Ritalin: The Pro's and Cons
Attention Deficit Hyperactivity Disorder (ADHD) currently affects up to 10% of schoolchildren in the UK, this number is growing rapidly, as more and more children are being diagnosed with it. According to the NHS, nearly a million prescriptions for ADHD are handed out each year. This figure has doubled in the last decade and constantly rising.
I love children. They are impulsive by nature. They are active by nature. They are inquisitive by nature. In fact, they are a force of nature. But some children are very impulsive and some really can’t sit still. They find it hard to focus and are falling behind at school.
In his book, ADHD and the Nature of Self Control written by Dr Russell Barkley, Ph.D. He states that “Acting without much forethought and responding on impulse to events that occur around them… are typical characteristics of young children.” Children seek immediate gratification, that is their nature. In other words, they lack self-control.
As a parent, we understand this. Our toddler is not able to control his body, his needs or his urges. We parent softly, in the hope that they will grow out of this. Dr Barkley, who is considered the world’s leading authority on ADHD, explains that a child whose inability to control his impulsivity and/or attention to such an extent that exceeds the ‘norm’ has a brain dysfunction called ADHD.
This disorder can affect their education dramatically. It can also hamper their ability to form lasting friendships. And in many cases, it can destroy family dynamics. One local mother, describes her 7 year-old son, “like a train driving at a million miles per hour, just waiting to crash...” The atmosphere in the family home was permanently tense as each moment held the possibility of chaos. As a parent, this can be frustrating and sometimes, heart-breaking.
As a family, it can be disastrous. And when your child suffers, you, as the parent, want to help.
How does one help the ADHD child?
Before the 1950’s, Central Nervous System drugs (more commonly known as stimulants) were never administered to children. They were considered unsafe and we were in the dark about the long-term side effects they may cause. Since, the 1970’s the use of these stimulant drugs to control impulse behaviours in children has risen dramatically.
When a child is diagnosed with ADHD they are often prescribed with a CNS drug, known as Methylphenidate (Ritalin, Medikinet, Equasym XL, Concerta). Stimulant drugs are a class of psychoactive drug that works by increasing activity in the brain, specifically the central nervous system and the autonomic nervous system. It enhances the effects of dopamine and norepinephrine which can lead to an immediate increase in blood pressure, respiratory function and euphoria. More simply put, the stimulant drug helps the nerves in the brain ‘talk to each other’ so that the child can function better, it enhances their ability to be much more aware of their surroundings which of course helps them to fit in socially, at home and in the classroom.
Thus, the observed benefits of using stimulant drugs for ADHD are the following:
· Significant decrease in fidgeting and other signs of restlessness
· Improved control of fine motor skills, such as handwriting and sports
· Better management of moods and emotions
With the correct dosage, the stimulant drugs help boost a child’s self-esteem, create friendships and relationships whilst performing better at school.
It sounds like a wonder drug. And indeed, for many, it is.
One mother from North London was totally opposed to drugging her child. She fought for years with doctors, adamant that this wasn’t going to be her solution. She tried everything from massage, yoga, occupational therapy to child psychologists. He was diagnosed with severe ADHD at 6 years old. Eventually, at a loss and desperate for some form of intervention, she acquiesced. He was prescribed Medikinet. She says, “I agreed to try it for a week, but I didn’t need a week, it changed our lives in four days. He was still his cheeky self but calmer and able to sit down and have a conversation. Within two months, his social life was transformed. He went from having no friends to having playdates every day. He can listen in class and is now able to play sports now as he can manage the rules. Our homelife is so much better, he can play with his siblings as he is more able to control his emotions and understand what is happening around him. Our lives have been transformed, my only regret is that I took too long to medicate my son.”
Another mother describes her child as angry at the world, aggressive with others and unpredictable yet within minutes of taking the drug he becomes tranquil, happy and willing to learn. She describes the change quite vividly, “It’s like he is suddenly comfortable in his own skin, he likes himself, likes people and likes life.” She quite frankly believes that mothers who don’t medicate are doing their children an injustice.
As life-changing as stimulant drugs tend to be, there is a horror that lies beneath the wonder.
Almost all mothers complain that their child experiences a decrease in appetite and trouble falling asleep at night. Some children suffer with hallucinations, suicidal urges and many users suffer with tics for the rest of their lives. Other mothers find their children become ‘zombie-like’. It can also pose a tragic outcome, between 1990-2000, there were 186 suspected Ritalin deaths reported to the FDA Medwatch programme in America.
