The neurological condition attention deficit hyperactivity disorder (ADHD) is genetic, new research has found. ‘You often find that if one child is ADHD, the other children are too, because the condition in 80% of cases is genetic, research shows,” says Professor André Venter, an international expert based at the University of the Free State.
According to him, there is an increase in diagnoses of the disorder. ‘This could be that with better knowledge and awareness now, more are coming out of the closet,” he says.
Venter is the chairperson of the Pediatric and Neurological Development Association of South Africa (Panda), member of the International Child Neurology Association, fellow of the American Academy of Cerebral Palsy and Child Development as well as a member of the South African Association of Sensory Interpretation.
The frustration with ADHD, Venter says, is that the diagnosis is largely made by focusing on a child’s history and through a constellation of symptoms: lack of attention and focus, and behavioural problems such as impulsiveness, low tolerance threshold and boredom. But it can also be associated with depression characterised by sadness and social withdrawal.
According to an ADHD conference held earlier this year in Johannesburg, a child suffering from ADHD often fails to give attention to details, making careless mistakes; has difficulty sustaining attention; appears not to listen; struggles to follow instructions; has difficulty with organisation (for example, can’t get ready on time for school in the morning); is easily distracted and is forgetful. The hyperactive child tends to fidget and has difficulty remaining seated, runs about or climbs excessively, acts as though driven by a motor, talks excessively, blurts out answers before questions are completed.
Children with ADHD, Venter explains, have different neurotransmitter patterns in certain parts of the brain. Neurotransmitters, responsible for the full function of the brain, ensure that nerve impulses travel from one nerve cell to another. ADHD children (and adults) have a lower level of some transmitters, particularly dopamine, that are responsible for regulating behaviour.
‘This is not a disease,” Venter is emphatic, ‘it is a disorder and while everything is working, it’s working incorrectly.”
Many things cause it, some just genetic — if your parents’ brains were wired in that way, you get it; but also causes such as birth traumas, emotional stress during pregnancy, near drowning and post-partum depression.
Unfortunately, there is a stigma attached to ADHD, there is a lot of denial, and sometimes teachers can be insensitive too, Venter says, for example, saying to a child in front of the whole class: ‘What’s wrong with you today, did you forget your medication?”
However, this lack of sensitivity is not the case for all teachers. John Batwell, head of the maths department at a preparatory school in the northern suburbs of Johannesburg, is popular with the children at his school because, one of his pupils offers, ‘he has a great sense of humour, he’s kind and he sings”. Batwell, a teacher with 30 years’ teaching experience, has also spent five invaluable years in remedial schools, and says some of his kids actually keep him up to date ‘on how things are going with their medication”.
He estimates that about 10% of children in most schools are ADHD; this would mean that, if a school has about 500 pupils, about two to three children in every class have ADHD.
Batwell observes that you easily notice the difference between an ADHD child who is on treatment, and one who isn’t. ‘There is the fidgetiness, the distraction, the lack of focus. If the child has the right temperament in which to undertake his/her work, then the quality of output shows signs of improvement.”
Part of the problem is the society in which we live, he says, describing the typical Sandton Syndrome. ‘There are parents who are high flyers, working 18-hour days, chasing the buck, children are left with au pairs and they often eat fast foods, which don’t help, especially if a child is ADHD.”
Venter points out the other end of the spectrum — poor children in schools and homes with little knowledge and access to medical expertise to even make diagnoses such as ADHD.
‘These children get treated as though they are just naughty or cheeky, and it makes matters worse. We haven’t even begun to look at the disadvantaged communities; teachers and parents here haven’t even begun to identify symptoms and often these kids are just abused.”
In addition to social stigmas, sometimes neglectful parenting, and bad diets, the outcomes-based education (OBE) system might not necessarily be the best for ADHD children, according to Venter, because they do not perform well in team efforts and project work. ‘This is due to many ADHD children not really being socially adept at the team effort. They seem to need a more structured environment.”
However, Batwell points out that many educationists laud the OBE system, which develops social skills and cooperative working.
Treatment for ADHD
There are four main modalities to treatment. Not necessarily in order of priority, the first is medication. These include Ritalin, Concerta and Strattera. The first two are stimulants, the latter is a non-stimulant and they act on different pathways of the brain. The medication needs to tailored to the child’s needs.
The second is educational support, breaking down tasks into bite sizes so as not to overwhelm the child. The third is psychological services, for example, confidence and self-esteem building, and the last one is healthy diet including supplements.
While a healthy diet can help, a multi-faceted approach is needed: Medical research increases the body of knowledge, which should improve social awareness and remove the prevalent stigmas; medication is another route to take and very importantly, treat the child with love and compassion.
Classroom management of ADHD
Parents are responsible for the diagnoses and evaluation of attention deficit hyperactivity disorder (ADHD). But teachers can support them. In a paper, titled Tips on Classroom Management of ADHD, Dr Edward Hallowell and Dr John Ratey provide some pointers to teachers. They include:
- Try to build a network of support including experts, social workers, school psychologists, parents and colleagues who have experience with the condition.
- Ask a child how he/she will learn best — ‘the best expert on how the child learns is the child himself or herself”.
- ADHD children need structure and predictability so lists, reminders, previews, repetition, direction and limits are important, but so is enjoyment in class, so pay attention to emotions.
- Try humour, be playful, fun and unconventional as ADHD children enjoy novelty.
- Make frequent eye contact to bring the child back as these children tend to daydream.
- Seat the child near your desk.
- Set limits, boundaries and take charge but try not to be punitive.
- Aim for quality rather than quantity of homework as ADHD children need a reduced load.
- Give frequent feedback to keep the child on track.
- Positivity and optimism can’t be overemphasised as these children love encouragement and praise.
- Break down task into small sizes so the child is not overwhelmed.
- Teach them little tricks to help memory — techniques such as flashcards and rhymes, for instance.
- Simplify instructions, choices and scheduling.
- Ask questions that promote self-observation for example: ‘Why do you think that girl looked sad when you said that?” Often such children are not adept at picking up on social cues such as body language and tone of voice.
- A home-to-school notebook helps with day-to-day communication between teacher and parent and prevents crisis meetings. Meet with parents often, not just when there is a problem.
- Explain and normalise the treatment the child receives to avoid stigma.
- And the best part: be a conductor of a symphony; get the orchestra’s attention before beginning your class; and lastly,
- Be on the lookout for ‘sparkling moments”. ADHD children are far more talented than they seem — full of creativity, spontaneity and resilience.
Diet and ADHD
Some studies have shown that a lack of the mineral zinc and essential fatty acids such as Omega 3 are lacking in children with attention deficit hyperactivity disorder.
In one such trial study done in Durham, United Kingdom, last year, in which 300 children from eight schools participated, the results showed that an essential fatty acid formulation enhanced behavioural and academic performance.
A total of 88% of parents said they believed the supplement containing fatty acids benefited their child. The child was able to remember a longer sequence of instructions, had more confidence and self-esteem, was able to concentrate and stay focused on the task at hand, was less reliant on teacher input, was less excitable and hyperactive, and was less likely to be disruptive.
The study also showed that very few children ate fish, from which most fatty acids can be derived naturally.