Thursday, August 24, 2006

Ritalin, it's what's for breakfast sometimes

I read Aggravated DocSurg's post on Black Box warnings for ADHD medications

I followed his link to Flea's April post on the subject of medicating chilren with ADHD

Then I read the comments which is what started this rant. Just so you know.

The fact that kids with ADHD respond well to firm discipline does not mean that their parents are not providing precisely that. ADHD kids need structure and organization. They need the OTHER children in their environment to be disciplined. Of course they respond to discipline. Usually.

Sometimes they need medication too. I don't believe medication should be the first option, and if I got a "do over" there are definitely some things I'd change.

My 25 year old was diagnosed with ADHD at the age of 3. Kid couldn't sit still to listen to a short book. There were other issues. For example, much of the time he couldn't hear well. Instead of medicating him at age 3, we opted to have his tonsils and adenoids removed (he was having sleep apnea too).

His activity level decreased, in my estimation, by about 50% --- but he still had ADHD. He was still MUCH more active than any other kid in the neighborhood -- all boys. It was an interesting neighborhood.

We enrolled him in an early childhood intervention program. He learned to sit still and listen to stories. I'd love to know how his teacher managed that, when I couldn't one-on-one.

After pre-K, we enrolled him in our parish school where the teacher's discipline style meshed well with mine. She was gentle with the kids, but VERY firm. He thrived. OK, his speech therapist begged me to medicate him, but he did very well in kindergarten.

In first grade, his teacher let him sit UNDER his desk to do his work. He did fine in the classroom, but he was failing lunch. He was totally overwhelmed by the chaos in the cafeteria. He couldn't eat. Since he was already at the 3rd percentile for weight when he started school, this was a very bad thing.

At this point, I approached his pediatrician about evaluating him again for ADHD. The concensus was that he did have ADHD and might benefit from medication. I cried, but decided to try it. On day 1 of medication, his penmanship improved remarkably. So did his spelling. He was already excelling at other subjects, so not much else changed except that sometimes he sat in his chair instead of under his desk. And he gained weight.

Over the course of the next 5 years, we gradually increased his ritalin dose and added tofranil. We took him to a psychologist to be re-evaluated. Diagnosis: ADHD. Pure ADHD, no depression, no OCD, no PDD. Just ADHD.

One of his teachers suggested martial arts, so I started interviewing instructors. The first 2 said they thought they might be able to help him. The third had letters from parents detailing how martial arts in that particular school had helped their children. We signed up. Within a year, he was off tofranil and his ritalin dose had been decreased from 80 mg/day to 40.

If I got a do-over, he'd have started martial arts at about age 3. Maybe 4. It's hard to find a school that takes 3 year olds and does a good job of it.

Then I found homeschoolers on the internet. I had considered homeschooling when I didn't know that anyone else was doing it. The more I read about families dealing with ADHD, the more inclined I was to try it. I presented this option to my son - and he decided he would like to try it.

Homeschooling isn't a panacea. It does allow you to teach academics during the good times and do something else on the bad days. We got him down to 10 mg of ritalin in the morning (for math).

He wanted to go back to school for high school - and had to go back on ritalin 2x/day to do that. He also eventually earned his second degree black belt in Karate and managed to earn an associate degree as well -- with no ritalin for his college classes. He works. He pays his bills - on time. He does his own laundry. He's a fully functioning adult - with no medications. He still studies martial arts.

If I got a do-over, I'd have tried homeschooling him in first grade. It might not have been the answer, but knowing EVERYTHING I know now, I'd have tried it. There was a lot I didn't know then. I don't regret what we did, but I'd have done it differently.

For a while, he talked about having been "turned into a zombie" by medication. I wondered whose life he was remembering, because his memories certainly didn't match mine. We showed him a few home videos and reminded him that from about age 12, he was very much involved in decisions about dosage. He's dropped that line, but I still wonder where it came from.

I'm glad that there are stronger warnings on the stimulant drugs which are the mainstay of medical ADHD therapy. Physicians and parents need to consider all their other options and make as many changes in the environment as possible before resorting to medication. But they shouldn't eliminate medication as an option if it proves necessary.


emmy said...

If I had a do over, I would never have turned on the TV, and my kids wouldn't know what fast food was. I would have worked harder at toning down the environment than toning down their behavior. But I don't regret the Ritalin, not even one dose. It gave them the ability to cope.

Judy said...

While I don't regret the Ritalin, I wish I'd had different alternatives.

No television wouldn't hurt, but my son didn't know what fast food - or even candy - was until he went to school. Television was restricted to Sesame Street/Mr. Rogers type shows until then and I was very unhappy with the teacher who insisted on feeding my preschooler Strawberry Shortcake cereal instead of real food.