I welcome the Minister for Health and Children, Deputy Martin, and congratulate him on his appointment. I wish him every success in his new office.
Attention Deficit Disorder Report: Statements.
I welcome this opportunity to make a statement to the Seanad on attention deficit disorder and attention deficit hyperactivity disorder. I am aware that some Senators were members of the Joint Committee on Health and Children which published the report on attention deficit disorder in Ireland in April 1999. The primary aims of that report were to establish the need for new services, determine the level of services – medical, psychological and educational – throughout the country, and to investigate the extent of expertise in these services available for children and adults with ADHD. The study carried out by the committee had a number of objectives encompassing both the health and education services. These objectives varied from the needs of families with per sons suffering from ADHD to the qualifications of those likely to encounter persons suffering from the condition, such as teachers and general practitioners. These core objectives formed the basis of the recommendations of the report.
Attention deficit disorder and attention deficit hyperactivity disorder were first recognised in the 1980s. Researchers disagree on the exact causes of the disorders. However, there are two aspects of the conditions which are more or less agreed upon: that it is an inherited condition and that the problem of the condition results from a subtle difference in the fine tuning of the brain. 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 in children is recognised as a disorder when these behaviours are severe, developmentally inappropriate and impair functioning at home or at school. The numbers presenting to the health boards who require medical care would indicate that the prevalence rate is in line with the international norms at approximately 1% to 3% of the child population, and is based on criteria for the disorder contained in the ICD, the International Classification of Diseases.
ADHD is a clinical diagnosis and there is no test for establishing the presence of the condition. As I have pointed, out 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. Co-morbidity is present in as many as two-thirds of referred children with ADHD who may also have conduct disorder, mood disorder, anxiety disorder and substance abuse in adolescence.
Nevertheless, the numbers presenting to the health service may not be representative of the level of children presenting with ADHD-like symptoms. Child psychiatrist teams are fully capable of differentiating the child who has a neurophysiological problem from the child whose restlessness is due to anxiety and, therefore, assessing whether medication is the preferred form of treatment or whether it may have more of an environmental cause, such as parent disharmony or bullying. It is crucial, therefore, that the role of the educational sector is properly recognised with teachers being provided with the necessary skills in identifying a child under stress.
The diagnosis, assessment and treatment of attention deficit disorder and attention deficit hyperactivity disorder normally comes within the remit of the child and adolescent psychiatric services in each health board. The development of a comprehensive child and adolescent psychiatric service in each health board area has been identified as a priority in my Department's health strategy – Shaping a Healthier Future. Each of the health boards now has a dedicated, multi-disciplinary child and adolescent psychiatric service led by a consultant child and adolescent psychiatrist. These multi-disciplinary teams would primarily consist of registrars in child and adolescent psychiatry, clinical psychologists, occupational therapists, speech and language therapists and social workers.
Shaping a Healthier Future also recognises the important role of the voluntary sector in the provision of health and social services. It acknowledged the position which local support groups have to play in many instances of identifying needs in the community and in developing responses to them. As to the level of funding available for support groups for children suffering from ADD and ADHD, I am aware that some health boards have already provided financial assistance to support groups operating in their respective functional areas. I understand that a number of health boards are in direct consultation with local support groups to discuss their needs, including funding requirements and what role the groups might have in the future development of services. These consultations will strengthen links between health boards and local support groups, thereby securing an efficient and effective use of resources to respond to patient needs.
A draft policy document for the further development of child and adolescent psychiatric services has been completed by Dr. Paul McCarthy, clinical director of child and adolescent psychiatric services in the Eastern Health Board and adviser to my Department on child and adolescent psychiatric service policy. The draft development plan, which was circulated to all health boards for comments, includes consideration of the specific needs of children and adolescents with attention deficit disorder and attention deficit hyperactivity disorder. The views of the health boards are currently being considered and a final report is in preparation. In the meantime, additional revenue resources of approximately £3 million have been provided since 1998 to enable improvements in multi-disciplinary teams to be undertaken in the child and adolescent services including the development of services for children suffering from attention deficit disorder and attention deficit hyperactivity disorder. It is intended that these services will continue to be developed in the next few years as resources permit.
It is important to ensure that a national strategy is put in place to ensure that overall services in this area are provided in a consistent and co-ordinated manner. To this end, I intend to establish an appropriate framework with the chief executive officers of the health boards. My Department is currently in communication with the health boards in this regard.
As has been identified by the Joint Committee on Health and Children and as I have stated earlier, the ability of teachers in identifying ADHD and other learning disabilities is extremely important for the long-term welfare of the child. In view of this, during my term of office as Minister for Education and Science I established a planning group on which the Department of Health and Children was represented, on the development of a national educational psychological service for all schools. The report of the planning group was published in September 1998 and arrangements were put in place to establish this service under a national educational psychological service agency. On 1 September 1999 I formally announced the establishment of the agency to provide a comprehensive school psychological service.
The national school psychological service will be gradually phased in over a five year period. As many as 50 psychologists will be appointed before May of this year and 25 were appointed this month. At the end of five years it should be able to provide a comprehensive service to all schools. It is important that the transition be made in an orderly manner and that children should not be left without an assessment service during the five year development phase of the national school psychological service. In order to minimise any difficulties that may arise over this period I wrote to my predecessor in the Health Ministry, Deputy Cowen – my own letters are now visiting me on my desk – requesting that health board psychologists continue to provide assessment of children in schools. A letter issued to the chief executive officers of each health board requesting their boards to co-operate in maintaining existing services and that health board psychologists liaise with educational psychologists in accordance with the recommendations of the planning group.
Prior to its establishment there was consultation between the two Departments on how a new national educational psychological service will relate to psychiatric services provided by the health boards for children and young people and on related matters such as the development of guidance and counselling and support for schools in relation to children under stress.
This new service will have an orientation towards early identification of learning and socio-emotional difficulties with a view to more effective and successful interventions for children under stress. This should subsequently reduce the number of referrals to the health service to those most in need of medical intervention.
It was once believed that ADHD disappeared at puberty but it is now acknowledged that it is a lifetime condition for many adults. The high level of stress in adults suffering from unrecognised ADHD often results in substance abuse and other problems such as overeating and overspending. Their behaviour reflects their confusion, frustration and despair and they have an inability to get control of their lives. They frequently change jobs and have many absences from work. It is therefore important that a service be developed to assess the needs of those persons who have gone through adolescence without being diagnosed. It is equally important that treatment is maintained, if necessary, for those who were diagnosed at school or in early childhood and have been receiving care and treatment throughout their lives in the child and adolescent services.
In conclusion, I thank the members of the Joint Committee on Health and Children for their report on attention deficit disorder in Ireland and I assure the Senators that the Government shares the public concern about the need to provide an early intervention for children suffering this condition.
As Minister for Education and Science I had a particular insight into the special educational needs of children with attention deficit hyperactivity disorder. I see my role as Minister for Health and Children as identifying particular service deficits and rectifying these on a phased basis. Increased resources have been provided by the Government for the development of these services in recent years. The impact of the early intervention of the school-based national psychological services, the provision of capital funding in the national development plan for the development of improved facilities in child and adolescent psychiatry and greater links being forged between health boards and voluntary organisations should mean the assessment and treatment for persons suffering from this condition will be improved significantly in coming years.
