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17 September 2014
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Liam
Living with ADHD

Programme transcript.

Programme summary

Programme questions and answers

NARRATOR (JULIET STEVENSON): Tonight's Horizon takes a different approach. One we have never taken before. This programme looks at a much-misunderstood neurological condition.

LIAM: It's boring this. Aarrgh.

NARRATOR: It's a condition that some people do not even believe exists.

CHARLOTTE: You just get a feeling that they're sort of looking at you in an odd way.

NARRATOR: Horizon spent six months with two families learning to live with ADHD - Attention Deficit Hyperactivity Disorder. This is what it's really like.

CHARLOTTE: James, I'm really going to lose my temper in a minute.

JAMES: I'd rather have ADHD than be normal.

LIAM: Pig Head.

CHARLOTTE: I'm hoping that the positive side of their ADHD is going to take them forwards.

JAZMINE: I wouldn't want to not have it because it's just the way I am. I wouldn't be me.

NARRATOR: It's Saturday morning in Wigan. Brian and Eleanor Hill are taking their two sons Lewis, who's 2 ½ and Liam who's 5, into town shopping. Liam is not like other children.

ELEANOR: Liam just wait for the door to open. Stand here, Liam.

BRIAN: Liam, don't you dare, come here, come here it's high up that, I don't like this.

ELEANOR: Liam there's cars coming, straight here now.

BRIAN: Me hearts just stopped beating then.

LIAM: Why?

BRIAN: Because that was frightening when you went into there.

ELEANOR: Give me your hand, give me your hand, Liam.

NARRATOR: Liam is fearless and impulsive. Brian and Eleanor know that if he sees something across the road he won't think twice about running towards it, regardless of traffic.

ELEANOR: Liam, not too far in front please. Come here. First time I've told you Liam, if I have to keep telling you the same things you do not go on the ride. Hold my hand. I'm standing here and I'm not moving until you hold my hand, one, two, hold my hand, well hold the pram then, thank you, one or the other.

NARRATOR: He also rarely does what he is told.

ELEANOR: Hold the pram that's the second time I've told you Liam, no. I want you to hold my hand because it's very busy and I don't want you to get lost. Hold the pram, now. Right I tell you one more time you don't go on the ride. We've not even got in to Wigan Liam.

BRIAN: Calm down.

ELEANOR: Ok. I don't want to calm, I want him to hold the pram, it's a simple thing.

LIAM: Hello.

ELEANOR: Liam, not too far in front please.

NARRATOR: Liam is constantly on the go, and he never stays with anything for long.

LIAM: [SHOUTING].

ELEANOR: It's horrendous, there's no way you could possibly come shopping with the two of them. No, very rarely we come to shop.

NARRATOR: No matter how many times Brian and Eleanor tell him not to, Liam will do the same thing over and over again.

ELEANOR: Liam, Brian, Liam. Come here now, here. That frightened me. That has really frightened me. Get in.

BRIAN: What did he do?

ELEANOR: He jumped straight at that bloody edging.

BRIAN: Get in the car Liam, mummy's upset now.

LIAM: Pig head. Oh Liam be quiet, I can get my own belt on.

NARRATOR: Liam's behaviour puts enormous strain on the whole family. Last year Eleanor reached crisis point.

ELEANOR: Your nerves can only stand so much and I think that's what happened, with me last year it was like my body just said enough's enough really.

LIAM: Pippin! Pippin in the rain, [SINGING], do you like it too.

ELEANOR: I got so low, I went to the doctors and the school got involved then and then it suddenly became, they started taking us serious.

ELEANOR: Liam.

LIAM: I don't want a coat on.

ELEANOR: No, you need it on because it will be cold, I don't want you to get cold. Now listen, now the rules are you don't go out of them gates. Ok. You don't go anywhere apart from that allotment without telling me and checking with me first. Do you understand? Listen. Say yes Mummy I understand.

LIAM: Yes Mummy I understand.

ELEANOR: Right well Daddy's going to come round with you just to check.

BRIAN: Liam be careful up there kids. Watch him Matthew.

NARRATOR: Brian and Eleanor are so concerned about Liam's behaviour that they've taken him to see their local Child and Family Mental Health Unit. They are waiting to find out if the problem with Liam is ADHD - Attention Deficit Hyperactivity Disorder.

