Above: Lené Witbooi, one of Good Hope Psychological Service’s interns at the Paarl branch.

– Lené Witbooi

Lené Witbooi, one of Good Hope Psychological Service’s interns at our Paarl branch, has written this informative article about ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common childhood disorders (Law, Sideridis, Prock, & Sheridan, 2014; Jacobs, 2014; Fabio, Castriciano, & Rondanini, 2015; Lerner & Johns, 2012). It is a developmental disorder characterised by severe levels of attention-disorganised and/or hyperactivity-impulsivity beyond that observed in individuals at a comparable level of development (American Psychiatric Association, 2000). It is a “condition of the brain that makes it difficult for children to control their behaviour in school and social settings” (Lerner & Johns, 2012).

ADHD can lead to anxiety, confusion and chaos.

ADHD can lead to anxiety, confusion and chaos.

Due to the characteristic behaviour that manifests differently from person to person, it is difficult to provide an accurate prevalence rate (Jacobs, 2014). However, research does indicate that almost 10 percent of children between the ages of 4 to 17 are reported by their parents as being diagnosed with ADHD (American Academy of Child and Adolescent & Adolescent Psychiatry and American Psychiatric, 2013). Thus, in a classroom of 30 students, 2 to 3 children might have ADHD.

ADHD has become a household term as many parents and teachers have become familiar with this condition (Walton, 2015), but do we really understand what it feels like to struggle with ADHD? I often have to provide parents with guidance on how they can manage hyperactivity/impulsivity and/or inattention. For parents whose children are diagnosed with ADHD, it can become quite a daunting task. They struggle to understand why their children simply won’t just listen and why they behave in certain ways.

After various conversations with my colleague, Ally, who has been diagnosed with ADHD at the age of 21 years old, it reminded me of how poorly those without ADHD actually understand the experience of those who have been diagnosed with ADHD. Ally kindly offered to be interviewed in order to share her lived experience of ADHD with us. She discussed her primary symptoms, as well as how they manifested in primary and high school, as well as during her university years through to where she is now as a working woman. She also discusses the consequences of not being diagnosed sooner. The interview ends off with a personal message from Ally to parents whose children have been diagnosed with ADHD. The hope is that this article will inform parents, teachers, as well as learners about the emotional, social and academic struggles that accompany ADHD.

Background
Ally is currently a registered counsellor at Good Hope Psychological Service (GHPS). She grew up in the Eastern Cape with her mom, dad and two older brothers. After completing Grade 12 in 2002, she left her hometown to study tourism in Bloemfontein. She discovered that she is not interested in tourism and after a year decided to study psychology at Stellenbosch University. She completed her BEd Psychology degree in 2007.

First signs in primary school
There were always signs of ADHD but because Ally’s school marks were not poor, the teachers did not see the need to look into her behaviour. Below are some of the symptoms as Ally described it:

“I never finished my work… I would stare out the window and do just normal inattentive little girl things… I would get into trouble for talking too much.”

It got a bit more complicated during her high school years
During her high school years, her symptoms did not only affect her academically but also socially and emotionally:

“Basically, what happened was when I was in Grade 10, I was 16 and I was having a really difficult time at school. I was struggling with friendship groups, I was being bullied, I was not happy with my performance academically and I wasn’t very sporty. So, I was having a really rough time and I didn’t know how to handle it very well and that resulted in a suicide attempt in August of 2000. As it was quite a serious attempt, I missed the rest of that school year because I had to go into rehabilitation. Life was very overwhelming at that point, so I would just go into the school for the time that I was writing, get the paper, write, hand-in and go back. I got 40% for the end of Grade 10, which was a pass. By the end of Grade 11, I had worked my way back up to pass everything, with the exception of Biology. Unfortunately, you apply for university with your Grade 11 marks and at that stage, Bloemfontein University was the only university that would accept you with a failed subject as long as there is nothing failed in matric. So, by the end of matric, I finished with an A-average, but I couldn’t go to the university that I wanted to.”

University life
University life was also very challenging for Ally, as she explains:

“I was having difficulties attending classes and a lot of challenges with relationships. I was very impulsive and got myself into difficult situations. If I look back now, I am thankful that worse things didn’t happen to me. I would sometimes get up to go to class and then I would get distracted by my computer or a friend would invite me to go to the beach and that would sound nice and I would just do things like that instead of going to class. But when I did go to class I would work hard, and I was averaging 50% and 60%.”

