ADHD: Part 2 of 3
ADHD - "TO DRUG OR NOT TO DRUG?" - Part II
Last time we looked at what ADHD is, & is not? The words of a prominent neurologist probably sum it all up best: "The more you study hyperactivity or ADD, the less certain you are as to what it is, or whether it is a thousand different situations all called by the same name."
Despite this controversy amongst the experts, the standard treatment used for children diagnosed as being ADHD sufferers is quite standardised. "Behaviour management", "appropriate educational programs", "counselling" & the use of "psychostimulant medications" are the recommended mix of therapies.
However, the predominant medical behaviour nowadays would appear to be to medicate first, "ask questions later".
Psychostimulant drugs are "believed" to change levels of neurotransmitters in the brain. Since neurotransmitter deficiency is suspected (but unable to be proven) as the root of the problem, this type of treatment would appear to make perfect sense. The most common drugs used are Ritalin & Dexamphetamine.
So, how do stimulants help hyperactivity? "Researchers had long reported that Ritalin at low doses had a paradoxical effect - it was "speed" that slowed children down. Eventually it was recognised that stimulants had the same effect on almost everyone: They improved the short-term concentration. It was just that people with ADHD needed more help focussing than the rest of us." (New York Times)
No-one can argue that psychostimulants do seem to improve the behaviour of kids with ADHD. But it is vital to recognise that "response to the medication should not be used as the basis to diagnose ADHD" (National ADD Association). That is, the fact that a child may be demonstrating unacceptable behaviours, & that when they take psychostimulants their behaviour improves, doesn't mean that they technically have ADHD. Most of us would behave better when a little bit "stoned".
Another apparent common conception is that their child will get better "grades" if they take their medication. This may be inaccurate: "Ritalin & other therapies may correct classroom behaviour problems but there is no evidence that this improves a child's academic performance." (NIH consensus report)
I can still remember the first few parents that discussed with me the "new wonder" drug that would cure their childrens' behaviour problems. The recurring words were "& there's no side effects". Well here's the real list of possibilities: Weight loss, sleep disturbance, fast heart beat, high blood pressure, chest pain, fever, joint pain, skin rash/hives, uncontrolled movements, black tarry stools, blood in urine or stools, changes in vision, seizures, cramps, bleeding/bruising, mania, insomnia, hallucinations, hyperactivity, impulsivity & inattention (!?), psychosis, delusions, depression, dizziness, nervousness, irritability, & attacks of Turette's or other tic syndromes. In other words, for a small number of kids, the cure is much worse than the disease.
In part 1 it was mentioned how even pre-schoolers were being diagnosed with ADHD. But perhaps even more scary is that these same kids are being treated with a drug that "should not be used in children under 6 years, since safety & efficacy for this age group has not been established".
The other unsolved mystery is long term usage of these medications: "Long term data on safety & efficacy of long term use of Ritalin in children are not yet available." (Medication safety labeling) I wonder when this information will be forthcoming since these drugs have been in use since the 1960s!
Another issue that parents need to be aware of is the possible interactions between psychostimulants & other drugs. Particularly caffeine, asthma medications, cold/sinus/hayfever/allergy medications, amphetamines, & cocaine. What does this mean? If you give your child the psychostimulants - no Coca Cola, tea, coffee, chocolate, or those new "energy" drinks. Otherwise you have no idea what therapeutic dose your child is getting! If your child takes asthma or allergy drugs then discuss this in detail with your doctor as you will need to know what side effects to look out for. And for the parents of teenagers, be certain that your child understands the potentially tragic effect of mixing social drugs with their medication.
When using psychostimulants, another caution is to avoid playing with the dosages without expert guidance: "If you think this medicine is not working properly after you have taken it for several weeks, do not increase the dose." (Drug company information) Because these are stimulants which sedate at low doses, more is definitely not better, as you risk tipping the scales toward "stimulating" your child.
Is that the end of the bad news? Wait ..... there's more! Is the widespread use of psychostimulants creating another" drug problem? I have heard of classrooms in Geelong where as many as 30% of the kids are taking the medication. It appears that Geelong is developing the reputation as the "place to go" to get your child medicated. What are we training our children to do if we teach them that they need a drug to feel & behave acceptably?
A trend seen for some time is the use of Ritalin for a "high" or "hit". Known as "Vitamin R", some entrepeneurial ADHD kids are stockpiling their medication to sell to their class-mates who "snort" ground up medicine for a temporary high. In fact Ritalin is classified in the same addictive drug class as cocaine, morphine, opium & heroin.
