What a blessed couple of weeks! Although having loads of the usual pressures, our dream to launch Goldilocks and The Bear Foundation became a reality (see our splash page http://www.gb4adhd.co.za/, or Facebook page https://www.facebook.com/gb4adhd/ . This led to extensive media coverage and also radio interviews!
During these interviews I became once again aware of the amount of stigma, misconceptions, and myths surrounding the diagnosis of Attention-deficit/Hyperactivity Disorder (ADHD) and the treatment thereof – the cause being either a lack of information and knowledge, or misinformation.
So let me address some of these myths:
- Myth 1: ADHD is a new invention of modern society
“Mental Restlessness” was first described by Sir Alexander Crichton in 1798, while “Fidgety Philip” (a popular storybook character and now also an allegory for children with ADHD) was created by Heinrich Hoffmann in 1844. Sir George Still (in 1902) was the first to describe the symptoms of restlessness, inattention and impulsiveness in children – the starting point of the description ADHD as we know it.
- Myth 2: ADHD is not a real disorder
Since the first descriptions of ADHD, more than 10 000 clinical and scientific publications have been published on ADHD and there are clear differences between children (and adults) with and without ADHD. ADHD has been recognised as a legitimate diagnosis by major international medical, psychological, and educational organisations. ADHD is best understood as a bio-psychosocial condition: it is medical in origin but is affected and influenced by the environment, social and emotional aspects of the person and situation. However, research shows that genetic (hereditary) and neurological factors (such as pregnancy and birth complications, brain damage, toxins and infections) are the main causes of ADHD rather than social factors (such as poor parenting and diet).
ADHD is one of the most genetic conditions – it runs in families, with a heritability chance of almost 60% for a child if a parent has ADHD, and a 70%–80% chance for a twin if the other twin has ADHD. Research demonstrated imbalances of chemical messengers (neurotransmitters such as dopamine and noradrenalin) within the brain, as well as differences in the development of self-management systems in the brains of individuals with ADHD (e.g. changes in areas of the brain responsible for concentration, regulation, organisation, planning, time-management, decision-making, etc.).
- Myth 3: ADHD is over diagnosed
ADHD is the most common psychiatric disorder in children – affecting an average of 5% of school-aged children – irrespective of in which countries or cultural groups these prevalence studies were conducted! The seeming “explosion” of ADHD diagnoses and prescriptions for treatment in recent years has led to accusations that doctors, teachers, and parents are labelling ordinary, energetic children with a disease and medicating them to control normal, but unwelcome, behaviour.
Although the rate of diagnosed ADHD in children has increased over the past two decades, this is not due to “over diagnosis”, but rather improved awareness about ADHD amongst healthcare practitioners and parents and therefore increased help-seeking behaviour and screenings. Also, because we are now more aware that ADHD persists through adolescence and into adulthood, children often continue to be treated for longer – resulting in an increase in prescriptions for ADHD treatment. Unfortunately, despite this, many children (and adults) suffering from ADHD remain undiagnosed, misdiagnosed, or if diagnosed, do not receive optimal treatment.
- Myth 4: Any child who is naughty, fidgety or talkative is diagnosed with ADHD
Many children with ADHD are not hyperactive – but rather quiet daydreamers! ADHD is a clinical diagnosis, which should only be made by a specialist psychiatrist, paediatrician or other healthcare professional with training and expertise in the diagnosis of ADHD. Although screening children for the presence of ADHD is very important, the final diagnosis will always be confirmed by a thorough clinical assessment – which will also exclude conditions that mimic ADHD (e.g. depression, anxiety, visual problems, and certain medical conditions). In South Africa, psychiatrists use very well-researched diagnostic criteria (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) which describes the core and associated symptoms of ADHD.
- Myth 5: ADHD is due to the “junk” we eat
There is no scientific evidence to prove that eating sugar or junk food will cause ADHD. Although some children (both those with and those without ADHD) are particularly sensitive to certain food components (such as artificial colourants, additives, and refined sugar), and others benefit from specific food supplements (such as omegas), dietary intervention alone does not “prevent” or “cure” ADHD. If ADHD was due to foodstuff alone, then surely the prevalence would have been much higher and “everyone” would have ADHD!
