Dáil Éireann debate -
Thursday, 26 Oct 2000

Vol. 525 No. 1

Adjournment Debate. - Attention Deficit Disorder.

Mr. Browne

(Carlow-Kilkenny): I am pleased to have an opportunity to raise this issue on the Adjournment because the replies from the Ministers for Health and Children, Education and Science and Justice, Equality and Law Reform on the last occasion were as woolly as I expected, that is, that these issues were the responsibility of the health boards. This is the standard reply to these issues.

Attention deficit disorder and attention deficit hyperactivity disorder might seem strange definitions for those who are not aware of the problem. This was new information for me when a parent of two people who suffer from the disorder briefed me on it. This parent went to Canada and England to do research on the disorder and received very little help in Ireland. When she asked for support here, a consultant psychiatrist said to her, "That cannot be prescribed in Ireland, you should go to England to get it, and anyway most of these people end up in jail." It was not very consoling for a professional to say this to a concerned parent. When one of the people in prison who suffers from this disorder told the psychiatrist there, he said glibly, "Ah, sure we all suffer from ADD." Perhaps he does and perhaps he should not be there at all. Nevertheless this is outrageous and extremely serious because many people end up in jail. The difficulty is that their impulse makes them do things and, until matters are under control, they may break the law.

Where in Ireland can this disorder be treated? As a doctor, I am sure the Minister of State will not read the gobbledygook with which he is provided. Where in Ireland can people who suffer from this serious disorder receive treatment? If treatment is not available in Ireland, will the Minister for Health and Children pay for treatment in England? Patients should not have to go to England or Canada for treatment. Where can this parent find treatment for her family? Excuses will be made that the disorder is difficult to define and have assessed. Some health boards do not want to carry out assessments but tell patients to have assessments done themselves. I got a lot of information on the Internet and it seems there are very clear lines defining whether one suffers from the disorder. It is extremely difficult. Children are given a drug up to the age of 12 and this is where the problem begins. They must receive medical care. It is unfair that people end up in jail and are told to cop themselves on. I hope to receive a realistic answer from the Minister so that I can tell a concerned parent where to get treatment.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I thank the Deputy for raising this issue and regret that the previous reply was not up to standard.

Attention Deficit Disorder, ADD, /Attention Deficit Hyperactivity Disorder, ADHD, is an internationally recognised condition of brain dysfunction. It is a complicated and variable condition with many different presentations. The combination of inattentive, hyperactive and impulsive behaviour is recognised as a disorder when these behaviours are severe, developmentally inappropriate and impair functioning at home or at school. ADD/ADHD was first recognised as recently as the 1980s. Researchers disagree on the exact causes of the disorder. However, there are two aspects of the condition which are more or less agreed upon – it is an inherited condition and the problem of the condition results from a subtle difference in the fine tuning of the brain.

ADD/ADHD is a clinical diagnosis. There is no test for establishing the presence of the condition. The gradient of dysfunctional intensity can vary greatly and it is important to seek evidence of other psychological conditions such as stress disorders and adjustment reactions before a definitive diagnosis and treatment programme may be undertaken. A physical examination is useful in ruling out issues such as hearing problems or neurological conditions.

Until recently most child psychiatrists believed that ADD/ADHD improved in adolescence and disappeared in adulthood. However, more recent research and observation indicates that 25% of children with ADD/ADHD still meet the criteria in early adulthood, dropping to 8% by their late twenties. Sixty per cent of children retain at least one disabling symptom in adulthood. Adults with ADD/ADHD can experience excesses such as over-eating, over-spending and over-working. In the workplace they have often lost workdays and change jobs frequently.

As outlined in the Minister's reply to Deputy Browne's question on 19 October, the diagnosis, assessment and treatment of ADD/ADHD is provided for children by consultant child and adolescent psychiatrists. A working group was established by the Department of Health and Children in June to review the child and adolescent psychiatric services and to finalise a plan for their further development. Among the priority issues being addressed by this group is the need for further development of services for children with ADD/ADHD. An interim report from the group is expected later this year.

As I said earlier, until recently most child psychiatrists believed ADD/ADHD improved in adolescence and disappeared in adulthood. It is important that treatment is maintained, if necessary, into adulthood for those who were diagnosed at school or in early childhood with ADD/ADHD and have been receiving care and treatment throughout their lives in the child and adolescent services. At present adults who present with ADD/ADHD are seen by consultant psychiatrists working within the general psychiatric services. The consultant determines the appropriate treatment, refers patients to appropriate services and prescribes medication if required.

My Department is currently considering whether there may be a case for the further development of the adult psychiatric services in this regard. However, the development of appropriate services for children is the priority and, as I have outlined, that is being addressed by my Department at present. I hope that gives the Deputy some insight into the problem.

Mr. Browne

(Carlow-Kilkenny): Where can I tell this parent to go for treatment?

Dr. Moffatt

The health boards will be able to advise on that.