AFFLICTION: Medical expert offers insight on traits and treatments of attention deficit/hyperactive disorder…

By Own Correspondent

Over the past 50 years, attention deficit/hyperactive disorder — more commonly known as ADHD — has evolved from a little-known condition into arguably the most studied disorder in the field of child psychiatry.

Most commonly diagnosed when children reach school age, ADHD affects millions of children across the country and around the world, according to the Centres for Disease Control and Prevention.

“Historically, there was some recognition of ‘minimal brain dysfunction,’ but we didn’t know much about it,” said Ronald Brown, dean of University of Nevada’s (Las Vegas) School of Integrated Health Sciences, who has been studying ADHD for nearly five decades.

 “Over the years, diagnosis and management have become much more specific, and now we have a checkbox of symptoms that assists us in identifying the disorder,” Brown said. Brown, a clinical health psychologist, said behavioural issues are typically first identified when children begin the first grade, and symptoms are usually more frequently noticed and diagnosed in boys.

“We’ve all heard the saying, ‘boys will be boys’ and ‘they’ll grow out of it,’ but we know that there are children who have significant problems even before they start school,” he said. “When you are 6 or 7, you really have to listen and pay attention in school because it is a much more structured environment than what you might find at home. For kids with ADHD, that can be hard, and that’s when parents start to see that there may be something going on.”

Brown is the co-author of the books, ADHD in Children and Adolescents and ADHD in Adults,  both of which have been published in multiple languages and versions around the world. We caught up with him to learn more about ADHD, how it has evolved throughout the years, and signs that parents should look out for if their child is not performing well in school.

What exactly is ADHD? How do you know if you or your child has it?

ADHD is suspected in patients who have several symptoms that are associated with the inability to sustain attention and effort. In the psychiatric field, we rely much more today on functional outcomes than symptoms alone. Thus, in order to have an official ADHD diagnosis, there needs to be a functional impairment, or more specifically, problems in academic performance at school or difficulties holding employment.

What we’ve concluded is that if you have symptoms and they impair you, chances are you need some type of intervention. If you simply have symptoms of ADHD but it does not functionally impair you, it is fairly unlikely that you have ADHD. If you have a kindergartner with a lot of energy, that’s fine. But if they are unable to complete their activities or are unable to pay attention for five minutes, and maybe they are aggressive with their peers, chances are you are on to something.

How has our understanding of ADHD evolved throughout the past 50 years?

Reforms in special education and children with learning problems were very pervasive in the late 1970s and early 1980s. When I was growing up, Dr. Spock was the leading expert on children. It was a time shortly after psychoanalytic psychiatry, and the very beginnings of behaviorism.

When I started graduate school, clinicians started to quantify behavior and particularly symptoms of psychopathology in measurable terms. That’s when they began to designate children as having a problem, which jumpstarted the next stage of discussion. Now we know how ADHD impacts kids and how it impacts their teachers. All of these studies have been done very meticulously. Long-term follow up studies have shown the effects of medication and behavioural therapy over time.

Follow up studies of these children with ADHD show that as adults, they suffer from poorer job performance, have greater difficulties in their marriages, and are at greater risk for substance abuse. These problems are particularly heightened if there is no treatment program.

What is the best way to manage ADHD?

The first thing you need to do is find out if your child actually has ADHD. We assess behavioural symptoms and complete a history on when their behaviour started changing. We find out how their behaviour is at school and at home, and we us a behavioural checklist and ask the parent and teacher to fill out a grading scale on the child’s behaviour.

Once the child has been diagnosed, it’s important to emphasise structure, both at school and in the home. Sometimes symptoms may be elevated depending on how much structure is imposed throughout the day. Behavioural therapy and medication are the only evidence-based therapies for ADHD, according to the American Academy of Paediatrics.

We don’t have an ADHD biomarker, or a specific biological variable that is implicated in the disorder and typically would show on a laboratory test.

Can you explain the difference in how ADHD affects boys and girls?

Girls may suffer the disorder more silently because in school, girls tend to be quieter than boys. Therefore, when girls have ADHD, it can really impact them more severely because it isn’t recognised until later. On the other hand, what we’ve seen is that boys are the ones who typically act out in class, which draws more attention to their behavioural issues.

ADHD is diagnosed three times more frequently in boys, although research suggests that girls may be under-diagnosed. The reason for the difference in diagnosis among genders is that ADHD can manifest differently in boys than in girls. Boys tend to have impulsive, hyperactive and other acting-out behaviours.

Girls tend to have more inattentive traits and other psychiatric symptoms that may include symptoms of anxiety and depression. Girls frequently misinterpret, misperceive or miss social cues, misperceive other people’s behaviours, and struggle to fit in a peer group.

