The ADHD test: What it involves

Your child’s teacher has asked for a meeting and possibly she shares information that confirms what you may or may not have noticed at home. This usually revolves around your child’s behaviour in school and terms such as ‘distractible’, ‘disruptive’, ‘inattentive’, ‘difficulty completing tasks’, ‘daydreaming’, ‘social problems’ and more will pepper the conversation.  Often the suggestion is made that he or she be tested for ADHD.  The reason is that this might provide a diagnosis of the problem, leading to the usual medications for the mental disorder.   But what is this ‘ADHD test’?  How does one test for this condition and what procedures are followed?

 

The truth is that there is no test for ADHD.  There are no objective diagnostic criteria for ADHD – no physical symptoms and no neurological signs.  Neither is there a blood test that can give markers for a possible ‘chemical imbalance in the brain’ or brain scan findings.  In fact, there are no physical or psychological tests that can be done to verify that a child has ADHD. 

 

What is used is mere observation of behaviours in a consulting room, contents of a questionnaire filled in by teachers and parents, and perhaps a report from a psychologist noting inattentive behaviour, poor sequential memory and restlessness during an intelligence test, tests of academic standing or personality test. None of the latter test results can be used to diagnose ADHD.   In other words, it is only the presence of behavioural symptoms of ADHD that constitute the ‘test’.  One of the most popular checklists used for diagnosis is called the Revised Conners Questionnaire.

 

The symptoms are listed in the publication used by psychiatrists for diagnostic purposes and known as the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5).  If the child shows about 6 of the behaviours listed for either hyperactivity/impulsivity or inattentiveness and these have persisted for at least 6 months, the diagnosis of ADHD can be made.  The Conner’s Questionnaire consists basically of a variation of the traits listed in the DSM-5.

 

Because it is common for children to behave well in a doctor’s office, many examining doctors don’t see the signs of ADHD during the brief consultation you are given.  Instead, doctors prescribing the drugs used to treat ADHD may do so on the grounds of reports from teachers and parents.  This is startling to consider because the doctor is supposed to then treat a presumed disease or disorder with brain-altering drugs without having seen any sign of it.

 

Get a second opinion  

 

It isn’t extreme to suggest that parents seek out a second opinion regarding the reasons for a child’s behaviours and difficulties.    While drugs might provide a welcome relief for all concerned, including an extremely hyperactive child, they are only treating the symptoms.  The real, underlying reasons for the observed behaviours and the distressing symptoms suffered by the child may go unnoticed and untreated and continue to plague the child for years to come.  Indeed, many continue into adulthood with stubborn challenges that impede the realization of their potential and happiness.

 

Many professionals are legitimately concerned that ADHD has become a ‘catch all’ diagnosis.  Making it more difficult is the truth that there is no actual test to prove that the condition exists in a particular child.  Because of this, one can’t be surprised that the quick fix has been to rely on medications such as Ritalin and other drugs to take care of the problem.  While they may be helpful in the course of treatment of the real causes, drugs have become an overused starting place.

 

Professionals who take the time and trouble to explore all the possible underlying reasons for inappropriate and maladaptive behaviours usually cast their nets wide.  Amongst other possible offenders giving rise to ‘ADHD look-alike’ behaviours are:

 

  • Food and dietary issues, including allergies and intolerances
  • Unhealthy digestive systems, affecting brain function
  • Family dynamics, including parenting techniques
  • Delays in brain development needing correction
  • Irregular functioning of certain neurological systems needed to support behaviour and learning
  • Neurological and physiological impairment due to pollutants or toxins
  • Stress and other emotional factors
  • Academic factors, including academic deficits or extremely high intelligence

 

Choices available to parents

 

Many parents are ready to accept that their child may have ADHD but are not willing to give them drugs.  This is understandable and commendable but it doesn’t help to ignore the condition.  These days, many strides are being made in the identification and treatment of those behaviours making life difficult for families.

 

Integrated Learning Therapy (ILT) practitioners offer an holistic evaluation of such children (and older individuals).  Very often we do identify the real cause – and with the cooperation of the family, are able to offer substantial help through a home-based treatment plan.  This means that there aren’t weekly (and expensive) visits to a therapist but the family manages the programme in their own homes at times convenient for them.

 

For more information about our services and a list of practitioners available around the country, visit the website www.ilt.co.za

 

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Your child and electronic devices

Most parents are aware of the debate raging around the pros and cons of allowing children use of electronic devices, including cell phones, tablets, computers, electronic games, TV and so on.  Many schools are encouraging this by prescribing tablets for use in and out of foundation phase classrooms.  Is all the negative hype exaggerated or is there a realistic need for limiting time spent with technology?  Let’s have a look at some evidence relating to this difficult question.

