‘When I started taking ADHD medication it was as if someone flicked a switch’
After having been treated for depression unsuccessfully and asked to leave school, getting the correct diagnosis gave Askar Keen a new lease of life.
This article was written by Sarah Boseley, and appeared online on the Guardian, 03.08.18.
Askar Keen is waiting for his A-level results after the most turbulent and distressing three years of his young life. At the age of 10, he asked for a medical textbook for Christmas, obsessed with becoming a doctor. It was and still is his passion. Yet when he was 17, he was asked to leave school and tried to end his life.
Keen, now 19, is not what anybody imagines to be the archetypal boy with ADHD – attention deficit hyperactivity disorder. But it was only when he got that diagnosis and started on medication that he could pull the scattering pieces of his life back together.
“I wasn’t the bouncing off the wall type of kid and did alright academically,” he said. “People tend not to spot the much less obvious signs. My hyperactivity did manifest but not in the stereotypical way.”
He gave everything to his obsession with medicine but could not interest himself in anything else. “If you imagine most people have a dial where they can turn up their attention and turn it down,” he said. He could not. He got through his GCSEs, but could not focus on some aspects even of the subjects he needed at A-level. Biology was fine – but not when it came to plants.
He was also unable to regulate his emotions. “I could be extremely anxious, prone to massive bouts of low mood. Making friends and keeping friends was extremely difficult.” In his reports nearly all his teachers remarked that he was “quite intelligent but can’t focus” or “loves to focus on what he enjoys doing but not on what he hates”.
He was diagnosed with depression and received cognitive behavioural therapy and antidepressants, “but things continued to decline to the point where I wanted to end my life,” he said. “My lifelong dream had been to do something medical but I could see that falling apart. I ended up being sectioned by the police just before I turned 18. I’d just been asked to leave school because my attendance was so low because of the depression.”
A doctor had once suggested ADHD. Waiting times for an NHS referral were long so his desperate parents paid £750 for a private consultation. Keen was diagnosed in February 2017 and prescribed medication.
“It didn’t mean a lot to me at first,” he said. But when the low initial dose was increased, he said, he was shocked at the difference it made. “It was as if someone had flicked a switch.”
He started his A-levels again at a new school and is hoping to study at university to become a paramedic.
ADHD attracts scepticism because the symptoms are behaviours that used to be classified as plain naughty – impulsivity, including shouting out in class, hyperactivity and inattention. The drugs to treat it are stigmatised, say the experts, tarred as “smart drugs” that parents in the US allegedly seek out for their children in hope of raising their grades.
But Keen’s story is not unusual. ADHD is not a label for rowdy, naughty boys but a classified neuro-developmental disorder.
It is also probably far more prevalent in girls than most people assume.
“ADHD is perceived to be disruptive behaviour but there are a lot of people who are withdrawn or anxious. That is why girls are missed,” says Jo Platt, MP and chair of the all-party parliamentary group on ADHD. “They might be very capable of passing exams or getting through lessons.”
As a result, there are large numbers of girls and women in the criminal justice system with ADHD, says Dr Louise Theodosiou of the of the Child and Adolescent Faculty of the Royal College of Psychiatrists. “A systematic review found that up to 18% of girls in prison might have ADHD,” she said.
“There is something really huge that we need to be thinking about in relation to our kids,” she said. She is concerned also about the population of “looked-after” children. “They are the hardest to diagnose because their early history may have been lost. They are more likely to be in the criminal justice system for a number of reasons. The impact on their self-esteem is huge.”
She says children need to be diagnosed when they are really young so they get support. There has been “a really intense decade of awareness raising” she says. “It is really clear how much suffering undiagnosed ADHD causes.”
Some children with ADHD may appear to be unruly and pushing the boundaries, “but underneath that there is a child who is frightened and distressed”. Diagnosis of ADHD is not foolproof, she says. “It is not like an X-ray.” But in addition to input from the family and from school there are now standardised computer tests which can help assess a child’s impulsivity and concentration.
“We absolutely have to get it right. It’s not like diagnosing a cold. It has implications and we tend to be very careful,” she says.
Nobody supports the mass medication of children. Critics of the stimulant drugs like Ritalin (methylphenidate) that are prescribed for ADHD say they are used too much and warn of side-effects like growth stunting. The National Institute for Health and Care Excellence’s guidance is that they should only be given for severe ADHD, together with other support. But although prescriptions rose eight-fold between 2000 and 2015, the UK has one of the lowest rates of prescribing these drugs in the world.
When a child is given a prescription, “it is a huge deal for the child and the family,” says Theodosiou. “It is a label of being unwell. It is profoundly difficult for the family.”
“Medication can be transformative” says Dr Theodosiou. “I see wonderful results. I’ve had kids coming back saying for the first time I have been invited to a party. When they first came they were on antidepressant medication, making no eye contact and tearful.”
Young people come in with gelled hair and clothes that show their new self-confidence, saying they did their homework and are starting to think about going to college and having a future.
“It’s a wonderful journey to go on with a young person,” she said. “When you put people on medication, their brains are operating at the same rate as other people and they can start to do all that learning.”