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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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 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. 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. 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 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.
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.
 Mesch, G.S. & Talmud, I. 2010. Wired youth: The social world of adolescence in the information age. Routledge, p.31.
 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.
 Turkle, S. 2011. Alone together: Why we expect more from technology and less from each other. New York: Basic Books, p.267.
 Dr Richard Freed, 2015. Wired child: Reclaiming childhood in a digital age. CreateSpace Independent Publishing Platform.