Special Education Resources

AD/HD is a complex condition -- difficult enough to understand even if you are fully informed with up-to-date research information!

Sometimes the following conditions may co-exist alongside AD/HD in individuals, but not always, and these conditions can 'mimic' and/or disguise certain characteristics of AD/HD, causing inaccurate diagnosis by the inexperienced. For information on common 'comorbidities' (conditions that often co-exist with AD/HD) see the Associated Disorders page on the ADDnet site.

The following conditions are among those that should be treated as distinct conditions themselves and require consideration within their own right. They are best approached within a 'multi-modal' treatment program only if AD/HD is clearly also present):

In short - these conditions are not AD/HD, and AD/HD is not these conditions!
 

Anxiety disorder. AD/HD may cause anxiety when people find themselves in school, life or work situations with which they cannot cope. AD/HD differs from 'garden-variety' anxiety disorder in that an anxiety disorder is usually episodic, whereas AD/HD is continual and lifelong. If anxiety comes and goes, it is probably not AD/HD.

Depression. AD/HD may also cause depression, and sometimes depression causes a high level of distractibility that could be diagnosed as AD/HD. Depression, however, is also usually episodic. When depressed patients are given Ritalin or other stimulant drugs, which seem to help with AD/HD patients, depressed patients will often experience a short-term 'high' followed by an even more severe rebound-depression.

Manic-Depressive/Bipolar disorder. Bipolar disorder is not often diagnosed as AD/HD because the classic symptom of bipolar disorder are so severe. One day a person is renting a ballroom in a hotel to entertain all his friends; the next day he's suicidal. Yet AD/HD is often misdiagnosed as bipolar disorder. A visit to any adult-AD/HD support group usually produces first-person stories of AD/HD adults who were given lithium or some other inappropriate drug because their AD/HD was misdiagnosed as bipolar disorder.

Seasonal Affective Disorder. This recently discovered condition appears to be related to a deficiency of sunlight exposure during the winter months and is most prevalent in northern latitudes. Seasonal affective disorder (SAD) symptoms include depression, lethargy, and a lack of concentration during the winter months. It's historically cyclical. predictable, and is currently treated by shining a certain spectrum and brightness of light on a person for a few minutes or hours at a particular time each day, tricking the body into thinking that the longer days of spring or summer have arrived. Seasonal affective disorder is sometimes misdiagnosed as AD/HD, and vice versa, but seasonality is hallmark trait.

The following misconceptions are still often heard in the UK, but usually contain little or no scientific basis and are largely myths. Some may contain some truth for some people, but if you hear anything like the following, be VERY suspicious! AD/HD is a condition for which there are very few easy answers and quick explanations. Whether a parent, a professional or a sufferer, your best defence against myths and unsound information is to be very well informed with good scientific evidence based on wide, wise and sympathetic experience.

"AD/HD is caused by poor parenting."

AD/HD is a neurobiological condition, which has increasingly strong evidence of hereditary (genetic) links. It is not caused by poor parenting but can be influenced by both good and poor parenting. It can, however often push good parents to cope badly. With good treatment and support, ordinary good parents can learn the skills to be good parents of AD/HD children.

"AD/HD is another word for being hyperactive."

Although most boys and some girls with AD/HD often are hyperactive, overactive or restless, AD/HD is primarily about a group of behaviours which also includes impulsiveness, inattention, distractibility and failure to anticipate the consequences of actions. Many children and adults, frequently girls and women, may not be overactive, or only overactive some of the time. This often means they may not be causing the same amount of 'trouble' and are less 'noticeable' than their hyperactive cousins. This also means there is a real danger of them being left undiagnosed and without effective support. The more serious consequences for the person often result from other symptoms. You do not have to be hyperactive (or even hyperactive most of the time) to have AD/HD.

"AD/HD is a condition which only affects children."

There is some debate as to how many AD/HD children go on to become AD/HD adults - but probably around 50% retain many of the symptoms they experienced in childhood. Often, if hyperactivity is present, this subsides to subjective feelings of restlessness. More and more adults in their 20?s and 30?s, in middle age and even the elderly are now being diagnosed and treated, often very successfully.

"AD/HD doesn't affect nearly as many girls as boys."

There is a lively debate about how many girls may have AD/HD in proportion to boys. Girls have not been so well studied, and it may be that a different diagnostic criteria should be used for girls - as often less obvious symptoms for them may have just as serious effects. What is known is that many girls who have severe attention problems, but are not hyperactive, are often not identified and diagnosed because they are less 'noticeable'. In order to provide equal opportunities to girls according to their needs much more emphasis needs to be placed on finding and helping girls with AD/HD. We may find eventually that numbers are perhaps much more equal.

"AD/HD is just another specific learning difficulty."

