Your Baby & Toddler - - Talk­ing Point -

to some ex­tent sub­jec­tive, ac­knowl­edges Jo­han­nes­burg psy­chi­a­trist Dr Bren­dan Belsham in his ex­cel­lent book, What’s The Fuss About ADHD? (2012), which is a must-read if you sus­pect your child may be af­fected. A good doc­tor will seek a thor­ough as­sess­ment from par­ents, teach­ers and other sig­nif­i­cant adults, as well as from the child him­self. Fur­ther­more, a di­ag­no­sis needs to be made by a qual­i­fied per­son. This would be a child psy­chi­a­trist, a pae­di­atric neu­rol­o­gist, a spe­cial­ist neu­rode­vel­op­men­tal pae­di­a­tri­cian, or a GP with an in­ter­est in the con­di­tion, says Dr Belsham. They should then as­sess the child us­ing a rat­ing scale where dif­fer­ent eval­u­a­tors can rank the sever­ity of each symp­tom.

ge­netic or en­vi­ron­men­tal?

ADHD is a poly­genic con­di­tion, says Dr Belsham. So as op­posed to some­thing like cys­tic fi­bro­sis, which is caused by a sin­gle gene mu­ta­tion, ADHD is caused by a com­plex in­ter­play of sev­eral genes – as well as the en­vi­ron­ment. Sci­en­tists know that neu­ro­trans­mit­ters in the brain called dopamine, and to a lesser ex­tent no­ra­drenaline, play a role in ADHD. A vari­ant on the dopamine re­cep­tor DRD4 (the 7R al­lele) in­ter­feres with the usu­ally smooth process of re­leas­ing dopamine, and re-tak­ing up ex­cess dopamine, in synapses in the brain. Ri­talin reg­u­lates the amount of dopamine trans­mit­ted across synapses or taken up again, and that’s why it is ef­fec­tive in al­le­vi­at­ing the symp­toms of ADHD.

But while “close rel­a­tives of an ADHD child have been found to have an ap­prox­i­mately five times in­creased risk of hav­ing it them­selves,” ac­cord­ing to Dr Belsham, that’s not the full pic­ture. Ge­netic makeup con­trib­utes “70 to 80 per­cent to the ob­served symp­toms ADHD,” he says, which means that “shared fac­tors in the home en­vi­ron­ment” can ac­count for a fair­sized per­cent­age of ADHD di­ag­noses – but equally, that the right home en­vi­ron­ment can also mit­i­gate against ADHD de­vel­op­ing in a child. That’s the hope­ful bit.

“The trick is to fig­ure out, once you know you have the propen­sity to­wards ADHD, how to min­imise the im­pact of these genes, how to make them whis­per in­stead of shout,” says Dr Belsham. He lists the fol­low­ing as strong risk fac­tors for a child con­tract­ing ADHD: smok­ing and al­co­hol con­sump­tion dur­ing preg­nancy, ma­ter­nal stress, pre­ma­tu­rity and oxy­gen de­pri­va­tion at birth, epilepsy, brain in­fec­tions, HIV/AIDS and cer­tain con­gen­i­tal and ge­netic con­di­tions. A re­cent study by Fred­er­ica Per­era and oth­ers in the jour­nal Plos One linked ex­po­sure to poly­cyclic aro­matic hy­dro­car­bons

is avail­able as an ebook on kin­dle from ama­, or from book­shops

(which are air pol­lu­tants) to a five times higher risk of de­vel­op­ing ADHD. Ex­ces­sive screen time and obe­sity have even been cor­re­lated with ADHD – al­though whether this is a cause, ef­fect or merely co-oc­cur­rence is de­bat­able. Dr Belsham also be­lieves that there is a con­nec­tion be­tween an in­se­curely at­tached child and ADHD.

is adhd over­diag­nosed?

Though it’s been de­scribed by doc­tors since the early 1900s, be­fore 1980, ADHD wasn’t of­fi­cially recog­nised by its cur­rent name. Right now in the US around eight per­cent of chil­dren are di­ag­nosed with the con­di­tion. The rate of in­crease seems sharp, but whether we are get­ting bet­ter at recog­nis­ing the dis­or­der, or whether the di­ag­no­sis is too eas­ily slapped onto a “dif­fi­cult” child, is de­bat­able. Either way, you should en­sure you con­sult with the qual­i­fied pro­fes­sion­als be­fore la­belling your child.

is adhd over­med­i­cated?

Ri­talin is an am­phetamine­like drug. It was mar­keted for chil­dren in 1963 as a “tonic”. An anec­dote in Dr Belsham’s book tells how the drug was named af­ter the wife of the chemist who syn­the­sised the drug – as she used it be­fore play­ing ten­nis. Her name was Rita, so the drug be­came known as Ri­talin. Ad­der­all is a sim­i­lar am­phet­a­mine-based drug. Strat­tera, or ato­m­ox­e­tine, is the first non-stim­u­lant drug used to treat ADHD.

There is ev­i­dence that Ri­talin is used as an oc­ca­sional drug or “study aid” by stu­dents. Some pro­fes­sion­als have in­deed voiced con­cerns that Ri­talin is pre­scribed too freely among chil­dren of high-achiev­ing, am­bi­tious, or wealthy par­ents, or of par­ents who de­mand med­i­cal in­ter­ven­tions rather than first in­ves­ti­gat­ing al­ter­na­tive ways to make the ADHD genes ex­press them­selves in that whis­per to which Dr Belsham re­ferred ear­lier.

or­chids and dan­de­lions

Quot­ing Thom Hart­mann’s book The Edi­son Gene, Dr Belsham ar­gues that many char­ac­ter­is­tics of ADHD chil­dren – “rest­less­ness, risk­tak­ing” – may be dis­cour­aged by our school sys­tem, but are qual­i­ties that are nec­es­sary to a per­cent­age of hu­man be­ings so that hu­man­ity as a whole can ben­e­fit from ex­plor­ers and pi­o­neers, chal­lengers to the sta­tus quo and driv­ers of so­ci­etal change.

“Dan­de­lion chil­dren” is a term for re­silient chil­dren who will achieve their po­ten­tial and cope in most cir­cum­stances. In con­trast, so-called “or­chid chil­dren,” says Dr Belsham, “are par­tic­u­larly sen­si­tive to their rear­ing con­di­tions. Given the right en­vi­ron­ment, they bloom spec­tac­u­larly, but if ne­glected they quickly wither and wilt. Whether good or bad, the en­vi­ron­ment has a pro­nounced ef­fect on how they turn out.” Orchid chil­dren are at higher risk of ADHD, yet if they are nur­tured, they are more likely to “bloom spec­tac­u­larly” into those dis­cov­er­ers and achiev­ers we need and re­vere.

ADHD need not doom a child to fail­ure. If you sus­pect your child has it, get the best di­ag­no­sis and treat­ment you can – and watch him soar. Yb

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