Ritalin debate

Discussion in 'The Watercooler' started by Malika, Jan 30, 2012.

  1. Malika

    Malika Well-Known Member

    I have joined a forum in France for the parents of ADHD children. The members are mostly very incensed about a programme that screened on television here last night about how people in general are becoming more and more dependent on drugs and it had a section about hyperactive kids on Ritalin. People on the forum feel it really misrepresented things, making out that parents just want to drug their turbulent children to give themselves an easier time and also to do well in school and that teachers and schools in particular want "difficult" children drugged.

    I watched the programme and did feel it gave a skewed account, not representing the other side of parents who don't want to "drug" their children but want them to have a quality of life they could not have without Ritalin, and so on. However, it does of course raise the whole debate about stimulants, rights and wrongs, and I am really interested to know what the perception generally is in the States now. Despite what the programme said (TV is always sensationalist), I would say that people here are generally against giving stimulants to children and ADHD is really not well understood, though this is slowly changing.

    Is there pressure in American schools for ADHD children - and others - to take stimulants?
  2. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    It appears France is a little behind the US in the stimulant debate. We heard these arguments here beginning years ago but they have leveled off. The use of stimulants in the US has definitely become more targeted. Schools can suggest but the certainly can't mandate.

  3. HaoZi

    HaoZi Guest

    Again, the U.S. is so big that there are pockets of every side of a debate somewhere. I'd like to say the general tone is "if it truly helps the kid" but I can't even be certain of that.
  4. AnnieO

    AnnieO Shooting from the Hip

    I can say this from personal experience... We had a teacher command us to put Jett on medication for ADHD. (This is after bio tripled his Concerta dose and we took him off them, because the poor kid was bouncing off the walls...)

    He does horribly on Concerta. Horribly. We haven't tried anything else because... He doesn't seem to need medicated.

    Jett's BFF is severe ADHD. Unmedicated on weekends, which I understand but DANG! The child is a HUGE handful. OFF medications, he acts just like Jett acted ON them.

    in my opinion... If the medication helps, great - if not, don't force it...
  5. hearts and roses

    hearts and roses Mind Reader

    There was an interesting opinion piece in the NY Times yesterday, discussing the use of Ritalin...does it really help?

    Of course, H immediately latched on and began spouting off on his anti medication tirade. Ugh.

    January 28, 2012
    Ritalin Gone Wrong
    THREE million children in this country take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage of drugs like Ritalin and Adderall that they considered absolutely essential to their children's functioning.

    But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled?

    In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder.

    As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs.

    Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

    Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.

    What gets publicized are short-term results and studies on brain differences among children. Indeed, there are a number of incontrovertible facts that seem at first glance to support medication. It is because of this partial foundation in reality that the problem with the current approach to treating children has been so difficult to see.

    Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.

    In 1973, I reviewed the literature on drug treatment of children for The New England Journal of Medicine. Dozens of well-controlled studies showed that these drugs immediately improved children's performance on repetitive tasks requiring concentration and diligence. I had conducted one of these studies myself. Teachers and parents also reported improved behavior in almost every short-term study. This spurred an increase in drug treatment and led many to conclude that the 'brain deficit' hypothesis had been confirmed.

    But questions continued to be raised, especially concerning the drugs' mechanism of action and the durability of effects. Ritalin and Adderall, a combination of dextroamphetamine and amphetamine, are stimulants. So why do they appear to calm children down? Some experts argued that because the brains of children with attention problems were different, the drugs had a mysterious paradoxical effect on them.

    However, there really was no paradox. Versions of these drugs had been given to World War II radar operators to help them stay awake and focus on boring, repetitive tasks. And when we reviewed the literature on attention-deficit drugs again in 1990 we found that all children, whether they had attention problems or not, responded to stimulant drugs the same way. Moreover, while the drugs helped children settle down in class, they actually increased activity in the playground. Stimulants generally have the same effects for all children and adults. They enhance the ability to concentrate, especially on tasks that are not inherently interesting or when one is fatigued or bored, but they don't improve broader learning abilities.

    And just as in the many dieters who have used and abandoned similar drugs to lose weight, the effects of stimulants on children with attention problems fade after prolonged use. Some experts have argued that children with A.D.D. wouldn't develop such tolerance because their brains were somehow different. But in fact, the loss of appetite and sleeplessness in children first prescribed attention-deficit drugs do fade, and, as we now know, so do the effects on behavior. They apparently develop a tolerance to the drug, and thus its efficacy disappears. Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.