AD/HD is not of itself a learning difficulty - and its presence has many and varying effects. Many AD/HD children and adults do also have specific or other learning difficulties (for example, dyslexia). These are an important and common part of the range of coexisting conditions which need to be diagnosed and treated in conjunction with AD/HD. Having AD/HD is likely to make it much more difficult to benefit from many learning experiences whether or not learning difficulties are also present.

"AD/HD is caused by food allergies."

The causes of AD/HD are not fully known, but little convincing scientific evidence has shown food as a major factor affecting AD/HD behaviour. Genetic links appear to play a far greater role. A good, balanced diet will have beneficial effects for all AD/HD people. A small proportion of AD/HD children and adults (around 1 or 2% was stated at a recent meeting of the Royal College of Psychiatrists) may have symptoms relieved by changes in diet involving the removal of certain additives, so it is worth considering diet as a part of the treatment puzzle.

"AD/HD is a condition for which the causes have to be known before treatment is given."

It will be a long time before we are likely to know the exact causes of AD/HD, although progress is being made in understanding the physical and genetic basis of the condition. The exact causes of many kinds of sight problems and cancer are not known either. This does not stop glasses being prescribed for poor eyesight or cancer treatment being given. Treatment which is known to be effective should be seriously considered if any condition is a problem and making life difficult.

"AD/HD is a condition which is extremely difficult to treat." .

AD/HD may be difficult to treat in some people, but some treatments often do have very beneficial effects, such as stimulant medication, although many people are adverse to using this method despite it's good safety record. The vast majority of current research suggests that stimulant medication frequently brings significant benefits quickly, and to a majority of sufferers, but rarely deals with all of the problems and issues that are associated with AD/HD. Some problems may take a lifetime of support and strategies - there are no quick and easy answers to the conundrum, but some treatments have often proven to help a great deal.

"AD/HD is a condition which children will outgrow."

It is becoming increasingly clear that a large proportion of children retain symptoms of AD/HD into their adult years, often with slight differences to their symptoms. Many may become much less overtly hyperactive - but the lack of this does not mean that related problems have necessarily gone away. Adults do tend to learn better coping strategies, but many find they can manage their lives far more effectively if a strategy can help them to focus and concentrate. All treatments should be available if they work and are helpful in dealing with the potentially serious problems associated with AD/HD. The experience of numerous adults has shown that medication can often be hugely beneficial to a prosperous, successful and fulfilling life.

"Children should only take medication on school days and during school hours."

Stimulant medication, compared to many other types of medication, is for most children very safe and effective - whether it is taken regularly or just at certain times. Often AD/HD children need lots of help in improving their social relationships (such as with brothers and sisters), helping get through their homework period in the evenings and weekends, and in situations where there is much less structure than in school. Many consider it cruel to remove the opportunity for children to better monitor their own behaviour and learn from it - especially just when they may need medication most to succeed. Children with poor sight are not required to remove their glasses when going home!

"AD/HD is now the correct term and nothing else describes it correctly!"

More is being learned about AD/HD all the time and it is likely that our descriptions will change and become much more specific - perhaps eventually describing a whole range of conditions with related features. Minimal brain disfunction has gone away as a term for this condition as did 'Moral Control Deficit' (thank goodness!) - hyperkinetic disorder is rapidly becoming less used in the UK, and AD/HD still does not accurately describe some of the cluster of symptoms and behaviours which cause problems and some question the use of the word 'deficit' to describe such variable attention abilities. So watch this space! The terms (and our understanding) are certainly likely to change but the condition won't!

"Professionals are the only experts who know about AD/HD."

People who are expert in identifying AD/HD need both knowledge and experience. Many professionals now have this - many others, especially in the UK - have not yet had training about AD/HD or the experience of working with it. If you have lived with AD/HD for your lifetime, or are the parent of an AD/HD child, you certainly have extensive experience and should clearly contribute this to any assessment process. You may also be very well informed. You should try to ensure that whatever professionals you approach have both knowledge and experience of AD/HD - plus a high level of emotional intelligence, respect and an ability to see the inherent positive qualities in people despite any superficial difference. These qualities will help to ensure both a successful treatment partnership and lead to more beneficial outcomes. In a field as fast moving as AD/HD it is unwise to seek help from those unable to 'move with the times'.

"AD/HD is a condition which is massively overtreated, especially in some countries abroad."

It will always be possible to find examples of conditions which are treated when it is not wise to do so. However, in many places children and adults with AD/HD find it extremely difficult to get either a diagnosis or treatment purely due to ignorance and prejudice - despite real and severe problems as a result of their AD/HD. In the same places many people with dyslexia or other learning problems have found it difficult to get help too. People with sight problems receive prescriptions for glasses or contact lenses - where prescriptions for glasses are high, critics are not concerned about overprescription as real problems are being tackled. Very few parents anywhere in the world will want to treat their children unnecessarily or will agree to it. Most parents sincerely want their children to succeed. There are places in the world where high proportions of the people with AD/HD who are having problems with their lives are treated - and on the whole these people are lucky to live in an area where there is such greater empathy, knowledge and support. We do not expect people with depression to continue to suffer unnecessarily, nor with infections nor with many other conditions which cause difficulties and pain. Inappropriate diagnosis helps no-one, but 'high' levels of diagnosis and treatment for genuine AD/HD can only be positive to those affected. In the middle ages no-one 'had' AD/HD, they were clearly just possessed! :-)

"Stimulant medication turns children into zombies."

