Just because something might not be harmful doesn’t mean that it should be given out willy-nilly. And perhaps these medications have deleterious effects that are not necessarily related to physical health, but instead negatively affect an individual by limiting their creativity. Like Smartass said in the last post, what would have happened if Mozart would have been given Ritalin in order to better fit in with mainstream Viennese society? How many Mozarts could we potentially be losing every day because of our insistence on conformity and obedience at all costs? True, we can’t prove that Ritalin limits creativity, but we also can’t prove that it doesn’t. And I, personally, would rather raise a terror child that wound up being a great artist or musician than medicating them to be another cog in our society. Of course, not all ADD-labeled kids are latent geniuses. However, I do believe there is a definite link between ADD and genius, and that if we had the room within our society for geniuses, there would be a lot more Mozarts and a lot fewer ADD diagnoses. Can I prove this? No. Can you prove it’s not true? No.
Well, I actually was a kid like that. Disordered sleeping? Check. Temper tantrums? Check. Suicidal ideations? Check. And some of that stuff still bothers me. I still believe that it would have been a mistake for me to be medicated, and think that my problems have actually enriched my life in ways I can only imagine. But then again, since I’m not a parent of an ADD child (or a psychologist that agrees with you), my opinion is meaningless, correct?
And given my family history (father and sister, as well as a large number of others on paternal side, have severe OCD and possibly ADD, small incidence of mental problems on maternal side) it’s entirely possible that I will “lose” the genetic lottery if/when I have a child. And while I can’t know “for sure,” I can say with a reasonable amount of certainty that medication wouldn’t even be the tenth thing on my list to try. Maybe it wasn’t on yours either. However, I have seen enough people willing to medicate themselves and their children at the first sign of ADD/anxiety/depression to make it clear that for many people, pharmaceuticals are the first thing they go to. And in my unqualified opinion, this is a mistake.
I don’t know that it would be unlikely for anymedical doctor to prescribe under those conditions. I’m certain it would not be likely for the appropriate specialist ( child psychiatrist or pediatrician?) to prescribe under those conditions. But I’ve known doctors to prescribe antibiotics for colds and my mother and sister are both taking anti-depressants prescribed by their family practitioner on the basis of a fifteen minute office visit. And the one that bothers me most- my niece’s 9 year old daughter who is currently being prescribed something ( Concerta?) for ADHD and risperidol (an antipsychotic) by a neurologist. Does the fact that he’s a neurologist mean he doesn’t know what he’s doing? Nope. Does the fact that the only thing the kid is getting is prescriptions suggest to me that maybe he doesn’t know what he’s doing? Yep. In my casework experiences with both children and adults, medication for ADHD and anti-psychotics come along with counseling. She’s not getting any.
I would never comdemn anyone for choosing not to take medications, though I would recommend that anyone who has been given a diagnosis of ADHD (or whose child has) should at least try meds for it if they are recommended by a psychiatrist. A lot of people have misconceptions about ADHD meds that they may find are not true at all.
For instance, since I have been on Ritalin, I have had the same creative energy and intellectual capacity that I ever had. The only difference is that I can focus it.
I probably could have altered my life to accommodate my ADHD rather than taking meds for it; I could have gotten a job and developed other pastimes that never required me to pay attention to anything for more than fifteen minutes at a time. I know, however, that I would not have been happy, especially knowing that it was this particular personality trait that was holding me back. This may not be the case for everybody, and that’s fine.
I think that the danger of taking something away from a kid (or an adult) by prescribing ADHD meds is greatly outweighed by the chance of changing things for the better, and is tempered almost completely by the fact that these meds are so easily stopped if they aren’t working out.
Just my take. I’m more of an authority on the condition in adults than in children, but I hope I can add something.
On the other hand, how many Mozarts are we losing every day because they can’t sit down at the piano long enough to work out the melodies that are going through their heads?
As I said in my post above, the notion that treatment for ADHD stifles creativity is, IMO, a misconception, completely counter to both my personal experience and my experience with (adult) patients.
In case there’s any confusion, since you are an adult and taking the meds for your own personal benefit, I would not want to in any way disuade you from taking them. What concerns me is forcing them on kids. We know that the brain continues to develop into adolescence. And we also know that mind-affecting drugs often have different affects on children than they do on adults. We do not know all of the consequences of putting a child on daily doses of these drugs for years of the child’s development.