    TO date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.

    But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

    Indeed, all of the treatment successes faded over time, although the study is continuing. Clearly, these children need a broader base of support than was offered in this medication study, support that begins earlier and lasts longer.

    Nevertheless, findings in neuroscience are being used to prop up the argument for drugs to treat the hypothesized 'inborn defect.' These studies show that children who receive an A.D.D. diagnosis have different patterns of neurotransmitters in their brains and other anomalies. While the technological sophistication of these studies may impress parents and nonprofessionals, they can be misleading. Of course the brains of children with behavior problems will show anomalies on brain scans. It could not be otherwise. Behavior and the brain are intertwined. Depression also waxes and wanes in many people, and as it does so, parallel changes in brain functioning occur, regardless of medication.

    Many of the brain studies of children with A.D.D. involve examining participants while they are engaged in an attention task. If these children are not paying attention because of lack of motivation or an underdeveloped capacity to regulate their behavior, their brain scans are certain to be anomalous.

    However brain functioning is measured, these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience.

    It is certainly true that large numbers of children have problems with attention, self-regulation and behavior. But are these problems because of some aspect present at birth? Or are they caused by experiences in early childhood? These questions can be answered only by studying children and their surroundings from before birth through childhood and adolescence, as my colleagues at the University of Minnesota and I have been doing for decades.

    Since 1975, we have followed 200 children who were born into poverty and were therefore more vulnerable to behavior problems. We enrolled their mothers during pregnancy, and over the course of their lives, we studied their relationships with their caregivers, teachers and peers. We followed their progress through school and their experiences in early adulthood. At regular intervals we measured their health, behavior, performance on intelligence tests and other characteristics.

    By late adolescence, 50 percent of our sample qualified for some psychiatric diagnosis. Almost half displayed behavior problems at school on at least one occasion, and 24 percent dropped out by 12th grade; 14 percent met criteria for A.D.D. in either first or sixth grade.

    Other large-scale epidemiological studies confirm such trends in the general population of disadvantaged children. Among all children, including all socioeconomic groups, the incidence of A.D.D. is estimated at 8 percent. What we found was that the environment of the child predicted development of A.D.D. problems. In stark contrast, measures of neurological anomalies at birth, I.Q. and infant temperament — including infant activity level — did not predict A.D.D.

    Plenty of affluent children are also diagnosed with A.D.D. Behavior problems in children have many possible sources. Among them are family stresses like domestic violence, lack of social support from friends or relatives, chaotic living situations, including frequent moves, and, especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared. For example, a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath. Or a 3-year-old is becoming frustrated in solving a problem, and a parent taunts or ridicules. Such practices excessively stimulate and also compromise the child's developing capacity for self-regulation.

    Putting children on drugs does nothing to change the conditions that derail their development in the first place. Yet those conditions are receiving scant attention. Policy makers are so convinced that children with attention deficits have an organic disease that they have all but called off the search for a comprehensive understanding of the condition. The National Institute of Mental Health finances research aimed largely at physiological and brain components of A.D.D. While there is some research on other treatment approaches, very little is studied regarding the role of experience. Scientists, aware of this orientation, tend to submit only grants aimed at elucidating the biochemistry.

    Thus, only one question is asked: are there aspects of brain functioning associated with childhood attention problems? The answer is always yes. Overlooked is the very real possibility that both the brain anomalies and the A.D.D. result from experience.

    Our present course poses numerous risks. First, there will never be a single solution for all children with learning and behavior problems. While some smaller number may benefit from short-term drug treatment, large-scale, long-term treatment for millions of children is not the answer.

    Second, the large-scale medication of children feeds into a societal view that all of life's problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them.

    Finally, the illusion that children's behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone — politicians, scientists, teachers and parents — off the hook. Everyone except the children, that is.

    If drugs, which studies show work for four to eight weeks, are not the answer, what is? Many of these children have anxiety or depression; others are showing family stresses. We need to treat them as individuals.

    As for shortages, they will continue to wax and wane. Because these drugs are habit forming, Congress decides how much can be produced. The number approved doesn't keep pace with the tidal wave of prescriptions. By the end of this year, there will in all likelihood be another shortage, as we continue to rely on drugs that are not doing what so many well-meaning parents, therapists and teachers believe they are doing.