Making children 'dopey' and spaced-out is not a typical side effect of stimulant medication. (Indeed, spacey behaviour is often typical of untreated AD/HD of the inattentive type). If there are negative effects on the Child's personality, the most likely cause is that the medication is not the most effective for them, or the dosage is wrong, or the interval between doses is wrong. In a small number of cases medication simply does not help. When used correctly, medication usually acts to make AD/HD people more focused and alert - rather than depress activity or put children to sleep. Stories about zombies are more likely to be the result of inaccurate publicity by people who do not believe in medication, even for those who benefit from it.

"Stimulant medication is basically dangerous - and should only ever be used for a short time."

Ritalin in particular, and also Dexedrine, are among the most studied of any medications - involving large numbers of people over many years. For a few people, side effects (such as loss of appetite and insomnia) are unpleasant enough to discontinue the treatment. But stimulant medication, used properly and compared to other medications (including alcohol and cigarettes) is extremely safe, quickly metabolised, effective, with usually only short term side effects. Some people have now taken stimulant medication for many years, and have still found it very safe and effective. Many of the other drugs used for AD/HD and associated conditions (such as anti-depressants) have more noticeable side effects and they can be potentially more serious. If you are worried, become as well informed about the scientific research relating to the various drugs used for AD/HD as possible by talking to a respected professional.

"If you do take medication, you should have frequent holidays from it."

Stimulant medication has proven to be safe and effective whether taken regularly or from time to time. Many other medications have more severe side effects - but each medication should be considered in its own right, and the risks balanced against the benefits. Medication holidays, especially when a child is trying to build social relationships over the summer holidays for example, may have more negative effects than staying on medication. The aim of a medication holiday is to assess whether medication is still necessary for the individual. It is therefore unwise and misleading to attempt this at a time where any form of stress may be encountered.

"Stimulant medication stunts children's growth."

The jury is still out in terms of proving there are no effects long term - but most evidence shows that where growth is ever slightly affected, children 'catch-up' and attain normal heights in the long term. Slight effects, likely to be temporary, need to be balanced against the benefits of being better able to concentrate, focus, better maintain social relationships and sustain school performance.

"The accepted dose of Ritalin is 20 mg. at about 9 am and 1 p.m."

Every person is different, and will respond somewhat differently - to dosages and time intervals. Often it takes considerable time to find the right dose - with a good deal of careful and controlled experimentation. There are heavy, tall people helped by a half a tablet of Ritalin a couple of times a day - there are tiny people who need perhaps 3 or more tablets up to 4 or more times a day to have the optimum effect. And the effects may change over time. Everyone is an individual.

"If effects are not apparent immediately, then medication is not going to work."

Everyone is a little different - some people respond well to Ritalin and others get much more benefit from Dexedrine, and not from Ritalin. Perhaps 10% will not be helped at all by stimulants - even after all the possible times and alternatives and doses are tried. There are other medications that can frequently be highly beneficial for some people with AD/HD (such as tricyclic anti-depressants, particularly when the person is also depressed as a result of struggling with AD/HD). So it is important to experiment and closely monitor what works or doesn't work. Sometimes big changes happen by raising or lowering the dose. Too low a dose can also cause just as many problems as too high a dose.

"AD/HD only becomes serious in families which are dysfunctional. Parents must take a great deal of the blame."

AD/HD is real and serious in both strong and healthy families as well as dysfunctional ones and is no respecter of class. Family stress can make all kinds of things worse, but AD/HD is not caused by either bad children or poor parenting! Blame is never very useful in any situation, as it doesn't help to sort out real problems. Rather than blame, most parents deserve commendation and support for their often heroic efforts to manage situations which are frequently next to impossible!

"AD/HD is a condition which a person develops in response to stress or traumatic experience."

Evidence is becoming more and more clear of strong hereditary links to the condition. AD/HD is always present from early childhood in some form. If a person suddenly becomes distractible or impulsive or displays other AD/HD type symptoms first when a teenager or adult, then some other explanation should be sought. However, care must always be taken when assessing teenagers and adults for AD/HD in the UK, as it is still not uncommon for education and medical professionals to be unaware of the condition. This means that in many cases, despite AD/HD being present, it has often been overlooked as a cause. Parents may mention that their teenager was 'always a bit boisterous', or 'he was always scatty, loosing his sports kit' etc. Teachers may inadvertently label children with AD/HD as simply 'lazy', 'naughty' or a 'daydreamer', without being aware of the true cause of the child's problem.

