Ritalin Gone Wrong

<p><a href="http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html%5B/url%5D"&gt;http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html&lt;/a&gt;&lt;/p>

<p>Anyone else read this? Thoughts?</p>

<p>A shortage. Gee I wonder why. Maybe bc anyone can walk into a doctors office and say they have trouble focusing and they are more than happy to write out a prescription for you.
Also no one needs to take the meds long term. It's not like a chronic illness that someone could die from if they stop taking them. </p>

<p>Sent from my iPod touch using CC</p>

<p>
[quote]
It is certainly true that large numbers of children have problems with attention, self-regulation and behavior. But are these problems because of some aspect present at birth? Or are they caused by experiences in early childhood? .........................</p>

<p>Since 1975, we have followed 200 children who were born into poverty and were therefore more vulnerable to behavior problems..........</p>

<p>By late adolescence, 50 percent of our sample qualified for some psychiatric diagnosis. Almost half displayed behavior problems at school on at least one occasion, and 24 percent dropped out by 12th grade; 14 percent met criteria for A.D.D. in either first or sixth grade.....</p>

<p>What we found was that the environment of the child predicted development of A.D.D. problems. In stark contrast, measures of neurological anomalies at birth, I.Q. and infant temperament — including infant activity level — did not predict A.D.D.</p>

<p>Plenty of affluent children are also diagnosed with A.D.D. Behavior problems in children have many possible sources. Among them are family stresses like domestic violence, lack of social support from friends or relatives, chaotic living situations, including frequent moves, and, especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared.

[/quote]
</p>

<p>excepts from article</p>

<p>As I understand the article, the author takes the fact that 50% of kids with deprived childhoods have a "psychiatric diagnosis" and extrapolates that ADHD in children from non-deprived childhoods is heavily influenced by familial environment. I don't follow his argument. I wonder how the author's peers view his conclusions, as he seems quite the outlier. I don't dispute that more investigation is needed to understand ADHD, but the author seems to be jumping to conclusions. I was also perplexed by his example of his theoretical ADHD cause "stimulation for which the baby is not prepared", i.e., "a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath." (Somehow this reminded me of the now-debunked refrigerator mother theory of autism.) FYI, I'm the mother of one child with ADHD (who was treated sucessfully with stimulants) and one without. Bathed both the same way!</p>

<p>The author is not an ADD/ADHD expert and his article poorly written when I skimmed it just now, especially when he spends as much time on decades old research, personal experiences with disadvataged not diagneosed kids and years old data. Too bad this newspaper chose him as a spokesperson. The author needs to do a ton more research of the disorder and current literature instead of relying on his personal experience as a psychologist with apparentently poor knowledge of anything medical. Too much reliance on psychobabble and little on neuroscience- he sounds too old fashioned for me. Any physician not even in primary care probably has more accurate information. Sounds more like a tabloid or USA Today style article- doesn't NYC have better sources???</p>

<p>Wow that is a bad essay. I am sure ADD and medication is overused, but this is a really bad essay.</p>

<p>I came away with this: he has no answer. His one 1975 study tells us nothing about whether ADD may emerge from biology or genetics. Moreover, he thinks we should not put ADD children on medication but he can't point to a single alternative solution. Then he tells us about one study that showed medication doesn't help for more than eight years (but nor did therapy or a combination).</p>

<p>If my child had ADD, I'd take eight improved years over nothingness. And no, I would not be worried that "it feeds into a societal view that all of life’s problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them." Really? Why moreso than if my diabetic child was given insulin every day?</p>

<p>This is of interest to me as my youngest child (a son who just turned 7) is in the process of being fully diagnosed now. The battery of tests required by his neuropsychologist for the diagnosis to obtain both medication and an IEP is extensive and will possibly take several months to complete (his Dr believes that no good comes from pushing the child to complete hours of testing in one sitting, rather just to go at a pace in which the child is comfortable with). In this instance a prescription was not easy to obtain (we have already been at the referral, insurance approval, evaluation stage since early last fall). I realize this is not the case everywhere.</p>

<p>Recent contact with my son's teacher indicated that he is not progressing at all due to his inattention and lack of retention of what is taught. He is not a disruption or overactive but just cannot focus. As we are not even a quarter of the way through the NEPSY tests the psych is administering he has advised temporary medication monitored by the Peditrician lest my son fall even farther behind. (Early subtests indicated substantial attention deficits with normal to above average intelligence) The pediatrician was less than thrilled to be in charge of the initial script (Psych is out of the country and felt it was necessary to do this ASAP). The explanation I was given was they just don't want to be in charge of making sure the follow up is done. However, we did get the consult due to the good name of the Psychiatrist and proof that we have been in process now for awhile.</p>

