Attention Deficit Hyperactivity Disorder is still regarded as a relatively new phenomenon in Ireland, a psychologist told a seminar in Limerick at the weekend.
Addressing 300 parents and professionals at Mary Immaculate College, Dr Deirdre Killelea, an American educational and clinical psychologist and the mother of an ADHD child, said: "While it is generally accepted that early assessment and treatment are very important, the reality is that many people in this country are only hearing about ADHD in their adolescence and even their adulthood."
At the first Irish ADHD service at Our Lady's Hospital, Crumlin, which she opened earlier this year, many of the patients she saw were "very confused and discouraged by their lives. Most of these individuals, whether they are children, adolescents or adults, have suffered enormous pain. They have been rejected, embarrassed and humiliated time and time again.
"Many have no confidence in themselves and have come to expect failure and are often withdrawn or alternatively larger than life and on the defensive." She described ADHD as having three distinguishing characteristics: a lack of sustained attention except to the things the individual loves, an almost reckless impulsiveness and sometimes a wriggling, wiggling, toe-tapping hyperactivity. Without the hyperactivity the condition is called Attention Deficit Disorder or ADD.
Children with this disorder had difficulty paying attention, controlling their emotions and planning what they were going to do before they did it. They could be fearless and accident-prone, often engaging in dangerous activities without thinking of the consequences. As a result of their behaviour, which could look quite rude or insensitive, they could often have difficulties forming relationships and seemed at odds in social situations, Dr Killelea said.
Dr G.D. Kewley, consultant paediatrician and director of the Learning Assessment Centre, Horsham, West Sussex, said medical management of ADHD aimed at treating the core symptoms. This was usually necessary, while psychological intervention, education and medication should be included where appropriate.
An initial trial of medication was only continued if there were positive results with insignificant side-effects.
Dr Kewley said studies showed that in about 90 per cent of children with ADHD, there would be a very significant improvement, but many would have residual difficulties. Once the ADHD was effectively managed, the other problems could often be dealt with.
Fine-tuning of dosage and timing was crucial. Short-term side-effects could occur in a small percentage of children, but these were dose-related and usually transient.
"The most commonly seen include appetite-suppression, tummy ache, headache, loss of sparkle, sleep difficulties, the rebound effect, tics or itchy skin."
Concerns regarding possible height retardation had not been confirmed, nor had concerns over possible tolerance or addiction. It was such a complicated and variable condition that occasionally the use of second medication was required and management of ADHD should be in the hands of experienced professionals, he added.
Mr Willie O'Dea, Minister of State at the Department of Education, said the Minister was concerned about children who were diagnosed as having ADD, as he was about all schoolchildren with learning difficulties. Special provision had been made for a number of children who had been diagnosed as having ADD.
Within the last year, ADHD support groups have started in Cork, Waterford, Wexford, Cavan and Kerry, as well as those in the mid-west region and Dublin.