More and more children are being diagnosed with attention deficit hyperactivity disorder (ADHD). Some are prescribed the powerful drug Ritalin and kept in mainstream classes with additional support. But if the system is unable to cope, the consequences can be disastrous, as they were for Joel Burr. Douglas Blane reports
Joel Burr, a cheeky-looking 15-year-old lad with attention deficit hyperactivity disorder (ADHD), will never be taught in a mainstream school again, even though he is much less hyperactive than he used to be. Exactly a year ago his Mum found him hanging from a door with a belt around his neck.
School and Joel had never been an ideal match, and at one time in primary school he was getting only four hours tuition a week. But he wanted to stay in mainstream education and because of his ability everyone agreed that that was the best option for him. Eventually, with the help of the calming drug Ritalin, things did improve for a time.
He settled into secondary school and, for a boy with ADHD, was getting on quite well for the first two years. Then, at the beginning of third year, something happened. His Mum, Coralie Burr, says the learning support that was so essential for Joel was reduced to a minimum.
The council denies this. The only thing that changed between second and third year, says a spokesman, was the person delivering the support.
What is not in question is that Joel's behaviour grew rapidly worse, and within six weeks the decision had been taken to exclude him permanently.
Two months later, at home and getting no schooling at all, and while his Mum was awaiting a reply from the council to her letter appealing against exclusion, Joel hanged himself.
Doctors were able to revive Joel but his heart had been stopped for so long that his brain had suffered severe damage. He no longer walks or talks, but he has an infectious smile and his eyes are full of life and mischief.
Although speech is an enormous struggle, he did manage it on one occasion. In hospital he kept pulling out his tubes and his nurse, who these days visits him at home, kept putting them back. Summoning all his resources, Joel managed two words which had been among his favourites before he damaged himself. "**** off," he told the nurse. He and she both smile as they listen to his Mum telling the story.
Mrs Burr now looks after him at home with the help of visiting carers but he gets no schooling. For a time he tried Kings Park in Dundee, a school for children with special needs, but the nature of other pupils' difficulties meant that noise levels were high and lessons seemed unstructured. Joel became very distressed. Just because he is brain-damaged and in a wheelchair, doesn't mean that his ADHD has conveniently gone away, explains his Mum. She withdrew him from the school and now he gets no formal education of any kind.
"We can't force Mrs Burr to send Joel along," said a spokesman for Dundee education department. "That is the one facility we have in the city for kids with special educational needs. It is a good facility."
Joel's bright eyes show awareness and he can use his hands. In these days of increasingly advanced technology in schools it should not be difficult to find suitable computer equipment that would give him access to distance learning, games and the mental stimulation so essential to encourage damaged brains to begin to restore lost functions.
In many ways life has changed utterly for Joel since he almost killed himself. He can't go to school. He can't walk or run. He can't shout or sing. People are nicer to him than they used to be, his Mum says, because now his disability is obvious.
However, some things haven't changed. Joel still likes to be well dressed; he still loves fashion, music and cars. He still has ADHD and he still needs an awful lot of assistance with his education.
More and more children are being diagnosed with ADHD and there is continuing pressure to teach these children in mainstream schools. This creates problems for teachers because the main features of ADHD - inattention, hyperactivity and impulsiveness - are precisely the sort of behaviours they have always worked hard to eradicate. It only takes one loud, unco-operative child to distract a class so badly that not only does he or she learn little, but so do 20 to 30 other children.
Controversy surrounds ADHD. Some people doubt the very existence of the condition, others question the methods of treatment - especially in the United States where the number of children on the powerful drug Ritalin is a national scandal.
The consensus among experts in the UK is that ADHD does exist, that the incidence of it is rapidly increasing, that it can range from a mild to severe affliction and that Ritalin helps in about 70 per cent of cases but should be seen as a short-term measure.
All this means that teachers are having to cope with behaviour that would formerly have had children excluded or sent to a special school. The difficulties are perhaps greatest with those whose behavioural problems are not considered extreme enough for additional support to be provided. But aiming simply to cope is not the best policy because if it fails the consequences can be disastrous - as they were for Joel Burr.
Strategies have been developed which can help teachers manage ADHD children positively in a classroom, and education authorities such as Edinburgh, Glasgow and Fife now run courses and provide extensive material to assist mainstream teachers.
Uninhibited, unco-operative children with short attention spans have always existed but there is a theory that our high-tech world has changed the nature of children, all of whom now need much more stimulation, variety and multi-tasking than ever before. Classroom techniques based on this idea have been developed in the United States and Japan and recently have begun to be tried in this country (see TES Scotland, October 15, 1999, How to set their minds alight).
