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Articles by Dr. Billy Levin

Reality of Attention Deficit Hyperactivity Disorder (ADHD)

September 2008
©Dr. W.J. LEVIN MB ChB (Pta)

This article was written by Dr Billy for publication in the "Benoni City Times" a local South African newspaper to help raise more awareness to ADHD and the realities of ADHD during the ADHD Awareness Weeks in the UK, Europe and USA.

I have decided to write this very short article in response to the many parents and patients experiencing major problems with this condition and not being aware why this is happening or what can be done to achieve success. I sincerely hope this very brief description will foster and encourage more attempts at obtaining detailed and accurate information and insight and demand better management for them or their children.

ADHD is a very real and devastating genetically inherited Neurological condition. For most, the condition is severe enough to warrant medical treatment and possibly further intervention. It presents as either a right brain dominance behaviour problem (Hyperactivity) or a left-brain immaturity-learning problem (Attentional Deficit Disorder), or various degrees of both. As both hemispheres have so many varied functions the symptoms are very wide and varied. It is not caused by diet factors, poor parenting or family strife, but these factors may aggravate the condition.

It presents at any age but the behaviour problems are more readily recognised as they are so disruptive. ADD is often missed and neglected. However no person is too young or too old to be treated, if treatment is necessary.

The condition has, not only classical symptoms but also, often, external features to testify to the inherited nature of this condition. There is a clear-cut examination procedure that does not require any Psychological investigation or an electro-encephalo-gram. The diagnosis can be finalised within two hours in a doctorís consulting room. However spesific-rating scales completed by parents and teacher are essential, as is the evaluation of the developmental and family history and previous school reports. The 12 question, modified Connerís rating that I use can show behaviour, learning and emotional problems as well as their severity with 95% accuracy. Used in a series it can instantly reveal the effectiveness or lack there of, of medical treatment and other interventions. There is no need for an Occupational therapy assessment. Because it is a medical condition it is the doctorís responsibility to not only diagnose, but also fully inform patient, parents and school about the diagnosis and treatment\and request cooperation from all, including the patient.

There is also an absolute need to monitor medication using rating scales on a regular basis, preferably monthly. To do this effectively the school and parents must have complete insight into how the rating scales function. The purpose of monitoring is to evaluate the need to adjust medical treatment to an optimal level. Anything less will not allow the patient to be taught or to behave in an acceptable manner. Sympathetic recognition of this situation will prevent the patient from being punished for an inherited condition inadequately treated. Effective medical treatment is possible within ten days, but success takes longer.

The medical treatment is stimulant medication used seven days a week. There are no long-term serious side effects to this treatment. The minor transient side effects are easily managed by a competent doctor and enlightened patients or parents of the patient. There is almost never a need to stop medical treatment because of the minor transient side effects. The timing of medication is vital as rebound symptoms flare up if treatment is not continuous. Very young children do sometimes not respond well to stimulant medication. Thus there is sometimes a need for other medication as well.

Some patient, tend to outgrow the condition due to maturity taking place, if it is mild enough. These usually have a good I.Q. and the circumstances for motivation and acceptance are favourable and treatment is continuous and started early enough. Delayed diagnosis, ineffective treatment, poor circumstances and petty parenting may lead to complications like Oppositional Defiant Disorder or Conduct Disorder (delinquency) in the teenage years. Some patients will unfortunately require permanent and continuous treatment like in Gout, Hypertension, Diabetes and many other medical conditions. These conditions, as in ADHD, the treatment are aimed at effective control as there is no cure.

In teenagers and adults non-treatment, or non recognition or ineffective treatment may lead to school drop-out, delinquency, drugging, driving accidents, job drifting, drinking problems, depression, and divorce and in extreme cases death. Death from drugging, over dose, driving under influence of alcohol and accidents, depression and suicide. The condition must be seen as far too serious to be taken lightly or neglected. It affects not only the patient but the whole family and even society. Doctors must have the knowledge insight and understanding to fully recognise, advise and treat effectively. If ten percent of our population have this condition, at least half (5%) need treatment. Nowhere are more than two percent receiving treatment and less than one percent are receiving effective treatment. Drug holidays are not advisable.

This clearly suggests a large percentage of our population are not only, not receiving treatment, they do not even know why they have problems. Lack of knowledge and insight particularly in schools cannot help and misinformation is a major factor fostered by media sensationalism. Neglected and abused patients have a legal, moral and ethical right to recognition and effective and scientific treatment. The cost to society caused by neglect of ADHD runs into millions annually! A knowledgeable and sympathetic team is the secret to attainable success for 95% of cases. Is it not long overdue for patients, parents, schools, doctors and society to unite in a common ca use? After all our children are our future!

September, both in the USA and UK, a National awareness week is held to make people more aware of this most important situation. Both are holding national conferences to emphasise the importance of ADHD. Can we in South Africa afford to do less?

Dr.W.J. Levin

Sept 2008

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