A Professional making a careful diagnosis of a teenager or adult will always look carefully at the patients past (from verbal reports and school records if available) to ascertain if evidence of AD/HD has been present, even if it has not been previously recognised as such. It is only then that a considered, balanced and accurate judgement can be made as to whether AD/HD is at the root of the patients current problems.

With advances in research and technology, it may not be long before a simple and accurate test for AD/HD exits, but for now, it does not. There is no substitute for a well informed professional presented with all the necessary information.

"AD/HD is best sorted out by firm discipline."

Many people with AD/HD, especially when hyperactivity is involved, have great difficulties moderating and limiting their behaviour. This problem is often helped by structures which are supportive; coaching, medication, specific behavioural techniques, and many more may have a role. 'Firm discipline' implies wilful misbehaviour, and that 'the person could control behaviour if they only tried harder', which is not the case with AD/HD. Firm and positive support may well be helpful, especially with the persons agreement and understanding as clear 'boundaries' can help AD/HD people understand better where they 'fit in' socially. 'Firm discipline' also suggests 'punishment' as a method of control, which will backfire, as continued negative criticism is likely to engender resentment and rebellion. A child with AD/HD does not want to misbehave and often is unaware of their 'misbehaviour' until it is too late. So, punishing a child for something they cannot easily control will cause confusion, and reinforce their sense of inadequacy, failure and low self-esteem - all highly counter-productive.

Any approach which is really going to be helpful should focus on positive re-enforcement for 'good' behaviour and consider strategies which are sympathetic to the individuals personality, understanding and needs.

"Often medication doesn't work because patients don't follow the doctor's orders."

Medication can be a problem for many AD/HD people for lots of reasons, e.g. 'how do you remember to take your medication, that helps you to remember to take your medication!'. For a small but significant minority, stimulant medication either won't work, or some of the side effects may be unacceptable (e.g. Tourettes syndrome symptoms may occasionally be made worse by AD/HD medication). For others, it is very hard for them to come-to-terms with the fact that they may need to take medications, and that they are different from other people. Teenagers especially often do not want to accept that anything is different about them, which marks them out from their friends, or challenges their own image of themselves.

For medication to be effective, the child/teenager/adult must agree to take it, and they will only do this if they are confident that the medication is safe and will help them. They also have to have any (often justified) fears of 'teasing' or 'bullying' from classmates or siblings addressed in the Young person's page on AddNett site. This is only achieved by fully explaining the facts in a sympathetic, honest and patient way appropriate to their age and level of understanding.

It is also important to realise that the feelings of any siblings are carefully listened too and addressed. The reason is clear; in the past 'Johnny's bad behaviour' has always caused friction between the family, they may feel left out as much of the families attention is given to the 'problem' of the AD/HD child. They may feel, understandably, jealous of the (to them) 'unfair' attention 'Johnny' receives as a result of his 'bad behaviour'. And now they are expected to believe that all this 'isn't Johnny's fault'! To them, this is all to much to swallow and is likely to result in much resentment. This resentment could even result in attempts to sabotage any treatments being attempted. Again, the only solution is sympathetic, honest and patient efforts to fully explain the condition. It is crucial to let any siblings know that they are equally important members of the family, and that their feelings matter too. With that understanding, they can often become willing partners in efforts to improve the family's harmony.

"Ritalin often makes behaviour worse, and changes children into real monsters."

A fairly common side effect of Ritalin is known as the 'rebound' effect - this means that when the medication wears off, the AD/HD symptoms (often including temper tantrums) may return with a vengeance - worse than before. For most, carefully adjusting the medication to ensure that levels are high enough to be effective, but wear off gradually late in the day, will provide a solution - this might mean taking a small dose late afternoon or early evening for example (this has to be balanced against the common side effect of insomnia when given too close to bedtime).

Finding the optimum dosage pattern is not an easy task, even for experienced physicians, but can often be achieved with due patience. Unfortunately, many parents give up too soon, under the misconception that the medication just makes their child worse. With careful monitoring, cooperation with the Child's doctor, patience and persistence the delicate balance of correct dosage can usually be found. For many 'rebound' seems to decrease once the child (or adult) gets used to the medication.

Sometimes Doctor's prescribe a special 'slow release' form of medication (such as Ritalin SR) to counter the effects of 'rebound', but some others do not feel this form of the medication is as beneficial.

"Using stimulant medications for AD/HD often leads to hard drug use."

Considerable research has been done in this area. And it is true that people with AD/HD are often more likely to abuse drugs ..... but this is much more frequent before they are correctly treated for their AD/HD. Research indicates very clearly that stimulant medication given to people with AD/HD helps prevent most moving on to hard drug use.

