Changing Lanes ADHD project
The inventor Thomas Edison was said to have had it and Gordon Brown, one of Scotland's most highly qualified mental health nurses, reckons that Phoebe Buffet, the scatty character from the 'Friends' TV series, also shows signs of Attention Deficit Hyperactivity Disorder (ADHD). ADHD is a condition which is believed to affect between three to five per cent of the population and is most apparent in school-aged children.
Gordon is head of an ADHD project for young people in Falkirk called Changing Lanes, which he developed because there was a gap in the schools' intervention part of the service. Gordon explains:
'Prior to the Changing Lanes project, which we set up in 2003, our existing ADHD service for young people in Falkirk was very good at asking parents if there were any problems the condition was causing their children at school but it wasn't particularly good at doing anything about it if there were any.
'We applied for funding and put together this service which is staffed by me three days a week, a full-time psychology assistant and a half-time teacher who covers all primary and secondary schools in Falkirk.'
Changing Lanes is unique, certainly in Scotland, for a number of reasons. Firstly, Gordon Brown's qualifications and experience in the general field of child and adolescent mental health, and in ADHD in particular, means the project is the only one of its kind to be led by a nurse rather than a psychiatrist. In Falkirk, he is responsible for the assessment, diagnosis and treatment of ADHD which lightens the work load for the area's psychiatrists and means young people who may have other more severe and complex conditions can be seen and helped more quickly.
Secondly, Changing Lanes is that rare thing: a 'joined-up' ADHD service combining clinic, home and school-based interventions. Says Gordon:
'Before we developed the Changing Lanes programme, teachers who suspected a pupil might have ADHD would prompt parents to go to their GP and get a referral. Typically, parents would tell the GP that there was a problem at school but they weren't sure what it was. The GP would contact us, still with very little information about the problem.
'I spoke to the GPs and asked if there was some way we could make the referral process run more smoothly. The result is, we drew up a questionnaire that teachers fill in along with the parents, highlighting the difficulties they've been seeing in the classroom. It's signed by both parties and taken along to the GP.'
Signs and symptoms
Once a referral has been taken up by the Changing Lanes team, and with the parent's permission, a Changing Lanes assessment pro forma and a more detailed questionnaire are sent to the pupil's school along with a request for copies of the pupil's school reports from P1, P2 and P3. Gordon explains:
'Because ADHD is a neuro-developmental disorder, there will have been signs and symptoms of it prior to the age of 7. But often not the ones you might expect. Typically, the language a teacher might use in a P1 report will be along the lines of: 'John is a bright, bubbly, effervescent child. He's the life and soul of the classroom. He makes us all laugh and brightens up our day. He has a very sunny disposition.'
'In P1, that sounds very positive but if he's still like that in P4 and not doing any work, the language of the report changes, with the pupil being described as 'disruptive' and 'deliberately setting out to annoy others'.'
The Changing Lanes assessment process can include a school observation to see how a child behaves in the classroom, in the run-up to playtime, in the playground and back in the classroom after break. Says Gordon:
'A child who is hyperactive is often the first to get his jacket on, the first out of the class and the last in after break. In the playground, they can be running around aimlessly and will have difficulty settling back into classwork afterwards.'
Helping children with ADHD
If a diagnosis of ADHD is made as a result of the assessment, a written report is sent to the GP, the parents and the school followed by a meeting with the Changing Lanes team, where strategies will be discussed aimed at helping the young person manage the condition and improve their learning.
Eileen McGinlay, the Changing Lanes teacher, usually makes a follow-up visit to the school to observe specific difficulties in the classroom and advise on ways to help deal with them.
The Changing Lanes project already includes a five-week programme called 'Parent INC'. This programme is for parents of children who have been diagnosed with ADHD, where they learn more about the condition, how to manage the symptoms, how to help their children develop socially and physically and how to manage the more challenging aspects of their children's behaviour.
Now Gordon Brown is considering developing a standard training package for teachers where they can learn how to manage children with ADHD effectively, both in terms of symptoms and helping pupils access the curriculum more fully. He says:
'Currently, we go into schools and hold seminars and workshops on how to identify children who may have ADHD, because all the research is showing that outcomes for a good life are better with early intervention.
'It's still a common misconception, even amongst teachers, that children with ADHD misbehave all the time, are extremely hyperactive and never sit still. That may be the case for children with hyperactive subtype ADHD but not for those with inattentive subtype ADHD, who can be very amenable and friendly. But if you're inattentive, you're not absorbing - you're not learning.'
Girls are more likely to have inattentive-type ADHD, which is one of the reasons why, Gordon believes, far fewer girls than boys are diagnosed with the disorder.
'Phoebe from the 'Friends' TV series is an adult who displays symptoms of inattentive ADHD,' he says. 'She's a bit disorganised and doesn't really take in a lot of what's going on around her. But she's learned to manage the condition.
'There are a lot of girls in school who are inattentive, easily distracted, can't concentrate, can't focus, can't learn . . . but they're very nice. Teachers will say: 'She's a lovely girl!' They worry about sticking them with the ADHD 'label' but ignoring the problem, or playing it down, is not doing these children any favours.'
Although research has shown that best practice for the treatment of ADHD is a combination of medicine, school interventions and behaviour interventions, it's the medication aspect that, according to Gordon Brown, some teachers have a problem with. He says:
'Medication is not always our first line of treatment but when it is used, the effect can be instantaneous and very positive. Teachers who have been used to seeing a hyperactive child, sometimes for years, suddenly see them more settled and able to attend. They worry that they've been 'zombified' or sedated. What I tell them is: 'You need to compare them to the rest of the class, not to what they were like yesterday. If they now seem the same as everyone else, then the medicine is working - it's doing its job.'
If given increased resources, Gordon Brown would like to see the Changing Lanes service rolled out across the whole of the Forth Valley area. He says: 'I'm pleased that more young people are getting help as a result of what we're doing but we're really just scratching the surface. There are a lot more out there who are not getting the help they need.'
Changing Lanes will soon be launching 'The Distractibles' - a group for adolescents with ADHD.
Further information
A short, easy-to-read guide to ADHD is available from the Changing Lanes Project. Contact details:
Changing Lanes
The Manor
Brown Street
Camelon
Falkirk
FK1 4PX
Tel: 01324 610846
ADHD websites
Useful websites include:
National Attention Deficit Disorder Information and Support Service (ADDISS)