If my children spent their entire adolescences as holy terrors and then, at age 18 or so, decided to start taking something like Ritalin, I would probably be okay with it (and it wouldn’t really matter if I wasn’t okay with it). But I won’t be giving it to them before then. During the portion of their lives in which I am resposible for evaluating risks for them, this is one that I simply am not willing to take on their behalf.
For me, one key distinction is whether I am medicating my children to prevent them from suffering or to prevent myself from suffering. I decided a long time ago that I was willing to accept a significant amount of suffering in order to have kids. In practice, my wife has accepted more of it, and while she may joke about Ritalin on occasion, she would be just as opposed to it as I am. In the case of most clinical diagnoses, a key criterion is the degree to which the “condition” is debilitating for the person who has it, not the amount of discomfort it causes others.
After a re-read of my previous post, I want to clarify that I am not claiming to be a Mozart or an Einstein. My point was that different does not necessariy equal dysfunctional. In terms of life accomplishment, those guys were clearly way out of my league.
Let us please remember that Mozart lived in an age when bloodletting was considered a useful treatment for rheumatic fever, that he suffered from bouts of severe depression that hampered all aspects of his life, and that he died at age 34.
What if Mozart had been on Ritalin? Maybe (since we’re now so far in the realm of supposition that we may as well suppose in another direction) MAYBE he would have acquired the court appointments he craved, maybe he would have been able to channel his musical genius into a career instead of the novelty it was considered, maybe he would not have suffered from the depression that, if nothing else, certainly did not make his limited time on this earth very comfortable for him.
Once again - I minded. No one else noticed, because I performed. Since my unhappiness affected no one but me, no one bothered to find out why I was so unhappy.
Don’t for one minute think that these kids aren’t suffering. Typical comments about kids before treatment are “not working to potential” and “doesn’t work or play well with others.” Not exactly the recipe for a happy childhood.
That’s how it seems to me… one of my closest friends has ADD (her entire family has it, actually) and it doesn’t seem to improve her life when she’s spacing out or off her meds. Seems related to a lot of the problems her brother has had, too, in school and out.
I was not treated as a child, as the diagnosis did not become common until I was late in my teens. My life was almost constant frustration with and anger at myself, leading to horrible self-image problems and severe bouts of depression. 23 years of untreated, rather profound ADHD left a huge mark on my personality even to this day, mostly in ways that I don’t like at all.
I don’t want to overstate the case or present myself as typical. But when you’re evaluating the potential harm that could come to your kid’s psyche by putting him on ADHD meds, don’t forget that harm can also be done by letting it go untreated.
That’s a nice little diversion. Taken by itself, I might be lead to believe that the people in this thread were discussing how to help a bunch of unhappy children who are upset about their own limitations. However, having read every word of every post, I am far more likely to conclude that the people in this thread are discussing how to deal with children who are not behaving the way the adults around them would prefer for them to.
What you are doing is cherry-picking one statement from a very long post and responding to it completely out of context in an effort to undermine my credibility, and I don’t appreciate it.
Speaking solely for myself, I have never “suffered” from an “inability to focus”. However, I have suffered from the attempts of others to make me “appear to focus” or to concentrate on attempts to teach me things that I already know. I have suffered from people who believe that, if I am not staring intently at them, I must not be listening to what they are saying. As a teenager, I suffered years of depression as a result of a feeling that the people in my life were not willing to accept me for who I am. I have also suffered somewhat because of an “inability to play the piano or the guitar” in spite of a fair amount of desire to do so.
Let me answer you this way: If I ever encounter a discussion of any kind (and I haven’t) where adults are discussing the unhappiness of children who exhibit apparent ADHD and how to help them, I will respond in a different way.
For one thing, if you will check my initial post to this thread, it did not say anything along the lines of, “Let the kids suffer.” What I did was to try to strongly encourage parents to resist the temptation to medicate their children and focus on learning to help them (and themselves) using behavioral approaches. If someone has a child who is suffering, I most definitely advocate taking steps to help that child. However, there do exist ways to help parents and children that are a bit different from the prevalent atmosphere of medicating children at the drop of a tantrum (and no, I am not referring to any particular poster here).
My wife just pointed out this post by Primaflora:
Depending on your defintion of “severely behaviorally disordered”, the answer is probably no, although you could find practitioners who would have described me in this way. I have spent my days with them, in a treatment setting.
