Ritalin and impulse control

Discussion in 'General Parenting' started by Malika, Jun 20, 2012.

  1. Malika

    Malika Well-Known Member

    I also belong to a French forum for parents of children with ADHD. Whereas prescribing stimulants for ADHD (Ritalin and Concerta are the only stimulants available here) is generally very poorly viewed, with a lot of hostility to it, these parents largely seem enormously in favour of stimulants. There are a couple of doctors (also parents of ADHD kids) who contribute there; one was speaking yesterday about how Ritalin helps with the social isolation suffered by these children by giving them impulse control...
    This surprises me a little. I don't hear that so much here, I think. Is it people's experience that Ritalin does indeed make a child stop and think before playing too brusquely or being impatient or interrupting others or being quarrelsome, etc?
  2. InsaneCdn

    InsaneCdn Well-Known Member

    From my family's experience? (three of us use medications related to Ritalin)
    ALL that Ritalin does is buy "time" in the brain.
    This shows up in different ways... but really, it's all the same problem: the "attention management" problem of ADD/ADHD is that thoughts get lost... midstream, into thin air, so to speak.

    I like to explain that without the medications, I'm in a bit of a fog. Things come floating through the brain... some are what I'm supposed to be working on, other things are not. Some of each category gets worked on, some of what should get worked on gets "lost", and ... all sorts of random, wonderful, creative things happen when I'm supposed to be doing something else. It's part of the "plus" of ADD. The downside is... stuff that NEEDS to get done, gets missed. I don't even see the... laundry, or dust, or dishes, or paperwork. There's too many more interesting thoughts going on.

    But... on medications, I have a split-second longer for my brain to react. When random thoughts come floating by (don't forget the concert tonight, need early supper, for example), I "doodle" the thought and return to what I'm supposed to be working on. I can hang onto the original train of thought even with the interruption, and can take a moment to "file" the other thought. I notice more (not enough, but more) of what needs to be done. I interact better with other people. I can actually hold a give-and-take conversation on a topic of the other person's choosing (some of the time...) Can't do any of that without the medications.

    How does this affect impatience? By buying time in the brain, it is possible to listen to the end of the other person's thought, and not lose your own. Which ties directly into interrupting others. If an unmedicated ADD/ADHD person has a really brilliant idea... it's either speak NOW, or lose the thought. So, we interrupt, or get impatient when others don't want us to jump in.

    Social niceties are also affected. ADD/ADHD people tend to not be social stars. We don't intuitively figure out the social dance. But... medications, if they work, buy time to process the non-intuitive rules, to figure out what might be a better approach or a better reaction to the situation. It doesn't solve ALL of it, but... that split-second of think time really does make a difference.
  3. KTMom91

    KTMom91 Well-Known Member

    Both Miss KT (ADHD) and Hubby (ADD) have been on Ritalin. Ritalin for Miss KT was a godsend. She was so freakin' LOUD without the medications, never sat still, and was literally spinning around and bouncing off the walls of the hallways without medications. And she nagged and pestered constantly.She's on a combo of Concerta with Ritalin as needed for night classes, and is currently on page 12 of her senior thesis...writing and researching, with no help from anyone.

    Hubby on Ritalin makes him better able to do his job. He won't obsessively focus on one minor thing, he's able to see the entire project and analyze things more clearly. I honestly don't think he would have progressed so far without the medication helping him do his best. He's still working on the social part, but it's ok.
  4. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Yes the stimulants help with impulse control. One of the hallmark traits of ADHD is poor impulse control as well as the lack of attention and hyperactivity. The stimulants give the person the ability to stop and think that most people have normally to think about if this is something that they really want to do. It doesnt speed them up or drug them into a zombie. Not if it is the correct medication or at the correct dose. That isnt the intended idea. You just want a child that acts like a normal kid. One who will make normal mistakes. Medication will never take away every issue. It just gives you a chance to actually reach a person who without the medication doesnt have the attention span or impulse control of a gnat on speed.
  5. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    My difficult child was diagnosis'd with ADHD-combined/highly impulsive type and yes, stimulants, the right stimulant helped him immensely. With the impulsive some kids with adhd carry, the action or reaction happens before the intellect kicks in. Certainly they know right from wrong, but the impulse rules. With the correct adhd medication, the impulse can be positively affected. But the medications go hand in hand with consistently reiterated behavioral expectations and clear and consistent consequences. In other words, you don't pop and pill and "Poof" impulse issues are gone. The most effective treatment for adhd is a combination of medications, behavior mod, and therapy.