Light bulb moment: Realising she is struggling with ADHD
Because Ally was completing her BEd Psychology degree, they learnt about learning difficulties, which included ADHD. During class Ally realised that she met the criteria for ADHD, as she explains:

“When we did learning disabilities in the class and we got to the part where they discussed ADHD and ADD, my jaw dropped to the floor. After class, I went to see [the lecturer] and I said to her, ‘I have a feeling that this is my problem’ and ‘I tick all the boxes’ and she said I should see a doctor …”

Stimulant medication
Psychostimulant medication increases the arousal of alertness of the central nervous system (Lerner & Johns, 2012, p. 212). Individuals with ADHD do not produce enough neurotransmitters and therefore the psychostimulants work by “stimulating the production of the chemical neurotransmitters needed to send information from the brain stem to parts of the brain that deal with attention” (Lerner & Johns, 2012, p. 212). The psychostimulants appear to lengthen the individual’s attention spans, control impulsivity, decrease distractibility and motor activity, and improve visual-motor integration (Lerner & Johns, 2012, 212). The most frequent prescribed psychostimulant medication for ADHD is Ritalin, Dexedrine, Concerta, Adderal, and Vyvance. Ally explains the first time she was put on medication:

“She [the doctor] suggested that I went on to Ritalin as a trail and within the next term my marks were up by 20%. My relationships with my peers improved and I became involved in my first long-term relationship and I was part of the class. At last, it felt like life was starting to slot into place.”

Just like Ally, about 75% to 85% of children with ADHD show general improvement when using psychostimulant medication. There is a rapid improvement in attentiveness, hyperactivity, impulsivity, scholastic performance, handwriting skills, family life, and socialisation (Lerner & Johns, 2012). It improves their self-esteem and allows them to express greater control over their feelings and lives.

Changes that occurred after being diagnosed
After being diagnosed and placed on medication, Ally could immediately see a difference in her behaviour, which also led to differences in her academic and social life. She explains these changes:

“Suddenly I had friends in class. Before no one wanted to sit next to me because I kept distracting them. I realised people wanted to concentrate, but I couldn’t and I thought I was very funny. That [being diagnosed and using medication] definitely changed things for me. I finished my BEd Psychology degree in my fourth year with 80% for all my subjects. I had successful long-term relationships. The impulsiveness got better, and I can also say that emotional regulation was a big thing for me. Before I would have tantrums if I got frustrated and I would have out of the blue eruptions of anger that is completely disproportionate to the situation. I couldn’t handle disappointments and failure, and everything just became a massive thing.”

“Concentration improved and with that the motivation and the energy to study. I can definitely say that it had a huge influence on my social life. Before I was impulsive, I spent money on nonsense, you annoy your friends because you can’t wait your turn, you can’t keep secrets and you blurt out everything. So for me, the issues with the ADHD was even more social than academic, although academically it did fall apart and at that time I could not understand why. Looking back at my behaviour I can see how disruptive I was, how inappropriate I was. I remember the one day: my roommate walked in and I blurted out, ‘Dis ‘n lelike toppie wat jy aan het,’ and I still remember her face when she looked at me. Even though I realised that you can’t just say what comes into your head, I had no filter and medication definitely helped with that as well.”

Having ADHD as an adult: influence on work
As an adult, Ally still struggles with ADHD. There are days when she forgets to use her medication. On these days, the behaviour associated with ADHD affects her work, as she explains:

“It influences my work quite drastically. When I started working, I was just on Ritalin but then after the break, I would just be so tired. I started taking Concerta which lasted the whole day, so it went better again. At this stage, I am on long-acting Ritalin which lasts for the workday. The days I forget to take my tablets it does affect my work. Things that I have done are double bookings of clients or booking clients but not writing it in my diary. I’ll get distracted, just forgetting things and my admin will fall behind.”

The importance of parental support and acceptance
From my own experience from working with parents whose children have been diagnosed with ADHD, parents often are struggling to comprehend why their child has ADHD and they struggle to accept it. Ally discusses how her parents reacted:

“Looking back, we could see that if there were intervention sooner, the depressive episode I had might not have happened in the way it did, and I think they felt very bad about it. There was no reason for me to have had depression or to have acted like that, but if we look back at what was going wrong with my social life, I couldn’t make friends and I couldn’t regulate my emotions which led to cutting myself as an impulsive thing. I was feeling that I was never doing well enough, so a lot of these factors would have been lessened or prevented if I were diagnosed sooner.”

Personal message to parents who have children who struggle with ADHD
Because we know that it is not easy for parents whose children have been diagnosed with ADHD, or who suspect their children might struggle with ADHD, Ally provided a personal message of encouragement to these parents:

“I think that the most important thing is for a child to feel accepted and loved no matter what and if they do struggle, do not just listen to what you read on Facebook or what you hear on the street. Do the trouble of getting professional input and finding out exactly what is going on with your child in their unique life situation, and how you can help.”

Concluding remarks
According to a study done by Rosetti & Henderson (2013), young people, just like Ally, who suffer from learning disabilities such as ADHD, can suffer from “academic and social difficulties, lower levels of self-esteem, and social isolation”. But just like Ally, many young people can overcome these difficulties. I hope that the lived experience of Ally, who is thriving with ADHD, will enhance empathy, respect, and support for all who has been diagnosed with ADHD.

Disclaimer: Please remember that ADHD, just like any other developmental or psychiatric disorder, has certain general characteristics but remains a highly individual experience, as people have different life circumstances, personalities, family histories, talents, motivations and many other factors that influence our functioning. The above is one person’s story – and it does not mean that you or your child will experience it the same way.