I intend that the child and adolescent psychiatric service should be further developed in line with Dr. McCarthy's report. I have a particular interest in the needs of children with attention deficit hyperactivity disorder and will endeavour to provide for these particular needs as part of the overall development of the child and adolescent psychiatric service. I note the committee's recommendations regarding the needs of older age categories and will consider these as part of my development programme for the mental health services.
I welcome the Minister for Health and Children, Deputy Martin, to the Seanad. It is his first official visit in that capacity and I wish him well. I also welcome the visitors in the public gallery from the educational and medical fields and, most importantly, support groups throughout the country. I welcome in particular members of the mid-west support group who have travelled from Limerick. These people have done much to highlight the need to address immediately the needs of those suffering from attention deficit hyperactivity disorder, which is treatable. Given that he comes from an educational background I hope the Minister will be proactive and give this condition the priority it deserves. There is a need to allocate immediately a sum of £30,000 for a national prevalence study to follow through on the report under discussion.
I cannot give the report the attention it deserves in ten minutes. Senators have read it from cover to cover. It is extensive and ought to be essential reading not just for officials of the Departments of Health and Children and Education and Science but also of the Department of Justice, Equality and Law Reform. Each of these Departments has a role to play in the assessment, treatment and monitoring of this condition.
The report was adopted by the Joint Oireachtas Committee on Health and Children in April last year. In response to a request from the support groups I had asked the joint committee to examine ADHD and received some funding as rapporteur. The research was done by the Health Research Board. I pay tribute to Dr. Deirdre Killilea, clinical and educational psychologist, and Professor Michael Fitzgerald, who cannot be with us today, for their invaluable assistance.
The appendices to the report ought to be compulsory reading. The parents of ADHD children have harrowing stories to tell, from disturbed childhood to adult violence. On Tuesday I visited Limerick Prison with two mothers of ADHD children to speak to a young man of 19 who has been diagnosed as suffering from ADHD. It was a harrowing experience. I do not know what lies ahead for him, but he should have had a fulfilling life, instead he is serving a prison sentence. There are many others like him. There is a mother present whose son is in that predicament.
This matter has to receive immediate attention. There is a national development plan and I appeal to the Minister to provide in his first few months in office the £30,000 required to determine the prevalence of ADHD. Statistics are not available. This debate gives us an opportunity to highlight the lack of services. The Minister will be very au fait with ADHD from his visits to Limerick in an attempt to address some of the educational aspects of this issue. Some of the parents here today have had to resort to the courts to ensure the provision of appropriate educational services for their children. I do not need to cite the constitutional reference to every child's right to be educated. It is shocking that in the year 2000 parents have had to resort to the courts.
Efforts are made on behalf of ADHD sufferers by a small dedicated group which is already overburdened by the enormous demands placed on it. These people have responsibility for their ADHD children as well as their other children and their day to day family life. They are not merely acting on behalf of their own children, they are also acting on behalf of the unknown ADHD sufferers in this country who may not even have been given an assessment but are regarded as troublesome or spoilt children. The parents of ADHD children have spent huge sums of money being pushed and pulled from one psychiatrist to another without really finding out what was wrong with their children while knowing instinctively that something was wrong. One of the women here today, a past pupil of my own, detected that something was wrong with her 18 month old child. She has fought through to the courts to get something done for her child. Parents should not have to dedicate their entire lives to highlighting ADHD suffering. The Minister and his colleagues, the Ministers for Education and Science and Justice, Equality and Law Reform, must address this issue urgently.
ADHD and its coexisting conditions are treatable. The best results can be achieved through early diagnosis, medical and behavioural cognitive treatments and specific educational services and interventions. The report clearly points to a severe level of under-recognition and under-diagnosis among health and education professionals.
The aims are very specific. Support groups want to determine the extent of existing services throughout Ireland for child and adult sufferers and they want the provision of new medical, psychological and educational services. They also want the extent of expertise in the medical, psychological, educational and social services here to be determined.
I do not have sufficient time to comment on the ten objectives which merit more detailed discussion. However, I will address the recommendations which I consider to be the most important aspect of the report. There is a need for extensive ADHD diagnostic centres to be located in the regions. It is not sufficient to have a national centre. The mid-west support group is seeking a designated service specifically for comprehensive diagnosis and appropriate medical and psychological treatment.
The report states that a large number of children wait five to 11 years for a diagnosis, following parental identification of problems. Not alone are families spending money attending various psychiatrists, they are also spending thousands of pounds travelling to the UK for treatment. That is a waste of health board funding when the assessments could be carried out here.
Diagnostic centres must be provided for adults, namely those over 18 years of age. There is no adult ADHD service in Ireland at present. One adult referred to in the report waited 15 years for a diagnosis. The statistics are shocking. Health board adult psychiatrists must develop expertise in the study of adult ADHD. There is also a need for out-patient clinics. Only one adult in this study was in contact with a medical professional. Services must be available through the health boards and parents should not be required to pay privately for diagnostic services as many have had to do. Diagnostic centres must also be provided for young children as early diagnosis is essential for successful treatment.
The establishment of a multi-disciplinary team of psychiatrists, neurologists, paediatricans, clinical and educational psychologists is essential. Diagnostic centres must be equipped with the necessary assessment materials, including psychological and computerised tests to determine attention levels. The necessary expertise is available in the UK and Europe. I have asked Senator Avril Doyle, MEP, a member of the EU health and environment committee, to conduct a comparative study of ADHD treatments in other EU countries in order that we may liaise with our European counterparts whose treatment methods may be more advanced and ensure we follow best practice. Many of the parents visiting the House today travel to Britain to see Dr. Cooley, a well-known expert in this area. He has also visited Limerick and we know the expertise is there. The centres within the health boards must be multi-modal, providing behavioural, cognitive and medical treatment.
The Irish Medicines Board needs to approve a far greater number of medicines which are unavailable at present. Medications have been shown to reduce the core symptoms of hyperactivity, impulsivity and inattentiveness. They also reduce oppositional and aggressive behaviour. In this study parents noticed that their child's behavioural problems had diminished since the introduction of medication. The drug Ritalin needs to be available on prescription to adults with ADHD. Within this city the ADHD services within Our Lady's Hospital for Sick Children in Crumlin need to be extended to cope with the huge waiting list.
I speak to the converted when I address the Minister on the issue of educational services. Children with ADHD should be regarded as having specific educational needs. As a teacher I would not be equipped to diagnose or assess, but in retrospect I saw children who manifested ADHD symptoms. Children with ADHD in mainstream schools need access to remedial and resource teachers specially trained in the area of ADHD. They also need structured tailor-made activities and concrete learning experiences, preferably with a teacher trained in ADHD.
A specific school is required to accommodate children with severe ADHD. I know children who have been expelled from school, not just once but two or three times. Parents have been obliged to take legal proceedings to ensure they receive an education. These are innocent children born with a disorder that can be treated. They are unable to cope, yet they are labelled as dysfunctional and aggressive with a stigma attaching to them through life. I referred earlier to imprisonment and the study specifies what happens to children when people are unable to diagnose their problem.
