When the Guardian writes a piece about preschoolers and ADHD, as they do here , we don’t expect it to scaremonger or to conform to prejudices around this complex neurodevelopmental disorder. We expect some breast beating from the Daily Mail or the Telegraph, but we hope for sense from the Guardian. However, while medicating preschoolers is controversial, ADHD medication (please don’t call it drugs – this not pushing recreational ecstasy tablets or making toddlers smoke joints) is immediately written off as a Bad Thing – without any explanation for what type of medication it is.
ADHD medication is mainly stimulants, Ritalin for example. Stimulants release enough dopamine in the front of the brain to help children with an under-developed pre-frontal cortex concentrate, pay attention and to get on with some fairly routine tasks of sitting doing homework or concentrating on what the teacher is saying. The medication also helps them to screen out all the other external stimuli that normally compete for their attention – that buzzing light fitting, that beeping watch, and settle down to concentrate. Concentration has a transformative effect on school work – as the first As ever in my bright son’s recent school report has shown. A year ago, before medication – he was suspended from school for poor conduct – like so many other ADHDers, some languishing in the prison system. Now, at last, the intelligence we always knew was there is able to shine through.
Stimulants like Ritalin generally leave the body as quickly as caffeine, and are indeed quite similar to caffeine in their effect. In fact, some adult ADHDers who don’t want to take stimulant medication, control their symptoms with coffee (like the ADHD specialist Dr Ned Hallowell, for example). ADHD meds have had hundreds, possibly thousands of studies done on their effects, so are well trialled – and given how quickly it leaves the body – not known for any long-term harm. There may be some dependency with some types of medication, as a stimulant it suppresses appetite, so weight and height need to be monitored on it – but as the dose wears off after, say, 4 or 12 hours, depending on the type – you can make a heavy breakfast or supper up with nutrient-dense to balance out their food intake for the day.
What isn’t great, is that preschool children and their parents aren’t offered support first, before medication which can take a long time to come to terms with. It does feel intuitively wrong to give a child pills, but why when Calpol and Medised are issued over the counter like sweeties for a baby that needs settling. Of course, parents should be offered parenting classes to help educate then, and to give strategies to help them cope with their ADHD child – but they would be damn lucky if they could find any. The nearest I could find in the whole of West Sussex was over 15 miles away, on a sleepy seaside coastal town – difficult to access, and run by a retired nurse who felt sorry for bewildered parents navigating the system for a diagnosis. Nothing else existed.
Anyway, as a mother of twins, one who has ADHD and one who doesn’t, I can assure you that the condition has NOTHING TO DO with parenting, and everything to do with neurological wiring. This is another suggestion peddled by those who think it is all down to food additives and feckless mothers. I have twins, one who would walk the gangplank of a near Perfect Child with her bulging after-school activities and academic scholarship, next to her ADHD twin brother. But we try never to compare. “Comparison is the route to madness” is a quote we bandy around the house frequently. After all, you wouldn’t compare a paralympian sprinter with an able-bodied equivalent. It’s not relevant.
What is relevant, particularly to this Guardian article are that the NICE guidelines are a wonderful work of fiction. They are not worth the paper they are written on, if the Child and Mental Health Services lag as far far behind as they do. It’s not necessarily resources, I visited a shiny and new building locally in West Sussex that may as well have had tumbleweed blowing through it for all the life and bustle of doctors and children visiting. There were no parenting classes, there were no ADHD support groups, no social skills training, no mental health nurses, no nothing really – except for medication, and then with a month-long appointments in between. After a week, my son was sitting on the roof of the house, and I was ringing the shiny new building with no-one there to answer the phone.
Until ADHD is taken seriously as a neurological condition, and not pilloried or misdiagnosed by an ignorant press and ignorant doctors, the many ignorant comments that are posted below this piece – will continue. While medication is not supposed to be the “first-line” treatment, it is currently the “only” line of treatment – the rest is up to the parents to work out, to educate themselves, and hopefully the school at the same time.
Let’s see some numbers, statistics, and some naming and shaming in this Guardian piece before the commentators jump on the bandwagon and complain about medicalising pre-schoolers. There are plenty of other preschoolers receiving medication for other serious conditions, so why is it always ADHD that seems to get someone into a lather. It is not necessarily wrong to start somewhere. The medication only works if the condition is there, after all. At least these pre-schoolers are in the system and being recognised as needing support, and hopefully – not likely to be excluded from school like so many ADHDers are (under the disability act, this is not supposed to happen – but still does). Let us hope in the New Year, that the support that the Nice Guidelines suggest – happens. This would be a welcome Christmas present for all those struggling parents who no longer know which way to turn.
Better Late than Never 