Another trend is that parents are being coerced into medicating their unruly children by teachers & school counsellors. Threats of expulsion unless the child is given a "pharmaceutical straight jacket" are commonplace. This is a medical first - prescriptions being recommended by educators. Imagine a teacher informing you that your child needed antibiotics, or pain killers!
A small number of unfortunate kids end up on a "cocktail" of psychoactive drugs. Here's how the story goes: Child has behavioural disorder. Child is prescribed Ritalin. Side effect of Ritalin is disturbed sleep patterns. Child is prescribed some form of sleeping tablet as well. Another side effect of Ritalin is unmasking of tendency for depression. Child is now also taking Prozac or some other anti-depressant. If this process continues & child is still not coping well, a new diagnosis of Bipolar disorder is common. Medication is now changed or added for this diagnosis. The end result: Little children, taking big people's drugs!
Wait, there could still be more! One investigative journalist has suggested a link between the use of psychostimulant medication & recent violent school crimes. She cites examples of each of the recent "atrocities" at schools in the USA, & reveals the perpetrators medication histories. This may make sense as "the abuse of ritalin can lead to tolerance & severe psychological dependance. Psychotic episodes, violent & bizarre behaviour have been reported". And, "perhaps the best-known effect of chronic stimulant administration is psychosis".
Does this mean that every child taking psychostimulant medication is a potential "psycho"? Definitely not! I think the moral to the story is that as a community we need to be looking for warning signs of deeper behavioural problems. To medicate our kids & think that "everything will be OK" is a prevailing social trend. We need to be exploring the deeper emotional, psychological & even spiritual stresses that our kids are under, & seek more appropriate healing strategies.
So, am I telling you the worst thing you can do as a parent is to pump psychostimulants into your little child's bloodstream to normalise their behaviour? Well, it's not for me to make this decision for you. I do hope that this slightly depressing information helps make you aware of the bigger issues that surround the decision to medicate or whether to seek alternative solutions.
In the next part we will explore other treatment options that you should consider whether or not you decide to medicate your child.
HERE'S A THOUGHT:
"Do not exclusively say your prayers in the form of asking God for something. The prayer of thanksgiving is much more powerful. Name all the fine things you possess, all the wonderful things that have happened to you, & thank God for them. Make that your prayer." (Norman Vincent Peale)
Last time we looked at what ADHD is, & is not? The words of a prominent neurologist probably sum it all up best: "The more you study hyperactivity or ADD, the less certain you are as to what it is, or whether it is a thousand different situations all called by the same name."
Despite this controversy amongst the experts, the standard treatment used for children diagnosed as being ADHD sufferers is quite standardised. "Behaviour management", "appropriate educational programs", "counselling" & the use of "psychostimulant medications" are the recommended mix of therapies.
However, the predominant medical behaviour nowadays would appear to be to medicate first, "ask questions later".
Psychostimulant drugs are "believed" to change levels of neurotransmitters in the brain. Since neurotransmitter deficiency is suspected (but unable to be proven) as the root of the problem, this type of treatment would appear to make perfect sense. The most common drugs used are Ritalin & Dexamphetamine.
So, how do stimulants help hyperactivity? "Researchers had long reported that Ritalin at low doses had a paradoxical effect - it was "speed" that slowed children down. Eventually it was recognised that stimulants had the same effect on almost everyone: They improved the short-term concentration. It was just that people with ADHD needed more help focussing than the rest of us." (New York Times)
No-one can argue that psychostimulants do seem to improve the behaviour of kids with ADHD. But it is vital to recognise that "response to the medication should not be used as the basis to diagnose ADHD" (National ADD Association). That is, the fact that a child may be demonstrating unacceptable behaviours, & that when they take psychostimulants their behaviour improves, doesn't mean that they technically have ADHD. Most of us would behave better when a little bit "stoned".
Another apparent common conception is that their child will get better "grades" if they take their medication. This may be inaccurate: "Ritalin & other therapies may correct classroom behaviour problems but there is no evidence that this improves a child's academic performance." (NIH consensus report)
I can still remember the first few parents that discussed with me the "new wonder" drug that would cure their childrens' behaviour problems. The recurring words were "& there's no side effects". Well here's the real list of possibilities: Weight loss, sleep disturbance, fast heart beat, high blood pressure, chest pain, fever, joint pain, skin rash/hives, uncontrolled movements, black tarry stools, blood in urine or stools, changes in vision, seizures, cramps, bleeding/bruising, mania, insomnia, hallucinations, hyperactivity, impulsivity & inattention (!?), psychosis, delusions, depression, dizziness, nervousness, irritability, & attacks of Turette's or other tic syndromes. In other words, for a small number of kids, the cure is much worse than the disease.
