Short abstract
BBC 2, 3 February at 9 pm
Rating: ★★★
When I see a child with a disability or behaviour problem I know that I see them for 30 minutes and then move on to the next patient. The parents cannot move on. This programme showed some of what parents of children with attention-deficit hyperactivity disorder (ADHD) have to put up with.
As cameras followed two families for six months the parents told their experiences without interruption from an interviewer. The viewer saw some of the day to day behaviour of children with ADHD and the parents' feelings of frustration, impotence, anger, and guilt. There was sensible information about what ADHD is; co-morbidities such as dyslexia and oppositional defiant disorder; the genetics and neurobiology of ADHD; and methylphenidate, which for once was not demonised as a chemical cosh. It would have been helpful to see the children's behaviour in school.
Liam was a runner and a climber. He clearly had ADHD and oppositional defiant behaviour. Initially it was tempting to wonder which came first—his defiant behaviour or his parents' frequent (ineffective) efforts telling him to behave.
One could see why parents of children like this smack them or worse. Liam's mother admitted to being at the end of her tether and clearly felt guilty that she disliked her child. She admitted that if she disliked an adult that much she would have nothing to do with them. But she also recognised Liam's good qualities.
Figure 1.
Liam: a runner and a climber
Credit: BBC
Liam's behaviour at home, in a multistorey car park, and when shopping was a good picture of a child with ADHD. When the local ADHD assessment team gave the diagnosis, the parents were relieved. They found strength in that and opted for the moment not to give Liam medication. They have been offered special behaviour classes.
James and Jasmine were two siblings with ADHD. Their mother, who was doing a grand job as a single parent, realised she had had ADHD as a child and still had it. All three of them were on methylphenidate. On Jasmine's first day at secondary school the household was in chaos and mum forgot to give everyone their methylphenidate. We saw the deterioration in behaviour when a dose was missed. A psychologist worked with the mother on behaviour management—tokens and rewards for the children; and a timetable and structure to the mother's day, all of which seemed to help.
The shortage of child psychiatrists in the United Kingdom will not be resolved in the next decade, so most ADHD will continue to be diagnosed and treated by community paediatricians, often without the ideal package of behaviour support as well. I will use some parts of the video of this programme to give trainees an insight into ADHD outside the clinic.