly runs in families, meaning adults with ADHD often have children with it. Other than DNA, there appears to be a small increased risk of ADHD in children who were born prematurely and also in a small number who have suffered a traumatic head injury. Drinking and smoking in pregnancy also put a child at risk.

Encouragingly, about a third of children will grow out of ADHD and never need medication.

And while medicating children has been a contentious issue, Professor Silva says that while caution is always sensible it is wrong to let stigma stand in the way of a safe treatment that improves the lives of many children with moderate to severe symptoms.

“You only treat children with medication if they are not functioning because if they are, there are other ways to help,” she adds.

Dr Lawrence says contrary to popular belief, the data shows few youngsters are prescribed stimulant medication in Australia — about 13 per cent — “and the majority who take a stimulant do benefit from it”.

“But this is a medication that is not widely used in Australia for ADHD and potentially could be used to benefit more children,” he says.

Spotlight on medication:

Medication can help reduce the core symptoms of ADHD in 80 per cent of children and should be used in children who have moderate to severe symptoms.

Having an age-appropriate healthy diet, including omega-3 fatty acids and reducing food additives, if diagnosed with food intolerance, can help. Increasing exercise and contact with nature, assistance with behaviour, having a routine, supporting your child and managing some of their conditions associated with ADHD can be beneficial before medication is started.

However, a combination of a healthy, supportive lifestyle and medication can be very successful. There are a number of other ways of reducing ADHD symptoms which should be considered. Avoiding unhealthy dietary patterns (usually high in saturated fat, refined sugars, processed food and low in fruit and vegetables); reduce food additives; and increase omega-3 fatty acids.

Source: ADHD Go-To Guide by Desiree Silva and Michele Toner

Chunk and sprint:

Because of their inability to break tasks down, children with ADHD often become overwhelmed by what they perceive to be an enormous task. Instead of telling them to tidy their rooms, for example, break it down into a list of tasks and use a timer to create 15/20/30-minute sprints. ADHD brains are great sprinters. If they can see a finish line they are more likely to get started.

Source: ADHD Go-To Guide by Desiree Silva and Michele Toner

Did you know? ADHD is the most common mental health condition in children but diagnosis and treatment with drugs remain controversial