In part 1 it was mentioned how even pre-schoolers were being diagnosed with ADHD. But perhaps even more scary is that these same kids are being treated with a drug that "should not be used in children under 6 years, since safety & efficacy for this age group has not been established".
The other unsolved mystery is long term usage of these medications: "Long term data on safety & efficacy of long term use of Ritalin in children are not yet available." (Medication safety labeling) I wonder when this information will be forthcoming since these drugs have been in use since the 1960s!
Another issue that parents need to be aware of is the possible interactions between psychostimulants & other drugs. Particularly caffeine, asthma medications, cold/sinus/hayfever/allergy medications, amphetamines, & cocaine. What does this mean? If you give your child the psychostimulants - no Coca Cola, tea, coffee, chocolate, or those new "energy" drinks. Otherwise you have no idea what therapeutic dose your child is getting! If your child takes asthma or allergy drugs then discuss this in detail with your doctor as you will need to know what side effects to look out for. And for the parents of teenagers, be certain that your child understands the potentially tragic effect of mixing social drugs with their medication.
When using psychostimulants, another caution is to avoid playing with the dosages without expert guidance: "If you think this medicine is not working properly after you have taken it for several weeks, do not increase the dose." (Drug company information) Because these are stimulants which sedate at low doses, more is definitely not better, as you risk tipping the scales toward "stimulating" your child.
Is that the end of the bad news? Wait ..... there's more! Is the widespread use of psychostimulants creating another" drug problem? I have heard of classrooms in Geelong where as many as 30% of the kids are taking the medication. It appears that Geelong is developing the reputation as the "place to go" to get your child medicated. What are we training our children to do if we teach them that they need a drug to feel & behave acceptably?
A trend seen for some time is the use of Ritalin for a "high" or "hit". Known as "Vitamin R", some entrepeneurial ADHD kids are stockpiling their medication to sell to their class-mates who "snort" ground up medicine for a temporary high. In fact Ritalin is classified in the same addictive drug class as cocaine, morphine, opium & heroin.
Another trend is that parents are being coerced into medicating their unruly children by teachers & school counsellors. Threats of expulsion unless the child is given a "pharmaceutical straight jacket" are commonplace. This is a medical first - prescriptions being recommended by educators. Imagine a teacher informing you that your child needed antibiotics, or pain killers!
A small number of unfortunate kids end up on a "cocktail" of psychoactive drugs. Here's how the story goes: Child has behavioural disorder. Child is prescribed Ritalin. Side effect of Ritalin is disturbed sleep patterns. Child is prescribed some form of sleeping tablet as well. Another side effect of Ritalin is unmasking of tendency for depression. Child is now also taking Prozac or some other anti-depressant. If this process continues & child is still not coping well, a new diagnosis of Bipolar disorder is common. Medication is now changed or added for this diagnosis. The end result: Little children, taking big people's drugs!
Wait, there could still be more! One investigative journalist has suggested a link between the use of psychostimulant medication & recent violent school crimes. She cites examples of each of the recent "atrocities" at schools in the USA, & reveals the perpetrators medication histories. This may make sense as "the abuse of ritalin can lead to tolerance & severe psychological dependance. Psychotic episodes, violent & bizarre behaviour have been reported". And, "perhaps the best-known effect of chronic stimulant administration is psychosis".
Does this mean that every child taking psychostimulant medication is a potential "psycho"? Definitely not! I think the moral to the story is that as a community we need to be looking for warning signs of deeper behavioural problems. To medicate our kids & think that "everything will be OK" is a prevailing social trend. We need to be exploring the deeper emotional, psychological & even spiritual stresses that our kids are under, & seek more appropriate healing strategies.
So, am I telling you the worst thing you can do as a parent is to pump psychostimulants into your little child's bloodstream to normalise their behaviour? Well, it's not for me to make this decision for you. I do hope that this slightly depressing information helps make you aware of the bigger issues that surround the decision to medicate or whether to seek alternative solutions.
In the next part we will explore other treatment options that you should consider whether or not you decide to medicate your child.
HERE'S A THOUGHT:
"Do not exclusively say your prayers in the form of asking God for something. The prayer of thanksgiving is much more powerful. Name all the fine things you possess, all the wonderful things that have happened to you, & thank God for them. Make that your prayer." (Norman Vincent Peale)
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