JOHN NAISH - THE TIMES - DOES HAVING A LABEL FOR ADHD HELP?

"Youthful exuberance" (Normality) or "Impulsive" (Mental Health Label)

Does labelling children with behavioural problems such as ADHD help?

   John Naish
February 16 2009 12:00AM

Does having a clutch of acronyms after their names help or hinder children with multiple behaviour problems?

When Lisa Jordan’s son Daniel began experiencing social problems at play group, a specialist concluded that the boy was suffering from an autistic spectrum disorder (ASD). At 7, his behavioural difficulties led him to a paediatrician, who diagnosed attention deficit hyperactivity disorder (ADHD).

Now 10, Daniels suffers long, wakeful nights and serious tantrums. Health professionals have suggested that he also has sleep disorder (SD) and oppositional defiant disorder (ODD). Daniel is an “alphabet kid”, one of a growing population of British children with a trail of diagnostic letters after their names. But does a clutch of acronyms help or hinder?

No central figures are held on the number of children in Britain with mixed behavioural diagnoses, but Colin Troy, a Lancashire-based educationalist who has worked with children with special needs for 30 years, says: “They have been around for some time and are definitely on the increase. It used to be thought that you could not have a student with conditions such as Asperger’s and ADHD overlapping, but that belief has completely changed.” Indeed, a recent report in the Journal of Autism and Developmental Disorders found that half of the children with autism studied also had hyperactivity symptoms.

Research in the Journal of the American Academy of Child and Adolescent Psychiatry found that ADHD often occurs alongside disorders such as ODD and conduct disorder. Another study, led by Simon Baron Cohen, a professor of developmental psychopathology at the University of Cambridge, found that children with autism have a raised risk of Tourette’s syndrome.

Robbie Woliver, the American author of the recently published book Alphabet Kids: From ADD to Zellweger Syndrome, claims that millions of children in the US (including two of his own) are “plagued by clusters of disorders”. The numbers are rising, he says, “because of growing awareness, ongoing strides in research and improved diagnosis techniques. And because so many alphabet kids are just beginning to be included in published studies, the rates will rise even more dramatically.”

In Britain, the Department of Health cites 2004 research indicating that one child in ten has at least one clinically diagnosable mental disorder. But the figures seem to be rising fast. For example, a report last July produced by Wandsworth Primary Health Care Trust in Southwest London revealed that cases of autism in its area had risen from 161 in 2001 to 448 in 2007. Countless others are on the fringes of the diagnosis, according to a study last month by the UK’s Institute of Child Health in the Journal of the American Academy of Child and Adolescent Psychiatry. Professor David Skuse, one of the researchers involved, says that many children exhibit elevated levels of autistic traits, and that “our research suggests that these children are at slightly greater risk of developing behavioural and emotional problems”.

Lisa Jordan, who lives in Southeast London and cares full time for her son, hopes that growing awareness of multiple behavioural conditions could help to reduce some of the stigma that she feels is associated with her situation. “A lot of professionals are supportive and interested, but I definitely get the impression that others think I’ve been out shopping for Daniel’s diagnoses because I’m either needy or neurotic.”

But Colin Troy, who has worked as a head teacher at two special schools, says that there can be pitfalls in multiple diagnoses: “The difficulty for the parents is that it can be very confusing. They may see one professional who has a bee in his or her bonnet at the time about a certain condition, and will say that’s what the child has got. Then the parents will see another specialist and are given another diagnosis, and so on.

“As more and more children develop these overlapping conditions, new spectrum disorders are turning up, such as ‘sensory interpretation dysfunction’ and ‘pathological avoidance dysfunction’.

“The argument against multiple labels is that we are offering lots of medical excuses for children’s behaviour, because they have 16 letters behind their names. I work with parents, health professionals and teachers. “I tell them, ‘Never mind the labels’. These children are people first, then they are these characteristics. Sometimes when talking to groups, I literally cover myself with sticky labels to reinforce the point.”