BRIAN: Don't push it kid else you'll have to come in.

NARRATOR: Jazmine and James Fisher are 11 and 7 and live in Warminster with their mum Charlotte. Two years ago both children were diagnosed with ADHD.

CHARLOTTE: James don't, please. Look, don't make me cross, give it here please. James, if you rip my curtain off I will get cross with you, now stop being stupid. Give me the egg. James, I am not having it bounced in the house.

NARRATOR: ADHD is a neurobiological condition, a chemical imbalance in the brain characterised by three main symptoms, inattention, hyperactivity and impulsiveness.

CHARLOTTE: Leave it alone. Leave the egg alone.

NARRATOR: Because of it, Jazmine and James are bombarded by thoughts, and have difficulty controlling their behaviour.

JAMES: Where's the egg?

CHARLOTTE: James, James.

JAMES: What?

CHARLOTTE: Why don't you go and play on your Playstation?

JAMES: Ok. Now leave me alone you bitch.

CHARLOTTE: That's nice, thank you, I always like to be spoken to so nicely by you.

NARRATOR: Charlotte finds that conventional parenting methods just don't work with her children.

CHARLOTTE: I do try and ignore some of the behaviour, I suppose a lot of parents you know if they were called a bitch and things like that the hard line discipline would come out, but it just doesn't work, because he'll still do it anyway, so I'll just try and ignore. Obviously when he's getting really physical which you know sounds like is happening now, then I'll have to go and split them up, then sometimes I'll just get.

JAZMINE: He just came in my room and started attacking me, so hitting me yeah, telling me, saying where's the egg I know you've got it when I haven't, yeah, pushing me off my bed, so now I just hit him.

CHARLOTTE: Alright fair enough, can't really say anything can you. Now James if you're going to hit people you're going to get hit back aren't you. Well just ignore him Jazmine because that's what he wants, he wants you to get wound up by it so the best thing for a show off is to ignore them.

JAZMINE: Anyway I never liked that card, James I never really liked that card anyway. James, Follow the Yellow Brick Road.

CHARLOTTE: Don't do that, Jazmine don't go winding him up, well of course it did, I'm just going to ignore it, I don't even want to look.

CHARLOTTE: The emotions that he feels are so strong a lot of the time it's hard to control. I used to dread going round Safeway because he'd throw things at people, spit and writhe around on the floor, and I fucking hate you, you bitch, and things like that, and you'd have the supermarket, everyone in it looking at you, and there's me just going round with my trolley trying to ignore it.

CHARLOTTE: Move washing off.

NARRATOR: James's impulsive behaviour has got him into trouble. He's locked the laundry room door and dropped the key behind the freezer.

CHARLOTTE: Now you're strong, oh shit, big muscles, yeah, pull that freezer out, you'll have to get down and pull it. Pull it over, pull it over, mind your toes, that's it, now very carefully mind out the way, carefully, that's it. Right now hop over and get the key. Drama over, he's free. Oh. Well he didn't mean it Jazmine did he? He's freaked himself out. Oh you do learn lessons the hard way. Did you think you were going to stay in there forever? Never mind.

JAMES: It's not funny.

CHARLOTTE: No I know, it's not.

JAZMINE: You must have been very strong to get the key back.

CHARLOTTE: Yeah, well let's go and sort that out now, don't do that again, don't lock your self in there.

JAZMINE: That was funny.

NARRATOR: Despite their disability, Jazmine and James do have exceptional talents. With the right support, they can achieve remarkable results. James has recently won a place at a football school of excellence.

CHARLOTTE: These are all the things that James has got for his football and he absolutely loves it.

CHARLOTTE: He's good at it as well so he gets positive feedback which is so important for an ADHD child because they get so much negativity the whole time, to actually have something positive where people are saying yes well done James, that's really good, you know he's better behaved with positive encouragement. I think lot of people will be surprised that somebody who has ADHD can focus that well to do something.

NARRATOR: Jazmine on the other hand, has an impressive artistic flair.