  6. pepperidge

    pepperidge New Member

    Yes, I have seen them help both of my kids. One youngest kept getting in trouble in 7th grade for bothering kids in class (pinching them etc). the right stimulant made a big difference--probably the difference between him getting thrown out of class and being able to remain in class.

    However, there are better forms of Ritalin--try a longer acting version (Concerta ) or Adderal extended release. Short acting ones--beyond a couple days of trialing can be very hard, lead to lots of ups and downs that don't help anyone, parent or child.

    My kids also tried various forms of Tenex (blood pressure medicine) but it made my youngest much much more aggressive. We did two trials with the same result.

    FWIW if i had it to do over, I would trial medicines earlier rather than later, before the kid has had many years of internalizing how frustrated adults are with how poorly he behaves.

    When my youngest was in grade school he could not tolerate a stimulant, but we did find a low dose of Abilify made a difference. It also affects dopamine receptors.
  7. Malika

    Malika Well-Known Member

    I'm still scared of the medications. Scared of the side effects (scared of losing the boon which is that J has always gone to sleep like a light, totally tired out, early in the evening and he already eats like a bird, as it is...) and of J losing his zest, pep and essential liveliness of spirit. I am sure those fears are understandable and that everyone must feel like that to start with.
    At the same time, what you said pepperidge, about adults' negative view being internalised - this is happening. J does see himself as naughty and bad. Obviously I try to counter that with lots of affection and positive statements, but I too am adding to the negative image by my irritated comments when he does silly or annoying things or because of the hyperactivity sometimes... I know I shouldn't but it's almost stronger than me, at times.
    I do see with his relationships with his peers that it is not so much that he is lacking in social skills per se - he seems quite able to take the other person's perspective into account or not say hurtful things (frankly, so-called typical kids often blurt out 'things you should not say' and I certainly don't think J is worse than them in that regard), he seems to want to interact and play with others in a way that is quite "normal". But... what affects his relationship with others is the hyperactivity and impulsivity. Again. Interrupting, not behaving according to the social codes, rushing in too soon into things, being too brusque with his gestures so that in play he quite often hurts other boys.... Etc. If there were a medication that helped him not do these things but keep his basic personality and qualities, well, I think I would have to be duty bound to try it. But first he has to get a diagnosis!! I am due to see the psychiatrist at the beginning of July and will talk about some of all this with her - or attempt to , for she is a terrible listener...
    Interestingly, there is a message on the French forum today about how a child's personality has changed on medications, gone from being lively and sociable to withdrawn and sad... this is the fear. But you can only experiment to see, I suppose.
  8. InsaneCdn

    InsaneCdn Well-Known Member

    Malika... this is of course JMO, but...
    The personality effects tend to come from APs and ADs... not from stims, at least not if they are working correctly.

    K2 (classical ADD, or ADHD-inattentive) is on stims... and nothing else exotic (pain stuff for migraines, but THAT doesn't affect behavior...).
    When she forgets to take it (like, a couple of times per year), WE KNOW.
    She goes off into la-la land, dream-land, lost in a million thoughts (literally). Everything is in slow motion... except for her facial muscles.
    Without medications, she can talk the hind leg off a donkey.

    But on medications, she has better verbal control, and her internal motor is purring along at a "normal" clip. Her thoughts are slowed down enough to integrate with real life. That is the END of the impact. No difference in personality etc. Her colorful language (positive, not "colorful"), her musical talent, her "catch me if you can" athleticism... is all there, with or without medications. The medications just allow her to apply her talents in more productive ways.
  9. pepperidge

    pepperidge New Member


    I understand the fear of drugs. I think most of start there. I have to say that none of them has really altered personality in any fundamental way. The stims can be tried at various dosages. Sometimes it takes a little while to dial in the correct dosage. The thing is, particularly with the stims, you will know pretty fast if it really isn't right. Like in less than a week. And if you don't like it you can stop it, and there will be no lasting side effect. I think sometimes it is tried for autistic or bipolar children with some negative results, but you don't seem to be dealing with that. It is possible to give a higher dosage than is needed and what you would see would be a hyperfocused child probably.