My wife has asked me to inform you that this is a decent description of our daughters, particularly the part about sleeping. Most of the tantrum behavior has been successfully eliminated, but they do reappear on occasion. For those who aren’t familiar with this, a common tantrum for a young child involves dropping to the ground, going completely stiff (my first daughter could have been balanced on chairs) and screaming for 30 minutes to, potentially, several hours. When daughter 1 would do this, it would scare the shit out of Mrs. Smartass, because she was afraid the child was going to crack her head open when she went stiff and fell straight back.
Many parents have “breaks” where their young children take naps in the afternoon. They also have “adult time” after the kids have gone to bed. Our children do not take naps and putting them to sleep early is the same as saying that we want to get up at dawn. I can say that when you have kids who you never have a respite from, it is quite a test of a marriage.
Yes, although this is a more minor issue with my daughters. I have worked with kids who were too terrified to speak for an entire school day. My first daughter is more prone to social fears (she is more like me). It is for this reason that I insisted that she have experience of daycare, and interacting with other children, long before we had any real need of it.
I think it is clear that you are discussing a child with far more challenges than a diagnosis of ADHD. I hope you are not getting the idea that my distrust of the ADHD diagnosis means that I don’t think that kids ever have real medical problems or that I think that they should never be medicated.
If I have not made it clear, I’ll try again. I am not advocating that anyone ignore a suffering child. What I have a problem with is a real tendency, at least in the US, for parents to medicate children as a way of dealing with what is basically bad behavior. There certainly exist cases where a child has organic problems that can only be addressed pharmaceutically (or may not be able to be addressed at all). However, frustrated and exhausted parents are NOT a reliable indicator of this.
I want you to know that I have a great deal of sympathy for your situation and even more for your child. I also want to make sure that you understand that I am NOT in any way advocating that you cease the treatments that you are providing. The only thing I have been trying to address here is the much abused and overmedicated diagnosis of ADHD. I am not on any kind of anti-child-helping crusade.
Your frustration is at least becoming more understandable to me, but surely you can see that none of the things I have been discussing have anything to do with the issues that you and your children are facing, right?
Again, just to be clear, I am not, and I would not, suggest that you should not medicate a child with the issues you have described.
Honestly, I am sorry for any confusion that I might have caused which led you to believe that I was talking about parents and children that are in the position that your family is in.
I’d like to note briefly, so that everyone understands the significance of what I am about to say, that this is perhaps the twentieth post I’ve made using such language.
Now, back to your above remark-
What a truly idiotic fucking pile of festering self-serving bullshit.
I have been treated for ADD since I was in the second grade. Without the pills I could not think. I could not learn. I was unable to do a great many things I enjoyed.
My parents, teachers and therapists were concerned that I might be overmedicated. They worried about side effects. I worried about being able to think and focus and do.
No. Being honest with myself, you seem a lot more like the lecturer talking about demons.
This debate is rapidly spiraling into a confusing mess. It hasn’t been helped by my feat of missing three new posts that appeared while I was writing one.
Maybe I can reduce some of my messages to smaller statement that people will have an easier time taking aim at. I will point out, though, that my vacation is almost over, and I have tried my damnedest to communicate everything I really have to say on the issue here, so I’m not sure how much there will be left for me to meaningfully add. I am pointing this out in case I disappear on you. If it happens, I am teliing you in advance that it is not some kind of snub.
ADHD is a clinical diagnosis defined by a constellation of behaviors. While there are theories about potential underlying brain syndromes, in practice the diagnosis hinges on where one professional draws lines about bad behavior. Many of the behaviors involved in this diagnosis are voluntary, as the term is usually used. Admittedly, I do have a philosophical stance on these types of things. The training that I have received was behaviorist and included clinical experience with Direct Instruction. I am also a fan of control theory (“being depressed” is not something that you are; it is something that you do), although I don’t think it answers every question or meets every need (depression is a particularly cruel and unpredictable beast, and for some people not the best example to consider in this context).
When we talk about whether a child is ADHD, we can argue about the definition, i.e. whether a child exhibits a pattern of behavior. The far more thorny issue is whether a child’s behavior is evidence of serious dysfunction or evidence of differences that are often thought of as “personality”. I am extremely distrustful of the current atmosphere in the US that amounts to bad behavior = ADHD = dysfunction.