CHARLOTTE: Look at the detail of that, I mean it's brilliant. Jazmine she's quite creative. That's the side of her ADHD that comes out the most. Before Jasmine's diagnosis she had extremely low self esteem, she didn't believe in herself, she had a sense of failure. She didn't sleep, she had a concentration problem and she was hyperactive.

NARRATOR: Like many children with ADHD, Jazmine's condition was made much worse by the presence of another disorder.

CHARLOTTE: It's very rare for someone to actually just have ADHD, they usually have dyslexia, dyspraxia or something that runs alongside it. I managed to get the help of a psychologist and she ascertained that Jazmine was definitely dyslexic and she showed a lot of traits of ADHD.

NARRATOR: These linked conditions are known as co-morbidities. The most common is Oppositional Defiant Disorder where the child becomes hostile, disobedient and extremely difficult to parent.

ELEANOR: Liam, No, no, no. You've got a big bruise on your face now, no. Right come on you two it's raining. Come on, in you get.

ELEANOR: You constantly feel that you are in a no win situation sometimes because if I said black Liam will say white. If you say to him Liam don't put your feet on the table he will put his feet on the table.

ELEANOR: Come on, don't Liam because if you have another warning you need to go in your bedroom for 5 minutes. In now. Have you forgotten where we are going tomorrow night? In the house now, Liam, house now. In the house now.

LIAM: Stupid idiot.

NARRATOR: Psychologists believe that many ADHD children develop oppositional behaviour as a reaction to constantly being told off. It's their way of coping when they are being criticised for behaviour they simply cannot help.

ELEANOR: He needs to go upstairs in his bedroom for five minutes. He had three warnings and was asked to come in.

ELEANOR: Liam your 5 minutes only start from when you're quiet.

NARRATOR: All children throw tantrums and squabble. What makes ADHD children different is that their behaviour is extreme and unrelenting.

CHARLOTTE: Now what did you do that for? You know you're both as silly as each other.

NARRATOR: ADHD is only diagnosed when the symptoms are so bad that they are affecting the child's relationships and ability to learn.

CHARLOTTE: This is the Connors rating scale and this is one of the methods of trying to diagnose ADHD. You have one twos and threes and you have to answer best, you know is this a little true, is it pretty much true or is it very much true, or is it never at all. And these sort of questions here relate to symptoms of ADHD. And I mean Jazmine here scores a three for disturbing other children, only paying attention to things she is really interested in, has difficulty in waiting her turn, interrupts or intrudes on others, restless always up on the go. And if you look at how much better now Jazmine's hyperactivity is, or you know controlled it is, she scores a three for that, she was very hyper.

NARRATOR: After her children's diagnosis, Charlotte read up about the condition and made an extraordinary discovery.

CHARLOTTE: I read this particular book and I really I thought oh my God I have just read my whole life in this book. And I was quite shocked at how similar and you know it was almost a bit weird like how many things related to me and that's when I realised, God this has been my problem my whole life.

NARRATOR: From an early age Charlotte was difficult to handle and a desperate worry to her mother. As a teenager she was removed from six different schools and became hostile and self destructive.

CHARLOTTE: I was just a very bitter angry and resentful teenager and I didn't want anything to do with society any more. And I'd had a big void inside me where I'd always known I was different and I discovered drugs and the drugs filled that void and masked it and made me you know forget the pain of it all and I just.

CHARLOTTE'S MOTHER: You were trying to obliterate it I suppose.

CHARLOTTE: Well yeah and I just abused drugs and alcohol and I didn't want anything to do with society because society never wanted anything to do with me.

NARRATOR: Charlotte found that stimulant drugs affected her in an unusual way, they actually calmed her down.

CHARLOTTE: I did find especially with cocaine that it made me focus, it makes your thought patterns better so you can concentrate and you actually feel better for taking it. So it is I think a form of self medication. But of course you know doing so much coke it made me really, really ill.

CHARLOTTE'S MOTHER: I didn't think you'd make it much beyond the age of 21, 22, I have to say.

CHARLOTTE: It was just sort of a real downward spiral.

NARRATOR: At the age of 30, after years of cocaine abuse and suffering severe anxiety, Charlotte sought help. Like two thirds of children with ADHD, Charlotte's symptoms had continued in to adulthood. But there are only two NHS centres in the UK for Adult ADHD. Charlotte had to wait a year for a diagnosis and treatment.

