Debunking myths associated with ADHD and finding a Medical Aid that can support this chronic condition

February is that time of year when back to school excitement diminishes and we begin to see how our children adapt to their new environments and any challenges the new school year may bring. In some cases, parents anxiously await a phone call from the class teacher, to discuss “Timmy’s” concentration issues. All too often, parents are urged by teachers (with no medical background) to consider medication so that their “Timmy” can fare better in the schooling system.

According to News24 South Africa has one of the highest prescription rates for ADHD medication. Many disorders can become doused in stigma; ADHD is no exception. Drawing on the work of Dr. Sharon Saline; here are four myths about ADHD that have been debunked.

Myth One: ADHD is not real and is a recent psychiatric invention.

ADHD is very real. Parents with ADHD children can speak out about this. Despite what many may think it is classified as a chronic condition marked by persistent inattention, hyperactivity and sometimes impulsivity. ADHD begins in childhood and is a biologically based condition. It is not a fad and has been documented in medical literature since the early 1900s.

Myth Two: ADHD is a lack of willpower – kids could focus if they really wanted to.

ADHD manifests in a variety of challenges relating to: impulse control, planning, organisation, motivation, working memory and emotional regulation. Chemically this is as a result of lower levels of norepinephrine and dopamine. This makes it extremely difficult to focus on things, especially if those things are perceived as uninteresting or unfulfilling.

Myth Three: Only boys have ADHD.

When ADHD presents, boys tend to be more hyperactive and girls tend to be more inattentive. This means diagnosis of boys is higher because hyperactivity is more identifiable than inattention. Children who appear to be doing ‘well’ are overlooked until ADHD symptoms appear later in life.

Myth Four: ADHD is over-diagnosed, and medication is over-prescribed.

While there is a very real factor fuelling this myth, namely, when people are not given a thorough examination, they can be misdiagnosed with ADHD without ruling out other conditions which may manifest similar symptoms to ADHD. Therefore, a proper, detailed assessment is essential. There is an increase in diagnoses, not due to ‘over-diagnosis’ but rather more knowledge on ADHD and its manifestations.

More on proper diagnosis:

A psychologist, a psychiatrist, a neurologist or a family physician are the medical professionals you would seek out in order to get a proper diagnosis of ADHD. Since ADHD shows symptoms that can be related to other circumstances it is essential to see a specialist regarding the matter. It is also essential to know who isn’t qualified to diagnose ADHD, namely, teachers, other parents and other students. Not only does the diagnosis need to be done by a specialist, it is important to choose a specialist that suits you. ADHD is a lifelong journey. Once you find a specialist you will need to keep going back to that specialist for check-ups and new scripts – since ADHD medication is a schedule 6 medication, a new script is needed every month – so it is essential to find a specialist that suits your needs and budget.

What about ADHD and your Medical Aid?

In terms of the Medical Schemes Act, regardless of the benefit option you have selected, there is a defined list of benefits/treatments for which all Medical Aid schemes in South Africa have to provide cover for. This includes covering the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 25 chronic conditions.

Since ADHD is classified as a chronic condition, one would expect it to be covered as such by your medical aid as a prescribed minimum benefit. Unfortunately, this is not always the case. In many instances, medication would need to be funded from your medical savings or out of your pocket. This could amount to as much as R12000 per year, excluding any script fees or specialist appointments.

If you have a child with properly diagnosed ADHD, then you need to find a medical aid that can give you the best possible support?  Some medical aids regard ADHD as a chronic condition where you will receive chronic benefits to age 18 (Fedhealth), others don’t (Discovery)!

So, if you have a child with ADHD, check if it is listed as a chronic condition by your medical scheme and then check that the specific medication you use is also covered. Also, important to note when it comes to chronic medication, is that schemes can impose preferred providers and sometimes only pay for generic versions of medication. This essentially means that you need to get your medication from the medical scheme’s appointed service provider or you will need to fund a co-payment out of your own pocket for your chronic medication.

To find out if your medical aid covers ADHD visit and get in touch with one of our specialist consultants.