Ritalin and impulse control

[pepperidge]

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.

[TerryJ2]

I agree, that the kids who turn into zombies are overmedicated and the drs 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 gfg 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 w/o using the med, 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.

[Malika]

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.

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 pdoc is hesitant about diagnosing.

[SuZir]

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 pdoc is hesitant about diagnosing.

This was the reason my GFG 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.

[Malika]

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!

[InsaneCdn]

As an ADHDer myself... I'm going to defend the dx and do a myth-bust:

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

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.
From...
- 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.

[Malika]

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.

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

[MidwestMom]

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 ot her stuff. They act nuts off the meds 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.

[buddy]

As an ADHDer myself... I'm going to defend the dx 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.
From...
- 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.

Really good post, Should be tagged somehow. Thanks.

[Malika]

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?