The Minister referred to the 1998 report of the planning group of the National Educational Psychological Service which states that psychological services should be available. The youthreach services should be made available here because many of these children end up using them. In addition, professionals need to be educated in the medical, psychological and vocational services. Professionals are probably gleaning knowledge from their work with persons with ADHD.
Teacher training colleges and educational institutions need to train teachers how to recognise and cope with ADHD children in the classroom. Cursory recognition in the training course is insufficient – modules are required. Continued professional development is required. We can tap into increased research in the UK and other EU countries and America. There is a need, therefore, for inservice training, lectures, conferences and psychology courses in the assessment and diagnosis of ADHD. Staff providing vocational services need to be trained in behaviour management techniques.
Research is vital. Dr. Deirdre Killilea has made valuable research findings, but she and many like her, such as Professor Michael Fitzgerald, must be supported to ensure a heightening of awareness of the disorder among the medical and education professions.
I am delighted the Minister has been appointed to the Department of Health and Children. He has proved what he can do, especially for children with special needs within the educational services. The health service is his biggest priority and I ask him to address this issue and to liaise with the Minister for Justice, Equality and Law Reform to ensure that none of these innocent children will end up in prison, with prison officers telling us they know they should not be there. They are in prison because they have slipped through the net. On behalf of the parents visiting the House today I beg the Minister to spare their suffering and that of other parents who as yet do not know their children have this disorder.
We need to link into the research available elsewhere and to act quickly. Each day somebody is falling through the net. I know the matter is in capable hands and that the Minister will respond immediately. The immediate response required is minimal – the sum of £30,000 to assess prevalence because we need to keep the research ongoing.
Cuirim fáilte roimh an tAire go dtí an Teach. I take the opportunity to congratulate him on his appointment as Minister for Health and Children. If he brings, as I am confident he will, the same level of efficiency and achievement to this brief as he did to his previous one, I have no doubt he will be remembered equally for his achievement in his current field. I welcome the parents present in the public gallery. As someone who worked in the health services for many years I identify with the sentiments expressed by the Minister and I agree with what Senator Jackman has said.
When we talk about attention deficit disorder or attention deficit hyperactivity disorder many people will wonder what we are talking about. I agree with Senator Henry that many people have found their way into our prisons and many have been incorrectly diagnosed in the psychiatric services as a result of ignorance of this condition.
Attention deficit hyperactivity disorder, ADHD, is one of the most common psychiatric disorders of childhood and early adolescence. Attention deficit disorder refers to a cluster of behaviours that make a child underactive at school for his intellect levels and under-behave at home for a standard of parenting. It is more correct to refer to ADD as ADHD. ADHD is a chronic condition which continues throughout the school years. It is believed that as many as 60% of children affected by this condition will take most if not all of the symptoms into adulthood.
ADHD children vary in the number of these behaviours and the relative severity of each. ADHD is described as being made up of three core behaviours. First, inattentiveness – the child is easily distracted, forgets instructions, flits from task to task, is best with one-to-one supervision and has a poor short-term memory. Some children are distant, dreamy and spaced out. Second, impulsivity – the child speaks and acts without thinking and has a short fuse. Third, overactivity – the child is restless, fidgety, fiddles, touches and has hyperactivity.
In addition there a number of other behaviours that might be seen in children with ADHD. One of these is insatiability – the children are never satisfied. They keep putting up the crossbar, so to speak, as in a high jump competition. They go on and on, interrogate, intrude, and invariably lose friends. A child may be clumsy. The child may be out of tune socially, act silly in a crowd, misread social cues, be overpowering and bossy. Such children may have poor co-ordination – about half of them may be clumsy and half have an awkward flow of movement, experience difficulty doing two actions at once and produce messy written work. They may be disorganised. The children may be blind to mess, have problems structuring school work and be unable to get started on homework or projects. Variability is another behaviour. A child may suffer from mood swings, have unexplained good and bad days and can be extremely volatile. Such children also have special learning disabilities, examples of which are dyslexia, language problems, difficulties with handwriting and mathematics. Most have problems with written work and 60% have some other specific weaknesses.
What causes ADHD? In the past professionals tended to blame the parents for causing their child to have these behaviours. Others said that ADHD was due to additives in food. We know now that neither of these is the cause, although poor parenting and some food substances may occasionally influence existing ADHD sufferers.
Researchers still disagree on the exact cause of ADHD, however, there are two aspects of the condition that are agreed upon. First, it is a strongly hereditary condition and, second, it is caused by a minor difference in the fine tuning of the normal brain. Heredity is obvious, as many families have a parent or close friend with a similar problem. If one identical twin has ADHD, there is over a 90% chance the other will also have the condition. If one sibling has ADHD, there is about a 30% chance another child will be affected.
For years it was presumed that ADHD was a biologically-based condition which was part of the child's make-up. It was thought to be due to a slight difference in the functioning of the normal brain. This can be shown by the most modern research scans – PET and SPECT. Not only do these scans show the slight difference of tuning in ADHD, but the difference can be largely reversed in many cases after administering stimulant medication such as Ritalin.
For every child the environment in which they grow up is extremely important. A member of the immediate family having ADHD may lead to a more disorganised, chaotic family environment. Also, when a child has ADHD the fact that they seem to have an insatiable need for attention can wear out parents and make it difficult for families to enjoy the child's growing up as much as the growing up of a child without ADHD. Neither of these things causes ADHD, but it is important to be aware that they occur and that parents are not blamed for the behaviour of a child with ADHD, as is very often the case. Uncaring people say, "If they were minding their own business and staying at home with their children, etc., they would not be in such a position and the children would not be carrying on as they are". This is a load of nonsense.
Food allergies or intolerance have been talked about as making ADHD worse. It is an established fact that some children react specifically to certain foods. Parents will often know which foods cause their children to become more excitable and they try to cut these out of their child's diet. For example, certain children become hyperactive when they eat chocolate.
ADHD is a clinical diagnosis – there is no test for it. Parent and child interviews are the core of the assessment process. In addition, it is essential to obtain reports of behaviour, learning and attendance at school. Standardised instruments may be used for obtaining this information, although observations may be needed in classroom, family and peer group settings. A number of standardised rating scales and specific research tools are used. Medical evaluation includes a complete medical history and physical, neurological and laboratory investigations are also indicated. Speech and language evaluation may be suggested by the clinical findings and occupational therapy assessments can be valuable, for example, with motor clumsiness and adaptive skills. In many clinics psychologists have specialised in the use of these assessment instruments for diagnosis and ongoing evaluation. Liaison with school psychologists is absolutely crucial.
Treatment is multi-modal, representing a combination of psycho-social, educational and pharmacological interventions tailor made for the individual patient. While increasingly there is a popular focus on medication, this should not be used as a substitute for appropriate educational curricula, a point made by the Minister, appropriate student-teacher ratios, a matter which has been addressed to a large extent by the Minister, or other environmental accommodations. Certainly, pharmacotherapy is useful, with Ritalin and dextroamphetamines being useful in certain cases. In addition, treatment must be focused on the comorbid conditions.
