11 June 2009

ADHD: the tale of one boy and a dog

Liam Creed had a troubled history — until he became a dog-training volunteer and met a rebellious puppy called Aero

Liam Creed is not the most voluble of 17-year-olds. No small talk, speaks to a visitor when spoken to, and in that sense he is entirely normal. Yet for him to spend 90 minutes without swearing, kicking anything or exploding out of the room is considerable progress, and that is the level of calm that I witnessed . As a child Liam was naughty and difficult. He pulled up plants, broke things, scratched cars, was excluded from school and had no friends. He was 8 when a psychiatrist said he had attention deficit hyperactivity disorder (ADHD). Did it make a difference to have an explanation, I ask. “Not really. I just used it as an excuse for everything,” Liam replies with a grin.

This is an honest answer, and gratifyingly off-script. I am talking to Liam because his name is on the cover of a book that charts the story of a 14-year-old boy who has ADHD and has reached the last-chance saloon at school, when he is invited to spend one day a week working for a charity called Canine Partners (www.caninepartners.co.uk), which trains dogs to help disabled people. He meets a lovable and mischievous 14-month-old labrador called Aero and over six months the boy learns to take charge of the dog. In due course, a brilliantly trained Aero bounds off to his new owner, and the boy into the sunset, his ADHD under control and with a dream of working with dogs burning in his heart.

The book is based on an outline provided by Liam and his mum; the saccharine-loaded brush strokes have been crafted by a ghost writer. This is not to underestimate the difficulties that Liam and his parents have faced, and his experiences are instructive. So are his responses because he has a habit of inadvertently putting his finger on the controversy that surrounds ADHD. As often happens with recently medicalised conditions — attention deficit disorder became ADHD in the 1980s and can be treated with drugs — the number of diagnoses has risen rapidly. It is estimated that up to 5 per cent of school-age children have the condition and sceptics regard it as a convenient label for anti-social children who have grown up without structure and can’t pass exams. “I got into trouble a lot, just did things before I thought about them, probably because I wanted attention,” Liam says. “We didn’t know what to do until I was told what I had and was given Ritalin. The head teacher didn’t even believe in ADHD. Before I met Aero I didn’t think I was good at anything. After I met him I was like, I’m doing something with my life.”
Liam’s mum Heidi returns from work in a shop down the road in Chichester. I carry on asking Liam questions but instead of talking to me he looks at Heidi for reassurance, and she begins to answer for him. “I hope you’re aware that sometimes Liam can’t express what he’s feeling,” she says. Certainly she knows him infinitely better than I do, but he talks freely again when she leaves the room. “When I first met Aero he was the same as me because he wasn’t doing anything I was telling him to. We had stuff in common like him being all hyperactive. He was just a rebel. It was fun but scary. After a month I realised I was good at it.”

It was also dawning on Liam that the world was bigger than him, that some people were disabled — and that he could help. By training Aero he was taking on responsibility, I suggest. His face lights up. “Yeah, it felt brilliant. I was in charge. After a month of training, he was doing everything I told him. He would know when he’d done something wrong and he’d stop doing it when I told him. He would keep in eye contact whenever I needed him to.” That must have been a great feeling. “Yeah, ‘cos at school not a lot of people listened to me. Then I got this dog that does what I told him to. That made me feel better about myself. Made me feel I’d got a future. I stopped trying to be naughty, tried to make friends, think about other people rather than myself. When I got annoyed, instead of causing an argument I would just walk away. It was helping me to concentrate rather than just messing about. It made me feel I was wanted. I paid more attention to my work at school because before I was miserable and couldn’t be bothered to do anything. It’s made me more mature.”

What would he be doing if he hadn’t met Aero? “Lying in bed watching TV,” he says. His mum returns. “He would have been drinking and on drugs, I suspect, with the bad boys,” she says. Training Aero taught Liam “a little word called respect,” she adds. “And that to gain respect you have to give it. I’ve always said just because our [three]kids have got ADHD doesn’t mean you’ve been a bad parent. Luckily for my kids I smother them. They’ve had support.”