<p>My point with all of this is I struggled with the decision to medicate before a firm diagnosis is in. I worry about medication side effects and getting such a young child to be consistent. I worry more about stories I have heard about teens NOT willing to continue and falling into a downward spiral.</p>

<p>Looking back, I remember knowing at an early age that my son had issues. I began mentioning it to the Pediatrician when he was 3 only to be brushed off. He was preterm, intrauterine growth restricted (due to severe morning sickness and high blood pressure), 5th percentile for weight at birth, all factors that have been shown to be commonalities with many ADHD patients. A reaction to amoxicillan before the age of 1 required a dose of Benadryl which left him quite the opposite of drowsy (another indicator). So many other things in early childhood were so obvious yet these kids cannot get early intervention. I wonder if there were more known, more research, if there could be ways to help these children as young as possible without medicine. </p>

<p>So here we stand today, at age 7 and my son is embarassed, hates school, and feels "not smart". I feel like the article only continues to add to the stigma that kids with ADHD already face by making it a "low class" affliction and a non-issue for the higher classes (as in those kids are just spoiled).</p>

<p>Wow that is a bad essay. I am sure ADD and medication is overused, but this is a really bad essay.</p>

<p>The author isn't even an M.D. let alone a neurologist.</p>

<p>i haven't had any trouble getting my vvyanse scrip filled. What I don't understand is why my insurance needs yearly reauthorization for adhd medication for patients over 12. Cause we all know brains cure themselves with the onset of adolescence.</p>

<p>Momof3stars you may be interested in Dr Rateys research on adhd.
www.Johnratey.com</a> - Home</p>

<p>emeraldkity4, definitely an interesting concept and could not hurt. In fact, my son's neuropsych mentioned that karate is a very good activity for kids with ADHD, also chess (which DS is learning slowly but surely, he likes the battle aspect of it) for some reason.</p>

<p>My oldest was preterm ( had apgars of 4 & 4) & intercranial bleeds. She also had gross motor delay & while she wasn't diagnosed as adhd in grade school, she did have learning issues that involved concentration & memory.</p>

<p>I really encouraged physical activities- especially cross body movement & I think it helped.
School</a> of Education at Johns Hopkins University-ADD/ADHD and Brain Gym
She graduated from Reed college with a bio degree & currently is finishing up grad school.</p>

<p>From Emeraldkity's linked article:
"Research has also determined that a high percentage of children or adults who exhibit ADD/ADHD type behavior have experienced ear or yeast infections, other diseases, food allergies, or verbal abuse. These experiences have led to blocked neural development for being able to hear and process auditory information quickly and accurately. These children find it difficult to hear and understand what is being communicated. Their auditory system is inefficient and slow in its processing. They simply are unable to take in information, process it and act upon it with ease. For instance, in a classroom situation, because they cannot understand the directions given by the teacher, they will become frustrated, either tuning out or acting out. "</p>

<p>YES!!!! My son had terrible ear infections (the Dr's office knew him by sight) for the first year of his life. Tubes at age 14 months did work and he has had only 1-2 recurrences.</p>

<p>His neuropsychologist does suspect APD (auditory processing disorder) as well and DS certainly does show those traits (his hearing tests have been fine but he often complains he cannot "hear" the teacher. APD diagnosis will be further on in the testing process and also probably will be followed up with more specific testing just for that. </p>

<p>I am going to look into Brain Gym. The physical activity theory is very interesting as well because it would explain why, during the winter months, he is backsliding. This was the case last year as well, when spring came he started to make improvements again. There has been little outside recess this year due to the weather here in the NE.</p>

<p>momof3stars -- good luck with Brain Gym. Did anyone recommend Lindamood Bell for him? My son was diagnosed as having trouble learning to read in Kindergarten (he's now 16). The school kept saying he had ADD but I did not see any evidence of it at home or with friends. He was very social and never exhibited any ADD behavior, so I held off medication. We had his hearing tested and the audiologist (who specializes in speech and language disorders) said he had central auditory processing disorder (he was 8 or 9 at the time) and recommended Lindamood Bell Lindamood-Bell</a> for Reading and Comprehension help | Learning Centers | School Partnerships. We decided to go with the services available through school. I tried Concerta then Adderall for him in 8th grade; he took them for a few weeks then said he didn't want to anymore and they weren't really helping.</p>

<p>For the first time, he's getting As and Bs. But it has been a rough road.</p>

<p>Dr. Harold Koplewicz recently tried to debunk an article, and I really want to hear more about the Doctors history, other then his obvious love affair with drugs.His response to the article, Ritalin Gone Wrong" touched partial light on the problem with ADHD and ADD medications. </p>

<p>I was given Ritalin at age 6 and know the drug very well, thank you. Dr. Harold has not taken Ritalin for years, so he really does not know, he is obviously very chummy with the pharmaceutical companies. My attempts to comment on his blog were unsuccessful. </p>