    All I can say is that none of the medication trials we did did I ever feel that I had "lost" my kids.

    But as I said there are more advanced forms than Ritalin that release slowly into the bloodstream and have less rebound effects if you go that way.
  10. Malika

    Malika Well-Known Member

    Thanks for the encouragement. I do feel a sense of curiosity, I suppose, as well as the fear, to know how stimulants might affect J, positively improving his quality of life. At the same time... it is obviously not like going to buy them at a supermarket. So far I have received professional opinions that J is definitely not ADHD, and that he possibly is but there are question marks over it. I can't just say to someone "Oh yes, he's ADHD, please give me the medicine!" When we saw the school psychologist recently (who basically found that everything was "normal" although he moved around excessively when not engaged in the activities), she gave me the name of the neuro-pediatrician at the local hospital and said that this was who I should contact for a second opinion. I will ring them on Monday to make an appointment for September. The child psychiatrist I have seen so far says at present that the only diagnosis she would give at this point would be one of anxiety.
  11. pepperidge

    pepperidge New Member

    I think the whole stimulants turn them into zombies is way over sold. I also think that if there is a bias in the culture against diagnosing ADHD you will likely have a hard time, as there is no definitive test. I wonder if you found an expat doctor whether you would get someone more inclined to hear you out.

    How you describe J--has social skills but lacks some of the self control needed to practice them on a regular basis is so much like my youngest son.

    It is possible that stimulants won't help him, but the catch is that you don't know until you try them.
  12. TerryJ2

    TerryJ2 Well-Known Member

    I agree, that the kids who turn into zombies are overmedicated and the doctors and parents just need to pay more attention. From my observations, I think they are in the minority.

    We haven't used Ritalin, per se, but we have used Adderal/Concerta. It has been a godsend. Our difficult child is able to have a conversation and not run around in circles. Now that he's 15, he can control himself better in regard to remaining seated and speaking with-o using the medication, but he is still totally impulsive in regard to actions and choices that are bigger, such as stealing, drugs, etc. The problems just get bigger and more complicated.

    I would not dismiss it out-of-hand unless you've actually tried it.

    Best of luck.
  13. Malika

    Malika Well-Known Member

    To be honest, I don't know that the problem is so much a bias against diagnosing ADHD as much as that J presents ambiguously, so to speak... IF he was inattentive and really difficult at school, for sure we would have had a diagnosis by now. But because he sits still, concentrates, does his "work" with comments always of "good" or "very good" - well, people say that they are "not sure". Meanwhile his hyperactivity and impulsivity are plain for all to see. I can understand that the psychiatrist is hesitant about diagnosing.
  14. SuZir

    SuZir Well-Known Member

    This was the reason my difficult child never got ADHD diagnosis. He was impulsive and hyperactive and there was and is even some inattentiveness but he could always turn attention on, to concentrate, if he wanted to. And he didn't need any internal motivation to do so, if he was bribed well enough, he was doing just fine even with the most boring task. His attention is not typical anyway, he is very, very good at hyper focusing and can keep that on in lengthy periods of time, but that has always been seen as strength, not a symptom. But he can also focus 'normally' even to something boring, if he does have to. He just doesn't usually choose to do so. So it was always seen more as a choice for him, not something he simply couldn't do. It was always a close call though.

    I think that in many areas in Europe the focus with AD(H)D is in attention, where in North America also hyperactivity/impulsiveness by themselves may be enough for diagnosis.
  15. Malika

    Malika Well-Known Member

    That's interesting, SuZir! Good in a way to know that there are others like J... though of course I am sorry that you have had the troubles with your son that you have had. I think the popular understanding here is that ADHD must necessarily involve a deficient capacity to concentrate. J is inattentive in the sense that his attention readily flits from one subject to another but when he needs or wants to, like your son he will concentrate, even on boring tasks. He saw his first psychologist at the tender age of 18 months, in Morocco, and she told me at that point that he could not be ADHD because of the way he interacted with her and the way he focused on tasks... and that is a comment that has been made to me many times since, by one professional or another. So maybe he isn't ADHD as they define it... maybe he is just hyperactive and impulsive but that still leaves him/me/us with all the problems of that!
  16. InsaneCdn

    InsaneCdn Well-Known Member

    As an ADHDer myself... I'm going to defend the diagnosis and do a myth-bust:
    ADHD is NOT " a deficient capacity to concentrate". It isn't really "attention deficit".
    The real problem is difficulty (not inability) to MANAGE attention.