There are a number of pyscho-social interventions which include family focused interventions – parent education, parent support groups, family therapy, parent management training, behavioural approaches, home-school liaison; school focused interventions – teacher information, teacher management training, structured classroom and school placement, remedial education; and child focused intervention – individual psychotherapy, cognitive behaviour therapy, social skills groups.
I am delighted this matter is being discussed and commend my colleagues who are members of the Joint Committee on Health and Children for the attention they have given this matter. Many people have ended up in prison and the disturbed wards of psychiatric institutions because of ignorance of the condition.
In conclusion, I wish to spare a thought for the long suffering parents of those children and, most importantly, for the sufferers who may slip through the net. We must devote our attention to ADHD. The behaviour of sufferers impacts in a very adverse way on family and school life – sufferers can cause absolute chaos in schools, as those among us who are educators are aware. It is imperative we get to grips with the problem as soon as possible. I know that given the Minister's performance in his previous portfolio we can expect great things from him in this regard.
I welcome the Minister. If he brings to this task the same enthusiasm he brought to his last portfolio we will all benefit greatly. I get a sense of that enthusiasm and achievement from what he said today.
I never heard of this problem until last year when, in one of our supermarkets, a customer explained it to me. That night I talked about it with my wife and we said how lucky we were that we had not known of the problem. Before solving anything, the real task is to recognise and identify the problem. This debate and the efforts of the committee are doing exactly that by bringing attention and putting a spotlight on it. We cannot attempt the first steps towards a solution until we identify the problem.
When I read Shaping a Healthier Future I learned things for the first time. I was unaware that this was also an adult problem – I thought it finished at adolescence. I suddenly realised this problem is not one that can be handled by a single Department. If ever a national crusade was needed it is necessary in this regard. I learned that between 1% and 3% of the child population may suffer from this – it is a much bigger problem than I thought. It is a task not just for teachers but also for employers and a solution must be broadly based.
We need a crusade and, therefore, champions – those who have come together to bring this to our attention – are necessary not only to say there is a problem but to indicate that there are solutions. Research, which the Minister spoke about, is necessary. The Minister also spoke about the need for a national strategy. I have no idea whether such a strategy would nibble at the surface of the problem or be a move in the right direction. I am sure it is a move in the right direction, but it is not enough. I get the impression from the Minister that he will give a listening ear to the problem if we can convince him that it needs far more attention. Our task is to ensure we put the spotlight on the problem and identify it so that those concerned – teachers, employers, children and others – recognise this is a disorder which can be tackled.
I have been involved for five years with the leaving certificate applied and I was aware of the Minister's successful efforts in regard to it when he held the Education and Science portfolio. That programme identified that certain talents, abilities, skills, intelligences were not recognised in the traditional manner in the education system and, consequently, were not measured, assessed or rewarded. The great success of that course reminds me of what can be achieved. Parents who have had to follow a lonely path for many years suddenly feel, following the publication of the report, that they are not on their own any more and that they have support. The support they receive depends on how much the nation gets behind them and drives the effort to address this disorder. I am confident that this debate is the first step.
Champions are needed, although they are not always identified and rewarded. For example, I read recently an article on the heroes of the 20th century. The inventor of the seat belt was included, but he selflessly insisted that he would receive no royalties because he described it as an example of how he wished to help the world. Parents and, particularly, teachers who have contributed a great deal in this area behave in a similar manner. Such selflessness will mean that many people will get behind efforts to deal with this disorder.
There is a great need for more research. Previous speakers, including the Minister, have touched on the areas about which we are knowledgeable already. However, we do not know enough and need to find out a great deal more. Extra resources must be committed to address the problem but it is up to us to make the case. I met a successful man last year and I asked him how he had succeeded when so many others had not. He was not able to answer immediately but a half an hour later he replied that whether one believes one can or cannot, one is right. For example, if one goes out to play a football match believing one has no chance against the other team, one is right and will not win, but if one goes out to play believing that one will win, one can do so. Those involved with ADD need to adopt such an attitude. If we believe that we can solve this problem, we will. This debate is another step forward in making sure that the nation recognises it. I was pleased with the Minister's contribution. I am aware that no matter how many words he uses, they will probably not be enough to resolve the problem but he is heading in the right direction. I congratulate him for accepting this challenge.
I have no doubt that the Minister is intensely bored with having compliments showered upon his head. I was waiting for a halo to accompany him into the House. Professor Ronan Fanning, a feature writer in a Sunday newspaper, stated that as far as the universities are concerned, Deputy Martin was the best ever Minister for Education. Fergus Finlay, a columnist in the Saturday edition of The Examiner, could not remember any new initiative that the Minister took during his time in the Department of Education and Science. I am tempted to conclude that Mr. Finlay must be suffering from acute ADD. He was not paying attention when Deputy Martin took a plethora of well acknowledged initiatives, but I hope that he will pay attention to the fact that he has received an honourable mention in the House.
The problem has been identified, particularly by the Mid-Western Health Board. Its representatives compiled a comprehensive report, to which all of us have had access in preparing for the debate, and I thank them. I also commend the Oireachtas Joint Committee on Health and Children which identified ADD as an issue that needed to be addressed urgently. It too produced a comprehensive report. The Minister and I come from a city where it is often asked why we are always one report away from action.
A great deal of research has been carried out and it is critical that extensive and sustained action should be initiated. That should be the outcome of the debate. The Minister should bring to bear in his new brief his insight and understanding of children's issues and the expertise and experience available to him. Armed with this information he should spearhead the action required to tackle this problem in a sustained manner.
Early detection is the most important element in dealing with the problem. It is estimated that one in 30 children suffer from the disorder. Teachers are the first professionals with whom children come in contact for a prolonged period. It is important that they are enabled to detect the disorder early and that is a big challenge. Every time the economy needs more skills, something new is tacked on to the requirements on teachers. Where would we be without them? However, there is a body of research which demonstrates without doubt that when this problem is treated early and adequately, significant improvements accrue. That should be a huge impetus for us to tackle the problem quickly.
The additional burden of early detection must be placed on teachers. We pride ourselves on having an education system that is child centred and has teachers of children rather than subjects. However, teachers are provided with very little training to enable them to detect such a disorder and that is a fundamental flaw in teacher training at every level. This issue must be taken seriously in the context of teacher education. If education is to be truly child centred, teachers must at least be enabled to detect this disorder and others, such as dyslexia, so that they can refer children for diagnosis and treatment.
Literacy is an issue which has arisen again and the Minister concerned himself very much with it during his time in the Department of Education and Science. An issue arising now is that, after a number of years of remedial education, there has not been a significant reduction in the number of young people with reading disabilities. We must ask what kind of co-ordination there should be between the classroom teacher, who has a holistic approach to education, and the specialist teacher who may make a direct intervention. Where do we create the space or the time for collaboration between these two types of teacher? That is a broader issue which perhaps I should not have raised, but it is important. Parents suffer enormous anguish when their child experiences the symptoms that have been well described, and very often it is the teachers with whom they should be in closest contact.
