If you had a child who was born unable to walk, would you blame yourself? Or would you try to find therapy for the child? If you were offered a drug that could make your child walk, would you accept it? Of course you would - who wouldn't? Now imagine that your child was born with a subtle difference in brain structure that made him or her hyperactive, inattentive, highly distractable and impulsive. Would you blame yourself or try to find therapy? And if you were offered a drug that could help, would you give it to your child?
"If you would deny my son the treatment which makes his present life possible, I would say no, no, no. I will not see him grow up friendless, illiterate and out of control, in order to satisfy some philosophical objection," says Evelyn McGonagle, whose 10-yearold son is on Ritalin, a drug used to treat Attention Deficit Hyperactivity Disorder (ADHD).
McGonagle was one of the many parents of children who were angered by a recent Tony Humphreys column in EL. ADHD, Humphreys wrote, was a "hypothetical" condition that was over-diagnosed with the result that parents were "drugging" their children with Ritalin unnecessarily to control behaviour that was actually caused by a lack of parental love, poor parenting skills and disadvantage.
The facts are these: research has proven that ADHD affects all social classes and is not caused by poor parenting, family problems, poor teachers or schools - nor are too much television, food allergies, or excess sugar to blame. There is no cure for ADHD, but Ritalin - a brand name for the generic psychostimulant methylphenidate - can be a transformative drug for 80 per cent of sufferers when used correctly.
Ritalin has been used for 50 years and is one of the most tested and researched drugs on the market. It is not habit-forming and it does not tranquilise children into submission.
In other words, good parents like Evelyn McGonagle have children with ADHD and use Ritalin responsibly to help them cope. In a letter to The Irish Times, she stated: "I have never written to a newspaper before, but I found your article so offensive and patently untrue that I felt compelled to reply.
"I am very, very tired of hearing the same old lines trotted out by `experts': i.e. there is no such thing as ADHD, it's bad parenting, bad teaching, lack of love, lack of proper discipline, etc.
Have you any idea how offensive your assertions are to those of us who have struggled down a long, hard road, where our children and ourselves have been subjected to harsh judgments and found wanting?"
People who have ADHD read the column too. Peter (16), a second-level student in Dublin, told The Irish Times: "I feel about the article the way disabled people must have felt when they read Mary Ellen Synon's article on the Paralympics."
The allegation that these children are not loved enough hurt parents the most.
"ADHD stems from differences in the structure of the brain and has nothing to do with love or lack of love," says Marie Murray, head of psychology at St Vincent's Psychiatric Hospital in Fairview, Dublin.
Stephanie Mahony, chairman of the Hyperactivity Attention Deficit Disorder support group (HADD) in Dublin, and the mother of a boy with ADHD, described Humphreys's claims as "grossly insulting to all parents at every level of society.
"No one could be less disadvantaged than my son. He has had everything we could offer. We - and the whole family - give him buckets of love. It is truly soul-destroying to see these kids rebuffed by peers and/or adults as `unruly', `aggressive', or `out of control'," says Mahony.
Describing the Humphreys column as "quite harmful", child and adolescent psychologist Sally Phelan rejects his suggestion that ADHD is overdiagnosed in this State. "If anything, it is underdiagnosed. The notion that bad parents have bad children is overly simplistic. Guilt is the single most damaging thing; it's precisely what parents looking for help don't need to hear," she says.
The notion that parents would want their child to have this devastating disorder in order to get themselves off the hook for bad parenting - not to mention the idea that doctors would co-operate in this denial - is as unrealistic as it is repugnant.
Child psychiatrists and paediatricians, who are the only people qualified to make the diagnosis, are extremely cautious in diagnosing the condition and clear guidelines for diagnosis are adhered to, says Dr Tom Moran, consultant child psychiatrist at St James's Hospital, Dublin.
The approach to diagnosis is multi-disciplinary and involves repeated observation of the child. ADHD is not a behaviour problem - it is a disability, Dr Moran stresses.
The unfair "bold child/bad parent" label is part of a destructive social stigma that can make it difficult - and often impossible - for children with ADHD and their families to find the medical, psychological and educational help these children need in order to fulfil their potential.
AS A result of this stigma, it is not overdiagnosis, but underdiagnosis that is the real tragedy in this State.
Rose Keaveney, the mother of a boy with ADHD, spent 16 years going to 11 child psychologists and psychiatrists before her son's ADHD was diagnosed at the age of 23.
Rose's husband, Ray Keaveney, still weeps when telling of his struggle to get psychologists and social workers to accept that there was something biologically amiss with his son. A second son was also diagnosed with ADD (ADHD without hyperactivity) in his teenage years, which means that he also missed out on the help he should have had as a child.
While ADHD has been known since the 1960s, Irish psychologists and psychiatrists were reluctant to accept it. Dr Moran explains that in the 1980s, family therapy was in vogue and children with ADHD were seen as symptomatic of family dysfunction.
These children were not seen as individuals in need of help - with the result that many young lives were thwarted before a more enlightened approach to ADHD emerged in the 1990s.
Yet even today many ADHD children are not getting the help they deserve, unless their parents can afford to pay for it, and even then there are barriers. Sixty per cent of ADHD children also have learning disabilities, such as dyslexia, and too often these children have been left to muddle through primary school. By puberty many have developed such serious behaviour problems and poor self-esteem as a result of being labelled "bold" that many secondary schools want nothing to do with them, according to HADD.
"There is a scandalous lack of access to occupational therapy and speech and language therapy services for children," says Dr Moran. "The Department of Education must acknowledge that we have to change our mind-set about these children and learn to accommodate them as children with disabilities." When you consider that this disability will continue to cause at least half of these children significant problems as adults, with impacts on jobs, families and social relationships, it seems inhumane to condemn children to lifelong struggle by neglecting their educational needs.
We are on the beginning of a learning curve with ADHD and research over the next 10 years will probably reveal that there are many sub-disorders within this umbrella diagnosis. What is certain is that ADHD is not a "hypothetical" condition, as Humphreys alleged. Admittedly, finding physical proof is difficult - just as it is with Alzheimer's and Parkinson's diseases.
Neuro-imaging has shown differences in the brains of ADHD children, but such evidence remains inconclusive - although there can be little doubt that these children's brains are wired differently, for they cannot foresee the consequences of their actions.
The focus of study is on the frontal lobes (the brain's emotional centre) and on dopamine - a neurotransmitter. These children seem to be missing the brain wiring that would make them think before they act, rather than doing both simultaneously.
The genetic link is so strong that if a parent has ADHD, his or her children have a 50 per cent chance of inheriting it. At Trinity College Dublin, researchers are looking at the possibility that a dopamine transporter gene is responsible.
Living with an ADHD child can be like having a poltergeist in the house. Yet while they can be exasperating, these children have many qualities, such as sensitivity, creativity, exuberance, openness, affection and giftedness. Let no one deny parents their love for these special children.
Contact the Keaveneys at the Galway ADHD support group (091) 798266
HADD is contactable at Carmichael House, North Brunswick Street, Dublin 7.