<p>Today I spoke at length with a mother who has a 16 year old, who was given Ritalin at age 5, and developed permanent "tics" from the meds. She has 2 "normal children" and one with ADHD. She told me that Adderall is her 16 year old's prescribed drug now, but that she has to give her child another medication to control the tics from the previously prescribed Ritalin.</p>

<p>So what does a Doctor who has extreame ADHD and was prescribed Ritalin at age 6, and later, Adderall think?</p>

<p>Here is the truth. These drugs may have temporary benefits. They kept me quieter in school for a brief time, according to my mother. I spoke with my mother about this 3 days ago, and she wrote me this email yesterday. This is my mother, Grace, commenting on an article I published about ADD/ADHD. </p>

<p>Sent: Tuesday, January 31, 2012 8:40 AM
Subject: ADD</p>

<p>"Your kindgergarten teacher complained that you were off the wall- she had never experienced a child like you.She was a fairly new teacher. (How lacking in tact was her remark to a young mother).</p>

<p>Your first grade teacher (an experienced teacher thought you were hyperactive. Your pediatrician gave you a kind of intelligence test (I remember your scores were uneven- some very high showing your intelligence- one on spatial relations was a low score (me too). He did some coordination testing and pretty soon put you on Ritalin. Ritalin helped you focus in school. In fifth grade you had a very fine teacher who was very anti pills. She said lets take Mike off of ritalin. Let me see if I can help him do OK in school without the use of ritalin.</p>

<p>Meanwhile I worked very hard on your diet- wholesome food,fruits, vegetables, no additives, preservatives, luncheon meats. This was the Feingold diet, which was never proven to be 100% affective in helping children with ADD. It sure had to benefit you to eat healthy. </p>

<p>Meanwhile my friend ,Joan Sladek, thought her son Brian had ADD. When his peditrician tried him on Ritalin, it made Brian very hyper. His doctor immediately took him off of ritalin.
Both of these cases were decades ago."</p>

<p>End quote from my mother Grace. The reality is that it is very difficult to trust any doctor's opinions that just prescribe drugs without really knowing firsthand how they work ,longterm ,on us and our children. </p>

<p>The public now sees thru the veneer of Doctors who have an interest, as some of them do, they receive compensation for their efforts in pushing these meds on young children, who have no business taking these medications.</p>

<p>Long term, from my personal perspective, these prescriptions do not work after "a while". I think 1-2 years is too generous. Short term gain, long term pain. The mother I spoke with today has to deal with a 16 year old with "tics" with another medication to calm down the tics, and the Adderall problems in her household. She takes Adderall, mainly for energy, and her son (gradual addiction thru lifetime of stimulant prescriptions, WANTS to quit adderall but has had a very difficult time doing so. She was trying to find a natural adderall substitute, or herbal substitute for Adderall. I explained that there really is no substitute for king adderall, but as it affects me it affects so many others, with side effects including anger, isolation, zombie like behavior, mood swings, etc. All of us who have taken the medication over time know the effects and the side effects. The Doctors who tell us what to take but are not taking, have not taken, or really are not in the game other then financial beneficiary really don't need to say anything more. We know what you don't know. Don't tell us differently, it is time to get to the truth. Yes, these meds may help some for a while. But for people like myself who have been through it for 40 years as a patient, we know the truth to be self evident. The meds have short term gain but long term pain and long term questionable results. My ADHD is worse then it ever was, and my junior counterparts have tics and mothers with problems. Problems that would not have occurred if the medications were never there in the first place.</p>

<p>Anecdotal reports about your personal experience and the experience of someone you know mean nothing. Name any medication currently prescribed and some percentage of patients will have had a bad experience with it or think it's worthless. Frankly, the amount of amateur pontificating that surrounds every discussion of ADHD makes me tired. Personal opinions about ADHD diagnoses, ADHD meds, the pharmaceutical industry and the medical profession shed plenty of heat, but no light on the subject. Even worse is a shoddy piece of work like the Times opinion piece that gains credibility from the NYT imprimatur but adds nothing to the conversation.</p>

<p>EmeraldKity: I forgot to say congratulations on your DD's success. It does give hope and I do know many success stories of ADHD children. The stories I know that are less hopeful are mostly those of children who did not receive early intervention and eventually just gave up. </p>

<p>Classof2015: I am familiar with Lindamood Bell (a friend's daughter worked for them as a teacher) and will research that. I plan on presenting any options to DS's neuropsychologist at his next appointment, asking him what he thinks (so far) will be ideal. I don't get the feeling that he is either pro or con meds, he seems to be cautious thus far. I am also considering Sylvan Learning Center at least for the immediate future as the nearest Brain Gym instructor is about 2 hours from me and I have not known of Lindamood existing in this general area.</p>

