Tuesday 1 May 2012

ADHD, To Medicate, or Not?

Riley has Attention Deficit Hyperactivity Disorder, ADHD. His paediatrician tells us he should be taking Ritalin. 20mgs a day. She says that if he does not take it, HE WILL NOT BE ABLE TO CONCENTRATE AND LEARN! We are being irresponsible parents if we don't give it to him.

Ritalin is Methylphenidate, a psychostimulant, also an effective replacement drug for methamphetamine addicts. It is a Schedule 8 drug, in the same category as cocaine, ketamine and morphine.

When methylphenidate was tested on rats, the data showed that the drug does support brain development, but the rats grow up to be more stressed and emotional than the control group. But, hello, when did our children become comparable to rats? There is not a lot of research on actual children using Ritalin, mainly just rats.

The research I did find indicates that the effects of methylphenidate are still disturbingly blurry. Results released earlier this year by The University of Wisconsin (on monkeys, not rats, but still not humans) paralled a study completed in 1977 showing that low doses of methylphenidate can improve cognitive ability in the classroom, but that higher doses (those strong enough to reduce the hypermobility) actually had a detrimental effect on cognitive ability and impaired memory.

Researchers noted, "At the higher dose, "performance on the task is impaired," ... "but the subjects don't seem to care, all three monkeys continued making the same errors over and over." The monkeys stayed on task more than twice as long at the higher dose, even though they had much more trouble performing the task."(1.)

The United Nations released two press releases about this, one in 1996 and one in 1997. Among other things, these reports noted the fact that methylphenidate had the same pharmacological properties as widely abused amphetamines, otherwise known as "ice" and "speed". They also reported on the fact that the legal manufacture of methylphenidate rose from 3 tonnes in 1990 to more than 8.5 tonnes in 1994. It is still on the rise.

There is not a lot of data on how many school aged children actually take Ritalin in Australia, but what data there is indicates that Western Australia has double the number of school aged children on Ritalin than the rest of Australia. The data for the United States of America is really scary, the number of children on Ritalin has risen from 2000 in 1993 to 90,000 today.

Dr James Scott, from the University of Queensland Centre for Clinical Research was quoted in 2011 stating that 5-10% of Australian children had ADHD and that girls were under-diagnosed. When I looked  a little deeper at Dr Scott this is what I found, "Dr Scott has received grants to attend educational functions by Eli Lilly and Janssen-Cilag. He has also received fees for speaking at conferences on ADHD-related topics such as attachment, but not on topics relating directly to the use of medications." Eli Lilly  and Janssen-Cilag are both manufacturers of ADHD medication containing methylphenidate.

The Royal Children's Hospital, Melbourne states that stimulants are the most effective treatment for symptoms of ADHD. According to them, children have been taking stimulant medication for ADHD for 50 years. I was so shocked to read this and it seems that it is true, to a degree. Methylphenidate has been used since the late 1930s to treat hyperactivity.

My husband and I are both university educated, we like to think that we do not cower to authority. When Riley was diagnosed with ADHD, we did what we were told, smuggly patting each other on the back for 'doing what was right for our son'. Both of us believed that Ritalin was the right thing to do.

Last year Riley's paediatrician advised us to stop the Ritalin until he gained 2 kilograms as he has on the 2nd percentile for his weight for his age and she "didn't [want] to end up on the page of The West Australian". The main side effects of methylphenidate are loss of weight/poor weight gain, the there's also these affects, lesser effects: suicidal thoughts, confusion, chest tightness, chest pain or heart palpitations, shortness of breath, more outgoing or aggressive behaviour than normal, strange behaviour, hallucinations, agitation or restlessness and uncontrolled movements of the head, neck, mouth, arms, or legs (known as tics) and then the even lesser effects; increased blood pressure, increased heart rate, dizziness, unpleasant or distressed feelings, abnormally good mood, insomnia, tremors, headache, diarrhoea, or constipation, and a dry mouth, or unpleasant taste.

Let's remember when we look over the list above, that we are talking about children!
What are we doing to our bright, bouncy children?  

Riley also told the paediatrician that he didn't like the way Ritalin made him feel, but she reiterated the fact that HE MUST BE MEDICATED (if we were to see any educational results). He did gain weight and we just, sort of stopped reminding him to take his pill in the morning. His teacher just, sort of stopped reminding him to take it at lunch. And we just sort of saw a happier little boy emerge.