Liam is focusing on a carpentry course at college and doing well. He does volunteer work at Canine Partners and dreams about owning a dog, and perhaps working with them. He still takes a drug called Concerta. Such long-term use of drugs for ADHD concerns many health professionals; in the last year 573,400 prescriptions have been given for the condition in the UK.

Philip Asherson, Professor of Molecular Psychiatry at the Institute of Psychiatry, defends their use. “While this remains controversial, there are many people who have benefited from the diagnosis, learning about the disorder and finding ways to manage or treat symptoms,” he says. “ADHD tends to have a reduced impact in some as they get older, because people gain more control over their behaviour as they grow up; so I can see a structured task, that is enjoyable and helps with personal responsibility, will help a young person to gain self-control. However, a significant group of people with ADHD have more persistent symptoms that appear to require medication in addition to psychological or self-support strategies.”
When NICE issued guidelines on ADHD last year, it restricted drug use to children aged 5 and over who have severe symptoms. Most children should be offered only psychological therapy, NICE said. Few would disagree — even those who believe that ADHD is a behavioural problem rather than a neurological condition do not deny that the problems associated with the condition exist — though in practice therapy can be hard to find.

Sami Timimi, a consultant child and adolescent psychiatrist and the author of several books on ADHD, is the leading critic of the medicalisation of the condition and argues that ADHD has become an industry. “There is no evidence to back the description of it in mainstream literature as a neurological condition,” he says. “It’s now pretty clear that enthusiasm for ADHD was on the back of some excellent marketing by companies who saw that if they could medicalise behavioural problems in children they could open up a huge market for their drug products.
“There’s also good evidence that stimulants such as Ritalin and Concerta are not associated with benefits in behaviour and are associated with significant risks including growth progression and cardio-vascular problems. The ADHD industry is in jeopardy but market forces mean that habits are hard to break. NICE didn’t have the stomach to challenge that because they were aware that practice in this country would have to radically transform itself, and people don’t have the resources to do that.

“This disorder is about the age-old problem of growing boys and aggressive behaviour. Our ideas about childhood have shifted from seeing duty and responsibility as primary values and towards rights and freedoms. Parents and schools feel constrained in the way they can approach boisterous boys, so [difficult] behaviour tends to become either criminalised or medicalised.” Is training a dog a viable way of responding to an ADHD diagnosis? “It means that he’s going to have to internalise some ideas about self-discipline and follow a routine,” says Timimi. “If he’s enthusiastic, it might make a big difference.”
Andrea Bilbow is the founder of ADDISS, The National Attention Deficit Disorder Information and Support Service (www.addiss.co.uk), and the mother of two children with ADHD. In her experience the key to helping children is to find an activity they enjoy and that they’re good at. “What they need is an interest, a goal — no matter now small — something they can focus on that involves discipline and structure and that has an outcome where they can experience success,” she says. “If they haven’t got the motivation, it isn’t going to work. They also need parents who are going to support them, believe in them. Then it has a really positive effect.”

A Puppy called Aero by Liam Creed is published by Murray General at £14.99 on June 11. To order it for £13.49 inc p&p, call 0845 2712134 or visit booksfirst

What is ADHD?
The core symptoms of ADHD are lack of concentration, hyperactivity and impulsiveness. Children with ADHD commonly have a short attention span, are restless, easily distracted and fidget constantly, though not all children with behaviour problems have ADHD.

The condition may be inherited and some studies have claimed that neurotransmitters — chemicals in the brain that carry messages — and the frontal lobes that control decision-making do not work properly. Other research has suggested that people with ADHD may have imbalances in the levels of noradrenaline and dopamine. Sceptics argue that behavioural problems are learnt or develop because of a lack of structure.
ADHD is most often diagnosed in boys and often leads to underachievement at school, poor social interaction and problems with discipline. It has no effect on intelligence.

It is diagnosed after an assessment by a psychiatrist or a paediatrician. There is no cure, but it can be managed through talking therapies and, in conjunction with these, medication.

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