Unless you have behavioural disturbances that are bothering others, you’re not going to be identified as quickly.

Sometimes, girls aren’t diagnosed until much later in life, which makes it harder as they get older. Industry experts have found that children who receive intervention do better in the long term, and we know the disorder occurs across all cultures, thereby lending validity to the diagnosis.

Are there any long-term effects of medication?

We know that when we follow up with kids who are on medication for ADHD, they haven’t sustained any sort of physiological effects. The medication doesn’t predispose them to drug abuse or hypertension.

If anything, it makes them less prone to substance abuse and addiction because it manages their behaviour. When you can enhance attention and curb impulse control with the proper amount of medication, kids tend to do better.

The bottom line is that medication and behaviour management work. When you can show success with medication, that can be a godsend for some people. We know that 80-90% of children with ADHD respond to their medication. All of the data we have shows that it is safe when prescribed appropriately.

Behaviour management also has been demonstrated to be an evidence-based treatment for ADHD. Source: University of Nevada, Las Vegas

PREMATURE BIRTH COMPLICATIONS CAN BE OVERCOME

PERSONAL TOUCH: Small interventions like skin-to-skin contact can make a big difference

By Thuli Zungu

Eight out of every 100 babies are born prematurely – 37 weeks into pregnancy, according to data collected by the United Nations’ Children’s Emergency Fund (Unicef).

Aliné Hall, clinical quality specialist child health at Mediclinic Southern Africa, says at position 24th out of 184 countries, South Africa also ranks high in terms of the number of new-born deaths due to complications related to preterm birth.

But, with the right kind of specialised care, starting within the first critical hour, and then continuing the care until they have grown and developed, preterm babies can go on to live healthy, prosperous lives, she says.

“Once the preterm baby is born there is a golden hour to assess and manage the immediate care the baby requires. This specialised care continues while the baby grows and overcomes many of the challenges a preterm baby faces.

“These interventions include breathing support, maintaining the baby’s temperature in an incubator, giving fluids and electrolytes intravenously and introducing mothers own expressed breast milk via a feeding tube. Our aim is to get the baby big and strong enough to go home to their families and to support the family through this journey,” says Hall.

Currently, prematurity is the leading cause of death in children under the age of five, with an estimated 15 million babies born too early on a global scale, every year, says Hall.

 Bringing this important cause a bit closer to home, Hall reports that Mediclinic Southern Africa currently admits between 2 500 and 3 000 preterm and sick newborns into its neonatal units every year. Mediclinic hospitals in Gauteng, Limpopo and Mbombela are currently the busiest provinces in the country in terms of obstetric services and neonatal admissions.

Hall says the most common complications associated with premature birth relate to the fact that preterm babies are often born with compromised immune systems, making them more prone to infections and sepsis. In addition, some of the most prevalent conditions facing a premature baby include breathing problems, retinopathy of prematurity, eye problems, neonatal jaundice and difficulties with feeding.

Hall says the medical and support staff within Mediclinic’s neonatal intensive care units (NICUs) are trained to respond urgently to premature birth cases and intervene as early as possible, to prevent further complications.

“We also encourage as much skin-to-skin contact with mothers as possible, in cases where babies are born premature. In fact, research conducted by the World Health Organization has found that skin-to-skin contact or ‘kangaroo mother care’ as it has become known, is a highly effective method of reducing the onset of infection and conditions such as hypothermia,”Hall says.

She says this aligns with this year’s theme for World Prematurity Day, which is ‘small actions make a big impact’.

“At Mediclinic, we are committed to taking such measures to improve outcomes for preterm babies and to provide their families with the best medical support possible,” she adds.

World Prematurity Day is an intercontinental movement, initiated by the European Foundation for the Care of Newborn Infants (EFCNI) and its partners, and has been observed around the world since 2008.

In addition, South Africa is also a signatory to the UN’s Sustainable Development Goals, one of which is to reduce neonatal mortality, a large proportion of which is caused by premature birth, says Hall.

“Many may be surprised to learn that seemingly small interventions like skin-to-skin contact can make a big difference and really turn the tide on some major health issues that often come with premature birth. We therefore deem it important for us as a healthcare sector leader in South Africa, to make a contribution to the cause and to raise awareness in any way we can, especially through the work we do in our NICUs across the country.

Purple, which represents ‘sensitivity and exceptionality’, is the trademark colour of World Prematurity Day, observed in different ways throughout the world. In the coming weeks, South Africans are encouraged to do their part by wearing purple ribbons, supporting awareness drives and educational initiatives, and sharing their stories of hope on social media.

World Prematurity Day was on November 17.