adhd and its impact on family life

8/7/2019 ADHD and Its Impact on Family Life.

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ADHD and itAs a mother of four children, three o f wh om havbeen diagnosed with ADHD, there's not much tha

Debbie Dean doesn't know about this disorder. Here describes wh at life has been like and dispels a few m

along the way. Introduction by Stephan KirbyIntroductionThis paper probably di ffers from others in this journal, in that i t was original ly submitted by DebbDean as an assignment for a third-year module during her mental heaith nurse training. Theassignment was highly commended by the assessing academics, and was recorded and rewardeas such. Now w e kn ow that th is goes aga inst convent ion for such journa ls but the content o f thassignment was so un ique that I fe l t i t warran ted prom ot ion.

W hat m akes i t unique is that Debbie is one of those rare people; a mo ther and a mature studnurse. Not hing un ique or rare in tha t, you may say, but wh en you consider that the burde n ofunde rtaking men tal health nurse trainin g alone is highly stressful but ad ded to this is the stress oa mother to four chi ldren (one daughter and three sons) - and her three sons have been ai l diagwi th a t tent ion def ic i t hyperar t ive d isorder (ADHD).

This article is an abridged version of tha t assignmen t and i t has been edited to c onfo rm topubl ication requirements but we hope that we have managed to retain the sense of poignancy capture d the ima ginatio n of the assessing academics wi th i ts wa rm th and huma nity. W e have dto reduce the cri t ical analysis of ADHD which formed a basis for the more personal element of thoriginal assignment, to a del iberately brief explanatory section - preferring to leave the focus of article as 'Debbie's tale '.

As a precursor to this article being pre pared for p ubl icatio n, Debbie's family - especial ly her c- were con sulted and al l gave their permission for us to progress wit h this.

We hope, in this - the unfolding story of Debbie's family l i fe - that the reader shares and appnot only the pain and agonies faced by both her and her family, but aiso the love and warmth thunderpins l i fe and supports and carries them through the hard times.

Stephan Kirby MSc, PgC(LST). Dip MDO. RMN.senior lecturer (forensic me ntal health), S chool of Health and Social Care,University of Teesside, Middlesbrough. Cleveland

keywords> carers> children, behaviour> family centred care

ADHD: a definitionGreen and Chee (1997) state that: Atte ntion d isorder (ADD) and At ten t ion def ic i t hyper


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A DHD is one o f the most co mm on d iso rde rs o fchild hoo d and adolescence {Guevara 2001). It is acomplex prob lem, as there are various types and thecond ition may include language and learning problems. In afew children it co-exists with one of two serious psychiatricdisorders, e ither opposit ional defiant d isorder (ODD) orcondu ct disorder (CD) (Dalsgaard ef a/2 002 ). This can causeimmense disruption in an already disturb ed life created by theADHD. ODD has been described as being the developmentalprecursor of CD (An gold and C ostello 2001).In everyday life, people often describe children wh o become

The causes of A DHD are said to differ; however, t w o causesare often discussed as the main cause of ADHD. The firstis said to be genetic. Researchers such as Green and Chee(1997) have shown in twin studies that i f one identicaltwin has ADHD there is a 90 per cent chance that the otheridentical twin wil l have ADHD, It has also been observedthat the parents of children diagnosed wi th A DHD w ere alsoinattentive and often in trouble during their school days,frequently stigmatised as a 'naughty chi ld'.

Second, and more controversially, there is the theory thatADHD could be caused by 'bad parenting'; however, this isa misconception perpetuated by the media. Regularly, themedia imply that ADHD is a trendy diagnosis imported fromnorth America to excuse a modern epidemic of appall ingbehaviour among chi ldren who have not been parentedproperly (Hart 2003). This idea is, in reality, not feasible, asnot al l chi ldren with ADHD come from unstable and dys-functional famil ies. Know ing this can alleviate any burdena parent may feel - no matter what family l i fe is l ike, thechild would sti ll have ADH D. Unfortunately, i t appears tha tas more is know n a bout A DHD , there is an equal increase inthe number of children being diagnosed, placing increasedburdens on families and professionals.

Living with ADHDLiving with ADHD can be equally frustrating for the chi ldand parents- Ch i ld ren wi th ADHD are o f ten labe l led as'd i f f icu l t ' wh ic h is annoying fo r bo th part ies concerned.Greer (2003) reminds us that chi ldren wit h undiagnose dADHD are generally misunderstood and experience failureat every t u rn . But this can also be the case after d iagnosis,as many people believe that once the child is on med ication(invariably R italin) all sym ptom s w ill instantly, miraculously,cease; if they don't then it must be the child being 'nau ghty 'deliberately

Unfor tunate ly, ra re ly does medica t ion work in such afantastic way. It does assist in increasing attention andreducing the impulsivity but it does not eliminate all of thesymptoms. C hildren with ADHD find it extremely difficult tocomplete 'ordinary' everyday tasks with accuracy, they areconstantly losing things, are late for school, and can forgetsimple instructions if more tha n one th ing is requested. Thisbehaviour impacts on family, school and social life. In thehome environment families can experience more negativityin their social life (Kendall et al 2003).

As previously stated, I am a mothe r of fou r c hi ldren, threeof whom (the boys) are diagnosed with ADHD. Although Iam n ot an expert on ADH D I can explain how it affects thefamily structure; for life with children diagnosed with ADHDIS anybody's w ors t n ig htm are. Hom e l i fe has to be veryorganised to the point that it's more like a military regimerather than a relaxed, homely atmos phere.


