What would you do if, at 24 months, your daughter slept only two hours a day, started drinking turpentine and threatened to stab her siblings? The chances are, you would follow doctors' orders and put her on medication - though perhaps not so willingly if you watched last night's Panorama programme, which showed the dangers and limitations of giving stimulants to children diagnosed with attention deficit hyperactivity disorder (ADHD).
A decade ago, Janice Hill's toddler was attacking her sister and trying to throw herself over the banister to see if she could fly. The GP mumbled something about "terrible twos", then when she continued to be terrible at three, four and five, he eventually referred her to psychiatric services where she was diagnosed with ADHD and offered methylphenidate, or MPH (commonly known as Ritalin). But Janice did not want her child on stimulant medication. Her eldest son's lactose intolerance had made her aware of the role of nutrition in controlling difficult behaviour. So she set about monitoring her daughter's diet.
She sent blood samples to laboratories and consulted biochemists. The girl was deficient in various vitamins and minerals (B6 and zinc), essential fatty oils, and hydrochloric acid - so sugary cola drinks and artificial additives were eliminated from her diet, and supplements were added. But Janice's child, it turned out, was also poisoned. She had been exposed to organophosphates in sheep dip and also to lead, from the water pipes in the farm where the family used to live.
It was an uphill struggle, but Janice cured her daughter. She did it defiantly, because she resented the doctors who labelled without looking into causes: "No one ever examined her or asked about her medical history. If it hadn't been for my experiences with my eldest son's diet, I hate to think where my daughter would be now." She also learned better parenting skills: to be more patient through the difficult times. Janice now runs the Scottish mental health charity Overload, which is suing various NHS trusts on behalf of 34 parents whose children suffered adverse side effects on psychotropic medication.
It is believed that up to 10% of children with an ADHD diagnosis can recover on a managed diet. In the UK, the Hyperactive Children's Support Group offers advice on diet and nutrition - so no parent needs to go it alone as Janice did. But for the remaining 90%, diet isn't the answer.
And that's the difficulty of ADHD: it isn't easy to pin down. For some, diet, acupuncture, neurofeedback, osteopathy or homoeopathy can be the answer. For others, not. To focus too much on the physical aspect (specifically the unsubstantiated genetic hypothesis) can be to overlook emotional triggers. This means missing an opportunity to release the child from his or her distress, and a possible lifetime of medication.
Take babies: they cannot verbalise anything, so very few parents realise how much babies feel. Closely observed, however, they show signs of terror and depression when abandoned or subjected to violent events. It's ironic that their emotions are least apparent in what may well be their most formative years.
David, for instance, was two when his mother was beaten by her husband. She remarried, and circumstances changed for the better. Still, David grew into a difficult, hyperactive adolescent. Their GP prescribed medication and psychotherapy. But it wasn't just David who had to change. His parents had to consider his behaviour as something meaningful in itself, rather than the mere outcome of what may or may not have been his genetic predisposition for ADHD. This involved coming to terms with the painful details of the mother's first marriage, and revising their view that "babies don't notice".
Under such emotionally charged conditions, the attraction of the "brain disorder" theory can be hard for parents to resist, especially as stimulant medication often has a dramatic effect - at least in the short term. But the trauma that underpinned David's hyperactivity had to be acknowledged if David was ever to be properly helped. And he needed help: his own hyperactivity so frightened him that, unusually, he requested medication to control himself. Psychotherapy helped him see that his ADHD expressed a constant wariness, a feeling of being on edge. He realised he didn't need to be that way any more.
Children like David who receive emotional or behavioural support can come off medication, under close professional supervision. Dr Steve Baldwin, director of clinical and counselling training units (Cactus) at the University of Teesside, uses behavioural self-control training (BSCT) to cure ADHD-style behaviour. "If the drug is withdrawn too suddenly, you can get 'rebound'. The carer imagines that this spiking of behaviour is the ADHD resurfacing, when in fact the child is showing normal drug withdrawal symptoms."
When a child bullies others children, or disrupts classes, parents can feel tremendous pressure to medicate. But a behavioural therapist like Baldwin can teach the child self- control, by working closely with the parents to encourage appropriate behaviour whilst discouraging disruptive outbursts. After a few weeks, the child learns to behave, and the effect is usually long-lasting.
Sometimes a resolution can be found just by withdrawing drug treatment, because stimulants themselves can cause disruption. Eleven-year old Mark, for instance, was given medication for ADHD. Initially, he improved, but after a few weeks, he started to relapse, fighting with his younger sister and displaying aggression which Baldwin recognised as a common side-effect of amphetamine-style drugs prescribed for ADHD. "Before medication, Mark had developmental, growing-up type problems. One teacher reported he couldn't concentrate, the other said he was one of the best in class. He was moved to the front of the class, and his behaviour returned to normal. There was no reason to medicate him."
One of Baldwin's concerns is to make a correct assessment. "Children can be misdiagnosed with ADHD because it suits the needs of busy professionals, when in fact the children may have a developmental problem or a specific learning disability. Some have epilepsy. Others have poor eyesight or bad hearing. If you give them stimulants, you can create a new problem." Baldwin has seen many children think, on one hand, that they need the drug to control their behaviour and yet blame the drug for the way they act. "They say, 'It's not me, it's the drug.' That makes it harder for them to take responsibility."
• Usefull sources:
On the web: The Santa website www.SANTA.inUK.com has information on drug-free solutions.
In print: Ritalin Nation by Richard DeGrandpre is published by W W Norton & Co and its paperback edition will be available from May (£9.95). Further info: contact Overload on 0131 555 4967 or write to the Hyperactive Children's Support Group at 71 Whyke Lane, Chichester, Sussex PO19 2LD.