Although controversial, there is also evidence that stimulant medication given to hard drug abusers with AD/HD can help significantly with their treatment, as their use of some 'street' drugs may be their own efforts to 'self medicate'. The 'paradox' effect - that giving a stimulant to someone who is hyperactive often has a calming effect that improves mental focus is well documented. As are the 'high' effects of abusing stimulants (or cocaine) by those without AD/HD. - It is therefore easy to see why undiagnosed AD/HD sufferers can be sub-consciously drawn to the effects of street drugs such as amphetamines ('speed') and cocaine because of the often 'positive' effects on their AD/HD symptoms (even if they do not know they have AD/HD, or why it happens).

The very real danger with using 'street' drugs for treating AD/HD (apart from being illegal!) are the uncontrolled nature of using such drugs. Many are 'cut' with highly damaging substances (such as household cleaning powder!) by unscrupulous dealers in an effort to maximise their profits. There is also a clear danger of addiction to drugs such as cocaine, and without any control over the purity of these drugs there is a risk of overdose.

Many doctors will refuse to prescribe AD/HD medication to those who continue to use 'street' drugs. For many people with AD/HD, when/if they experience (often for the first time in their lives) the more beneficial effects of proper, controlled, clinical AD/HD medication, with it's more consistent effect over their symptoms, their desire to 'self-medicate' with hard 'street' drugs will frequently diminish as they quickly learn to respect the importance of using appropriate medication.

Sadly, undiagnosed sufferers with a life experience of confusion as to why they are 'like this?', and consistently negative comments from others, will probably continue to drown their sorrows in alcohol and seek short term solace through damaging 'street' drugs.

"Look at him sitting quietly in front of the Nintendo, he can't have AD/HD!"

It is a very well known facet of AD/HD that under certain circumstances (usually when engrossed in a pleasurable task), children with AD/HD can often 'hyper-focus'. It is also the complicated and inconsistent nature of the disorder that AD/HD children can confound logic by behaving very 'well' for short periods. This can often happen when the child is experiencing a new and novel environment, but can be very frustrating if that 'new environment' is the doctors surgery during their first assessment for a possible diagnosis of AD/HD!

Experienced and responsible professionals will always look at the 'whole picture' when making a diagnosis, taking into account school reports/history, statements from those close to the child, as well as making their own observations. Parents know their children better than anyone - they have usually lived with them all of their lives and they know how they behave from day to day, hour to hour and situation to situation (although sometimes their natural attachment to their offspring does not always make them the most impartial judges of their Children's behaviour).

Dr. Sam Goldstein says the very best way to diagnose an AD/HD child is to go and live with him/her for a few weeks! As this is usually impractical, he says that the second best way is to take a thorough history. Parents will usually agree that anyone who hasn't lived with AD/HD can never really understand it in the way that someone who has lived with it does!

"Stimulant medication is basically a bad thing - it takes away a child's self control and then children don't learn to control themselves."

Stimulant medication helps people with AD/HD to observe their own behaviour better, to regulate it better and to learn from their own experience. A typical comment from many people first taking medication is that for the first time they begin to see things clearly. So the most common effect is the opposite of taking away control - it is more likely to help a child to do this for the first time.

It would be ridiculous to suggest to someone with short sight that they should not use their glasses, and bump into everything!

Children will be able to understand the reasons for taking their medication if they can properly appreciate all the facts about their disorder and the medication they have been given. Again, this is only done through careful, honest and patient efforts to explain it all from someone they trust (see the 'ADDvice' in Young person's page on AddNet site for suggestions in explaining). Children are not stupid, for many a short experience on medication can be enough for them to 'see clearly' how their behaviour has benefitted. Remember - medication only helps the child to focus clearly enough so that they can change their own behaviour.

"More research is needed on AD/HD before anything is done."

More research is certainly likely to be helpful in improving treatment and support. But AD/HD is the best researched of any 'child' psychiatric condition, and this research has extended over more than 30 years. We know more than enough now to be able to identify and help people whose lives are blighted by attention and impulsivity problems. While relatively few children and adults are diagnosed and treated at present in the U.K., there is no scientific reason why the numbers of people with this condition should vary vastly from the very well researched levels of prevalence in other parts of the world. People with AD/HD deserve to be treated here in the UK, as they deserve to be treated anywhere that claims to match treatment with need. Effective treatments are available, well researched and accepted as standard good practice internationally.

"People being treated for AD/HD should be seen every 6 months by their doctors."

There are AD/HD clinics where this is common, but many others regulate visits to their patients need. Especially in the early days of treatment, medication may have to be adjusted frequently and dramatically to meet the sufferers needs and regular advice is needed to help manage and support other strategies being used. What many parents need and want is regular access to advice and support, and the chance to consult quite frequently. Other adult sufferers may not want to spend lots of time in a doctors surgery, if they feel that their treatment has now given them the ability to really manage their lives independently. For them, a telephone call to check everything is going well is often enough. Unfortunately, Children's mental health services are thin on the ground and very frequent visits may not be practical for the doctor. The best approach may be to agree on a mutually practical frequency, with the option to call in 'emergencies'.