Heather Smith, the mother of Matthew* who died, aged 14, from long term use of Methylphenidate, asks on her award-winning website: “One toy might be recalled if 1 or 2 children die from it. How many children have to die from these drugs before we put an end to the horror?”
CNS drugs are classified as a Schedule II Controlled Substance by the U.S. Drug Enforcement Agency (DEA). This means that its medical uses have severe restrictions. Doctors should only prescribe stimulant medication when the child exhibits severe ADHD symptoms and only when the child is 6 and above. It is important to note that even if your doctor suggests the use of ADHD medicine, the decision to use it is still the sole responsibility of the parent. If a parent chooses to use ADHD medicine, there will be a series of forms that must be filled out by parents to monitor the side effects of this drug.
Some of the known side effects of Ritalin are:
Less common side effects:
Seizures (mostly in patients with a history)
Slower growth in children (height and weight)
Blurred vision or eyesight changes
Blood pressure changes
The NHS watchdog, the National Institute for Clinical Excellence (NICE), urge parents to explore alternative options such as parenting programmes and behavioural therapies before prescribing stimulants to their children. Tony Lloyd, chief executive of the ADHD Foundation, reminds us that the general guideline is that the drugs should only be dispensed as a last resort.
It seems most parents who decide to give their child medication for ADHD do go through an agonising decision-making process. Most have tried alternative methods and the majority don’t want to medicate their child. Even after extensive research and an informed decision, they still struggle with the idea of giving their child a drug.
One recovering drug-addict father remembers being given Ritalin as a child. He became zombie-like and withdrawn. His mother took him off the drugs. Fifteen years later, he gives the same drug to his 8year-old son, admitting, “It doesn’t feel right but I just can’t handle it any other way.”
It seems that once this unbearable decision has been made, and the wonder pill has done its magic, it is hard to look back. Finally, their lives resume some sense of normality.
So, does Ritalin work?
The answer is yes, it works but it begs the question, at what cost? As one relieved mother puts it, “you can’t deny it doesn’t work?” However, it is wise to point out that that testing for ADHD is subjective and based on a diagnostic checklist only. The US-based, National Institutes of Health (NIH) reports that, to date, “We do not have an independent, valid test for ADHD, and there is no data to indicate that ADHD is a brain malfunction.” Thus, whilst your child may display a cluster of signs that have been attributed to this disorder, please bear in mind, there is no scientific proof that it is either genetic or a brain disorder. We are still in the process of discovering more and more.
Although medication provides some wonderful solutions to navigate the difficulties of an ‘ADHD’ child, we must also stay alert and open to the fact that pills are not a cure. The ‘natural’ unmedicated child still lies beneath and once the symptoms disappear (through the wonder pill), do we question it anymore or are we so relieved that we just go back to our lives, sighing loudly? Often, the relief is so palpable, the mothers who do medicate are so amazed at the change, that looking elsewhere, is no longer an option.
One thing is for certain, if you do medicate as a parent, one needs to continue to research and question both the medicine and the child at hand. What happens if my child doesn’t grow out of this? What will he be like without the drug? Am I pretending the side effects aren’t that serious? Or, are the pro’s keeping me in the dark? These are all questions that boggle the mind. One prominent American psychiatrist, Dr Peter Breggin, M.D. who has been coined ‘The Conscience of Psychiatry’, states, “We are the first adults to handle the generation gap through the wholesale drugging of children.”
As parents, we must remain vigilant and awake, we never must feel we have found a definitive answer. Our children are not products, they are people. Children change, grow and develop at alarming rates. We must accept that, we too, must change our direction sometimes, grow in knowledge and continually develop strategies to improve their lives. It is not enough to say this works for now. Joyce Maynard, an American writer and journalist, urges us to remember, “It is not only children who grow. Parents do too. As much as we watch to see what our children do with their lives, they are watching us to see what we do with ours. I can’t tell my children to reach for the sun. All I can do is reach for it myself.”
*It is important to note here that Matthew had no history of pre-existing heart conditions or other defects. Matthew suffered from a sudden heart attack caused by prolonged exposure to methylphenidate.
Disclaimer: This article is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment from a physician or other qualified health provider. Any opinions, findings or recommendations expressed in this material are those of the author.
By Claire Freeman
This article is featured in Chazak's Yalla Monthly Magazine, August 2018 edition.
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