    L. Alan Sroufe is a professor emeritus of psychology at the University of Minnesota's Institute of Child Development.

    My difficult child was on add years ago and it did help. However, I never felt a lot of pressure from teachers to put her on it.
  6. Malika

    Malika Well-Known Member

    Thanks for posting that h and r - very interesting.
    I do think there should BE a debate and that this is a very hard decision - I'm sure many would agree with me - to make. If ever I got to a point where it seemed like J just couldn't function in his life as it is, what then? I'm not totally closed to the idea of him taking medications, by any means, but I also know that I would definitely prefer for him not to if we can get round it. At the same time... they said on this programme last night that 95 per cent of ADHD children being treated by a big university hospital in a city here were taking Ritalin. 95 per cent - that's enormous. And it is actually unusual here also for officially diagnosed ADHD children NOT to take Ritalin, despite the fact that it is generally poorly viewed to do so...
    I do not feel there should be a closed position on this, for or against. I feel we should be free to express what is on our hearts and minds in regard to what is such a difficult subject. I do feel scared of turning J into a zombie; having lived with his hyperactivity for five years, it seems to me part of who he is... if he were suddenly calm and placid, it would feel... so odd. I would feel guilty. Does that make any sense?
    Please note: I am NOT, repeat NOT, saying that I "disagree" with the use of Ritalin per se...
  7. InsaneCdn

    InsaneCdn Well-Known Member

    Given that...
    1) ADHD is frequently diagnosed when this is incorrect, and
    2) ADHD is frequently missed when it should be diagnosed, and
    3) even with a correct diagnosis, each person reacts differently to medications

    It is VERY difficult to make blanket statements of any sort about ADHD and medications, and be accurate.

    There was a post on the "parenting news" forum lately about some genetic markers that, when present, indicate that an ADHD person is likely to respond well to stims. This kind of research is extremely useful. It demonstrates that there are different reasons for ADHD, and that under the correct conditions, medications can be effective. It also explains why medications may not be effective.

    In the study mentioned by H&R, the child who has Auditory Processing Disorders (APD) instead of ADHD would have been included as an "adhd" child. But, medications would have NO impact... wrong intervention. Same symptoms, but different cause. We need far more accurate data on ALL of the various disabilities and conditions, and the ability to accurately differentiate between them, before we can even begin to understand where medications and interventions really fit.

    For my two kids? The effectiveness of stims has certainly NOT worn off... and that's 10 and 9 years out, respectively. None of the three of us can be effective, without medications.
  8. DDD

    DDD Well-Known Member

    In 1965 my first difficult child was trialed on Ritalin. She was the first patient to get the medication from a well respected and kind Pediatrician. At that time since it was a new drug the experts didn't know much other than "it can help" and she definitely needed help, lol. She had headaches and stomach aches and she soon was back to medication free. As a result of her ADHD she was expelled from "public" school (yeah, they could do that then) and I had to sell my home to get funds for a new private school. It really helped her. But for all her life she has not conformed to society.

    With her son (our easy child at that time) he was extremely bright, social etc. but he just couldn't settle in at school and it began to impact his sense of self. We started off on low dose Ritalin and eventually ended up with Concerta with no side effects. I am thankful that his preteen years were productive, happy and seemed to bode well for his future. His brother (difficult child#2) spent his early years living with his Mom. He was never abused but he never had a dependable and secure life. We know that likely impacted him for life whereas his Mom and older Bro had no chaos during their formative years. Once he moved into our home he began to take Concerta. Then he was able to conform to school rules "most of the time" and it made a huge different in his self perception and peer perception. I feel blessed to have had the medications available for the boys.

    on the other hand, I know in our community (just as in the CD family) teachers often recommend stimulant medications and diagnosis. ADHD. I know that many Pediatricians say "let's try Ritalin". No doubt in my mind that many children are unnecessarily on medications. I also personally know parents who won't use "those drugs on my kid" who have children who have great difficulty fitting into school and peer environments. There is no "one" answer. My personal optinion is that parents have to "track" their childrens patterns diligently to know what they are dealing with at the time. Since stims are quick in and quick out (and there are at least four medications to try) I think it can make a huge improvement with almost no danger. I think it's warranted. DDD
  9. AnnieO

    AnnieO Shooting from the Hip

    Malika... Something I never quite understood about ADHD medications, but do now...

