Should we give children with behavioral problems medication? Or is there another alternative? Who’s desicion is it wether or not they get ridelin?
Just a discussion I was having with a friend. Let me know what you think.
I’m against it. Parents should be able to look after their kids and control them. Most kids just need something constructive to do.
It’s spelled Ritalin, first off, and it shouldn’t be given to kids with behavioral problems. However, it’s useful in treating, in both kids and adults, people with Attention Deficit Disorder, and Attention Deficit Hyperactivity Disorder (and narcolepsy, but that’s a different issue). ADD and ADHD are not caused by lack of parental discipline, and can’t be treated by just giving people “something constructive to do”.
Having worked with children for many years, I can say with confidence that there are a number of children who are greatly helped by Ritalin.
True ADHD children have a great deal of difficulty focusing their attention, even on things they wish to focus on. Ritalin helps these children focus and spend their time the way they wish to. Children who could not sit still even if they wanted to begin to act normally.
HOWEVER, and this is a BIG HOWEVER:
Throughout the nineties, Ritalin was over-prescribed to a degree terrifying to imagine. Normal children who maybe didn’t restrict their own behavior to the the extent the parents wished were put on the drug, and turned into zombies. As a child care worker during this time, it was truly depressing to see.
Apart from the childhoods these children had stolen from them, an additional effect was that Ritalin has become anathema to many parents, even those of children who could actually benefit from the drug.
If a child is inappropriately rambunctious, a more comprehensive discipline strategy on the part of the parents may be all that is needed. If however, the child is dismayed by their own unexplained inability to focus, on one thing at a time, it may be a sign of a chemical imbalance that Ritalin could cure.
Nitpick: It’s spelled “ritalin”
And, I agree with you on one level, however, ADD is not something that can be easily solved by giving someone something “more constructive to do”.
Where I agree with you is that I think ADD/ADHD (which term is in vogue right now?) is WAY overdiagnosed, especially in children. Some kids are just brats and their parents should take more responsibility or, as you put it, “give them something more constructive to do.”
And, also, hyperactivity and disruptiveness are not requirements for ADHD (Relevant DSM-IV cite).
But if you have ADD, medication may be a godsend. Doesn’t work for everybody, but it works for a lot of people.
Also, you say:
This is a very broad statement. Like I said, some kids are just brats. Some, however, may have ADHD, may be bipolar, depressed, schizophrenic, etc. I think medication should certainly be an option for them. But I don’t think that’s what you were implying, I just wanted to be clear on that point.
FTR - this is the time period when most of my impressions regarding ADD/ADHD were formed (I was a teenager), I do not work with children, but I have been diagnosed with ADHD (WAY too late, IMHO), and ritalin, concerta, dexadrine et al. work wonders for me.
I have ADHD and I am still on Ritalin, even though I’m 24.
ADHD is not just an issue of “not having something constructive to do”, nor is it an issue of improper discipline.
I’d post more, but my sister wants the computer…I’ll come back later.
I am really curious as to how “putting kids on” what is, effectively, speed, “turns them into zombies.” When kids who have the prescription sell their supplies to other kids, the kids buying it are using it to get high, not as a downer, so how does this “zombie” claim fit into the reality of the drug.
I am willing to accept that it has been overprescribed on occasion, but the claims that simply giving kids speed will turn them into zombies seems a bit farfetched.
I’m not qualified to give an informed opinion either on the prevalence of ADHD or the benefits of Ritalin, but I want to make 3 personal observations.
I think it’s true to say that there has been a massive (no pun intended) increase both in adult and childhood obesity over the past decade or so. This is coupled with frequent observations that we all - children and adults - take far less exercise than we used to.
The syndrome “ADHD” was never discussed in the media or among parents before (roughly) late 1980s/early 90s. (I’m not saying it wasn’t a recognised syndrome among clinical people - I don’t know)
The drug Ritalin seemed to reach public consciousness around the same time we started hearing about ADHD.
My point? Could it be that adults have become so inactive that they mistake natural childhood exuberance for something pathological? That the definition of ‘normal’ childhood behaviour has become distorted in line with the general trend towards sedentary lifestyles? As for the mysterious appearance of Ritalin as a cure, I’ll leave that to the conspiracy theorists…
Not to hijack this thread, but…
I wonder how many adult Dopers out there have ADD/ADHD? Two, so far, plus me most likely (I have a doctor’s appointment on Friday to find out). Who else?
Have you ever seen a child on a steady prescription of Ritalin who didn’t need it?
It’s not simply speed, it has a more complex neurochemical reaction than that.
