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
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(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