The key to addressing this problem is early diagnosis. It is stated in one of these excellent reports that by the age of seven every child who suffers from this disorder ought to be referred for adequate medical treatment. We should set as an objective that by the age of seven, every child should be referred for treatment because early diagnosis and treatment will achieve the best possible results. I envisage the day – I hope it is not too far away – when this problem is seen in the context of health and education, and not in the context of justice. The fact that we are discussing this issue in the context of the Department of Justice, Equality and Law Reform is a testimony to our failure. Before the end of the Minister's term of office in the Department of Health and Children, I hope this issue will have been dealt with so successfully we will not be discussing it in terms of the Department of Justice, Equality and Law Reform.
Having a national strategy is the correct approach but it is important that such a strategy is implemented at a local level. There is little point in having multi-faceted services unless young people have access to them, regardless of where they live. It is not sufficient that this range of treatment is available to young people living in the major cities. The challenge for us is to ensure that when a package is put in place, arising from the national strategy, it can be accessed by all children who have a need for and who will benefit from the service. That is critically important.
There is a great deal of talk about social inclusion and poverty. Very often, such talk is couched in trade union language but young people who are born with a disorder of this nature, and who do not get adequate treatment within our education and health services from a very early age, are condemned to a level of exclusion. They are deprived of the opportunity to attain their full potential, the potential they could achieve given the proper services. It is important that the services identified in the context of these reports are developed against a national framework but that they are accessible at a local level.
I will not repeat all the symptoms of this disorder; that has been done already. The time for action has come. Senator Quinn talked about the cleverness of the man who invented the seat belt, and fair dues to him. Perhaps the Minister will be the man who will give a life belt to parents who suffer anguish when they are confronted with this problem, and to all the professionals who have put such a body of work together to enable us discuss this problem in a serious and systematic way. I hope that before the Minister's term of office has expired there will be an appreciable difference in the size of the problem. Perhaps we will debate this issue again and assess the progress made or action taken and the improvements that have been effected. That is what I would like to see as the outcome of this debate.
I welcome the Minister for Health and Children, Deputy Martin, to the House and wish him well in his new portfolio. The Minister's combined experience in the Department of Education and Science and now the Department of Health and Children puts him in a unique position to deal with the specific issue before the House. I welcome also the representatives of the attention deficit disorder national support group and in particular the mid-west group with whom I have a lot of contact and whose members have done tremendous work in the past three to four years in bringing to our attention the existence of this disorder. It is true that politicians in particular, and the wider public in general, were unaware of this disorder until it was raised by this group. The amount of work it has done on a voluntary basis demands high commendation. This debate has come about because the group lobbied so effectively over the years.
The work that has been done has given politicians specific information which has also been brought to the attention of the various Departments. I compliment my colleagues in this House and in the other House who are members of the committee for children, particularly our own spokesperson, Senator Jackman, on the work they have done in putting together the report published some time ago on attention deficit disorder in Ireland, which we are discussing today.
I appreciate that due to time constraints our contributions have to be restricted. There is now a volume of information on the cause of this disorder, the difficulties it creates for the individuals and families concerned as well as the professionals within the schools structure. Specific recommendations have been made in the report of the Oireachtas committee and information has been given to us by the attention deficit disorder group. There is now an onus on legislators, and particularly on the Government, to come to specific conclusions.
I am pleased the Minister is in the House today to listen to the debate. This is not a problem for one Department only. The Departments of Health and Children, Education and Science and Justice, Equality and Law Reform should have a major input in dealing with this problem. I ask the Minister to ensure this issue is put on the agenda of the Cabinet so that a Cabinet sub-committee can be established comprising those three Departments and the Department of Finance. A multi-departmental approach must be adopted to deal with this problem.
There are specific recommendations in the report in relation to the Department of Health and Children. I ask the Minister to ensure that proper funding is allocated to the eight health boards. We can have all the reports and documentation in the world, but what we need now are services. The facts have been established. We now have to deal with the realities and to do that we need to put in place the services. First and foremost is the need for diagnostic services, with properly trained psychiatrists, psychologists and counsellors to diagnose the problem.
The earlier the problem is diagnosed the greater the results and advantage for the sufferer, the family and the wider community. It is important this matter is dealt with by health boards immediately. We do not have the necessary services. The Minister has a unique opportunity to address this matter and I urge him to engage in discussions with the health boards to ensure properly trained staff are employed and diagnostic units established to deal with this problem. It is extremely important that proper treatment services be established. People suffer at different levels of severity of the disorder. It is important that treatment services are set up as close as possible to the homes of the children concerned so that they can have a normal family life and proper social interaction. We need a very specific treatment centre for those who suffer from a severe form of the disorder. We must address the issue in a structured way and with urgency.
As a former teacher, I know many teachers did not understand why particular children were disruptive in class. Only as we educate ourselves do we learn about these matters. We now realise that some of the children had the very symptoms identified in the report. Such children are considered by many educational institutions to be disruptive. There is no follow-up when many of them leave school, with the result that they end up in difficulties with the law. They are often convicted of offences and detained. This is a very serious matter. A directive should be given – particularly to the Department of Justice, Equality and Law Reform – that a person identified as suffering from attention deficit disorder who commits a first offence should not be detained. They should instead be given the necessary treatment to correct their disorder.
Various reports on this issue have been produced throughout Europe. A report compiled in southern California suggests that approximately 77% of people detained for criminal offences were identified as having some symptoms of attention deficit disorder. That figure compares closely with the statement recently by the Governor of Mountjoy Prison, Mr. Lonergan, that approximately 70% of inmates there display symptoms of attention deficit disorder. If the Government looks at the problem from that perspective, leaving aside the social issues involved, it will recognise that it is in the long-term interest of the community to ensure corrective action is taken at an early stage.
The cost to the Exchequer of not addressing this issue is enormous. It might be useful, if the Minister proceeds with the setting up of a sub-committee to examine this issue, to have each Department assess the costs involved in not addressing it. Not addressing it is, I suggest, costing the Department of Justice, Equality and Law Reform more money than the amount required by the Departments of Health and Children and Education and Science to correct the problem. Money provided for the Department of Justice, Equality and Law Reform would be much more effectively used in other areas. I hope the Minister will take a serious look at that point.
We are not into plaudits on this side of the House but the Minister, a formidable person in Government, has an admirable record and we have every confidence that he has the breadth of vision and openness required to address this issue. I thank him for coming to the House and look forward to a positive response.
It is not necessary for me to add to the fine words the Opposition Senators have spoken about the Minister. They have said as much in terms of praise as I, a member of the same party, could bestow on him. I hope people will speak as highly of him when his term of office in the Department of Health and Children ends.
Senator Jackman referred to the joint committee's report. I will read some extracts from that report which I think highlight more than anything else the personal experiences of families. Before doing so I wish to welcome members of the support group and people from Monaghan who have come to hear this debate.
I want to highlight the quest by one set of parents to have their child diagnosed and treated in Ireland. The report states:
When he was eight the phrases "class clown" and "smart alec" were being used in school and remedial help was withdrawn as he was deemed to be inattentive and impulsive. This was interpreted to mean lazy and not wanting to learn. . . .
