Pull-out Quote: 25% of adolescents living in Beirut suffer from an emotional, behavioral or learning disorder while only 6% of those needing treatment receive it.
ADHD is a common treatable childhood disorder characterized by hyperactivity, impulsivity and/or inattention. A clinical evaluation is needed only when one or more of these symptoms—which typically appear before the age of twelve—cause impairment in daily functioning. It is more common than most people assume, and it is more frequent in boys than it is in girls. Though 40 percent of children with ADHD eventually outgrow it, there is a possibility it can continue into adulthood.
“Unfortunately in Beirut, there are a large percentage of children who are struggling with these sorts of disorders and not getting the attention they deserve,” says Dr. Fadi Maalouf, director of the Child and Adolescent Psychiatry Program at AUBMC, and Lebanon’s premier authority on ADHD. Tucked away just off the busy streets of Hamra, Dr. Maalouf’s clinic specializes in diagnosing and treating children and adolescents with emotional, behavioral or learning disorders. A distinguished graduate of Harvard University, Dr. Maalouf has ten years of experience in the field and has been working in Lebanon since 2009.
According to the latest research conducted at AUBMC, at least thirteen percent of children worldwide and twenty-five percent of those in Beirut suffer from some sort of emotional, behavioral or learning disorder—the most common of which is anxiety and attention deficit hyperactive disorders. What is particularly worrisome in the Lebanese context is that only six percent of those who are struggling receive any sort of professional help. To put that in perspective, consider the fact that the world average for receiving treatment is close to twenty-four percent. “This is a shocking statistic since effective treatments exist and are readily available in Lebanon,” says Dr. Maalouf.
To target the problem of under diagnosis and in order to increase awareness of ADHD within society, the Child and Adolescent Psychiatry Program at AUBMC held their annual conference about this topic this year. The conference also celebrated the launching of the ‘Focus Fund’ conference, the first endowed mental health fund in Lebanon and the Arab region dedicated to improving children’s mental wellbeing. One of the goals of the fund is to direct resources at overcoming the obstacles poised by cultural challenges of accepting ADHD.
These challenges, most strongly felt by parents, often present themselves in the form of a stigma against prescription pills. “Discovering that my seven-year-old daughter was diagnosed with ADHD was not easy for me to accept,” says Samira, the mother of a longtime student at Etcetera. “When my daughter’s grades dropped in school, a teacher at Etcetera suggested that I take her to see a professional for a thorough evaluation.” When her doctor suggested medication, Samira spent a few sleepless nights weighing the pros and cons of such a move. “It was with great reluctance that I finally gave in. I was very
conflicted about it but soon I noticed a dramatic improvement in my daughter’s academic ability and overall sense of confidence.” After only a few months, Samira’s daughter started taking a renewed interest in books and reading, something she had not done prior to starting her treatment. “Everything changed when my daughter told me one day: ‘Mommy, now when I read the book, I’m in the book.’”
A top professor at AUB, Samira was better informed than most people about the disorder. “The truth is that I knew a lot about ADHD, but when it is your own child, it is a difficult pill to swallow.” Her initial fears were greatly eased when she took her daughter to see Dr. Maalouf. “If I could give advice to any parent who is struggling with this right now, it would be to say that I genuinely regret not going to see a doctor sooner.”
“There is still stigma around the issue of ADHD in Lebanon,” says Etcetera educational consultant Huda Abdul Malak. “It can be a very delicate and emotional issue for some parents.” She says that most of the time the stigma is rooted in a great deal of misinformation. “We always encourage our parents to see a health care professional to make sure they have the right facts in order to make the best decision possible for their child.”
Abdul Malak says that students diagnosed with ADHD or those who exhibit ADHD-like symptoms can excel in the classroom on the condition that there is a supportive infrastructure in place. “Some practical teaching tips can make a world of difference.” According to Abdul Malak and in line with Etcetera’s teaching philosophy, keeping the lesson schedule known in advance, repeating instructions and giving them one at a time, and working with students one-on-one, are all ways to create an accommodating learning environment. “Beyond structural adjustment, by far the most important element is an encouraging and positive attitude,” she says.
While it sounds simple enough, cultivating a positive attitude can be an uphill battle, considering popular misconceptions about ADHD being caused by bad parenting or lack of discipline. “This is absolutely not true,” insists Dr. Maalouf. “In fact, there is no single cause of ADHD. Since it tends to run in families, we know that it has a strong genetic dimension.”
According to Dr. Maalouf, parents are maybe surprised to hear that there is no single test indicating the presence of ADHD. “To reach a clinical diagnosis, we conduct extensive interviews with the parents and the child, inquiring about the child’s behavior at home and at school,” he says. “A great deal of information must be gathered and assessed,” he says, gesturing toward the pile of children’s’ notebooks on his desk. This is often followed by cognitive tests to determine a child’s attention span. Since the disorder exists on a spectrum, the diagnosis will specify whether it is a mild, moderate or severe case of ADHD. “Treatment can include medication, cognitive behavioral therapy, or special tutoring, but the most important aspect is strong family and educational support,” Dr. Maalouf says, stressing: “The earlier that support presents itself, the better it is.”
If ADHD is left untreated, bigger problems can ensue down the road, making early intervention absolutely vital. “Untreated ADHD can lead young people to being disruptive and withdrawn, and it’s vital they are supported and not just ignored or disciplined,” Dr. Maalouf stresses. If you want to learn more about childhood ADHD, visit: AUBMC.org