The brand of Ritalin prescribed to my son was tested on a grand total of 18 children between the ages of 7 -12, the majority in the later years. Somehow this limited test is deemed acceptable, but to the company's credit, they state that medication MUST occur "alongside other remedial measures". Who is responsible for these remedial measures though? Certainly not the drug company, or the prescribing doctor.

As parents, we have tried to put remedial measures in place for our son, but what about the Year 9 student who was looking down the other day in my class? When I asked him what was wrong he told me that he was sad because the school had told him he had to start taking his ADHD medication again. I sought him out in the playground and had a chat with him, telling him that my son also had ADHD, he said, "Poor bugger"! And he is right, the majority of children I teach have no other treatment in place other than the medication which they all hate to have to take.

The American outlook does seem bleak for children with ADHD. US studies indicate that children with ADHD are significantly less likely to succeed academically and that there is also a much higher rate of substance abuse in ADHD children. (2) .

The Australian research (not sponsored by a drug company) is a little more positive. The Raine Report (2010) used longitudinal data (as a part of the Western Australian Pregnancy Birth Cohort) to examine long-term social, emotional, school-based, growth and cardiovascular outcomes associated with stimulant medication for ADHD. Using the Department of Health data which stated that in 2010, 8% of Australian children had been diagnosed with ADHD the researchers took their sample group and compared them with their control group. Previous Australian testing was randomised with (a total of four) controlled trials that lasted between two weeks and six months. 

A lot in the Raine Report was inconclusive, however two things stand out for me. There is conclusive evidence that children (from this sample) taking ADHD medication have higher blood pressure than those who don't and that children who were identified as taking ADHD medication were 10 times more likely to be considered as performing below the expected age level by the teacher.

1. Study pinpoints effects of different doses of an ADHD drug; finds higher doses may harm learninghttp://www.wisc.edu/search/?cx=001601028090761970182%3A2g0iwqsnk2m&cof=FORID%3A10&q=adhd+trial
2. "Longterm Prognosis in Attention-Deficit/Hyperactivity Disorder," Mannuzza, Salvatore and Klein, Rachel; Child and Adolescent Psychiatric Clinics of North America, Volume 9, Number 3, July 2000
Amber L. Howard, Monique Robinson, Grant J. Smith, Gina L. Ambrosini, Jan P. Piek, and Wendy H. Oddy. ADHD Is Associated With a 'Western' Dietary Pattern in Adolescents. Journal of Attention Disorders, 2010; DOI:

1996http://www.pbs.org/wgbh/pages/frontline/shows/medicating/backlash/un.html
Adhd: Attention-Deficit Hyperactivity Disorder in Children and Adults
By Paul H. Wender
(Greenhill, Halperin, & Abikoff, 1999; Leonard, McCartan, White, & King, 2004; Schachter, Pham, King, Langford, & Moher, 2001; Van der Oord, Prins, Oosterlaan, & Emmelkamp, 2008).
 
 

9 comments:

  1. Well I didn't all the mumbo jumbo I have to admit. I have 2 sons with ADHD and both have been medicated for 16 years. The oldest is 32 and was a clear candidate for commiting sucicide before medication and the other is now turning 28. Both are doing well now. I felt so guilty putting them on these terrible drugs. My oldest thanked me. He described his brain as a room where the lights had always been turned off and when we gave him the drugs they were turned on. When I asked him newly into this new venture why he was still having troubles, he said that any room that had it furniture turned upside down for 16 years was going to take awhile to put everything back in place. No it is not a perfect solution and may not be for everyone. Give it a go and as my eldest will tell not just for school days, for everyday as it will not work. Confuses the brain. Anything else you want to talk about get in touch.

    ReplyDelete
    Replies
    1. Thanks for sharing Janine, I love your son's analogy. I just wish I had a magic ball with all of the right answers for Riley. More sleepless nights!

      Delete
  2. I hope i dont offend anyone with my comments, but i guess this is my experience, and my thoughts. So here goes...