"Once you know you have AD/HD and begin treatment, then things will begin to go right quite quickly."

Diagnosis and treatment is only the beginning of a long road which may last a lifetime. AD/HD is not curable, but is likely to be treatable. Although medication can, for some, bring dramatic results in a short period of time, for most, medication alone is only a part of the answer.

Often a period of elation, of 'knowing what was at the root of so many problems' follows diagnosis (sometimes accompanied with a huge appetite for information about AD/HD). This is often followed by a period of sadness as people with AD/HD are likely to grieve for the person they thought they were and for missed opportunities, along with anger at those that 'unfairly' criticised and penalised. They need to learn new strategies to repair and build relationships.

Diagnosis brings a new responsibility. Just as it is true that their disorder will undoubtedly have bought them 'unfair' discrimination in the past, it cannot be used as an excuse for not trying in the future.

The change is often very unsettling. Some things may improve - but other things may take a very long time and may at first get worse. It is important for people on this journey to be in touch with others who have been there as well - for support and encouragement and cheering up in the face of difficulty.

"Children and teens with conduct disorder should have the conduct disorder dealt with first as it is so difficult."

Conduct disorder is very common among some groups of people with AD/HD - particularly where hyperactivity is present, and the condition is not recognised and treated early. If AD/HD is at the root of the conduct disorder, which it most commonly is, most international experts say that treating the AD/HD is the way to best help the conduct disorder - that they are part of the same whole.

"AD/HD is simple to spot and treat on it's own."

AD/HD is not a simple condition, and it is fairly unusual to find it entirely on its own. It is very common to find coexisting conditions (comorbidities), like a specific learning difficulty or a degree of depression or others Poor self-esteem, as a result of AD/HD, is also frequently found. Other conditions commonly co-exist with AD/HD. Thus during diagnosis, it is vitally important that the other possible coexisting conditions or problems be considered and either identified to correctly treat or eliminated, as well as guarding against those conditions which can 'mimic' or mask AD/HD symptoms.

Successful treatment means treating and responding to the whole needs of the person - not just part of them.

"AD/HD is just one of those trendy new American conditions."

AD/HD was first recognised and described in 1902, here in the U.K., by Dr. George Still. The name has changed many times since then, as our knowledge of the condition has grown, but the condition has not changed.

In the 1930's stimulant medication was found to be effective and relevant research began to increase. Different countries, for a variety of reasons, have been relatively quick or slow to respond to the growing international knowledge about AD/HD. AD/HD appears to have a strongly hereditary link, and may well have been around for thousands of years.

Some experts working in the field of 'archaeological psychiatry' believe that AD/HD may be linked to our ancestors need to 'hunt' to live. To them, the ability to react instinctively fast, to be broadly aware of all around us at all times and have boundless energy would have been a distinct advantage. As civilization moved into a chiefly agrarian existence, priorities would have shifted towards the necessity to plan ahead for growing crops, methodical and steady work was required in the fields - the classic 'farmer' model. So it could be said that the efficiency of a society depended upon the dominance of different 'traits' at different times. Some of the residual 'genetic traits' of the early 'hunters' may have survived more strongly in a minority, but with today's expectations of conformity and steady planing for ones future, they would be considered a 'deviation from the norm' and shunned as a 'disorder', rather than an asset. This is clearly only a theory, but an enticing one, and having 'hunter genes' is a rather appealing concept for many of us! :-)

Generally, in the U.K. diagnosis and treatment is still at relatively early stage of understanding in comparison to other countries such as Australia, Canada, New Zealand, Israel and the USA, who have all trod the same 'road'. It was not that long ago when autism was believed to be the fault of the parents, blamed on a lack of affection - usually by the mother. That view has happily disappeared as the mainstream view. Perhaps, dyslexia holds a position somewhere between the two.

All the above conditions are related to neurobiological differences. But it takes time for parents and professionals to learn about them and develop good treatments and support. In all the key professions, there will be those who are resistant to change. In a recent meeting with the Department of Education and Employment, after voicing our concerns at the lack of progress towards effective screening and treatment, ADDNet was told "it is a large tanker that you are attempting to turn!". So sustained pressure for better services, and a degree of realism are both necessary.

"AD/HD is at least partly an excuse for naughty children being spoilt and deliberately difficult."

It is not possible to say that AD/HD children are never spoilt or intend to be difficult -- but all of them underneath want to succeed and be popular, successful in school and to understand and control their behaviour - just like other children. A cycle of failure may disguise this desire, and can be genuinely hard to see at times, even by the most patient of parents, teachers and doctors. A child faced with constant criticism will be retaliating from an entrenched position, not happily waiting in hope of gentle encouragement - Kick a dog and it bites!

