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Soaring numbers of children around the world are being diagnosed with ADHD, with cases rising as much as tenfold in some countries.
In the UK it’s estimated that between 2-5 per cent of children have the condition – and in the the US at least 5 per cent.
ADHD is a behavioural disorder characterised by difficulty maintaining attention, impulsive behaviour and extreme hyperactivity.
Treatment can be a minefield – and research has warned that the widely-prescribed drug Ritalin, should be used with caution.
And late last year a team of international experts said the quality of evidence available about its benefits and risks is poor.
Last year more than a million prescriptions for Ritalin were given in the UK. But Dr Paul Stillman warned it should be taken with caution and only after exploring other dietary and behavioural interventions
Even after 50 years of use, more research is needed to help doctors decide on the pros and cons of giving the controversial hyperactivity drug to children, they said.
And recent research has warned that children with ADHD can become trapped in a downward spiral where their unruly behaviour sabotages friendships – and rejection by their peers fuels further bad behaviour.
So what can parents do?
Here, Dr Paul Stillman, a Sussex GP with a special interest in behavioural problems reveals some surprising suggestions…
As someone who has spent many years helping families struggling with ADHD, and looking at different treatments approaches, I have become increasingly concerned at the relentless rise in the number of children affected.
I am also deeply worried at our willingness to use potent drugs, with often unpleasant side-effects, before exploring behavioural and dietary interventions.
There is no doubt that early intervention is incredibly important, but I am very uneasy about the number of prescriptions which are now being written for Ritalin and other ADHD medications.
Last year it was around a million in the UK and these drugs are not without side-effects.
We should be looking at proven lifestyle and dietary changes before resorting to medication.
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For example, I firmly believe that computer games can help children with ADHD.
Adults are often quick to blame them for their children’s bad behaviour.
But online games, can play an important role in helping youngsters with attention deficit hyperactivity disorders — so park the parental guilt if your kids spend hours glued to a screen.
ADHD is very difficult to diagnose because there is no simple definitive test. It can be difficult to distinguish between something which requires treatment and something that will sort itself out.
But one thing that we know for sure is that attention disorders can have a very negative effect on relationships.
It’s hardly surprising, if someone is being an awkward sod, sooner or later there will be a great temptation for any group to isolate them, and that reinforces the bad behaviour.
This vicious cycle has just been detailed in a study by Norwegian scientists who found it was most pronounced between the ages of four and six.
Playing computer games can help children with ADHD to develop their social skills so parents should not feel guilty about allowing children to play them, Dr Stillman says
And it’s no coincidence that it’s around this age that children are learning how to form friendly, co-operative relationships with people outside their immediate family.
The new study found the more ADHD symptoms children had at the age of four, the greater rejection they suffered by the age of six.
Conversely, the more rejection children with ADHD experienced, the worse their symptoms became.
In order to break this destructive cycle, it’s essential to help children with ADHD build relationships with their peers — and that’s where gaming comes in.
I am also deeply worried at our willingness to use potent drugs, with often unpleasant side-effects, before exploring behavioural and dietary interventions.
Adults get very het up about the time kids spend on computer games.
But games are now a very social activity and the people who play them are often communicating with a much wider circle of friends than our generation did as we were growing up.
Players are learning social skills, and forming friendships and relationships in a way that we never did.
Children who have difficulty with attention can benefit from this sort of online community, where they engage with people within the game, or step back a little while still being part of the group and included.
There is a lot of positive reinforcement, which these children need.
Another area where the research looks very promising is fish oils.
A trial of 90 children with newly diagnosed ADHD found compelling evidence that a specific clinically proven combination of omega-3 and omega-6 works almost as well as Ritalin.
ADHD: WHAT IS THE DISORDER?
ADHD is characterised by NHS Choices as a ‘a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness’.
Common symptoms include a short attention span, restlessness or constant fidgeting and being easily distracted, the health service says.
Many people with ADHD also have learning difficulties and other problems such as sleep disorders. The condition is normally diagnosed between the ages of three to seven.