    Which means us ADHDers can be anywhere on the spectrum of attention, at any point in time, and to a more extreme edge than "average" people.
    - spaced-out "not there" inattention (because we're paying attention to something else that happens to have caught our attention... not because we're "not paying attention"),
    - to the normal give-and-take, up-and-down attention that "average people have",
    - to "hyper-focus", which seems to be a gift that ADHDers have in abundance, and few other people have except for those with extreme talent in a specific area (a professional musician can get this when performing, or writing music; an athlete can get this in a game situation, etc.). Time stops. Everything is going in slow motion (in terms of the ADHDer having time to think it all through, be detailed, etc.) and at high speed (i.e. can be 2x or 3x faster than the average person with skill in this area can produce). Extreme productivity - but it comes in bursts, cannot be sustained, and can only be called up on command if it's for an "item of attention" that falls into our personal attention curve. I'm that way writing code... and NOT at all that way writing documentation!

    The problem comes from trying to operate in a world where most people are "average". Because... the ADHDer will be absent when they should be present, and flying high when maybe they should be less intense... often at odds with the world around them.
  17. Malika

    Malika Well-Known Member

    Well, there's the problem in terms of a diagnosis. J is not absent when he should be present (at school).
  18. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Malika, your little boy intrigues me (and he's so cute...have I mentioned that?) :) I'm also interested in the cultural differences (ADHD is a no biggie in the US...they'd be more apt to toss some stimulant at J without thinking twice about it here). And yet ADHD behavior is not always ADHD. There are so many other things that "ADHD" turns out to be, but I know J. will never get anything beyond "maybe ADHD" in France. And I am not sure he has that. He may have some other problem(s) or maybe none at all. From a US standpoint, it is very hard to guess.

    Ritalin can make a child not just a zombie, but a raving maniac. It is speed. Never forget it is speed. In the US, teens abuse it. They chop it up in pillcrushers and snort it alone or with other drugs to get high. Adderrall is more popular for this because it is stronger, but make no mistake about it...Ritaliln is also used. And many of the k ids who abused Ritalin with my lovely daughter were diagnosed with ADHD. So this should alwalys be a consideration when you decide to give this medicaton to your child. It is a controlled substance in the US for a reason. Also, my own son and myself (I most certainly have ADHD along with other stuff) made both of us MORE aggressive and hyper than anything else. In no way did they calm us down. I was flying like a kite. My son got mean and aggressive on it (and all stimulants). I have seen less of a zombie affect in kids than a hyper hyper affect (I do work at a daycare). A few kids do look like Zombies, but they are on Adderrall along with Occupational Therapist (OT) her stuff. They act nuts off the medications and then go into a wide awake coma when they are on it so that it is hard to get them to so much as get up and put on their coats.

    I am not saying at all that Ritalin never works. I am saying that you are being a smart, good mama for weighing all your options first. I am of the belief that ADHD can be handled without medication for many kids. My daughter was diagnosed three times with severe ADD (minus the H). Her concentration and memory socks badly :) But she hated the medication, even the Ritalin. She said it made her unable to sit still and, on higher doses, she started talking to herself and her friends were teasing her about it and she refused to take any stimulants after that. She did get a lot of school help and interventions and has learned coping skills which have pushed her grade point average to a high C average. She had been failing. So obviously, without medication, interventions are greatly teaching her how to do better in school. In fact, she is doing so well in English, they are putting her in AP English next year.

    I personally am not a big fan of stimulants after all my experiences with them, so I'm just another perspective you can take into account :) Take care and always...keep us posted.
  19. buddy

    buddy New Member

    Really good post, Should be tagged somehow. Thanks.
  20. Malika

    Malika Well-Known Member

    Yes, very good post from IC - but where does that leave the people who have the hyperactivity and the impulsivity but not this different way of attending? :)