CHARLOTTE: It's really sad that adult ADHD isn't recognised in adults, and it's got to change because what's going to happen to all our kids. You know I've started worrying already about Jazmine, my daughter, I mean she's what 11 going on, what's going to happen to all these kids when they get older?

NARRATOR: Charlotte, Jazmine and James all now take methylphenidate, a drug most commonly known as Ritalin. It is a powerful stimulant and can have significant side effects, such as preventing sleep and suppressing appetite.

CHARLOTTE: I've come to pick my prescription for Charlotte Fisher for Ritalin, thank you.

NARRATOR: This medication does not cure ADHD but helps to control symptoms.

CHARLOTTE: And I mean I can remember the first time I took the tablet, it was like a blanket of fog just lifted, and I stood there and thought for God's Sake no wonder I've been like this all my life and I was really shocked. Is this how other people feel? I've been walking round like this for years, no wonder I never got anywhere. It was a really really weird experience to feel normal.

NARRATOR: The drug works mainly by increasing levels of a brain chemical called dopamine. Scientists believe that there is a shortage of dopamine in people with ADHD. As a result, they lack control of their impulses.

JAZMINE: It's almost like when you have a light yeah you can switch it on and off. And with my Ritalin, I can switch the light on and off, like in my brain, my thoughts, but when I'm not taking my Ritalin it's like the light isn't working anymore and only stays on.

NARRATOR: Charlotte has another way of dealing with her symptoms. She goes to the gym and swims every day. She finds that exercise helps to control her impulsiveness.

CHARLOTTE: It really does help me be less manic, less hyper, less tense, less twitchy. You know I really really need to do this.

ELEANOR: They are just two totally different children. With Liam it always stood out that he was more hyper, more difficult or more strong-willed.

BRIAN: Sit down now Liam so it doesn't go all over the shop. Else you'll have to sit at table. Now don't start being silly. Come on eat your tea, what's going on with you now. Sit down and eat your tea and then we'll play after you've ate your tea.

NARRATOR: Brian and Eleanor have tried all the conventional ways of controlling Liam's behaviour. They even sought help from Social Services and Family Welfare who taught them tried and tested parenting techniques.

ELEANOR: There Lewis, Thursday.

NARRATOR: Star charts were introduced to encourage good behaviour. If Liam earns enough stamps for his chart, he will be given a reward at the end of the week. It works well with Lewis who is going through his terrible twos. But with Liam it doesn't work at all.

ELEANOR: No, no, just one. No, now don't spoil your chart, now stop. You get one stamp for being good now don't spoil it. Have a piece of chocolate, come here. Liam. Don't spoil that, now that's silly because that had all your nice stars on, and how good you've been over the last few days. Right, well I want to keep that Li because that shows me how good you've been. Don't, no, no.

NARRATOR: With the parenting techniques not working Eleanor fears for her relationship with her son.

ELEANOR: I mean you can't believe how you can dislike your child so much. And sometimes you could feel oh get me away from this child it wouldn't bother me if I never saw him again because if anybody else made you feel like that you wouldn't have no contact with that person ever again.

NARRATOR: After five months of assessments tomorrow is the day of Liam's appointment at the ADHD clinic.

ELEANOR: We've got mixed feelings me and Brian. He in his heart of hearts doesn't want it to be ADHD. But me a little bit sometimes, I need a reason for why he is like he is.

BRIAN: I think I would be really upset if they said that he needed to go on to medication long term. It's easy to label, label kids and say oh yes they've got this ADHD, but, I don't know.

NARRATOR: In Warminster, Charlotte's family gather to celebrate her 32nd birthday.

CHARLOTTE: How to, it ought to be How to try to be a Domestic Goddess.

NARRATOR: This family get together throws light on one of the main causes of ADHD.

CHARLOTTE: I'm diagnosed ADHD, Jazmine is, James is, Alexander has been diagnosed ADD and there is another member of our family who has been diagnosed and he's not here today and then there are the people we believe to be ADHD and that's definitely the Fred there and my father.

JIM: My mother used to go away every summer because she couldn't cope, as soon as we got back from school till when we went back. She couldn't cope with us, well we were all noisy.

CHARLOTTE: How many canes did you get at school Daddy?