When we talk about corrective measures, we touch on questions of whether any sort of action should be taken (while some people here seem to think I advocate “do nothing”, I don’t), and more specifically what sort of action should be taken. A great many of a child’s behaviors can be influenced using behavior modification techniques. A great many of any person’s behaviors can be modified using pharmaceuticals. In terms of the behaviors specifically associated with the condition commonly referred to as ADHD, I believe that in most, if not all, cases, these behaviors are better addressed using behavior modification techniques than using medication. An oversimplification of my position would be that it is better to train kids in acceptable behaviors and life strategies than to sedate them into a state that is more acceptable to others.
I am specifically referring to ADHD. I am not talking about any other disorders, conditions, dysfunctions, syndromes, or diseases. This means that I am not talking about OCD, antisocial peronality disorder, schizophrenia, cancer, chicken pox, asthma, or any of thousands of other things you might mention.
When discussing kids who have been labeled ADHD, I concede that there may be some who have an actual organic dysfunction that cannot be addressed by any behavioral techniques. But I have yet to be convinced of this. And I am convinced that for a large proportion of these kids, there is no underlying dysfunction and that we are taking “normal” human differences and treating them like a disorder. I have also personally witnessed enough instances to be quite confident when I say most, if not all, of these issues can be dealt with using behavioral techniques. Kids can be trained to use a toilet, and they can be trained to behave in acceptable ways. They can be taught to solve math problems and they can be taught to deal with social anxiety.
When kids are not given the teaching and training that they need, they continue to experience problems related to this deficit. While medication can often lessen the disruptiveness of these deficits, it does nothing to solve them. If a child is upset becase he can’t figure out how to solve a math problem, you can give him a pill to make him sleep, but you cannot give him a pill that teaches him to solve the math problem.
Different people require different levels of effort and training to acquire different skills and problem-solving strategies. Some children are extremely difficult to train in the behaviors that are commonly considered to be acceptable by society. Dealing with these children can be unbelievably stressful for parents and teachers, and training them can require a knowledge of training techniques that most parents do not know and a level of effort that seems shockingly huge.
All of this leads to what I originally said. While I won’t say that there are no kids who should be medicated for ADHD, I will say it should be considered to be a major fucking decision and I would encourage every parent to consider this course of action as an absolute last resort. Using solid behavioral training techniques in an appropriate way will resolve most of these issues, almost certainly wil not harm the children, and will produce benefits that are life-long. Use of medication, in and of itself, will not solve any underlying problems. It may mask symptoms and may be doing some amount of long-term harm, be it great or small.
Rephrased, if you knew you could use behavioral techniques to address a child’s behavioral problems and instead set the child up for a life-long dependence on drugs like Ritalin, would you be happy with your decision? What I am advocating is that you make every effort to try the former approach before resorting to the latter. I am confident that for most of the kids currently taking this drug, the former approach would not only suffice, but would produce better long-term outcomes for both parent and child.
I think I have ruffled the most feathers by saying that I simply will not medicate my children for any or all of the behaviors associated with ADHD. Whether or not I can convince any of you, I know for myself that this is not necessary. On the other hand, if one of them were to start having seizures and a neurologist recommended medication, would I give it to them? You bet your ass I would.
There is nothing here that I disagree with. My point, in part, is that there is so much “diagnosing” of misbehaving kids going on, I’m pretty suspicious of any underlying thing that should properly be described as a disorder. And, while I may have failed, I have certainly tried to indicate my belief in the last sentence here.
And right now, whether you are willing to admit it or not, I know for a fact of an insane number of cases where children act up, teachers complain to the parents and suggest Ritalin, the parent asks the pediatrician for the prescription, and gets it. At least, the parents reading this debate right here are being exposed to the fact that there is some controversy, and that this decision is a little more complicated than the decision to hand out multivitamins.
Your idealistic descriptions of parent-teacher-doctor relationships notwithstanding, I am responding to a problem that is increasingly widespread and that I am not imagining.
In terms of the vignettes you are referring to, I am not trying to criticize these people or encourage people who are getting significant benefits from Ritalin to suddenly discontinue use. However, the similarities between these vignettes and the majority of cases of ADHD diagnosis and treatment going on out there is not as solid and established as you are assuming. At least, not in my experience.