The whole point of diagnosis and treatment is to help children with AD/HD to succeed, to fulfil their true potential and to be accepted by friends and family. Our job is to provide the environment to help children to succeed - not to blame them for something essentially not their fault. Often the child is more distressed and confused by their 'different' behaviour than anyone else. Unable to deal with it they may see themselves as 'mad' or 'stupid' or simply 'bad', as the labels used by so many adults and peers start to stick. On the surface, AD/HD children can often give the impression of being obstinate and unworried by their actions, but, underneath they could be heading down a psychological spiral of lower and lower self esteem.

Turning around an AD/HD child who has begun this journey is not an easy task and no single treatment is likely to be effective on it's own. But most AD/HD children, given the right help, will succeed.

To dismiss sufferers of AD/HD as simply naughty, spoilt children is as ignorant as it is damaging. In the words of Dr Sam Goldstein; "The most important things we can offer children and adults with AD/HD are: Love, Acceptance, Respect and Empathy. In the absence of these things, All of the other things we do are unimportant."

"Serious AD/HD means it is likely your child will end up in prison."

It is true that where research has been done in prisons, a high proportion of inmates have AD/HD. Most of these have been undiagnosed and untreated over most of their lives. They have had a series of failures in life and often have often committed impulsive acts which have led to crime.

A diagnosis of AD/HD is the first big step in preventing this outcome for most people - and early diagnosis, appropriate treatment and support is the best way to equip these children with the skills to succeed, making crime an unnecessary career. Although impulsive people will always need to be careful in their interactions with others, the prognosis is definitely good.

"Providing more treatments for conditions like AD/HD will put too much pressure on an already overburdened health service."

The cost of not treating AD/HD, in both human and economic terms is simply huge.

As research is beginning to show, many prisons have a large proportion of undiagnosed AD/HD sufferers. Screening for AD/HD at an early age, with effective treatment will help prevent; school failure, crime, teenage pregnancy and drug abuse. More importantly, It would also mean we were enabling 2-5% of our population to have a much better chance of success in life, fulfil their potential and contribute positively to society. It would not be acceptable to withhold glasses from people who need them to see clearly or to withhold treatment for asthma or depression - for the same reason it is not acceptable to leave people with AD/HD without the opportunity for treatment.

"Support groups are dangerous and give out inaccurate information. Patients should only go to qualified medical professionals who will tell their patients if they have AD/HD and what to do about it."

Support groups, like professionals, must do all they can to provide information which is accurate and up-to date about AD/HD. Support Groups are enormously important in providing support and in mobilising and encouraging the development of local services. Their work often begins where the doctors work ends. It is impractical to expect a doctor to be able to talk to parents for long periods over the phone about the trials and tribulations of the school trip! But many parents who run the support group helplines do just that. They usually have dealt with the same problems and can bring a great sense of empathy and support as they have often 'been there'.

It is wrong to consider either the doctor, or support groups, as the only source of help for AD/HD. There roles should be viewed as quite separate and complimentary.

In countries like Australia and the USA it is the growth in support groups which have led to effective treatment being much more widely available. They have put enormous pressure on the government and on services to change and to respond to the needs of people with AD/HD. Some people will always consider groups which provide information, and press for change, a threat to their 'status quo' -- but responsible support groups do not mislead their members, understand the importance of receiving quality medical care and work actively with their local professionals to improve services wherever possible.

"Only psychiatrists can diagnose AD/HD as it is a psychiatric condition."

A number of professionals can legally diagnose AD/HD - including psychologists, paediatricians, and GPs. Many others can help in the diagnosis including teachers and parents.

What is important is a knowledge and experience of AD/HD, not what job title the professional holds. ADDNet UK is aware that some psychiatrists, doctors, paediatricians, special needs coordinators and parents have little or no knowledge of AD/HD. It is important when seeking advice on AD/HD to convince yourself that the advice comes from someone qualified to give it - not just in paper terms, but in real knowledge and experience.

Also important is an empathy and respect for the difficulties which AD/HD can cause. Only a qualified doctor can prescribe medication, but many others can help with other forms of treatment and support. In Australia, for example, it is most common for developmental paediatricians to diagnose AD/HD - working with their psychiatric colleagues if a child has very complex symptoms and needs or with speech therapists and psychologists when there are also learning and communication difficulties.

AD/HD can require intervention from a broad range of services and specialist skills. It is best, for the patients sake, if these agencies are engaged in cooperating.

"You have to have a very thorough assessment to find out if you really have AD/HD - this should involve computer tests, a brain scan, completion of questionnaires by several people who know the person, interviews with parents and teachers, past school records and the elimination of all other possibilities before this condition is treated."