In the long term, perhaps computers will provide a significant part of the solution to classroom management of ADHD. In the meantime, teachers need more advice and information about the disorder. Scientists need to find out why it is on the increase and if the trend can be reversed. And afflicted children need to be identified and provided with support.
Linda Corlett, an educational psychologist with the City of Edinburgh, says: "Part of the remit of an educational psychologist is to deliver in-service training, to translate the latest research to the teaching environment. My speciality is ADHD.
"A few years ago a number of psychologists, including myself, surveyed the published work on ADHD and did some empirical research. I then developed a package of material, including management guidelines for teachers on children with ADHD, which forms the basis of my part of the in-service course in Edinburgh.
"We try to give balanced information - some organisations are quite extreme in their views on ADHD - for teachers on behaviour management in a simple, practical form. It's a spectrum disorder and children with ADHD are all different.
"The best way of managing ADHD is for professionals to work with parents and tackle the problems in a multidisciplinary way but that may not always happen.
"My message is that if the child appears to have these difficulties, there are tried and tested ways of dealing with him. Colleagues have asked if the techniques can be used for any kids with behaviour problems, and because most of the course is about good behaviour management and intervention, the answer is yes."
Maureen Brice, an adviser in learning support and special needs for the City of Edinburgh, says: "We have set up courses for all teachers involving educational psychologists, psychiatrists from the Royal Hospital for Sick Children and experienced teachers. They look at identification of ADHD, medication and teaching strategies.
"We're keen to get the message across that this is a disability, not a child who is trying to annoy you. Children with ADHD may have a record of needs but may not, depending on the severity.
"If Ritalin is prescribed, schools have to deal with it like any other drug. It's not up to us to decide whether kids should be taking it: that's a medical decision.
"There's no doubt these are challenging children and, although the condition only became known as ADHD recently, I think they've always been with us. They used to be down as bad kids."
Paul Hamill, head of educational support and guidance at the University of Strathclyde's faculty of education, warns: "You need to take a balanced, rational approach to this. Behaviour takes place within a relationship. The most effective teachers I know can look at themselves as well as the child.
"I don't dispute for a minute that some children have ADHD, nor that some of them need perhaps to take drugs. But Ritalin sedates children and there are dangers in prescribing it without also addressing other issues. Behaviour is multi-layered and there can be many causes: ineffective parenting, damaged self-esteem, an inappropriate curriculum or ineffective teaching. The danger in saying it's ADHD is that you stop looking for more deep-rooted causes.
"I'd look at the curriculum, effective teaching, enhancing self-esteem, and then bring ADHD into that context.
"I've been working with a dozen schools with pupil support bases for children excluded from classrooms because of behaviour difficulties and I can assure you 80 per cent of them don't have ADHD."
Pamela Manley has an eight-year-old daughter with ADHD and is a member of a parents support group called Friends Without Frenzy.
"My daughter is fairly manageable at home," she says. "The pressure has come from school; she only takes Ritalin when she goes there. It's to do with her being able to sit down and do her work in a classroom. We tried taking her off it but the school had a really bad time.
"What I hope is that she'll learn techniques so she won't have to take it in years to come. But if she doesn't, I guess she'll be on Ritalin all the time she's in education.
"I think classes in school are too big for kids with ADHD. Educational support is vital; my daughter gets it three times a week.
"Our group has been going for about a year and we found it very difficult to get funding. We tried the council but they said no, so now we do car boot sales."
Aileen Small is the carer of a 12-year-old boy who has ADHD. "He's been on Ritalin since last October and is better than he was. It hasn't taken away the symptoms but it keeps him more controllable," she says.
"He got very frustrated when he changed from primary to secondary school. At primary he was half the time in mainstream and half in a support class, and he had an emotional support teacher when he felt distressed. But at secondary he has none of that, and also has to cope with the constant changes of class and teacher. He finds that really hard.
"I think people need to know more about how the brains of these kids work. The signal gets lost and they get very frustrated and it shows itself as anger instead of confusion. And they don't know how to deal with anger.
"He has a very hard time relating to teachers of the old school. Newer teachers have a different approach - not so much 'Sit there and do that' - and he works better with them.
"We find it difficult trying to communicate information about the condition to schools. Recently we arranged a seminar and got experts to talk about ADHD. MSPs came, so did people from social services and youth workers but although we invited the education department, no one came."
WHERE TO GO FOR ADVICE AND SUPPORT
YoungMinds is a national children's mental health charity which will provide a package on ADHD and also keeps a database of services around the country.Tel 020 7336 8445, freephone helpline 0800 018 2138.
Support groups Information on support groups and individuals throughout Scotland with an interest in ADHD can be found at www.adders.orgscotlandmap.htm or tel 01843 851145.
Linda Corlett, Edinburgh City Council, tel 0131 229 4223.