When he was ten the words "bad", "bold" and "undisciplined" were being used. His parents tried everything but nothing worked. . . . .
When he was 11 and while seeing the psychologist the child started to drink heavily, take drugs and steal from anyone and everyone. . .
When he was 13 he was expelled from school.
At this stage the father felt moving from the city to the country might help the family in general. However, the report continues:
The child's father, the image of head of the household and family protector shattered, started to stay out on his own – at least it was quiet. His wife remained at home heartbroken in an effort to contain her son who was now bulimic and paranoid. His frustration changed to aggression to violence.
Such words are used constantly by the parents of untreated children. By the time the child was 14 years old his mother had received a black eye and, desperate to have anyone listen, this child spent a night in an adult psychiatric ward because the family could no longer cope. By the time the child was 17 he was transferred to an adult psychiatric department from which he never received any service. His mother finally sought professional help in England. Today the young gentleman continues on treatment and must live in England to be monitored.
Many lives are ruined by attention deficit disorder. It not only destroys the life of the individual but that of the family and society in general. Figures of 1% and 3% have been mentioned in relation to the number of the population who may be affected by attention deficit disorder. The percentage increases to 5% depending on the report you read. Eighty per cent of affected children remain affected by the disorder by adolescence; by the time they become adults it is reported that 60% of them remain affected.
I agree with Senator Jackman that the report is compulsive reading. The symptoms are classic and it is the parents who realise there is something different about their child. They can identify it in a child as young as 18 months but they cannot put their finger on it. Very often they have older children who never caused them a day's trouble. When a parent calls their own child a monster there is something seriously wrong. Over the past couple of years I have heard this from parents on so many occasions.
When we talk about how to deal with it one has to ask whether we start in the prisons where quite a few of these individuals end up. Do we start with early school leavers, drop-outs and young people who have turned to drink, drugs and then crime or do we try to identify them at primary school? The disorder is such a vast problem. We have so many reports and studies that the time has come for urgent action. The Minister has said educational psychologists will be introduced on a phased basis over a five-year period. That time should be shorter. We need emergency treatment.
I support Senator Jackman's call for an initial allocation of £30,000 for a prevalence study. I disagree with all these studies because they are often left on shelves gathering dust. In this case, however, we must highlight sufferers in society because, as the Minister said, we do not know the exact number of people suffering from this disorder.
Action can be taken immediately by giving people who are at the forefront in dealing with these children, the GPs, a greater awareness of this ailment. In many cases parents will go to their GP not knowing what is wrong with their child. They will just bring their child to the GP's surgery saying they do not know what to do with him or her. That is the start of it. With all due respect to them, GPs are not fully aware or as informed about this condition as they should be.
All the other speakers referred to the role of teachers, which is of paramount importance. The Minister has had an input into the establishment of the remedial teaching service and that is the line we must take. Remedial teachers must be trained to identify children with this disorder and to begin the diagnostic process.
I welcome the development of the National Educational Psychological Service for all schools. However, we must move with more haste on it. As I have seen in my constituency, the delay in assessing children with psychological problems, not necessarily with ADD, is too long. This condition is treatable but early diagnosis followed by continual treatment is important. Making a child wait five years is unfair and will lead to problems in society. Many individuals have had their children assessed privately as a last resort. This process is expensive but some families feel there is nothing else they can do.
Medication for this condition is available up to 16 years of age. Unfortunately, families in my area cannot receive it at home. They must travel to the centres where their children have been diagnosed to be prescribed their medication. I can understand that there is a worry that abuse will take place after 16 years of age and that people will become addicted, particularly to Ritalin, but I cannot understand why an individual who has been prescribed medication must travel to a centre to get it. The medication is necessary and has proven effective but it should be given, under strict supervision, to people over 16 years and adults.
The Departments of Justice, Equality and Law Reform, Education and Science and Health and Children must adopt a comprehensive approach to this problem. The time has come for us to set up a pilot scheme. Each health board has a family centre but that is not enough. In the Cavan-Monaghan constituency it is estimated that there are 300 children suffering from this disorder but there is one centre in Drogheda. Psychologists in that area must deal with children suffering from a var iety of psychological disorders, not just those with ADD.
We must invest in tackling this problem. If we invest in our children it will benefit us all in the future. I ask the Minister to bring together the three Departments. We have a Minister with specific responsibility for children. I support Senator Taylor-Quinn's call for a sub-committee because this is such an important issue. Such a measure can only benefit our children and society in the future.
An Leas-Chathaoirleach
I understand the Minister must leave for another appointment but is anxious to make a brief intervention.
I regret I must leave the Seanad because I have another appointment. However, I am thrilled with this debate. It is a tremendous opportunity to debate ADHD. For the parents concerned it is more progress in an ongoing campaign which I was aware of when I was Minister for Education and Science. The Minister of State, Dr. Moffatt, will take over from me and will listen to further points other Members have to make.
I will take seriously the comments made here. The training of teachers is a key issue. In my former post I initiated two significant teacher training review bodies, one at primary and the other at secondary level. One of the areas of their terms of reference was special education, learning difficulties and how future pre-service training programmes and modules could accommodate special education so that all new teachers could have more significant exposure to these issues than perhaps heretofore. We are working with the partners in that regard.
With regard to the national prevalence study, I will work with the groups and come back to Members on it. I am sympathetic to that proposal and we can make progress on it. I will work nationally with the support group to ensure there will be a national study and that we can have a proper baseline study for the first time in the history of this State on this specific condition. I do not see a difficulty in progressing that issue either.
Over the past two years £3 million has been spent on establishing child and adolescent psychiatric units in every health board area. Within those multi-disciplinary teams ADHD will be accommodated. Therein lies the key to the future for structural developments in this area. At present we are appointing four more consultants. By the end of the year we will have a significant infrastructure in place, not just studies. Consultants in the child and adolescent units will deal with these issues in a hands-on approach. There are other issues in terms of other paramedics. We have more work to do in finding more psychologists and language therapists. There is a historical deficit in the provision of language therapists. I was aware of that from the education side and now I will tackle it from the health side. I will go back to education again because we have not cracked the problem of providing language therapists and occupational therapists. Once we build up those support services then we will be on the way to providing proper services for children and adolescents.
I am sorry for intervening in what may be an unprecedented manner but I just wanted to let Members know that I am taking very seriously the report of the Oireachtas Joint Committee and the views articulated.
I thank the Minister for his words. I also welcome his appointment as the new Minister for Health and Children. He is the living image of a man I have been doing business with for the past three years in the Department of Education and Science. I wish him well in his new ministry and I look forward to finding a result for this issue. I also recognise that he must leave at this point.
It is crucially important that issues relating to ADHD are developed. I am delighted with this debate. It is the type of debate where aspects of education can be teased out, brought forward and points made. However, there are dangers in terms of some of the recommendations and I have a view on how this might be approached. The extraordinary good work being carried out by the support groups and parents to draw attention to this problem needs to be fitted into what is happening in the mainstream. There is always a danger that a group of people with a particular difficulty will be left on the outside or kept in a corner and will have to battle on their own against a huge group demanding more, when they should be right in the middle and be part of any education and health developments as they require.
