The long read: For children with ADHD, getting the help they need depends on being correctly diagnosed. As a doctor, I have seen how tricky and frustrating a process that can be
For children with ADHD, getting the help they need depends on being correctly diagnosed. As a doctor, I have seen how tricky and frustrating a process that can be
Later that afternoon, I took Daniel’s case to a meeting where the day’s new referrals were discussed. Half a dozen senior doctors, nurses, psychologists and psychotherapists sat around the table and listened as each case was presented, trying to piece together the story being told and decide what to do next. When it was my turn, I launched into my findings, laying out what Daniel had told me and what I had gleaned from his parents about his childhood.
On the phone to Daniel’s mother, I said we needed to investigate things further. She tried hard to mask her frustration: “Well, as long as you are able to doDHD makes it hard to sit still or focus. Its effects are felt broadly. They can be seen early in childhood and continue throughout people’s lives: not just affecting attainment at school and work, but also making it difficult to form social relationships, adapt to stressful situations and regulate emotions.
Taylor’s article also suggested something else: that sometimes a child could experience attention difficulties without displaying hyperactive behaviour. Other research confirmed this, and the diagnosis was broadened in the 1990s to take into account the less visible but still real challenges of “attention deficit”. In paying more attention to symptoms of inattention, research also helped to explain why so few girls were diagnosed with the condition.
Mel told us that the patient she had been seeing had periods of intense sustained attention during particular activities that she enjoyed. It seemed like a counterintuitive finding, but this was common in people with ADHD, she pointed out. “Hyper-focus” – as it has come to be called – isn’t an official symptom, but it is a useful clue. More experienced clinicians had a stock of well-weathered intuitions like this that I had begun to hold on to.
We were also under pressure to reach a diagnosis faster: school visits to observe how children behaved in classrooms had become less common owing to time constraints. And we were relying more on computer tests that measured a child’s ability to focus on a repetitive task. We would gaze at the waiting list. Someone drew out a tangled diagram of our assessment pathway, trying to devise shorter routes through. But beyond employing new staff, there was only so much we could do.
Medical language has become more common among young people in other ways. There has been a recent push to teach simple therapy techniques in classrooms, educating children about mental health symptoms and giving advice about how to manage them in an attempt to prevent problems before they start. There is evidence that these education programmes, called “universal mental-health interventions”, can have a small benefit in reducing conditions such as depression.
Despite growing concern around self-diagnosis, most of the children I saw came only reluctantly to the clinic. They understandably thought there was nothing wrong with them. It was their parents and teachers who sent them in. I saw one eight-year-old girl who hadn’t been told why she was brought to see me. As I began my questions, she quickly smelled a rat and triumphantly answered no to all of them, her mother looking on in frustration.
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