However, we know that various factors are at play (see myth 2). There is little scientific evidence to show that dietary changes help with ADHD symptoms or academic functioning. However, a healthy balanced diet and regular physical exercise do form part of the ideal integrated treatment approach of children (and adults) with ADHD. It is important to treat each child as an individual and work with an appropriate professional to test what, if any, dietary changes might help improve the child’s symptoms.
- Myth 6: Pharmaceutical companies and psychiatrists are colluding for financial gain
When a cardiologist assess a patient, discover the patient’s blood pressure is high, and start him on treatment – is he colluding with pharmaceutical companies “just to sell more medication”? I prefer to belief that healthcare providers (read: psychiatrists) always have the patient’s best interest at heart. Why would they want to do something which is bad for a child? Pharmaceutical companies and medical professionals are both bounded to strict ethical codes (and personal values) we adhere to.
- Myth 7: ADHD medication is dangerous
It is true that any substance or medication (including herbal remedies) has the potential for risks and side effects. When it comes to medication, it is never a decision to be taken lightly. Always carefully consider the benefits of treating the child versus the potential harm of withholding treatment.
The medications used to treat ADHD have been proven safe and effective over more than 50 years of use, and has been researched in more than 200 successful clinical trials. The most famous and often cited study is the “MTA” or “Multisite Multimodal Treatment Study of Children with ADHD” conducted in 1999 (http://jamanetwork.com/journals/jamapsychiatry/fullarticle/205525). This 14-month randomised clinical trial of treatments in almost 600 school-aged children found medication to be superior to behaviour therapy or community care. Combined medication and behaviour therapy was found most effective, however, this was attributed to its effects on non-ADHD symptoms (e.g., oppositional / aggression, internalising, teacher rated social skills, parent-child relations, and reading achievement).
The most common side-effects children experience are a decreased appetite (and sometimes weight loss), dry mouth, headaches, stomach ache, and problems sleeping. However, most of these side-effects are mild and transient. The goal of treatment is not to subdue children or to “change their personality”! Medication does not “calm the brain down” – effective medication stimulates and improves the brain’s management system. It is important that medication should be carefully monitored and adjusted for every individual – to enhance the child’s functioning by sharpening their focus and increasing his or her ability to control their own behaviour.
Medication does not cure ADHD, but they are highly effective at easing symptoms of the disorder and enabling a child to learn better coping strategies. Also remember that treatment should always include therapy (e.g. parental guidance, addressing issues with self-esteem), educational support (e.g. learning support and strategies, and coping skills), addressing potential stressors (e.g. parental conflict, and bullying), and lifestyle changes (e.g. physical exercise and a healthy diet).
Untreated or inadequately treated ADHD can cause significant personal, interpersonal and social burdens, impacting negatively on overall quality of life. A child (and adult) with (untreated) ADHD is six times more likely to have another psychiatric disorder (such as depression, anxiety, or substance abuse) or learning disorders and self-esteem problems. Research has also shown that those diagnosed with ADHD completed on average two years less of formal schooling and attained a lesser employment status than those without. The risks of using appropriate medications to treat ADHD are minimal, whereas the risks of not using medication to treat ADHD are significant.
- Myth 8: ADHD medication is addictive and create addicts
It is actually the opposite: treating children with ADHD protects them against becoming addicts! In a ten year follow up study of a sample of 140 boys originally aged between 6-17 years, 73% had received some level of treated with stimulants at some stage during childhood (some also continued this into adulthood). The researchers found no association between treatment with ADHD medication and alcohol, drug, or nicotine use disorders in later life. Other studies also clearly showed that untreated ADHD increased the risk to develop substance abuse problems during teenage years or later life. This may be due to impulsivity, self-medication, or failure in the educational system and getting involved in destructive friendships and behavioural patterns.
We are scared of things we do not understand or know. Be careful of what you read – especially in the popular media and online (read: “Google”) – and believe. These sources can strengthen misperceptions and stigmatising beliefs about patients suffering from ADHD. Always discuss your concerns with a trained healthcare professional. The media is also our potential biggest allies (with a big responsibility) to create public awareness and education – and we are very grateful for the support we are experiencing. Knowledge is power – it can dispel myths, help you to have an informed opinion and to take informed decisions, with regard to ADHD. Knowledge give wings – it helps your child to fly!