The OECD issued a report three years ago which stated that one in four people in Ireland were suffering from literacy difficulties. Over the last couple of months a report issued by the Department of Education and Science indicated that more than one in ten pupils leaving primary schools have literacy difficulties at some level. We must look at how to deal with that.
I have made a proposal to the Taoiseach, the Tánaiste, the Minister for Education and Science and anybody else who will listen to me, including the Joint Committee on Education and Science, based on a number of fundamental principles which are the same as those being put forward by the support group. The first principle is early intervention. It applies not just to this disorder but also to autism and other conditions where children have special needs. A parent who is coping with rearing a child might be experiencing some difficulty, but very often by the time they figure out what is causing the difficulty too much time has been lost. It is unfair to set up a system which requires the parent to initiate diagnosis of the problem. That system cannot and will not be successful.
Where can we make the intervention? The first intervention should take place when the child is five years of age. Teachers of senior infant classes in every school should be asked to indicate the children who are having reading or pre-reading difficulties. Following that, there should be a case conference involving the class teacher, the remedial teacher if there is one in the school, the principal teacher and an educational psychologist. The case conference can evaluate the child's difficulties. The difficulties could be due to a mild form of dyslexia, a serious emotional problem or to a range of other conditions, including attention deficit disorder. At that point, the net can be pulled and we can see who is caught in it and requires support.
At that stage, it should be possible to put in place an individual programme for each child with a reading difficulty. A year later the programme can be assessed to see whether progress has been made, if the child has developed, if the child is developing social and reading skills and whether there has been an improvement. If there is not, the programme must be changed.
I wish to focus on how to implement this. First, we ask the class teacher to indicate the children having difficulties. That is straightforward and can be done without any new investment – it is simply a teacher input. The next step is a case conference of the appropriate people. That requires a huge increase in the number of educational psychologists. The Minister said there is a difficulty in finding such people. That is because the State is not supporting the education and qualification of educational psychologists.
I was speaking this weekend to three young people who are studying education psychology at Queen's University, Belfast. Their salaries are being paid by one of the education and library boards in the North in return for which they give a commitment to work there for a number of years after they qualify. That is how to deal with shortages. One simply ensures that a sufficient supply will be available. That policy should be implemented in the South because the case conference is the point at which the first intervention can and should take place.
The teacher input at this stage needs to be a specialist input. The teaching profession, for which I am a loud spokesperson, has to focus on the fact that teaching now requires specialists. The generalists must be supported by specialists. That means the colleges of education must put in place courses for teachers who will specialise in issues such as ADD. This matter is left slightly vague in the report and in the proposals put forward by the support group. It is not enough to propose that every teacher in the system should get two hours training on ADD. On qualification the teachers should be obliged to do a further year's training in these specialist areas. The colleges of education will have to change their ways and ensure that people with such skills would be available to schools.
There are two specialists, the educational psychologist and the teacher specialist, who may or may not be required to be part of the input. In some cases, the programme they put together for the child could be delivered through the remedial teacher and the class teacher. In other cases, that will not be possible. It must be stressed that the work can be done at this stage. I made passionate proposals to the Government before the publication of the national development plan, before the budget and in the course of the talks on the new social partnership programme, which I left this morning in order to speak in this debate, to address these issues.
I urge the people who are interested in this issue not to let themselves be hived off into a new committee or into producing another report. They need, deserve and have the right to be supported through the education and health system. This is how it must be done – identification at five years of age, a programme put in place, annual assessment and the proper professional support. I can make an input into this matter having been a teacher, and a pretty disruptive pupil, for many years – some might say I am still a disruptive pupil.
What is needed is a political decision to intervene, to invest the resources and to move the programme forward. That will not be cheap. We must decide as a society what to do with all the money we have created. This would be an investment in the future and savings will be made on prison and other treatment costs. If there were such early intervention, we would reap a huge reward.
Ba mhaith liom go ndéanfadh an Rialtas rud éigin mar sin. Tá géar-ghá leis; ba chóir go mbeadh tacaíocht do na moltaí atá sa tuarascáil seo. I highly recommend it.
The Minister of State, Deputy Moffatt, also knows a great deal about this problem and I welcome him to the House. We are surrounded with knowledgeable people – the Minister, Deputy Martin, the Minister of State and the teachers who have already spoken. There is a team working on this matter who know a great deal about it.
I congratulate the support group on compiling this well researched document. It has made it easy for Senators to appreciate the problem and how it has been neglected over the years. It was known as the hidden handicap. I have 15 years' experience as a career guidance teacher and I encountered many children with this disorder. Like other teachers, I misinterpreted the condition and assumed it was due to lack of parental control and discipline. One assumed the pupils needed a talking to and often they were sent home because we were incapable of containing them in the classroom. It transpires now that we were treating them incorrectly.
The report is timely. The Minister said he will devise a national strategy which will encompass an integrated interdepartmental approach and he will set up a subcommittee to that end. Many points have been made in relation to how best we can inform the public about this matter. To date the public have not been informed. Professionals and community workers had no feel for this area and its implications. We need to look at how best we can assess this disorder and diagnose the real problem. The only way to do that is when children enter primary school at four years of age. The earlier the intervention, the better chance there is to adjust the child to a normal routine in the school. Often when children enter second level all their bad social skills, low self-esteem and bad behaviour have been repeatedly reinforced and they cannot see themselves behaving any differently. We should intervene at an early stage, at the age of four, and a case study should be compiled which would adopt an integrated approach involving the educational psychologist, the school principal, the remedial teacher, the home-school link and parents to see how the problem can be best diagnosed, the situation assessed and a treatment programme devised to help the child.
The report suggested that at least 1% to 3% of the population suffers from this problem and I agree. In my 15 years' experience as a guidance counsellor, there was always one child coming from primary level who could not be contained in the classroom. The report reinforces that and, in some cases, some of those children would have had mild forms of ADD, although we would not have known then what is was. We need the information to be well informed.
Teachers have a huge role to play. They are the people who will deal on a one-to-one basis with children with this problem who attend school. Unless they develop a good relationship with the children and their parents and are familiar with the treatment which has been prescribed and the programme set in motion and how to handle that programme, not much progress will be made. It is a concentrated area.
Enough research has been conducted but we need constant case studies. I do not need any more research than has been conducted already and I would not ask for any more. If I were a guidance counsellor, I would know what is the problem, so I would want the educational psychologist, the school principal, the class teachers, the local GP, if necessary, so that he or she is familiar with problem, involved. I would want reference to them if further progress could not be made through normal channels to see how best a programme could be introduced. It is very simple in that the monitoring of children should be set in motion in schools in conjunction with parents. I do not see what more research can achieve.
More educational psychologists need to be employed in this area and the Minister has made a commitment in that regard. An integrated sub- committee of the Departments of Health and Children, Education and Science and Justice, Equality and Law Reform should be established and teachers, guidance counsellors and local people should be involved. Four or five primary schools in an area should be grouped together and work should be done with them. Each area should also be grouped accordingly. That would lead to a structure being put in place and it should not be too difficult to implement measures after that.