JIM: 72 in one term.

CHARLOTTE: There you go.

NARRATOR: ADHD tends to run in families it has a strong genetic component. So strong is this genetic link that Jazmine, James and Alexander all have a one in five chance of passing it onto their children too.

JIM: There's so much of it in both our families and it sort of comes out in various degrees in various parts of it. Some of us seem to be able to control it.

CHARLOTTE: Some of us are debilitated by it.

JIM: Some, yeah debilitated by it.

NARRATOR: While Charlotte's life has been transformed since her diagnosis, her symptoms are not always under control.

NARRATOR: It's Jazmine's first day at secondary school. The whole family are feeling the pressure of the change to their morning routine.

CHARLOTTE: James, if you break the lights here I'm going to break you face.

CHARLOTTE: James, I swear if you lock that door. Right give me the fucking key. Look, you know there's enough going on today without you being an arse. You are so pathetic, you really are.

JAZMINE: Mum do my hair now?

CHARLOTTE: Yes I will I'm waiting for the things to heat up.

JAZMINE: Can you smell it though.

CHARLOTTE: Yes I know that's why I just checked that the seat wasn't on fire.

JAZMINE: Hair.

CHARLOTTE: Yes I know Jazmine. I hate this sort of thing anyway.

JAZMINE: Well don't bloody do it.

CHARLOTTE: Shut up, or else I'll ruin your hair. Oh God the bacon. Just stay there and don't move. Right James, go and look in the airing cupboard and get a towel.

JAMES: Ye ye ye.

CHARLOTTE: James do you know what, you are really irritating, you were born that way. Right, thank you mum.

JAZMINE: Thanks mum.

CHARLOTTE: James, if you touch that you'll burn yourself like when you touched the iron when you were told you not to. Right swimming, James will you put, if you put plastic on there.

JAMES: What?

CHARLOTTE: Well it's going to ruin, look what you've done.

JAMES: It was already there mum.

CHARLOTTE: Well it better had been.

JAMES: Yes it was.

JAZMINE: No it wasn't.

JAMES: Yes it was.

JAZMINE: Nothing was on there.

JAMES: Yes it was.

JAZMINE: Let's have a look mum.

JAMES: Yes it was, I didn't touch it with that.

CHARLOTTE: Alright. Don't hit me.

JAMES: I don't care if you don't like the door shut.

CHARLOTTE: Alright what am I doing. I don't know whether I'm coming or going actually. Because I don't, I really don't like routine change and of course they're going to be affected more by me being really stressed out. Right I'm just gonna go before my gate gets snapped off.

JAZMINE: Let me in.

CHARLOTTE: Look I don't want all the frigging neighbourhood listening to all of this. Jazmine keep your voice down, James can you just stop. Ooooh I'm going to get your balls and puncture them in a minute. Stop it, right just stop annoying everybody, look, stop please.

JAMES: Bitch.

CHARLOTTE: Yes I am a bitch, and I'm stronger than you as well so don't mess around. Come on stop it, stop winding Jazmine up, try and be nice. Remember your first day at school. That's better. Right, because you are a nice boy really aren't you, yes. Right keys, oh Jesus, oh God.

NARRATOR: In the confusion caused by the new morning routine, the family forget to take their medication.

CHARLOTTE: Get in the car, hurry up, could you get in the car. Oh my God I've forgotten all the tablets haven't I. Oh shit, have you got your drink James? Have you got your drink? Jazmine don't let me forget before you go to take your tablets because it's all going wrong. Just get in the car, in the car, get in the car James.

JAMES: I'm in the car, you told me just to get in the car.

CHARLOTTE: Shut up, look James. I'm really going to lose my effing temper in a minute. Get in. James, look if you make her late for school I'm going to.

NARRATOR: It's been a chaotic and stressful morning. Not a start to term that Charlotte had hoped for. In Wigan, the day of Liam's appointment has arrived.

ELEANOR: Liam, if you fall down there you're going to really hurt yourself. Go and get your gel and I'll put your gel on, Liam down.

ELEANOR: Liam has got some lovely parts to his character. He's very cheeky, he's very brave.

ELEANOR: Down, down.

