Slipping through the net

Schools are failing to detect a large number of pupils suffering from Attention Deficit Hyperactivity Disorder, claims the ADHD family support group in Malta.

ADHD causes symptoms such as severe restlessness, extremely impulsive behaviour and very poor concentration, and as a result often leads to learning difficulties.

If sufferers are not diagnosed and treated early enough in life, they could develop serious psychological and social problems that last a lifetime. (See box for more details).

There are no statistics available on ADHD in Malta, but internationally it is known to affect between three and five per cent of all children - at least one child in every classroom. However, far fewer Maltese children than this are being identified as needing help for the disorder, the support group holds.

The Education Psychology Unit of the Education Division said the lack of statistics meant it was not possible to confirm or disprove the claim.

"We regularly have children referred to this unit and identified as having ADHD," said Natasha Barthet, an educational psychologist.

Tessa Anastasi, a member of the support group's executive committee, explained that at about five years of age, children with ADHD start to have difficulties with settling down to school and learning properly.

"At about seven they will have fallen behind in the learning curve, and their symptoms become easier to detect. But nowhere near the three to five per cent are being picked up," she insisted.

"The undiagnosed children are likely to end up in the lower streams, even though they may be intelligent enough not to. Most will fail to get enough 'O' levels to enter sixth form, and there are only a handful of ADHD sufferers at university."

A child is identified as suffering from ADHD following a psychological and educational assessment that includes interviews with parents and teachers on the history and development of the difficulties, as well as psychometric testing and observations.

Those diagnosed are given support, said Ms Barthet. A facilitator is sometimes provided, while the parents and teachers are shown how to manage the behaviour. In some cases, the child is referred to a child psychiatrist and possibly put on medication. Special arrangements can also be made for ADHD sufferers to be given assistance and concessions in the exams.

At least, this is the case for state schools. Church and independent schools vary in the extent to which they provide such a service, with only some, for example, employing special needs coordinators.

Ms Anastasi said the support being offered was not enough: "Proper courses should be run to help parents develop the necessary skills to work with their ADHD children, and similar sessions organised for the siblings, who also suffer."

The group also sees as a major drawback the fact that teachers are not allowed to administer any medication; certain drugs are effective in reducing ADHD-induced behaviour.

Changes in the law are needed to permit teachers to administer medicine - even something as simple as an aspirin - and recommendations to this effect have been submitted to the authorities.

Why, if the group's claim is true, are many ADHD students slipping through the net?

The group holds that many teachers are not well-enough informed about ADHD to be able to detect it in their pupils; they are not given enough information as trainee teachers and neither through in-service training.

"They should also have a resource centre that would enable them to learn more about this and other learning difficulties," Ms Anastasi said.

"There are techniques of dealing with ADHD children in the classroom, and teachers should know how to use them. A facilitator should only be necessary in extreme cases."

Parents share some of the responsibility too, she added. Many were ignorant of the existence of such a disorder, and might dismiss the symptoms as simply those of a difficult child. Others, she said, were reluctant to go to a psychologist, even when this is suggested by a teacher, due to the stigma still attached to any form of 'disability'.

In some cases, parents with an only child may just about be able to keep the behaviour in check, without knowing its cause, but this could mean a child with good potential merely getting mediocre marks and a mediocre job later in life - to say nothing of suffering the psychological problems.

ADHD

People with ADHD are commonly unable to sit still, plan ahead, complete tasks or be fully aware of what is happening around them. To other people they may seem to exist in a whirlwind of disorganised or frenzied activity.

ADHD can involve three major groups of symptoms:

1. Inattention

¤ Inability to stay focused long enough to finish a task.

¤ Shifts from one activity to another excessively.

¤ Tends to drift.

¤ Tends to lose place e.g. in reading.

¤ Has difficulty in following directions.

¤ Distracted by other stimuli in the room.

2. Impulsivity

¤ Inability to regulate emotions and behaviour.

¤ Does things unthinkingly.

¤ Acts quickly without giving sufficient forethought to consequence of their action.

¤ Characterised by spur of the moment decision making.

¤ Rushes through a task so makes careless errors.

¤ Social impulsivity.

3. Hyperactivity

¤ Restlessness.

¤ Fidgeting.

¤ 'As if driven by a motor'.

If not managed properly, the effect on the classroom is disruptive and may include challenging, aggressive or impulsive behaviour.

Among the possible consequences of late diagnosis are learning difficulties, conduct problems, emotional and socialisation difficulties, low self-esteem, school refusal and depression.

One mother recounts the experience of a boy with ADHD. His name has been changed:

"David was extremely naughty from very young. By 10 a.m., from the age of five, he would be sent round the track at school to get rid of some of his excess energy. His marks were always very average and his reports always said "very inattentive".

"He failed badly in his mid-yearly exams when he was in Form One (in a private school). I found out that all his project books were empty and I stormed to the school demanding to know what they were doing. Why weren't they following him up? Why had they let him down so badly? By this time his self-esteem had reached rock bottom.

"One day I happened to hear a member of the ADHD support group speaking on radio about the symptoms, and my ears practically stuck to the radio. She could well have been talking about my son.

"We took David to a psychologist, and although tests showed he was of normal intelligence, my suspicions were confirmed and a diagnosis made. That was when the school got moving a little. They provided him with some extra tuition, but he still missed out on a lot of subjects.

"He was advised to drop Maltese and he did. It was the biggest mistake we could have made. He is now in sixth form, and without Maltese he won't be able to get into university.

"Hopefully, things might change for other children with the new national curriculum, and the emphasis it places on ongoing performance records. That way they might be able to pick up learning difficulties much earlier than was the case with my son."

The ADHD Family Support Group (Malta) is open to sufferers, their families and any interested persons. Meetings are held every second Friday of the month at 6.30 p.m. at the Junior College in Msida. During the meetings, personal and social education sessions are held for children over seven, while younger children are supervised by a child minder. For more information please phone 99805789 or 79868840. Or email nastas@waldonet.net.mt