Is ADHD a learning disability – and can it lead to other mental health issues?
How does attention-deficit hyperactivity disorder develop? Does it impact a child’s intelligence later in life? And are there any mental health conditions associated with the condition? Paediatrician Dr Hannelie Potgieter, based at Mediclinic Potchefstroom, busts a few prevalent myths.
Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed chronic childhood disorders in South Africa, according to updated research cited in the SA Pharmaceutical Journal in 2017. The condition is also associated with high rates of other personality and behavioural issues, such as delinquency and substance abuse.
ADHD is classified as a chronic disorder by the global standard Diagnostic and Statistical Manual of Mental Disorders, says Dr Potgieter. This means that while it is not a spectrum of conditions, similar to autism, it is not strictly a learning disability either – but because a child with the condition will usually struggle to concentrate, it can cause a learning disability over time.
“A patient has to meet certain criteria before we can come to a diagnosis of ADHD,” she says. “We look mainly for behavioural warning signs that revolve around hyperactivity, impulsivity and inattention. These symptoms lead to other issues, at school and in his or her social circles: a child who cannot pay attention for long periods will struggle to see things, like homework and school projects, through to the end, and someone who is hyperactive will often battle to socialise properly.”
ADHD does not come alone
A child’s learning can be severely affected as a result – and worse effects may lie up ahead. “We have seen that in a majority of cases, ADHD does not occur in isolation,” says Dr Potgieter. “As they approach adolescence, these patients start being diagnosed with a range of psychiatric disorders, including anxiety or depression.”
Substance abuse, which can develop as a coping mechanism, is also common, as is oppositional defiance: a condition characterised by aggressive behaviour, angry outbursts and a frequent tendency to argue or engage in wilfully annoying behaviour.
“It can be a chicken-and-egg situation,” she says. “Anxiety and depression on their own will affect your powers of concentration, but when kids with ADHD begin to realise they’re a bit different from their peers, and always in trouble for it, that will make them anxious and depressed too.”
Many impulsive, hyperactive kids with a tendency to become depressed may be living with an undiagnosed bipolar disorder as they approach adulthood. “With some bipolar patients, when we look back at their behavioural history, we can see they might have been living with ADHD, and remained undiagnosed and untreated for many years.”
Symptoms can intensify with age
Those unpredictable behavioural patterns can intensify as a child ages. “A child who acts impulsively will most likely engage in risky behaviour,” says Dr Potgieter. “When you are seven or eight, you might do something naughty or defiant, but not necessarily physically dangerous. But as they grow up into teenagers and young adults, that impulsivity can see them doing drugs, or becoming involved in other activities where they are at serious risk.”
Early diagnosis is key to treatment. “What we find works best is when we focus on changing behaviour, as opposed to simply medicating,” she says. “And that needs to start very early in a child’s life – the sooner the better.”
“No matter how closely a child meets the clinical standards required for us to diagnose them with ADHD, we never begin treatment before the age of five,” she says. “That’s because there is always a chance that these behaviours are in fact age-appropriate, and just a part of their growing up.”
Therapy is also a priority in the early years after diagnosis. “Between the ages of five and seven, we generally steer clear of medication and focus on trying to adjust behaviour, through occupational and psychological therapy.”
Whether a child is treated with behavioural therapy or a course of medication, these measures are only effective if they are surrounded by a supportive and invested team. “Think of it as a multidisciplinary team, made up of not just doctors but teachers, parents, family members, even friends,” Dr Potgieter says. “Teachers need to be prepared to give that child special attention, and parents must do their bit at home as well. Then there are educational psychologists and occupational therapists – all of these are specialists in their own way, and they all play a vital role.”
A good paediatrician is at the core of that team.
“ADHD can be used as a label, and it can stick,” warns Dr Potgieter. “That can be harmful and unfair to the child. We don’t want to medicate every child, or under-diagnose either. With enough invested role players around to monitor a child’s behaviour and pick up warning signs, and with the child’s interests at heart, we can get to the correct diagnosis – and the best, most appropriate treatment – for that individual.”