ADHD: children are being labelled unruly but they need special care

Schoolchildren are wrongly being branded 'naughty' and are at risk of being expelled instead of being treated for a psychological disorder, according to health experts.

Jennifer Bell

ABU DHABI // Schoolchildren are wrongly being branded “naughty” and at risk of being expelled instead of being treated for a psychological disorder, according to health experts.

Half of the children with attention deficit hyperactivity disorder (ADHD) have yet to have the condition diagnosed, doctors believe.

This means they are getting into trouble rather than given the specialised learning they need.

ADHD makes it difficult for children to pay attention and control impulsive behaviour. Experts say there is a stigma attached, which exacerbates the problem.

“You have children failing school or getting expelled for bad behaviour,” said Dr Eeva Liisa Langille, the head of the paediatric department at Burjeel Hospital.

“It is a big problem. Not just for children who are missing education, but it is a big problem for society to have children missing learning.”

Dr Langille said more knowledge was needed on how to tell the difference between a child with ADHD and one looking to push the boundaries.

“If a child does not seem to be able to commit to any activity for any length of time, if a child wanders around and does not seem to be able to focus on what is at hand and have a randomness to their approach, if a child has difficulty accepting limits about what is acceptable. These are signs of ADHD,” Dr Langille said.

A screening questionnaire asking parents, family members and teachers simple questions can help to highlight indicators of ADHD, but an assessment by a psychologist or development paediatrician is needed to diagnose the condition, said Dr Langille, from Australia.

Dr Hamza Al Sayouf, a paediatric neurologist at Mediclinic City Hospital in Dubai, agrees that a delay in diagnosis means children get into trouble in school, and can lag behind their peers.

“These kids who are not treated means their maximum potential will never be reached,” he said. “Say a child has the potential to be four out of four – without treatment he will only ever reach a three.”

Statistics about the prevalence of ADHD differ among international health bodies.

The American Psychiatric Association reports that 5 per cent of children have the disorder.

But figures released in November by the US Centres for Disease Control and Prevention suggest that one in 10 children between the ages of 4 and 17 in the US have ADHD.

Many medical journals put the international prevalence between three and five per cent.

There are no official figures for the UAE but Dr Al Sayouf, from Jordan, said 1 or 2 per cent of school-age children have had the disorder diagnosed, although he believes between 3 and 5 per cent of children have the condition.

He blames the disparity between the figures on “a lack of awareness, stigma and the fact that the family do not know of the benefits of treating kids with ADHD”.

“We only see the severe cases who have had ADHD for years.”

Dr Al Sayouf said that many people pictured a child with ADHD as out of control, bouncing off the walls and disrupting others.

But this is not the sole picture, he said. There are different types of ADHD marked by three primary characteristics – inattention, hyperactivity and impulsivity.

Some children with ADHD are hyperactive, while others are more sedate.

“There is a misconception,” Dr Al Sayouf said. “A lot of parents think this is a very serious disorder that verges more on the physiological rather than the neurological side of things.

“Especially the Arab culture, they believe their child is crazy or has problems with discipline.”

ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood, according to the US National Institute of Mental Health. The average age when symptoms show is 7.

Dr Veena Luthra, a psychiatrist at the American Centre for Psychiatry and Neurology in Abu Dhabi, said ADHD could lead to pupils underachieving in school, especially as they move up the academic ladder.

This can affect their self-esteem, especially if their parents are unaware of their condition and lay extra blame on the child.

“Schools are becoming more aware of these problems and they refer these children to us for treatment,” Dr Luthra said. “Schools in the UAE do provide some support but need recommendations from a child psychiatrist or psychologist.”

Recommendations can include preferential seating close to the teacher, extra time on tests, taking tests in a quiet room free from distractions, help with organising material and writing down assignments, Dr Luthra said.

“Regular communication between the school and parents is absolutely necessary,” she said.

“Parents can use rewards for positive reinforcement. Good structure, clear rules and regular routine are needed at home.

“Medication is effective and improves concentration and decreases impulsive behaviour.”