How Collaboration can work
Under her care she has a six-year-old boy called "Jon". While he has a variety of social problems, he also has ADHD.
In such cases, where "environmental" and "medical" lines blur, it can be very difficult to diagnose ADHD, says Dr Bailey. But Jon has "settled quite remarkably on Ritalin and would have been grossly deprived if we had not used it".
The drug alone is not enough. "Intensive management is also needed in other areas. We have specialist teachers who go and discuss strategies directly in schools; it is successful as they have a more realistic appreciation of the situation for other teachers."
Jane Dodd (not her real name) is the teacher in charge of the small special needs unit that Jon attends. The impact of the drug on Jon is clear to her. "Some mornings it's obvious that he's only just had the dose before arriving. He's all over the place, hitting people, blowing on them, knocking things over, hurting himself. Within an hour, you see him calm down.
"From his point of view, I can see it's helped him no end, to be calm and settled. I've seen him when he's not; he's incapable of learning anything, or doing anything."
Jane Dodd attends review meetings with everybody concerned with the management of Jon's case twice a term. Initially, she had weekly phone contact with the child guidance unit. Jon still spends a lot of time there having therapy, and getting the one-to-one attention he sorely needs. "They've done most of the behaviour modification," she says. "We continue it here. We have a homeschool book and I write down how he's been; they do the same and we discuss it. It works, but it's time consuming."
Fear of overuse of Ritalin, its occasional worrying side-effects, and the difficulty of establishing good multi-disciplinary collaboration should not combine to deny the drug to children who really need it. Parents with years of bitter experience point to the devastating effects of untreated ADHD on the individual child, his or her future prospects and the sanity of the whole family.
Linda Brewer, treasurer of LADDER, says ADHD children are punished for the way they are. "The great tragedy is that by nine or ten, the bad experiences have gone very deep. Without the right help these children fail in every area of their lives."
* LADDER, the national learning and attention deficit disorders association, supplies information on receipt of a SAE to 142 Mostyn Road, London SW19 3LR.