 

The arguments against young children being allowed early access to devices[1] centre around possibly negative consequences for their neurological development.  The early years see rapid brain growth which is fueled by stimulation from the environment.  Overexposure to devices has been linked to intellectual delays, impaired learning, decreased concentration and memory, executive functioning and decreased ability to self-regulate (leading to lowered emotional control as seen in response to temper tantrums). In addition, too much time spent sitting with devices leads to less time engaged in physical movement, which can affect development as well.

 

Secondary effects also occur, such as sleep deprivation in children who are allowed devices in their bedrooms, addiction to technology and mental disturbances such as aggression, depression, problem behaviours and more.

 

Then there is the question of radiation emission.  The World Health Organisation (WHO) published a cautionary warning in 2011 against young children’s use of cell phones and other wireless devices because of the possibility of the emissions being carcinogenic.  In 2013 a researcher from Toronto’s School of Public Health recommended that, based on newer research, radio frequency exposure should be regarded as a probable carcinogen.

 

Effects on family life

Some families labour under the misconception that technology brings the family closer together. This can be true of families who have members living far apart: Skype, Facebook,  Whatsapp, Messaging and other apps make it possible to maintain relationships.  But what of the daily life of a family who lives together?

 

Some families are being driven apart by a wide emotional gulf between parents and children. This happens when each member is preoccupied by their phones, TVs or computers; unable to resist almost constant checking of a device to see what is happening in the world so that they don’t miss out on anything.  There is evidence to show that internet use reduces the time parents and children spend together[2].  Another study found that teenagers who spend more time playing on the computer (not for homework) or watching TV were less attached to their parents than youngsters whose time in front of screens is restricted.[3]  The key seems to be the reason for using the Internet.  While online gaming seems to hurt parent-child relationships, using the Internet to study or research homework topics does not.

 

The reason for the negative effect on family life is simple.  Interactive, amusement-based technologies and social media does away with the need for interaction with the family.  Gaming and life beyond the home with friends and other personalities is very seductive.  Children retreat to their own spaces to engage with digital entertainment so shared time with parents is lost.  Even if the family is present, members are ignored when the child concentrates on the device.

 

Adults add to this by being equally obsessed by the possibilities presented by the Internet.  Some claim that being able to work at home in the evenings gives them more time with their families but this is not true.  Time spent at home on the Internet and phones is not time spent with quality family interaction.  One academic[4] finds a generation of children who often have to cope with parents ‘who are close, tantalizingly so, but mentally elsewhere.’  In the words of one child: “My parents are always on their computers and on their cell phones …It’s very, very frustrating and I get lonely inside.”

 

All caregivers, be they parents, grandparents, teachers and others, need to consider that children’s brains need parental involvement to develop.  How children are treated will determine who they become and how they will develop.  Nature needs nurture so leaving children for hours at a time in front of the TV are prey to what amounts to under-stimulation that can adversely affect their brain development.

 

Children with healthy attachment to parents are better able to regulate their emotions, score better on measures of intelligence and academically and have higher self-esteem than children who are less attached.  Behaviour problems are fewer, depression is less common and school achievement is higher. Drug abuse is less and children from close families seem to have the will to venture into and take on the world.

 

Don’t be misled by cultural perceptions that portray hi-tech children as competent, happy and successful.  The truth is that many are struggling emotionally and socially.

 

Impact on education

Those children who use devices to help with schoolwork show benefit.   But research shows that time spent on video games, online gaming, watching TV, texting and engaging in social networks hinders school success.  High school learners tend to spend more time playing with their gadgets than they do actually attending school, studying and doing homework.

 

The bottom line is that, unless exposure time is strictly limited, the potential overuse of screen and phone technologies, which are actually entertainment providers, threatens children’s connection to family, academic effort and other important activities.  In very young children, added to this can be the danger of developmental delay, leading to learning  and behaviour problems. 

 

Considering that we live in a technological age, it is important that children do learn how to use these devices.  The problem is not their use of technology but it is their overuse of entertainment technologies that have the potential to disrupt the experiences that create a strong mind and a happy, successful life.[5]

 

Many professionals believe that children under the age of 2 years should not be allowed any access at all to electronic devices; 2-5 year olds should not spend more than one hour a day on devices and older children and youths restrict use to 2 hours per day.