Potential risk factors include smoking, alcohol or drug abuse during pregnancy, premature birth, and simply being male.
A third of the children on the study which was published in the Journal of Attention Disorders were given Ritalin, a third were given the supplement Equazen, and a third were given both the Equazen supplement and Ritalin.
Children receiving the Equazen took three capsules twice a day — a daily dose of 558 mg EPA, 174 mg DHA and 60 mg GLA.
Children on the Ritalin arm received an initial daily dose of 0.3 mg for every kilogram of bodyweight, which was increased to 0.5 mg/kg a day after a two-week — which is fairly standard practice to try to reduce side-effects.
Researchers assessed them at the start of the trial, and after one, three, six and 12 months using an internationally accepted ADHD rating scale which looks at the frequency of symptoms such as lack of attention and hyperactive or impulsive behaviour.
Both researchers and parents also used a seven-point scoring system to rate the severity of children’s symptoms.
Over the year-long trial, children in all three groups showed dramatic improvement, although it did take around three months for benefits from the supplement to kick in.
Perhaps more importantly, doctors were able to give children much lower doses of Ritalin when it was combined with Equazen.
A study found that a combination of Omega 3 and Omega 6 could be almost as effective as the drug Ritalin
This is the first trial to make a head-to-head comparison with Ritalin and an omega supplement, although earlier studies have shown low levels of omega-3 and 6 increase the risk of developing ADHD while supplementation reduces symptoms.
These long chain fatty acids are found in cell membranes in the brain and one theory is that they are important for signalling between neurons.
There is also some evidence that antioxidants may play a part, although their role is by no means clear cut.
A more recent meta-analyses, a super-study which combined the results of all relevant trials, found a significant association between oxidative stress and ADHD.
Try to make sure you and your child get your essential five a day — a healthy diet, exercise, sleep, fun and love.
One theory is that children with ADHD have a different response to oxidative stress and that’s what puts them at risk.
A number of studies suggest iron may be important, with one placebo-controlled trial reporting a significant decrease in symptoms after children took 80mg of iron a day for 12 weeks.
MRI brain scans of children with ADHD have also shown they have reduced levels of iron in their brain.
Intuitively this makes sense as iron plays such an important role in cognitive development, and deficiency is common among young children.
Dopamine, a hormone involved in neural signalling which has been linked to ADHD, is also known to be sensitive to changes in iron levels in the brain.
However, contrary to popular belief, there is no real evidence that sugar is a problem – but some of the additives often found in sugary drinks and foods can be.
Some children with ADHD are genetically more sensitive to the food colourings sunset yellow, quinoline yellow, tartrazine, carmoisine, allura red and ponceau 4R and the preservative sodium benzoate.
ADHD makes children five times more likely to suffer from sleep problems so a regular bedtime and banning electronics from the bedroom can both help, says Dr Stillman
Last, but not least, parenting styles can play a part — although I am not for a minute suggesting that ADHD is a sign of bad parenting.
You will always be your child’s most powerful role model and great habits are caught not taught.
Try to make sure you and your child get your essential five a day — a healthy diet, exercise, sleep, fun and love. Don’t expect miracles, but this positive foundation sets the scene for more positive behaviour.
This five a day can also help break negative patterns.
For instance, children with ADHD are five times more likely to experience sleep problems, but good sleep habits such as trying to wind down before a regular bedtime and banning electronics and games from the bedroom will all encourage better sleep patterns.
Parents often feel they need to constantly correct bad behaviour and some adults adopt an almost punitive approach, and take the view that abnormal behaviour should not be tolerated.
But when you have a child who can’t help their behaviour, negative reinforcement only makes things worse.
If you shout, they will too — probably louder and harder. Negativity and criticism simply creates more negativity and criticism.
If you really want to help a child with ADHD, you should challenge them to a game, and try to understand how they are learning to communicate with the world around them.
Equazen is available at Boots, Lloyds, Holland & Barrett, and independent pharmacies.
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