• I would like to speak to someone about the possibility of coming for a consultation for my child.  Is this possible? 

People are very much encouraged to speak to the LANC staff, asking for Mrs Latham, Centre Manager, if they have concerns about the assessment or would like to clarify questions. 

• I am concerned that if a diagnosis of AD/HD is made my child might be put on medication for this. 

A comprehensive assessment is always done to ascertain whether or not a child has AD/HD and/or related neurodevelopmental difficulties. There are very clear criteria for making a diagnosis of AD/HD and such a diagnosis will not be made unless these are clearly met.  The assessment also carefully evaluates the presence of any other associated difficulties such as Conduct Disorder, dyslexia, autistic spectrum difficulty etc.   

A diagnosis of AD/HD in no way automatically assumes that medication would be considered.  A decision on this is always up to the parents and child, if appropriate, or the adult being assessed.  A careful explanation of the risk profile, the possible benefits and side effects is made and if medication is started it is always for an initial trial period.  Educational and behavioural strategies are always important. 

• My child is very bright but is underachieving relative to his ability.  He is in a private school with small class sizes, however, he is still struggling. 

AD/HD and related conditions are no respecters of intelligence.  The problems of weak concentration, impulsiveness and/or hyperactivity can occur in a child of any intelligence.  Many bright children in particular have a ‘faulty on-off switch’ with the ability to hyper-focus on things interesting but are unable to concentrate on mundane things.  It is important not to allow the fact that your child can focus on computers or whatever he is interested in, to dissuade you from the possibility of a diagnosis. 

• My parents and other friends blame me for my child’s behaviour.  However, I know I have done everything humanly possible and yet there are very significant difficulties. 

Children with AD/HD, especially if there is associated Oppositional Defiant Disorder (teenagers before their time) can cause enormous family stress and dysfunction and generally fail to respond, or only partially respond, to reasonable behavioural management strategies.  Their inherent impulsiveness, emotional volatility and innate oppositionality, often together with poor memory, mean that behaviour management strategies may work for a little while but are frequently forgotten or things go wrong again. 

Behaviour management strategies are aimed at enhancing parenting rather than blaming the parents for the child’s innate difficulties. 

• My child’s teachers/GP have told me they do not believe in AD/HD and do not believe in the possible use of medication to help manage it. 

AD/HD is an internationally recognised condition for which there are clear guidelines both in the USA and Europe (European Guidelines for Hyperkinesis; NICE Guidelines 2008 – www.nice.org.uk ).  It is also a recognised disability.  It is very much part of the special needs spectrum and must be considered in effective provision of children’s and adult mental health services and in educational services. 

There has been an inordinate amount of pseudo-controversy about AD/HD (see Myth and Misinformation section), however, it is critical to appreciate the reality of AD/HD and its treatability, given the very serious negative impacts it can have on a child and family. 

I have recently seen the Panorama programme – read the tabloids on AD/HD and I am concerned that the side effects of medication have been mentioned. 

It is important to keep the side effects in perspective and recognise that most tabloids are out to create a hyped up story. There is absolutely no doubt that the reality of AD/HD and its impact on the child and family have tended to be very significantly under-rated in the press, whereas the alleged side effects of medication have been exaggerated. As with any medication there can be some short term side effects, especially involving appetite suppression or sleep difficulty, but there is no evidence of long term side effects with the use of such medications.  Any medication for any medical condition can have possible side effects.  The issues around medication must always be placed in context relative to the complications of having untreated AD/HD and related neurodevelopmental difficulties.  AD/HD is an extremely treatable condition. 

• My child often behaves excellently for his grandparents, who do not believe there is a problem. 

This is frequently the case as when children with AD/HD are doing something novel or interesting the problem is often not noticeable.  Because these children have the ability to switch on or off depending on their interest factor, this often occurs. It is important that parents do not automatically blame themselves in this situation and try to consider whether or not the child is innately excessively oppositional or impulsive. 

• I am concerned that as my child gets older services will not be available for him and it may not be possible for him to continue to be prescribed medication. 

The LANC runs a seamless service with transition from childhood to adolescence.  The adolescent and adult clinic is collated by Mr Nigel Humphrey, our Clinical Psychologist.  It is clearly recognised now that at least 80% of children with AD/HD transition with the problems through into adulthood.  The LANC is very aware that the transition period from leaving school and getting into a career pathway can be extremely difficult for those with AD/HD. 

With regard to the prescribing issues, this is generally less of a problem than in years past.  There is increasing recognition by authorities and by the recent NICE report, and also by the British Psychopharmacology Association, that AD/HD is a condition of adulthood.  The majority of GPs are now supportive of prescribing in these circumstances. 

• I am concerned that because the LANC has such expertise in AD/HD that that is all that is likely to be diagnosed.  

This is certainly not the case.  The LANC staff always go to great lengths to ascertain whether or not a child or adult has AD/HD, whether he or she meets the criteria and whether there is significant impairment.  The clinic is also careful to assess associated complicating and coexisting conditions.  If the staff feel that a child has reasons to explain the symptoms other than AD/HD or Asperger’s Syndrome etc., then that will be clearly stated and appropriate support given. 

• My child’s teachers do not believe in the use of medication for AD/HD.   

It is not up to teachers to decide whether or not medication is appropriate.  The clinic requests information from teachers and it is essential to know exactly what the child is doing and how he/she is behaving in the classroom.  However, it is not up to teachers to either make a firm diagnosis or to decide on medication.  That is part of the comprehensive assessment in which teachers take part, but the final decision is made jointly between the family and the clinical specialist. 

• My child has previously had a diagnosis of Asperger’s Syndrome (or dyslexia) and I am not sure this is the correct diagnosis. 

In years gone by broader, non-medical diagnoses, such as Asperger’s Syndrome, dyslexia etc. were made, which often failed to recognise the coexistence of AD/HD.  There has been a very strong trend in recent years to split the diagnosis up and recognise that many conditions coexist, rather than using diagnoses that tend to lump symptoms together, such as dyspraxia, dyslexia, Asperger’s Syndrome.  One of the concerns about the over-diagnosis of Asperger’s Syndrome in the past for example has been that it precludes the diagnosis of AD/HD rather than recognising the frequent association of these conditions and it has generally been a nice, safe diagnosis where the possibility of the use of medication to strengthen concentration or help with impulse control is therefore also precluded.