ELEANOR: He's very entertaining, he has you in hysterics with some of the things he does and says, and his dancing and things like that, he is such a bubbly character.

LIAM: [SINGING]. Look at this.

ELEANOR: Lovely, well done.

ELEANOR: My stomach is in knots, it's like ahh. I woke up at five o'clock again this morning thinking of different things, but we can't carry on as we're doing, we can't just keep thinking what is it, what is it, is it this is it that. And if she says it's not ADHD then where do we go from here? What's the next step? Or are they just going to say, no this is just him, that's his character and we've got to get on with it.

ELEANOR: Right come on Love, do you want to carry this? No Liam, we have to walk round, no Liam, Liam, Liam, Please, here now. Liam. This way, this way, Liam, come here, that's why I don't want you because it's all prickles, come here darling there's a big spider over there, there was, you just missed him, you nearly put your hands on him.

NARRATOR: Liam has been referred to a specialist ADHD team based outside Wigan. Community Paediatrician Dr Saroj Jamdar and ADHD nurse Alison Reardon have been working with the family and will make the formal diagnosis.

ELEANOR: Hello.

DR JAMDAR: Hello, good morning.

ELEANOR: Good morning.

DR JAMDAR: So, how are things at the moment?

ELEANOR: Um a great improvement compared to 6 months ago, um, we just think we're getting somewhere and then for no particular reason that we can think of it suddenly.

DR JAMDAR: Things go back.

ELEANOR: Things go back.

DR JAMDAR: The question we have is whether Liam has ADHD or whether he doesn't have ADHD and it's the million dollar question.

NARRATOR: Critical to a diagnosis is that Liam's behaviour is not confined to his home. Alison reports on assessments made at Liam's school, and there is a clear pattern of behaviour.

ALISON: We had an observation by our behaviour support team, there were a few concerns again with distractibility, fidgeting and perhaps a few interruptions.

NARRATOR: Dr Jamdar outlines the difference between Liam's impulsiveness that he cannot control and his deliberate, oppositional behaviour. They are two separate conditions.

DR JAMDAR: Oppositional Defiant Disorder is not something that the child is born with. It's a kind of interaction between the neurodevelopment of the child and the environment. As a result you see a child who is disobedient, tries to break the rules and causes lots of difficulty in management. Liam has a degree of ADHD but he also has significant problems with Oppositional defiant disorder.

NARRATOR: Liam does have ADHD. Eleanor and Brian's biggest fear now is whether or not Liam will need medication.

DR JAMDAR: ADHD is a condition which is along a spectrum and how you manage your children with ADHD depends upon where they are on this spectrum, you know. My feeling is that Liam's problems are mild at this stage and children who have mild to maybe just a little bit moderate degree of ADHD can be managed by suiting the environment to their needs. For children who are struggling with ADHD and it is affecting their self esteem, affecting their social behaviour, their personal behaviour, their learning style, then medications do have a role to play.

BRIAN: That would be the last resort, not the way I would want to go on any sort of medication at all.

ELEANOR: I feel now that we've got some answers anyway, thank you very much.

BRIAN: Thank you very much indeed.

CHARLOTTE: You're the only person here without ADHD here aren't you Treacle?

NARRATOR: Following the chaos of Jazmine's first day at school, Charlotte can see that things have got to change.

CHARLOTTE: We do live in I suppose our world of ADHD and I find it hard maybe to differentiate because I've always lived in that world. We are always going to be loud and outspoken and chatty and vibrant. I mean that's just the way we are. But I do wish that I could change my foul language. And I'm willing to try anything because I don't like my mood and that side of it.

CHARLOTTE: James, could you stop doing that. Are you just trying to make me in a bad mood or something? You're such an idiot.

CHARLOTTE: Medication is a major part for us of improving ADHD but it's not the only thing. Now I'd just like some other ways of being able to cope.

NARRATOR: Charlotte has asked clinical psychologist and ADHD specialist Dr Angel Adams for some family therapy.

Dr ANGEL ADAMS: I think the first thing that you need to think about when you are a clinician dealing with parents who also have ADHD is that these parents have a disability. People I don't think understand what their internal processes are about and how difficult it is just to kind of remember to organise things, you know to clean up after yourself. They don't have the ability to retain things in their memory, that's what we call a working memory deficit. So they've got a lot of odds against them and unless people really understand how difficult it is they are just going to judge them and say oh they're lazy, they're stupid.