    If the child functions better on medication, they won't be a zombie - on the right medication. Calm and placid doesn't come close to Jett's BFF on his medications. Manageable without duct tape, yes. He is still happy, gets excited - he is just more focused.

    If you give a child who does not have ADHD/a need for the medications a stimulant... EEK. Jett was on 27mg Concerta and was a BRAT on it. HORRIBLE. Peed all over the floor in his sleep because he would CRASH and could not wake. Sleepwalking was a norm - we put a baby gate at the end of the hallway, he never made it to the stair (with a concrete pad at the bottom). Since this wasn't working, bio had the dr increase the dose to 54mg. It was like giving a 2-y/o a double-shot of espresso every 10 minutes until he crashed - and he would literally be jabbering a mile a minute and then - ZZZZZZZ. He was mean, destructive, and generally complete difficult child... And then... husband got residential and took him off the Concerta. (Bio had just had it increased again to 81mg - and had the school giving it to him unknown to husband (and me)). And he calmed WAY down. We no longer had the problems with him peeing everywhere, sleepwalking was gone - and he focuses the same in school as when he was on it.
  10. InsaneCdn

    InsaneCdn Well-Known Member

    The "drugs = zombie" debate is more delicate.

    I take Ritalin - the good, old-fashioned, fast-acting non-generic form.
    It has... ZERO impact on my personality.
    What it does give me - because it is the right medication for ME - is the ability to hold it all together. Thoughts no longer get lost in mid-stream. I can put something down, and go back and find it. I'm definitely safer as a driver, because I am more aware of all of the details around me instead of "zooming in on some detail". I'm less irritated, because I'm wasting less time trying to recover from lost thoughts.

    Our kids are the same. The medications they are on have not turned them into "something else". (between us, there's 9 or 10 scripts)
    in my opinion - if drugs are affecting personality, then either it's the wrong medication (plus possibly the wrong diagnosis), OR it's a very complex case, where the safety of the person and others can only be achieved by living with side effects, including possibly altering personality.
  11. Hound dog

    Hound dog Nana's are Beautiful

    I have had experience with schools pressuring parents to put their kids on medications, yes, many many times over the years......watched it with other parents too.

    Do I think that we as a whole society tend to lean on medications too much...........um, might get me blasted a bit, but yeah honestly I do. Our society has this learned philosophy that there has got to be a medication to fix just about anything that might be wrong with someone. There is a portion of parents in society that have no clue how to actually "parent" their kids, those who just plain don't care to parent their kids.....and hope there is a magic pill to fix the issues without having to work at it. Many kids I've been exposed to and known well with the ADHD/ADD diagnosis are kids who aren't being parented effectively....either due to lack of skills or interest on the parent's part. This is NOT to say that there aren't plenty of kids out there who do have the disorder whom the medications greatly help.

    I was severe adhd as a child. Mom tried medications once.......zombie effect. Never again. Yet I somehow survived my childhood without medication and actually did as well as most of my peers if not better. Yes there were a few issues in school, following rules was not one of them by the way, but I either learned to cope or dealt with the consequences. Those issues improved over time.

    I had teachers push me to have both Travis and Nichole evaled for adhd/add. I did it even though I knew neither had it just to shut them up about it. psychiatrist did the evaluation correctly and it took a period of many weeks, which peeved off more than one teacher and school staff. Of course neither of them had it, which peeved off the school more.

    I'm sure some depends on where you live too, but I've lived in many places over the years and ran into it everywhere I went.

    So, in my opinion, if the diagnosis is correct (which often it's not) it still depends on each situation whether or not that child will require medications to help them cope. I personally? Would never use medications for a child with adhd or add. This is due to my own life experiences. I've as yet to see medications actually help a child (could be many reasons for this yes) for one, and I've seen just as many kids do as well if not better without medications.

    But then I still have major issues with this diagnosis having started out as an inability to stay on task and sit still develop over the years into some pretty major behavior issues too. Sitting still was torture for me as a kid.....and yes, I did have issues staying on task for any real length of time. But that had nothing to do with following rules and other behaviors I now see being excused as supposedly a part of the diagnosis. in my opinion one has little to do with the other. But that is just my own humble experienced opinion.

    So......this is leading to me hopping on a soapbox, so I'll quit now. lol
  12. InsaneCdn

    InsaneCdn Well-Known Member