    About 10 years ago, I was told by my doctor that other doctors would diagnose my son as ADHD. But my old fashioned doctor did not believe in it. So he told me to watch the foods that he ate, the preservatives, the sugar contents etc. He also reminded me that we are all different, some of us are good at school and academic studies and some of us are more hands on, but smart in our own way. I did discover the triggers of hyperactivity and lack of concentration, and I adjusted his diet. ( funny thing is as he got older and ate these things, he got migraine headaches). The bottom line, he still hated school and didn't want to be there, I believe nothing would have changed this. He is now very successful in his work place doing roof restoration. His boss thinks he is fantastic. He works hard and is rewarded very well for his age. I wont lie, We have been to hell and back, believe me. But at the end of the day, we have let him make his own mistakes and we have always been there to help him through the bad times. He has now grown up and learned many lessons, sometimes the hard way, but we couldn't be more proud of the young man he has become.

    As the leader of a youth organisation, I have many teenagers that have been diagnosed with ADHD and the funny thing is their doctors only recommend that they only take it during school hours. Why? These are kids that are absolutely fine while they are on camp with us. Why? I believe it is because they are kept occupied with something that they enjoy. Something that they want to do... Somewhere they want to be...

    At then end of the day, boys will be boys, kids will be kids. Maybe we should just accept, as they did in our day, that not all kids want to be at school, that not all kids are academic, but they will excel in what they enjoy.

    If you ask me, just as a mum, forget the Ritalin. Let kids grow up as they are. and I am sure Colleen, you and your hubby would be like me and my hubby, by your sons side at every stage, good or bad. He will be ok...

    Ok, thats it, I hope I haven't offended anyone with my comments.

    ReplyDelete
  3. Thanks Karen, I'm glad your son is doing well. Riley was also told only to take the medication on school days, which led to some emotional lows over the school holidays as he went through withdrawal symptoms. As a high school english teacher I know that schools do not cater for all leaning styles and that some boys are very disenfranchised.

    ReplyDelete
  4. My Dad and stepmother were told by my sister's teacher a few years ago to have my sister tested for ADHD because she wasn't concentrating in class and was being disruptive. I remember telling Dad not to let anyone medicate her because she doesn't have ADHD, she's just bored at school. My sister is not the most academic of people and would much rather be outside running around or chatting with her friends than stuck inside a classroom.

    I've also known a few children who have been diagnosed with ADHD who had parents who chose to remove food preservatives and additives from the family diet with great success rather than medicating.

    ReplyDelete
    Replies
    1. Thanks Sidetracked ands good on your dad and stepmother. We are trying the diet thing, so we will just have to see how we go!

      Delete
  5. I don't have an ADHD kid, so my advice is pretty cheap :) My brother (now 33) was a true psycho child. Climbing on to the house roof at 3, climbing on to car roofs and jumping on them, disruptive in class, physically fought with me constantly - hitting, biting, pulling out clumps of my hair (he's 3 years young than me), developed nervous tics in his face, insisted on yearing odd clothing combinations - odd socks with odd choices of shirts vs pants etc etc the list goes on.

    My parent poured their heart and soul in to raising him and guiding him. He had a huge outlet in sport. One of the issues in the classroom was that he was highly intelligent and was bored.

    Mum always said he walked such a fine line, that he was either going to be a brilliant criminal or a brilliant lawyer - turns out it was the latter. Also she said that she could have easily broken his spirit and crushed him, but a spirited, disruptive and original child with hope in his future was infinitely better than a crushed soul.

    We watched a child across the road, dosed with ritalin, turn from a vivacious child to a drawn, white and retiring shell....

    Every spirit is unique. How would Einstein have turned out if he was dosed up. Beethoven? Any creative/ingenious/inventive soul has to be a bit of an "oddball" (and I don't mean that disrespectfully - eccentric), otherwise where's their point of difference - advances aren't made through everyone doing, thinking, acting, learning the same way.

    Sorry - I have gone on, but I believe in the spirits of children and the need for these little souls to be nutured. And perhaps for some people it's through ritalin.

    It's just not an option I would choose for my child - who doesn't have ADHD, and in that regard I'm really not qualified to opine :)

    ReplyDelete
    Replies
    1. Thanks Rachael, I welcome your input. I believe there is hope for Riley and for now we will stick with our decision. :)

      Delete
  6. Hi there, I have NO experience with ADHD or the recommended medication. I just wanted to wish you luck with it all. You have been given an added difficulty in parenting and you are doing so much research to make sure you make the right decision for your circumstances, so I'm sure your decision will be loving AND well informed. All the best.

    ReplyDelete