CHARLOTTE: Hi.

Dr ANGEL ADAMS: You must be Charlotte.

NARRATOR: Dr Adams' plan is to offer Charlotte practical advice. She wants to give structure and order to the times Charlotte finds most difficult.

Dr ANGEL ADAMS: One of the things that helps is a list. Ok you have a list when you.

CHARLOTTE: Sorry, ah lists, because I do find it hard.

Dr ANGEL ADAMS: Why, why is that?

CHARLOTTE: Because I actually really hate them, but I know they do me good.

Dr ANGEL ADAMS: Ok. A list is like a crutch and the list can also be the boss in the house. You have it somewhere in your house where there is no clutter. The ADHD brain wants to have a place where there is no clutter to really take this in.

CHARLOTTE: Do you know what even though I say oh I hate lists, but looking at that it feels quite comforting in a silly way, because it's structured and someone else has done it.

Dr ANGEL ADAMS: Interesting.

CHARLOTTE: I know this sounds really silly but what do you mean quiet time, what do we do?

Dr ANGEL ADAMS: This is quiet time for you, not for them.

CHARLOTTE: What do I have to do in mine, I'd get bored, it sounds scary.

Dr ANGEL ADAMS: Quiet time just meaning, quiet time, all I meant by that was your kids aren't there saying this and that, and you're yelling and they're swearing. It's your quiet time to get grounded before they wake up to do the things that you have to do, to think about what you are going to do with your anger. What tends to happen is you wait for things to happen, it's all in the moment. Well, somebody's here.

CHARLOTTE: This is Angel.

Dr ANGEL ADAMS: You must be James.

CHARLOTTE: This is James.

Dr ANGEL ADAMS: And you're Jazmine, nice to meet you.

CHARLOTTE: Is there anything you want to?

JAZMINE: I do, yeah what really annoys me is like James winds me up and it's like mum falls for it and she doesn't realise that he's annoying me.

CHARLOTTE: They are both competing 24 for my one to one and I can't even sometimes be on the phone otherwise this sort of thing starts.

Dr ANGEL ADAMS: Let's see how you'd deal with this right now?

CHARLOTTE: Well I'd say to James, I just think I'd say, I don't know, I just think oh god what shall I do. What would you do then?

Dr ANGEL ADAMS: Well I mean I, I would, at this point it is too late, he's ran out of the room which is probably a good thing. I would probably praise him for doing that because he actually stopped an escalation by moving out of the room, and he needs to hear that right away and he needs to know it.

JAZMINE: With James yeah, you say oh yeah James you're not playing on the Playstation for two weeks and then he plays on it.

CHARLOTTE: I'm inconsistent.

Dr ANGEL ADAMS: That is a very good point.

JAZMINE: You let him off all the time.

CHARLOTTE: I haven't this week though have I?

JAZMINE: Yeah but you normally do.

NARRATOR: Dr Adams identifies Charlotte's inconsistency as a key problem. She suggests the family introduce a token system adapted especially for children with ADHD. It's a system where the rewards and punishments are frequent, powerful and above all, immediate.

Dr ANGEL ADAMS: You have a little plastic jar and you're putting in tokens that they are earning.

CHARLOTTE: And a certain amount of these make up.

Dr ANGEL ADAMS: Yeah, you see they're immediate because they're going in.

JAMES: Mum is it ok, am I still banned from the Playstation?

CHARLOTTE: Pardon?

JAMES: Am I still banned from the Playstation?

CHARLOTTE: Well, so I mean it's that time now like I could say be honest with him, no it was an unreasonable thing of mum because I was cross and it was in the morning.

Dr ANGEL ADAMS: Yeah I would, that's the most wonderful thing you could do because you're being human, you admitting your own mistake and you're correcting it. Practice that just now, tell him.

CHARLOTTE: What say it? It was an unreasonable punishment and yes you can play on your Playstation in your room.

JAMES: Yes.

Dr ANGEL ADAMS: How does that feel?

CHARLOTTE: It doesn't feel bad because I've been kind of wishing that I could say it anyway.

JAMES: Thank you mum.