If you work with children who are on it without needing to be, you don’t need to ask that question.
Now there’s ODD. :dubious:
But many children are on ritalin without needing to be.
Ritalin and Adderol (another ADHD drug) may be overprescribed due to parents who don’t want children to act like children and doctors who base their diagnosis on a 15 minute meeting but that is hardly the only problem.
Both of these drugs are known as “study medicine” because they help people to focus on otherwise boring and monotonous tasks. Come exam time many kids with legitimate prescriptions make a killing selling these drugs to others who need something to help them study or write their papers.
Just one. While he was on it he was bouncing off walls.
Is there any actual clinical citation for this zombie effect?
tomndeb,
Drugs like Ritalin (and lots of others, too) generally have a very different effect on children and adults. What makes an adult more active may calm a child down and vice versa. Antihistamines are sometimes that way, too.
I know an adult who takes Ritalin for Chronic Fatigue Syndrome on days when she just can’t move.
**
I don’t have any citation for the effect but I’ve have known many people who give this as one of the reasons they stopped taking ritalin.
Having done research on ADHD/ADD for about three years (a while ago, admittedly), this is still one of the hardest questions to answer for me.
It’s hard because ADHD/ADD is a difficult thing and because giving medication to treat behavioural problems (contrary to a genuine physical condition) is a difficult thing, even more so in children. The group is very, very heterogeneous.
I struggle with ADHD because it is still hard not to over- or underdiagnose these children. This is, IMHO, mostly due to the trend that DSM-IV research criteria, which are tentative and do not necessarily point to an established medical condition, but are used in everyday medical practice. This is a strange, if not a bad, thing.
Ritalin (methylphenidate) is, indeed, not as simple as speed, although it is an amphetamine. It may seem strange to give hyperactive children “speed” but the general idea is that they are hyperactive because the inability to focus or concentrate. Importantly, Ritalin also boosts the performance of non-ADHD children (cite). So of course (ADHD/ADD) children improve when administered Ritalin, but all children do, so that is hardly proof that some need it and some don’t.
Then there is the thing of adult ADHD. Technically, the DSM-IV criteria describe a childhood disorder. Nobody knows, at least as far as I know, how this develops into adulthood. Precious little reseach has been done in this area.
And, considering this, when to stop administering it? Short-term trials have found none or relatively mild side effect of Ritalin. But when this condition continues into adulthood and people could be dependent on Ritalin for life, that is a totally different thing. There may be unwanted negative side effects associated with long-term usage.
While this all points to a “no, don’t use the crap”, the alternative might be having your childhood, education and chances in life wasted because Ritalin wasn’t given to you when you did need it (for whatever reason; ADHD, stupid parents, name it) is, to say the least, kind of a bummer.
So there you go, I honestly wouldn’t know the answer to the OP, other than: be careful and decide on a child by child basis and try to keep it as short as possible.
And: always in combination with some kind of behavioural therapy.
I took ritalin for 1 year. You would have no problem guessing which year. My comprehension level increased to the point where my average grade went up 2 levels. I was brought to tears in college over a statistics class that I ended up taking 3 times. I could read the words, understand what each word meant, but not be able to understand the sentence. I feel like I lived the book “flowers for Algeres” (sp?).
I agree it is not for behavior problems. Behavior may manifest itself in the form of restlessness but ritalin isn’t going to correct problems that are truly behavioral.
Don’t listen to those talk show weenies. They don’t know what they’re talking about. I’m waiting for one of them to tell depressed people to stop worrying and be happy.
I think it’s Algernon. I liked that one also. My favorite was the story where the talented people had to wear ankle weights, among other things, to equalize the population. I can’t remember the name of that one at all.
I fully believe that some children/adults do benefit from Ritalin.
However, I think that some doctors need to slow down from flinging out the prescriptions and talk to parents about diet and exercise. Of course your kid is going to be bouncing off the walls after having Froot Loops and Coke for breakfast.
It’s just an easy way out for some parents, IMO.
Except that I wold expect an amphetamine to increase her ability to move. I am looking for evidence of the opposite effect.
However, ADHD is a physical problem (although it manifests as behavior for its most clear diagnosis):
Brain Image Scanning & Mapping with AD/HD
I am not claiming that Ritalin (or Adderal or Dexedrine or Cylert or anything else) is a cure-all. It clearly is not. I am also not claiming that Ritalin has not been over-prescribed.
I am looking for actual medical references that indicate that Ritalin will cause a “zombie” effect in a person (child or adult) who is not suffering from one of the clearly physical (if clearly not understood) brain disfunctions.