Friday, January 19, 2018

Bad behaviour or misunderstood disorder?


SENSITISING THE PUBLIC: Speakers at the ADHD seminar attorney and founder of ADHD Aware Natalie Knochenhauer, Professor Gerard Hutchinson, Doctor Madonna Wojtaszek-Healy and Child Development Specialist Femi Williams.

Mark Fraser

There is a stigma attached to children with ADHD (Attention Deficit Hyperactivity Disorder) — behaviours always get attributed to poor parenting. According to the experts, these stereotypes and stigma can have devastating consequences. Parents whose children may have ADHD are afraid to get them evaluated and treated.

Mary’s son is miserable — non-stop climbing on furniture, he is rude, always seems disinterested, and is just a very hyper child who would not behave and follow instructions. His behaviour doesn’t change outside of the home, in fact, in some instances it is worse. At school he is easily distracted, won’t complete tasks, doesn’t sit still, leaves his seat very often and often bullies his peers. There is no formal national statistics on ADHD however, in the American population, the prevalence of ADHD is estimated as between five and 12 per cent.

The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes. The condition is also now being diagnosed in adults (adult ADHD) and it is believed that between two and four per cent of all American adults suffer from ADHD.

ADHD is a common behavioural disorder.

Children with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what’s expected of them but have trouble following through because they can’t sit still, pay attention, or attend to details. It is diagnosed based on symptoms related to inattention, hyperactivity, and impulsivity and is considered a chronic condition that is often carried into adulthood. Recent research links the disorder to heredity and abnormalities in neurotransmitters or brain chemicals.

On October 12 the ADHD Foundation of Trinidad and Tobago hosted a sensitisation and awareness Workshop on ADHD/ADD at the Lion’s Civic Centre in Port of Spain. It was aimed at teachers, educators, parents and other significant stakeholders. Prof Gerard Hutchinson gave attendees a clinical overview of ADHD in Trinidad and Tobago. He said ADHD is the driving force behind the negative behaviours in many youths who are institutionalised, adding that it has contributed to them being less likely to stay in school, less likely to be manageable by parents and remain in a disciplined environment.

“ADHD can be a precursor to things like depression and substance abuse but it can also co-exist with learning disability, dyslexia and conduct disorder. It is important for children to have the opportunity to have behavioural and psychological assessments in order that the diagnosis can be made as early as possible and intervention introduced in order to improve their lives,” Hutchinson said. He said teacher and parent education on ADHD is imperative in order to properly treat with ADHD in the classroom and at home.

ADHD takes in two concepts — firstly, attention deficit, the child’s inability to sustain attention, concentration and complete a task; and secondly, hyperactivity, described as a physical extension of the attention deficit, where the child fidgets and squirms a lot and talks impulsively. Medication can help reduce symptoms of hyperactivity, inattentiveness, and impulsivity. The option to medicate may be a difficult choice for many parents who fear the effect of the drugs on children. While their concerns may be justified, according to Hutchinson it is important to medicate a child with ADHD.

“Medication must be a consideration but that is not to say that medication must be the only form of treatment because behavioural treatment does work and they work effectively but they require structure the discipline and a high level of organisation. In T&T the only medication currently available for the treatment is a long acting version of Ritalin which is called Concerta; Ritalin used to be available,” Hutchinson said. He noted that as with most disorders mediation does not treat everyone. He noted that there are other medications available abroad and the ADHD Association is looking at ways of offering more options.

United States based Educational Psychologist and Special Needs Consultant Doctor Madonna Wojtaszek-Healy provided a general overview of ADHD/ADHD in the educational settings. Speaking from personal experience, (two of her children being diagnosed with ADHD) she said that her children have been the driving force behind her advocacy in educating people about the disorders.

Wojtaszek-Healy touched on areas of behavioural strategies, helping parents cope and the myths and realities of the disorder especially where medicating the child is concerned.

“People with ADHD have trouble sustaining attention and effort over long periods of time. Their minds ten to wander and they get distracted, not being able to finish the task at hand. Don’t be fooled by children who can pay attention to things that are novel, highly interesting or highly stimulating. These provide their own intrinsic stimulation which activates the brain functions that help them focus. A major problem for these kids, beyond the frustrations of rarely accomplishing what they need to and always feeling as if they are disappointing others is the judgment of others that they are morally deficient. Failure to control one’s impulses does not lend well to making good moral judgments and carrying out practices that demonstrate one’s values. Sadly, these people are often viewed as immoral and flawed in character, not disabled. If one parent has it, 60 per cent of the offspring usually do.”

When it comes to behavioural strategies Wojtaszek-Healy’s advice was to watch for positive behaviour and reinforce.

“Different people are