 

This is a subject definitely worth thinking very seriously about – and also considering your role in modelling behaviour.  If you spend every available moment at home or in public places on your devices, you can’t expect your children not to follow suit.  You may excuse your obsession by saying that you need to stay in touch for business purposes but this is usually another of the many modern myths that have been created around technology.

[1] www.huffintonpost.com/cris-rowan/10-reasons-why-handheld-devices-should-be-banned

[2] Mesch, G.S. & Talmud, I. 2010. Wired youth: The social world of adolescence in the information age. Routledge, p.31.

[3] Richards, R., McGee, R., Williams, S.M, Welch, D & Hancox, R.J. 2010. Adolescent screen time and attachment to parents and peers. Archives of Pediatrics & Adolescent Medicine, 164(3), 258-262.

[4] Turkle, S. 2011. Alone together: Why we expect more from technology and less from each other. New York: Basic Books, p.267.

[5] Dr Richard Freed, 2015. Wired child: Reclaiming childhood in a digital age.  CreateSpace Independent Publishing Platform.

Bread and ADHD behaviours

Is bread really the staff of life for all people?    The answer is almost certainly that it might have been once but in our modern times, the preservatives that are used to keep it fresh for longer might be underlying the difficult behaviours associated with ADHD.

 

These days there is a lot written about how diet affects learning and behaviour.  Some families try to avoid certain foods – sugar and highly coloured foods are examples.  But if you have a child who is struggling with really challenging mood swings, fatigue, defiant attitudes, eczema, asthma, poor progress at school, perhaps you need to look more closely at bread.

 

One of the major preservatives in bread is Proprionate.  If you take this post seriously and read the labels on the breads your family eats daily, you’ll see that it is added to virtually all commercially available bread and rolls.  The official name is Calcium Proprionate and it is a mould inhibitor, also found in various cheeses. The food scientists claim that it is harmless and they base this opinion on the fact that it occurs naturally in the human body.  That may be so, but there is limited evidence as to how much is tolerated by our body and how high doses may affect the body.

 

Many South African families rely on bread for meals and snacks throughout the day.  Breakfast, school lunches and afternoon snacks are often based on bread.  It is an easy, relatively cheap and quick hunger satisfier.  But this high intake of bread is accompanied by a high intake of proprionate.

 

One person who realised the link between proprionate and a myriad of mental and health problems is Sue Dengate.  She is an Australian researcher and writer who spent years trying to understand the underlying reasons for her own children’s extreme behaviour and learning challenges.  Her efforts have resulted in her founding the FAILSAFE eating approach which is widely followed in Australia and elsewhere.  Her website is a font of knowledge about how intolerances to food and food additives – including proprionate – affect both brain and body.

 

For example, she mentions how some breastfed babies stopped their constant screaming when their mothers switched to preservative-free bread; how children were able to first reduce and then stop their ADHD medication after giving up preserved bread, even how high-functioning adults suffering from chronic fatigue syndrome regained their energy after excluding certain breads.

 

Bread preservative may not be the only additive causing problems but this post focuses on it because it is probably the additive eaten most often by people who think they are eating a healthy diet.  So many of us can cope with preservatives, colourants and flavourants but that isn’t an argument for closing our minds to the possibility that the challenging ADHD-type behaviours that we struggle with daily might be caused by or at least worsened by modern foods. The children that we’re focusing on are more vulnerable to many of the potential offenders found in our environment, including foods. The fact that other children are not affected by these things is not an excuse to ignore the possibility that one or many more potential offenders are affecting the brain, immune system and other bodily systems in an ‘ADHD’ child.

 

So what bread can be eaten?  I don’t have a list of breads free of Calcium Proprionate but recently found a brand at Pick ‘n Pay that was free of it.  Otherwise, ciabatta is a bread that is proprionate free.  The reason is that the preservative would kill the micro-organisms that produce the gas that form the holes in the bread.   Artisanal breads available at the increasingly popular farmer’s markets may also be free of preservatives but you would be wise to check on this before buying.  Investing in a bread making machine would be another option. 

 

For more information about Sue Dengate’s amazing work, and full instructions as to how to follow her FAILSAFE diet, visit her website at www.fedup.com.au

 

Integrated Learning Therapy (ILT) tries hard to ensure that every possible avenue is explored when unravelling the causes of learning difficulties and puzzling behaviours.  You might be interested in learning more by taking our Parent’s course, which aims to share with parents many of the reasons why your child is not thriving in and out of school.  Find out more about this correspondence course by writing to us at info@ilt.co.za.  We are pleased to offer the course at a special parent’s discount for the months of July and August.