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D ebb i e D ean a n dher three sonsCorey (i n blazer ) ,Josh (midd le) ,S h a w n , (i nf o o t b a l l t o p )

(a 100-mile ro und trip) just to collect prescriptions.Over the years I have noticed a massive rise in the numberof children diagnosed with ADHD, including my twin boys,wh o were diagnosed at the age of six. It was acl


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ADHD is forgetfulness. Frequently,is, 'Have they had their lunchtime medication?' Allsee the situation improving. If the school does no te the importance of medication and therefore seek the

school, and, ultimately, the parentse to deal with the situations that are likely to arise fromI can fully understand tha t teachers are busy, but simplyng the afternoon medication to one of their pupils wouldeviate a host of problems. This would be better for theas he or she wou ld be more settled, and the teachers,this could help prevent any major disturbances that theywith.I have encountered w ith th e educationem is an apparent unwillingness to complete assess-

o other professionals that they cannot cope.atising w ith children w ith ADH De social side of life with children w ith ADHD is extremely

y excitable and when outside of their normal and safebecome more hyperactive and extremely boister-Sometimes this is embarrassing,ately worn out.e outside the home often stare

e been heard on more than oneon to say, 'I wou ld give him a

t to be unable to controlchild. However, if I am feelingworn down I am temptedtell them to simply mind their ownarequite often put on

a major impaa on my daughter:of my time has to go to the boys. Throughou thool life my daughter has had to take frequent timeng quality time w ith me without the boys takingr. She rarely had her friends round to the house when

ly if there were other people around. She frequen tly

a challenge just to try andso that she could get on with her homework.

'People outside the hom eoften stare when the boysare "playing up" and havebeen heard on m ore than one

occasion to say "I would givehim a hard slap if he were

mine". This is very annoyingand leaves parents feelinginadequate because they

are thought to be unable tocontrol their child.'

now 15, has decided that he no longer wants to takeRitalin - so he doesn't. His (child) psychologist feels heis old enough to decide what he wants and, just becausewe are his parents, we can't force him. I did tell the psy-chologist that I would be willing to 'shove them down histhroat', but unfortunately he said this was not allowed.Something feels amiss when parents do not have a sayin what they want for the child, especially when they arethe ones who have to put up with the ensuing chaos andare left to pick up the pieces. As parents we want him tocontinue with the medication; it is just unfortunate thatwe can do nothing about it.Treatment options?Contrary to what the literature says about 'multimodaltherapy being the winning com bination' my children havenever once been offered any form of therapy other thanmedication. Do we not get these therapies because we iivein the wrong area? Is it a postcode lottery? We have beentold that the only effective direction to take with ADHD ismedication, unfortunately the m edication alone is just notcutt ing it- Similarly, we have never had any form o f supportfrom any outside agencies and this just reinforces my feelingthat, in general, the majority of professionals do not reallycare, it is just a job to them and they can go home to their'normal' lives. I really doubt if they, for all their qualificationsand knowledge, can really begin to understand what it islike to live in a household w ith onechild with ADHD, let alone threechildren.

Looking on the bright sideI suppose on the plus side the hyper-activity does tend to decrease as thechild gets older, as it has now wit hmy eldest son. Unfortunately hischallenging behaviour is becomingmore of an issue; and after readingthe literature around ADHD I nowwonder if he has developed ODD.His behaviour fits the symptoms ofODD exactly: he always says 'no ' asa matter of pnnciple; he constantlychallenges anything he has beentold; he regularly argues that blackis white; is immensely annoying, andis never to blame for any thing - itis always someone else's fault. It'sas if he waits for me to draw the line so he can, at worse,rub it out, or, at best, simply jump over it. The possibilityof my son having ODD could also account for the fact thatthe medication is not as effective as it should be. So wehave yet more questions for the child psychiatrist, not thatit particularly matters, as there is no medication or othertreatments for this disorder. But ch ildren are supposed togrow out of it (yippee!)-

The main dilemma fo r parents with children diagnosedwith ADHD is that the parents often have to cope withso much hassle, torment and upset (caused either inno-cently or otherwise) by the child that they can becomecomplacent in ma intaining a consistent approach to

ReferencesAngold A, Costello EJ (2The epidemiology of

disorders of conduct:nosological issues andcomorbJdJty. In: Hill J,Maughan B (Eds) CoDisorders in Childhoan d Adolescence.Cambridge, CambridgUniversity Press.

Ball C (2001) Attention-deficit hyperactivitydisorder and the useof methylphenidate.Psychiatric Bulletin 2304-306.

Dalsgaard Sefa/(2002)Conduct problems,gender and adultpsychiatric outcome ochildren with a ttentiodeficit hyperactivitydisorder. Bntish JournPsychiatry. 181,416

Greer JE (2003) ADHD-separating fact fromfiction. The ExceptioParent. 33, 11.

Green C, Chee K (1997)Understanding ADHDLondon. Ebury Press.

Guevara JP (2001) Evidebased managementof attention deficithyperactivity disorder.British MedicalJourn323, 1232-1235.

Hart D (2003) Childrenwith ADHD spendlonger playing compugames. New researchfinds excessive butimpoverished 'media chosen by children wiADHD.http://vwvw.rcpsych apress/preleases/pr/pr_htm (Last accessed: M4 2004)

Kendall Je( a/(2003 )Children's accountsof attention deficit/


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adhd and its impact on family life

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