An accurate diagnosis of AD/HD does require a very careful appreciation of the 'whole picture'. It will often mean looking at school records, direct observation and interviews of those close to the child, but it should not be a process of endless 'jumping through hoops'. It is not usually necessary to go through a very lengthy and complex diagnostic process to identify AD/HD. An experienced professional will know what to look for, and will often be able to confirm the need for further investigation, or rule out AD/HD, very quickly in some cases. At present, 'brain scans' are only used in research, and no computer test exists that can diagnose AD/HD definitively.

More care needs to be taken where other conditions are thought to be present. The key to an accurate diagnosis of AD/HD, and other conditions, is in getting a thorough understanding of the patients history and getting a reasonable amount of supportive evidence wherever possible. If a person has depression, they are not made to suffer until a lengthy diagnosis process has been completed. Sometimes when professionals are new to AD/HD they are very cautious. But many people with AD/HD will go for help because they are having serious problems in their lives -- so a balance between what is needed and what is possible and desirable is essential, so that prompt and sympathetic treatment can be given if needed.

"Families with AD/HD children should always try behaviour management techniques and family therapy first before medication is considered."

Behaviour management and family therapy (done by people who know about AD/HD) is often very helpful. Both experience and research have shown that it is much more likely to be helpful if the AD/HD has already been diagnosed and treatment has begun. Medication, where used and successful, enables children to learn much more from these other kinds of support. Without this support, therapy and training may be more likely to fail.

"Other countries such as Australia, Canada, South Africa and the USA provide much better treatment for AD/HD children."

This may be true in some, or even many places, but is certainly not in others. If you talk to people living in rural areas of Australia or the USA, or not near medical schools, or in communities where bad behaviour is always thought to be the fault of the individual, people with AD/HD may have just as hard a time getting treatment - or even harder - than in the U.K. or some other countries in Europe.

The UK does have some centres of excellence, staffed by committed and caring professionals, and more services are being developed. They are out there, you just have to look harder sometimes! Local support groups are often able to give a guide to local services.

"All doctors need to agree on 'good practice' and diagnostic criteria before anyone can implement them."

All doctors never agree about any treatment, so there is no reason why AD/HD should be different. It is right to search for good methods of diagnosis and treatment - which identify real problems and provide real solutions (this is the intent of evidence based medicine). With AD/HD this is available and there is a very wide international consensus and extensive research to support this. We know more than enough to effectively help the majority of people who need help - often desperately.

It was not until very recently that the UK's Department of Health recognised adult AD/HD, but many doctors have recognised the breadth of international experience for some time and successfully treated the needs of their adult patients. Some doctors will continue to use the ICD 10 criteria for diagnosis (that fails to recognise AD/HD without high levels of hyperactivity) and will continue to call AD/HD 'hyperkinetic disorder'. Rome wasn't built in a day!

"GPs are not allowed to prescribe stimulant medication in the U.K., especially to adults, without the backing of an AD/HD specialist."

GPs can prescribe stimulant medication with or without the backing of a specialist - but they understandably want support for what is often an unknown or unfamiliar disorder or treatment. As knowledge and experience grows, doctors will become more confident about providing treatment as the result of their own judgement. Some GPs deliver babies, perform minor operations and deliver other specialist help - many can potentially learn lots about AD/HD in order to treat it as well. Many responsible GPs go to great lengths to keep themselves informed of new research and are happy to broaden their knowledge for the sake of their patients. Wise GPs are not afraid to acknowledge their limitations and will not hesitate to refer patients on to a specialist colleague when necessary.

"The U.K. education system is ideally organised for AD/HD children - if only the right resources were present."

Any inflexible educational system is largely unsuitable for AD/HD children - there is little choice about what they can do and when they can do it. This is especially true once children reach secondary school. If the majority of AD/HD children are to fully succeed in the present system then changes need to be made to accommodate their unique learning styles - They can succeed, often extremely well, if the conditions are right and teachers have an effective knowledge of AD/HD.

The UK's special needs 'Statementing' process is a slow, complex and confusing process that can often lead to little in the way of effective help and resources for children with AD/HDMany UK schools continue to refuse to administer prescribed medication, despite the negative effects in the classroom. At present there is little legal redress to this situation as there is no 'obligation' to administer medication. More open minded schools, however, do see the sense in supporting all their pupils needs, and will help.

Some children will be able to succeed, or at least survive, in mainstream schools with the help of sympathetic teaching staff. But if this is not appropriate, a number of schools can provide more specialist help (see ADDNet's list of schools.

"Having AD/HD is a real tragedy as people with it have terrible problems."

AD/HD can create huge problems, academic failure, failure in relationships, family breakdown and much more. For most people, there is also the very real positive side - and this can be a big positive! People with AD/HD are often very intelligent, creative and rarely, if ever, boring. They can be flexible, generous and open minded. When people with AD/HD have supportive environments they can have an enormous amount to contribute to society.