We have had a great debate on the subject. I am delighted with the Minister's commitment. The Minister of State, Deputy Moffatt, is familiar with this area as a doctor and a public representative. He will hear another doctor speak on the matter, Deputy Fitzpatrick. Furthermore, many former teachers who are now politicians would be familiar with the area. The Minister could not have more support for his actions and we support him and compliment and congratulate him for giving us the opportunity to discuss it.
I am neither a teacher nor a doctor but am representative of the general population in that, if it was not for the information sent to me by the representative groups in this area, I would be unaware of this problem. This is a key point in the debate. There is a need for awareness of the existence of the difficulty, as has been stated by other speakers, at school level, among GPs and among the population generally.
I have only recently become a member of the Joint Committee on Health and Children, so I was not part of the compilation of this fine report on attention deficit disorder in Ireland. I commend committee members on their work on it and commend Senator Jackman on her work in this area. I also commend the representative groups and lobby groups for parents and families on their excellent work in bringing this matter to our attention. I commend the Minister on his response and welcome the debate which, with other actions, will move the issue forward.
The report makes clear the extent of the difficulty faced by the family of a child with this problem to anyone who would not otherwise be aware of it. We are talking about the lives of children, their parents and their community. When one reads of the effects of severe cases of attention deficit disorder, one can see the havoc which can be wreaked on an individual's life. It is unnecessary because we know the extent of the problem and we have solutions. The bottom line is that we are agreed on the analysis, the extent of the problem and the solution to it, so now is the time for action.
I urge the Minister who, as Minister for Education and Science, was not found wanting in spending money on certain areas, to put the necessary resources into this area now and not to deliberate further on the matter. We have the resources and we are familiar with the cliché about the Celtic tiger. The prosperity available to us gives us choices and options. We now have possibilities available to us which were not available before. We now have the ability to ensure that the best possible service and the best delivery of it can be made available to those who need it. As Senator O'Toole pointed out, it is not just in this area but in other areas, such as autism, where services can be resourced or put in place which would make an extraordinary difference to the lives of those involved. Obviously early detection is extremely important, as are continual service, regular reviews and managing the problem.
This problem was diagnosed only in the 1980s. That does not mean it arose then. Obviously this means a considerable number of adults continue to suffer from attention deficit disorder whose lives have been blighted by it or who have suffered a lesser disability as a result of it. We must not forget those people in this debate and we must ensure that they are remembered when resources are put in place. There are a number of stories contained in the report of the Joint Committee which make harrowing reading. One could not help feeling that a considerable number of people have effectively been failed by the support system. However, it is not too late to do something for them and put an action programme in place to ensure they are no longer failed by the system and that the long years of suffering and neglect they have endured do not continue.
We are agreed on the problem and the solution. The time for talking is over and the time for action has arrived.
I welcome the opportunity to discuss the report and welcome the Minister of State at the Department of Health and Children, Deputy Moffatt. This is the greatest challenge this country faces at present. We are seeing huge social change in our lifestyles and family structures. Social workers and health board officals are agreed that there are major deficiencies in our support services. While I welcome the report and see the need to identify and address problems, I do not approve of pigeon-holing people. A major factor in the problem of attention deficiency disorder is the lack of family support systems in health boards and local authorities. Health boards and local authorities must co-ordinate their structures to support families who are our responsibility. Health boards provide very little support to help families to deal with the problems which affect them on a daily basis. With proper management and co-ordination between local authorities, the Department of the Environment and Local Government and health boards, we could, without major cost, establish structures which could co-operate with families and provide the necessary support structures for the betterment of children and families.
I recently spoke to a front line social worker who deals with problems and crises as they arise. The main function of social workers is child protection, and rightly so. However, their resources are very limited. We must establish family support services which will help families in their diffi culties and with the problems which arise in rearing children and in dealing with the difficulties which arise in homes. A social worker told me recently of visiting a house where a 12 year old child had been left to look after four younger children. Reports can identify problems and categorise situations as educational problems but I believe the most effective way to deal with these problems is to tackle them within the family. Health boards should examine these problems in their totality. They should deal with housing difficulties and provide support groups for families who need them.
I once saw a young boy clear the cutlery from 200 tables which had been set for a function and stack the pieces neatly. He was trying to show those watching that he was capable of doing something useful. Such children must be helped. Our society and our family structures are changing. We have single parent families headed by men and women and a range of changes in our social structures. We must provide people who can support single mothers and fathers and work with families to provide them with stability and a function in life.
The report is not unconnected to the problem of suicide. Unless people feel they have an importance and that their existence is meaningful to themselves and to society their problems will not be solved by being analysed or pigeon-holed.
I welcome the Minister of State, Deputy Moffatt, to the House. Like myself, he has experience in his other life of people with ADHD although when he and I were going through medical school the condition had not been heard of. The subject was not on the curriculum. I thank Senator Jackman for putting the subject on our curriculum and for bringing it to our attention.
We have all known children who were difficult but we could not identify what was causing the difficulty and we were often quite dismissive. It was only when I worked as a GP that I met parents who were under considerable stress caused by the behaviour of, perhaps, only one child in the family. There were no support services. As a GP I was unable to give them any counsel or help and I could only refer them to the school psychiatric service. Even that service is only beginning to come to grips with this problem and is very understaffed and overworked. In my own area there is a three to six month waiting period for assessment.
I was interested to hear Senator O'Toole identify what should be done and where it should be done. I have a slight disagreement with Senator O'Toole. By the time a child reaches the age of five his parents – and this disorder affects mainly male children – are distracted and will need very heavy intervention. Continuous assessment of children should begin when the child and his mother come home from the maternity hospital. We must establish structures and, as Senator Chambers recommends, they should be family orientated. We should not wait until a disaster is about to befall a family or a child before taking action. Support structures should be in place from day one. Neither the Minister nor I can wave a magic wand and put everything in place but we should be working in this direction.
Many adults are irreparably damaged because they were not helped when they were going through the school system. I wonder if the elderly people who are sometimes found dead, having lived alone in cold water flats, might have been suffering from ADHD in their younger years? It is possible that their condition was not diagnosed and they were pushed to the margins of society and left there. So long as they did not bother anyone no one bothered them until they were struck by a personal disaster.
In her recent excellent address to the joint sitting of the Houses of the Oireachtas the President said that children are not born bad, that there is a tendency to label them as disruptive, that it is adults who make them like that, perhaps through our sins of omission in not recognising their problems and in not taking steps to help them through the systems currently in place, which I realise have to be broadened and beefed up through the allocation of far greater resources.
As other Senators said this is the time to do so when the coffers are burgeoning. We can afford to put the necessary systems in place at pre-school level to help the children concerned. I do not like using the word "treat" as it turns ADHD into a medical condition, which carries a stigma. It is behavioural in character and cannot be diagnosed by a blood test. There is a need for continuous assessment and intervention.
Sitting suspended at 12.52 p.m. and resumed at 1.30 p.m.