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Childhood ADHD: A closer look

Attention deficit hyperactivity disorder (ADHD) is a chronic condition that, if left untreated, can impair a child’s social relationships and self-esteem.

What is ADHD?

‘ADHD is a chronic condition characterised by a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with normal functioning and development,’ explains Professor Angelo Lasich, a specialist child psychiatrist at the Life Mental Health unit based at Life St Joseph’s. It is the most commonly diagnosed disorder in children in South Africa. ‘It occurs in all ethnic and socio-economic groups and its prevalence rate among preschool and primary school children ranges from three to 12%. It is also three times more common in boys than girls.’

Behaviour and diagnosis

It is quite normal for children to be more active, more exuberant, less attentive and more impulsive than adults. So when parents complain that their child has difficulty paying attention, controlling their activity or resisting impulses, others may be quick to dismiss these problems simply as normal behaviour. Usually this is correct, but sometimes it is not.

If children have problems with attention, overactivity and lack of inhibition and the problems have reached an extreme level, they are not simply a little immature and will most likely not outgrow these problems. They need help.

‘There is no shortcut to making a diagnosis,’ says Professor Lasich. ‘The assessment of the child will require input from a number of professionals, including a paediatrician, an educational psychologist and a clinical psychologist, and, sometimes, speech and occupational therapists. It is important to rule out other conditions – medical, psychological and psychiatric – as there are a number that mimic the symptoms of ADHD.’

Treatment and management

Once diagnosed, it is important for treatment to start as soon as possible. ‘Early treatment will ensure that the child is not disadvantaged academically and is able to adjust to the social demands that come with the school environment,’ says Professor Lasich. ‘Earlier is also better than later because it prevents the child from adopting “coping” behaviours that may further impede his or her normal psychological and social development.’ Treatment includes both biological (medication) and psychosocial interventions.

Ritalin, Concerta and other central nervous system stimulants are the most commonly prescribed drugs and have proved very effective in treating its symptoms. But these medications may come with detrimental side effects, including insomnia, depression, decreased appetite, headaches, drowsiness, cramps and convulsions.

A healthy diet is also recommended in the management of ADHD. ‘Some parents report that their children respond adversely to sugar and/or artificial colourants, and preservatives in foods containing these substances tend to precipitate and aggravate their ADHD symptoms,’ says Professor Lasich. ‘Recent studies have also indicated that fructose, or fruit sugar, may interfere with brain function and should be avoided by those suffering from ADHD,’ he adds.

Alternative treatments
Other frequently touted treatment options include herbal products, special vitamin combinations and, more recently, neurofeedback, a form of brain-function training. However, Professor Lasich says, ‘My experience of “alternative” treatments has not conclusively proved their effectiveness. What makes it difficult to establish their efficacy in treating ADHD is the absence of controlled clinical trials. Time may prove otherwise.’

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