It is entirely possible that you are an example of the minority of cases which I have said may exist but am not convinced of. It is also possible that you have been medicating problems that could have been addressed another way. The fact that you are happy with your own outcome, or that you do not believe any other approach to the issues you describe was possible does not mean that no other resolution was possible. The fact that behavioral techniques were not used to help you with the issues you describe does not mean that they could not have been.
I don’t know your history. It is possible that these techniques were tried and that every less-intrusive alternative was explored before you were medicated. In this case, I would not change a thing if I could.
If this does describe your history, I can confidently guarantee you that your history is the exception and not the rule.
For every behavior that is associated with ADHD, I have either witnessed or participated in successful “treatment” using behavioral techniques. The results included happier parents AND children. My wife and I use them to address the issues that my daughters present. Believe it or don’t. But your conclusions about me are, at best, premature and unwarranted.
Since you think that I am talking out of my ass, by all means ignore any advice I have given. To do otherwise would be evidence of pretty dysfunctional solution-seeking, wouldn’t it?
By the way, I’ve enjoyed about as many of the random attacks as I believe I need right now. On the day that I realized that I did not want to pursue psychology as a career, the decision was based on my realization of how screwed up the service industry that has been built around the science has become. Thanks to our low amounts of understanding and the fact that the “system” is dominated by a) psychiatrists who don’t know much more about the human mind than they do about nuclear physics, and b) politicians and bureaucrats, there are very few cases where professionals have much real, meaningful help to offer. And in those cases where they do, the system is designed to discourage this ever actually happening.
Having obseved the system for most of my life, thanks to my step-father, and having spent some time “inside” it, I have seen that a lot of what passes for a “mental health industry” in this country is not far from the proverbial driving school for pigs. (They don’t succeed, but they do annoy the pigs).
I knew that whatever internal desire I have to help others was not strong enough to enable me to suffer through such continual frustration and ineffectiveness that is imposed. While I sympathize with all of you, it still is not.
While I believe that ADHD is overdiagnosed, I also believe, based on meeting so many other folks with the same problems over the years, that when somebody actually has ADHD, medication combined with other therapy is the best treatment. I also found large amounts of kids attempting to self medicate (including the buying of speed from illegal sources) because they were unhappy with their ADHD.
I can only judge your knowledge of the issue by what you’ve posted here.
So perhaps VM you would be well served by cutting down on some of your bluster, and focusing on that point.
Your evidence so far- some secondhand stories of parents clamoring for meds after a teacher suggestion and docs just casually writing off scripts. Maybe you can do better. Because the point that more may be included inside those fuzzy lines than perhaps should be is defensible - you just have not yet made the defense of it.
No doubt there is a lack of rigor in some cases. But inappropriate use of a label by some does not invalidate the label.
No doubt that the numbers of those being diagnosed is significant - but so is the number of adults who can and should be diagnosed with treatably high cholesterol or diabetes - a large number does not invalidate the label either.
Once you make the point adequately we can then discuss what factors drive the alleged overuse of the label and how to improve upon it in real life manner, without significantly undertreating as well.
Actually, for many children with ADHD who experience impulsive behavior, their behavior is quite noxious to their peers. Nobody likes being interrupted. Children don’t enjoy playing with someone who wants to switch from one activity to another, and someone who rarely agrees to play a game that they would prefer. Few children like having conversations butted in upon or the physical intrusiveness that some children show. Children don’t call other children “spaz” out of kindness and love.
Last year I saw an adolescent with ADHD - Primarily Inattentive Type whose mother was against using medications. He had made it to high school without ever having been diagnosed. He did not at all enjoy doing poorly in school, forgetting his books and pencils, and having trouble focusing. He thought he was just a stupid person. He had a hard time eating with the family because he could not stop himself from hearing the noise of other family members chewing. I worked with him to try to implement some organizational changes, and gave his mother and teachers some suggestions regarding the monitoring of his work assignments and completion. He was able to make some mild changes in being distracted by sounds in his environment, but not fully.
It is not my experience, nor is it evident in the literature, that children are not affected by their symptomatology. On the contrary, they often suffer greatly, although they may also be less keenly aware of how much they are negatively impacting peers or of the insidious effects of poor school performance on their sense of self worth.
There was a nice Everwood episode on this, and many other series touched upon it too. It’s becoming a bit of a cliche. On the one hand I think that the imagination of writers of such stories is severely limited to real life inspirations, and on the other hand I think people’s perceptions can be formed to much by scare stories. Good thing about something like Everwood is the nuance.