CHARLOTTE: It's a pleasure.

Dr ANGEL ADAMS: You have a very close relationship with your kids and they've obviously had a good upbringing with you because they're functioning pretty good.

NARRATOR: In Wigan, Brian and Eleanor have found that since Liam's diagnosis, it's much easier to understand his behaviour.

BRIAN: Good climbing, good climbing.

BRIAN: I think we feel better now that we actually know that, not to be labelled but that there was something. It's a mild case but something that we can manage and at this stage we don't need to look at medicines. So I'm quite a bit happier.

BRIAN: We nearly fell in Li.

ELEANOR: I feel like there's a weight been lifted because we now know there is reason why he does react like he does.

BRIAN: There's a troll that lives under here.

LIAM: No there isn't.

BRIAN: I bet you there's a troll under there. I bet you'll here it coming if you go under.

BRIAN: You used to shout Liam, Liam, Liam. And after four times you used to be like bubbling inside saying why is this child not taking me on? Now you understand why he's not.

NARRATOR: Eleanor and Brian will be given specialized parenting classes to help deal with Liam's ADHD and his oppositional behaviour. Medication still remains an option for the future.

ELEANOR: I've got this new sense of love him, it does put a different outlook on everything, I mean don't get me wrong he still drives me mad and that because he tests everything to the limit and he's constantly a hundred miles an hour at everything you do and you're constantly having to repeat yourself, but it just does take that edge off.

NARRATOR: It's been three weeks since Dr Adams' visit to Charlotte's house and the lists have made an impact.

CHARLOTTE: Yes, we are all on target. I just feel so much calmer now most of the time, and I think having the structure, I'm actually surprised in the morning how much time I've got. I know it sounds silly but when everything is organised and you've got oh you do this at 8 o'clock and you know you get up at this time, there's actually more time and it's not as rushed and stressful.

CHARLOTTE: You're a good boy aren't you? Yes, yes, yes.

NARRATOR: Dr Adams' token system is also fully operational. The brightly coloured beads are given frequently, not just for good behaviour but for any appropriate behaviour. The rewards must also be given immediately. This tangible currency helps Charlotte to be consistent with her punishments and rewards. Tokens are taken away for very bad behaviour, but crucially they can also be earned back.

CHARLOTTE: I have to be honest there's just been a couple of times where I've taken one token away and what I do is I just give them something that they are not going to like doing, but it's nothing really, really horrid, I mean they have to clean my dirty marks off the carpet there. And I mean obviously they go I hate you like that but then they get their token back, and they will do it.

JAMES: Forty six, forty seven, forty eight, forty nine, fifty, fifty one, fifty two.

CHARLOTTE: And what does 50 mean?

JAMES: Something.

CHARLOTTE: Absolutely, so you get something now don't you? These ones here, these can only be earned together with your sister and they're for doing nice things with each other and being nice to each other, and if both you and Jazmine have got one, but I said they can only earn these together.

CHARLOTTE: Oh well done.

JAZMINE: Are you going to be picking me up?

CHARLOTTE: Yes, ah, isn't that nice to see, you see lots of things like that what do they have, what do they mean?

JAMES: Special tokens.

CHARLOTTE: Special tokens that's right, and special tokens are for people that are nice to each other aren't they? My children are nice to each other.

CHARLOTTE: That looks good doesn't it? That's it, well done, that's it, where do you think this bit needs to go. It's nice to actually do things with Jazmine and James. You know just to do these kind of things that probably other mums or granny's take for granted doing with their children but for us it is you know a big sort of stepping stone really to enjoy just normal things of family life that other people take for granted. Watch out Nigella.

NARRATOR: With the support she now has in place, Charlotte hopes that Jazmine and James will be able to lead happy and independent lives.

OFF SCREEN QUESTION FROM INTERVIEWER: What do you think it is that's going to keep them on the straight and narrow?

CHARLOTTE: A combination of me as a Mum understanding and being there, the fact that they are on their medication and people are now beginning to understand what ADHD is. I think that is one of the key things, people are understanding that this is a real condition whereas when I was a teenager I was just written off and I hope that people's understanding of it continues to grow.

CHARLOTTE: Is that forty? There you go, that's so horrible.

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