 

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Talking to children after a traumatic event

Very few of us feel comfortable about speaking to a child after a traumatic event. What should we say?  What should we do?  One thing is sure: we have to deal with the reality of what happened because if we don’t, the child will suffer.

 

The trauma doesn’t have to be something they experience personally.  Our news is full of disasters and it is virtually impossible to keep children from hearing about events, such as the recent Knysna fires, the continual violent deaths in Cape Town ganglands, knifings at schools, disappearance of children, floods and fires in the informal settlements, and more.  Trying to hide all these things from children will do more harm than good.

 

The adult’s job, be they teachers or parents, is to firstly shape the way they interpret the information they receive, and secondly to give them time and the opportunity to express their feelings.

 

Younger children may not have the vocabulary to verbally discuss their understanding or feelings.  They may show their need by becoming clingy.  Let them cling.  Sometimes a hug says more than words.   They may also get release through drawings, which is also true of older children.

 

Children who have good understanding of language will need to talk about their feelings.  Your role should be to try and find out what they know and how much they know about the event.  Don’t interrogate the child but get this information by inviting them to tell you all about it.  Use simple, clear language that is age-appropriate for the child.  Don’t lie to them or tell them there’s nothing to worry about but also refrain from telling them more than they want to hear.  In other words, don’t offer additional information.

 

You’ll also need to try to monitor the information your child might be getting from others.  They speak to their friends and you can’t stop that. In fact, those discussions might help the healing process.  You can, however, prevent them from seeing too much and too graphic television coverage.  Young children shouldn’t be watching news broadcasts.  Our country, like many others, is dominated by disturbing news.  Instead, use news time to read a story, play a family game or do some arts and crafts.

 

Do try hard to put their feelings into words.  For example, “It’s so very sad that people’s houses burnt down,” or “All of us feel scared after hearing that a child was killed at school.”  Don’t try to lighten the situation and don’t make promises you can’t keep.  Saying something like, “Don’t worry, that won’t happen again” and another incident occurs, will only destroy the trust your child has in you.

 

You should remind them of the positive: that others are rallying around to help the victims; that the authorities are working out how to prevent similar future events, even what steps are taken by their own schools to prevent children carrying weapons onto the grounds or to protect them from being absconded by kidnappers.

 

Young children will show reaction to trauma in behaviours.  Preschoolers may become clingy, wet their beds or soil their underwear and resort to thumb sucking.  Primary school children may also become clingy but may suffer nightmares, unusual behaviour such as aggressiveness, trouble with schoolwork, moodiness, headaches, stomach aches, develop a rash(eczema) and even show breathing difficulties such as wheezing.

 

Giving children a sense of control over the situation can be helpful.  Ask them what would help to make them feel better.  If they answer that they would like to sleep with you then allow them to do so.  Perhaps they would like to be involved in doing something to help those who suffered through the event.  This type of behaviour gives them a sense of having control over their lives and can be helpful.

 

Adolescents may respond differently.  They may be more unwilling to speak about their fears and uncertainties. They may try to repress fears.  The result is that they may often act out, misbehave or become depressed.  In addition, they may have access to the internet and social media which can expose them to sights and information that can raise their anxiety levels.  Try to find out and, if needed, impose some limits on this exposure.

 

The types of effects that stress has on older children may include: headaches, stomach aches, fatigue, isolating themselves socially, using drugs or alcohol, sleeplessness, trouble concentrating, physical complaints and pains, change in usual behaviour and eating disorders.

 

If your adolescent is unwilling to talk to you, counselling from an impartial third-party might help.

 

Some practical steps that you can take include[1]

 

  • Keep to a routine as far as possible.  Humans find comfort in routines because they are predictable and reliable. This gives us a sense of security
  • Brainstorm ways of helping the victims – collecting clothes or food, or even writing a letter to a family expressing sympathy
  • As always, during times of stress and trauma, children need a well-balanced diet and ample time for rest and relaxation.  Remember that stress has wide-ranging physiological effects which interfere with health and well-being.  Good food and rest are important for helping the body cope
  • Find ways of showing your children that you love them and are determined to protect them no matter what

 

You can’t hide your child from the stressors of our world.  The dangers out there are many and real.   Preparing to help your children begins at an early age when you talk a lot to your children and invite them to share their feelings with you.  An open parent-child relationship can be a huge benefit if they are to become resilient to traumas in their lives.

 

 

 

 

[1] Dr David Marks, Raising stable kids in an unstable world.

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