The community pharmacy is often the first port of call for parents with nagging concerns regarding their children’s wellbeing, on many occasions providing a bridge between “gut feeling” and GP. As awareness of attention-deficit/hyperactive disorder (ADHD) increases, pharmacists may be asked for their opinion on suspicious symptoms initially, or advice on medication dosage or interactions following a diagnosis of ADHD.

The community pharmacist is one of the most accessible healthcare professionals and can take advantage of this fact to counsel and support both patients and family members about ADHD. 

One of the most common neurobehavioural disorders of childhood, ADHD affects 1-5% of school-going children (5-15 years) in Ireland, according to the Royal College of Psychiatrists (Irish Division) Child and Adolescent Section. This means that between 11,250 and 56,250 children will have ADHD at any one time, and up to 125 new cases of children with ADHD will arise each year.

But there is a huge difference between suspecting a child has ADHD and knowing for certain, and parents, teachers and individuals are cautioned against diagnosing ADHD themselves and to seek advice from a healthcare professional at the earliest opportunity.

“There are certain conditions where there is a massive episode and someone ends up in hospital and a diagnosis is firmly made, such as a heart attack, an epilepsy episode or a stroke. And then there are other conditions that are more creeping. It might start with a niggling suspicion that something is not quite right, and that’s what we tend to see in a pharmacy,” explains Sheena Lynch, who runs Lynch’s Pharmacy in Broadale, Douglas, in Co Cork, with her husband Garvan Lynch, pharmacist. Between them, they have over 30 years’ pharmacy experience. 

A nudge in the right direction

“We frequently see people come in at that initial stage, where they might have a small suspicion that their child is showing one or two symptoms of ADHD, or they have a gut feeling that something is not right. At that point, what people are looking for is information.

“With regard to ADHD, our job would be to provide accurate information – it’s one of those conditions that is very misunderstood and the pharmacist would be a trusted source of accurate information. For a person who has already received a diagnosis of ADHD for their child, the pharmacist can be approached for additional information about the prescribed medicine. Perhaps the person has concerns given that some ADHD medication has suffered from bad press in recent years. We would see our job at that stage as providers of solid and accurate medical and medicine-related information, both on the condition and on the treatment that is used; to dispel the myths,” said Sheena, the pharmacy’s research and information officer.

Sheena has helped to develop a range of easy-to-follow, custom-made management programmes at the pharmacy for a large number of health conditions, including ADHD, and also runs a website (www.lynchspharmacy.com) which offers information and guidance for patients to help them manage and live with their health condition.

“We tend not to view our patients as just a singular dispensing, or even a monthly dispensing, encounter; we view our relationship with them as long-term. There may be certain times of the year when a patient would require maybe 30-45 minutes of assistance, or discussion and counselling on their condition to make sure they are managing it well, following which they may not need us for months. It’s an ongoing relationship rather than one that stops with dispensing, and it helps us to catch any potentially serious complications before they occur,” she stressed, demonstrating how the expanding role of pharmacists in managing chronic conditions is succeeding in the community.

“If we are the first port of call for patients with regard to ADHD it’s usually because they have a gut feeling that something is wrong, and they’re looking for information about signs and symptoms. For most children diagnosed with this condition, the signs and symptoms appear before the age of seven. In some children, signs of ADHD are noticeable as early as infancy.”

Awareness of symptoms

Children with ADHD generally have problems paying attention or concentrating. They can’t seem to follow directions and are easily bored or frustrated with tasks. They also tend to move constantly and are impulsive, not stopping to think before they act.

Many children who have ADHD tend more toward one category than the other, but most would have some combination of inattention and hyperactive-impulsive behaviour, often becoming more apparent during activities that require focused mental effort.

“During the initial consult, we would also talk through other possible reasons for the child’s behaviour because sometimes it’s possible that the parent may have latched on to ADHD as the only explanation whereas most healthy children can be inattentive, hyperactive or impulsive at one time or another. 

“The shift in behaviour could be diet related, or perhaps linked to a recent emotional upheaval. It’s also important for parents to realise that it’s normal for a very young child to have a short attention span and not stick with one activity for long. Even in older children and adolescents, attention span often depends on the level of interest,” Sheena pointed out.

However, if the pharmacist feels there is genuine reason for concern, patients would be encouraged to speak to their GP, who may then make a referral to the specialist child and adolescent psychiatric service for further assessment and treatment.

The HADD (Hyperactivity Attention Deficit Disorder) family support group emphasised the importance of early diagnosis. “The good news is that ADHD is extremely treatable, indeed, it responds better to treatment than any other condition in children and adolescents. So, with the right kinds of education, intervention and supports, the individual can go on to reach their potential,” said a spokesperson.

Treatment options

Although there is no cure for ADHD, currently available treatments can reduce the symptoms of ADHD and improve functioning. This may be achieved using medication and/or treatments including various types of psychotherapy and lifestyle interventions.

“When a child is diagnosed with ADHD, the pharmacists can provide a full product information service regarding medicine dose and general instructions: Basically, what the patient is taking, when to take it, and what are the interactions and side-effects,” Sheena added.

She said that stimulant drugs (psychostimulants, such as methylphenidate) and non-stimulant medication (atomoxetine) are the most commonly prescribed medications for treating ADHD. Although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behaviour, thus reducing hyperactivity.

Although some international research suggests that the prevalence of ADHD may be increasing, Sheena and Garvan are not aware of a discernable increase in either the number of enquiries about ADHD or related prescriptions at their pharmacy.

“What we have noticed is that over the years people are increasingly exploring alternative management options for ADHD. There are a lot of complementary therapies running the gamut that would have clinical evidence behind them for this particular disorder, such as music therapy, art therapy, relaxation techniques, Snoezelen therapy – which is the quiet room, low-voltage lighting – and so on.

“For the primary carer, we would be encouraging interventions such meditation or t’ai chi, basically anything that can help them relax. Research has shown that children with ADHD tend to pick up on the moods of those around them, and if the primary carer is stressed, the condition tends to present more frequently.

“We have noticed a discernable shift from either taking medicine or using an alternative, to a combination of both. Very often, the combination of treatments can produce a greater beneficial effect, and this is something we’d actively encourage. 

“We’ve always felt that the value of a pharmacy is as much in the information we can dispense as the medicines. It’s not just about treating an illness with medicine, it’s about helping people to live better with their condition; it’s about filling that illness management gap and being there when they need you.”