<p>On the subject of school provided services: my DS is receiving SOME extra help (20 min daily) from a Resource Reading teacher. However, that teacher has said his retention rate is practically non-existent (as has his primary teacher). </p>

<p>DS's school will not even consider an IEP for him until we have a diagnosis from the psychiatrist. I could not even get them to do basic testing to get the wheels in motion for an IEP based on the Pediatrician's rec last fall. Apparently the process in our district is a lot more complicated than in other districts, my Pediatrician was astounded they would even ask for a referral (which the school Psychologist then let sit on her desk with no action for over two weeks and then when I called told me they consider a Ped request for testing to be insufficient grounds) and the Neuropsych has also expressed much frustration from previous experiences.</p>

<p>
[quote]
DS's school will not even consider an IEP for him until we have a diagnosis from the psychiatrist.

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</p>

<p>Wow -- that makes the process much more difficult. My son got an IEP in Kindergarten (and I'm not sure of the steps but I think the school tested him).</p>

<p>I remember one mom (who I'm not exactly friends with) told me I should hire an attorney to make sure the school got him the services he deserved, etc. I did not want to go that route (which seems more adversarial than I'm comfortable with). I'm not suggesting you should do that either, but I wonder how you find out about the universal standard for schools to institute the IEP just so you know your school is following them.</p>

<p>Class of 2015: I feel the same way about being seen as adversarial. I think my breaking point on that is coming though lol. Yes, this is a rural public school. We are in NYS and have come in at the bottom range of statewide testing for the last several years and are on a "plan" administered by the State. However, they are only providing tutoring to students grade 3 and up because those are the prime testing years and they seem to only be concerned with those kids. Very short sighted IMO.</p>

<p>I actually just did email the teacher yesterday (after several rounds of hearing "It just doesn't work that way anymore") and said I have no idea how it used to work let alone how it works now but that I have heard from several people that my son has rights (so far all I can find online are rights he has after an IEP has been instituted) I asked: do I need to email the Superintendent/Director of Special Ed to get some action? Her response was that she herself is frustrated with the process and was meeting with the Principal yesterday and she will not stop until she gets some answers. I have a meeting with the teacher set up for next week. </p>

<p>I would consider private school but there are none in the area outside of Catholic/Christian schools which are having enough trouble staying afloat that I doubt they have more to offer him. A neighboring school district may be an opportunity if it comes to that (the Psych said that he has had good interaction with the staff there). We would either have to consider an investment property in the district or pay tuition. I need to find out more first to be able to decide. </p>

<p>My question in all of this is, based on my experience: What happens if a child at our school does not have insurance that covers psychiatric testing? Luckily our insurance does but it was very limited on what they would approve (the Dr is doing the rest on a reduced rate because he wants to do all of what he feels is necessary). However, if we did not have this then the school would have just said Pay OOP or nothing will happen? It doesn't make sense. I feel like they are pushing the burden of proof off on us because it lightens their load. Meanwhile, it has been 5 months since the school has known of the Ped's recommendation.</p>

<p>The author appears to be a Developmental Psychologist, with a Ph.D. from U Wisconsin- Madison. He was on faculty at U Minnesota (now retired), a very well respected psychology department. He doesn't have to have a MD to be knowledgeable in the field.</p>

<p>MomOf3Stars, at first blush, it sounds like your school district may be out of compliance with applicable law. Hard to believe, but many schools, out of ignorance or a desire to save money or both, put up tremendous resistance in this area. While I understand that you don't want to be in an adversarial position, you will have to advocate for your child to get him the services he's entitled to. It's often taken the involvement of lawyers and even lawsuits, in extreme cases, to force school districts to do what they're legally obligated to do. I suggest you take a look at the Wrightslaw website (a dot com) to get a handle on this area and keep researching from there. The more prepared you are, the better off you'll be. When a school system knows its dealing with a savvy parent, it will be less resistant.</p>

<p>MommaJ: I totally agree. I feel like playing Ms Nice Guy is over for me. My feeling is that the school does not want to waste resources on a student until they are sure they will get something (State $$) out of it. I realize my tax dollars are a small part of their budget but I DO pay my taxes on time every year (and in our downtrodden community I think that puts us in the minority these days). Now I am understanding why, after a whole year of complaining about my son last year, his Kindergarten teacher did a 180 when I pressed her about this. In weeks it went from "disruption in class, no attention span, not learning on pace" to me asking if we needed intervention and her answer "Oh nevermind he is much better now". I should have pressed on. I will check the site you mentioned. </p>

<p>Another email from the vacationing Psych. He is hoping that subduing the ADHD a little during testing with meds will bring out more of the APD aspects that he thinks are my son's bigger issue.</p>