In yesterday's Times, L. Alan Sroufe argues that we are over medicating our kids with Ritalin and other ADD drugs. He argues that these drugs have serious side effects and that the concentration benefits wear off over time. (At one point in the article, he says the side affects are serious and permanent, but later claims that the side affects are temporary. Confused.) He said that ADD is misunderstood. It isn't a neurological problem, but a behavior problems that is caused by bad parenting.
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. For example, a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath. Or a 3-year-old is becoming frustrated in solving a problem, and a parent taunts or ridicules. Such practices excessively stimulate and also compromise the child’s developing capacity for self-regulation.
At this moment, I'm drumming my fingers on my desk, while I try to decide how much personal information that I should reveal. Answer: not much. Let's just say that my views on the topic are based on some family experiences, conversations with neurologists and parents, and whatever scholarly articles squeak through the paywall.
Attention problems aren't just because of bad parenting. That's a ludicrous, old fashioned, and annoying notion. Attention problems are clearly neurological. You'll see the gene passed down from parent to child and you'll see differences among children within one family. It seems highly unlike that a mom was in the habit of plunging Kid #1 in a tub of water, but not Kid #2. The Bad Parent theory fails to explain ADD.
While Sroufe's Bad Parent theory makes me vomit, I am very sympathetic to his concern about the over medication of kids.
I think there is a rather large population of kids who have trouble concentrating in school. They are smart, wonderful kids, but they simply cannot sit still in a desk for seven hours a day, while a teacher talks about the GDP of Peru. With the rise of high stakes testing, there is even more pressure on schools to reign in these daydreamers and force them to the concentrate. Rather than creating learning environments that will suit the daydreamers, schools are growing less and less tolerant of them.
To meet the demands for high test scores, schools are pressuring parents to medicate the kids. (I have lots of anecdotal stories here, but I'm not telling those stories right now. ) It is much, much cheaper to medicate a kid, then provide him or her with a classroom aide. These medications do have temporary side affects that are rather gruesome. Some cause the kid to pull out hair or pick at his skin until it bleeds.
The problem is that these drugs work to a certain extent. They do help the kid get through a boring day at school. I just wish there was a drug to give the schools that would help them be less boring.
Apt. 11d 
Gah, I’m with you. E is hitting a wall here in 4th grade (not literally). But the behavior problems are definitely on an upswing, so much so that I’ve called a team meeting and requested a Functional Behavioral Assessment. (Which they’ll tell me he doesn’t need until I offer to pay for it.)
I don’t even know what to do about the medication issue.E’s pdoc has suggested he may need meds down the line, but man, I am not ready for that.
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I’d like to suggest that kids with ADD who often benefit from medication (from my perspective as a teacher) are kids who have trouble with focus/concentration/attention even when they are doing something that is really interesting to them. Kids who really like the book they are reading, but just can’t manage to focus long enough to make sure they fully understand the plot, for example, or kids who really want to talk about cell division but have trouble staying in their seats while the other kids are talking about cell division. Thinking that attention issues only arise because the kid is bored is part of the problem too.
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Yeah, I get what you’re saying, Jackie. But wouldn’t it be cool, if the kid who is jumping out of his seat and really wants to talk about cell division, was allowed to jump out of his seat and talk about it. I know that in a traditional classroom, you can’t have a kid jump out of his seat every five minutes, but maybe there could be alternative classroom where seat jumping was cool. Because the kid who is now medicated and sits in his seat is also biting the back of his hand, because of the anxiety side effects and has stopped laughing.
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I’m with Sroufe up to a point. I do think ADD is wildly overmedicated but I wouldn’t blame that on bad parenting but rather environmental stressors that are largely beyond parental control. In fairness to Sroufe, I think he would agree that’s it these environmental factors rather than poor parenting that are largely the cause of attention problems. We’re at a place where it’s really hard for parents to stop their children from overstimulation from a very young age. Children adapt to the overstimulation and then can’t adjust to low input environments.
“I’d like to suggest that kids with ADD who often benefit from medication (from my perspective as a teacher) are kids who have trouble with focus/concentration/attention even when they are doing something that is really interesting to them.”
I like this way of thinking of the problem. Sometimes my work performance would suggest I have ADD but really I like to think that my work is just boring sometimes and people aren’t meant to do boring work for long stretches.
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I was also intrigued by something else he says:
“…patterns of parental intrusiveness that involve stimulation for which the baby is not prepared.For example, a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath.”
I work with child and educational psychologists (who work with Sroufe!) and I never realized before talking with them how big of a deal it is to pick children up from behind unannounced.
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I would have written about this today too, but am frantic on deadline. Instead, I’ll refer you to a piece I wrote two years ago for DoubleX on the topic. We are so in agreement on this issue.
http://scribe.doublex.com/blog/xxfactor/public-school-issue-judith-warner-ignores
As for the parental intrusiveness, sounds to me like Sroufe is reading Magda Gerber’s work.
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I totally see what you’re saying too, Laura (and Helaine, for that matter). I just don’t want to substitute the Bad Teacher for the Bad Parent, as both are oversimplifications (and not-so-coincidentally,both are usually overworked non/underpaid women).
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“I’d like to suggest that kids with ADD who often benefit from medication (from my perspective as a teacher) are kids who have trouble with focus/concentration/attention even when they are doing something that is really interesting to them.”
That is interesting.
My 9-year-old recently got invited not to participate in her class basketball team (which is normally open to all comers) as the coach thinks she would stand in the middle of the court and space out. (She did better in volleyball, a much more static game.) If team sports were a big deal for our family (rather than a curse that must be suffered through), I suppose I’d be begging for a prescription right now. (We have a young relative who became addicted to the prescription Adderall she was taking for her ADD, so medication will be the last avenue we explore for our daughter.)
In some ways, I’m actually much more concerned about adult ADHD, because it seems to have such catastrophic effects on people’s ability to relate interpersonally or to be a good spouse. This is often combined with high professional performance, so you can have a person who is well-suited for their profession, but their personal life is a series of smoking ruins.
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“I’d like to suggest that kids with ADD who often benefit from medication (from my perspective as a teacher) are kids who have trouble with focus/concentration/attention even when they are doing something that is really interesting to them.”
I like this as a guide for parents (if not neurologists). I remember being fascinated by the effect of ritalin-class drugs when reading a paper that said that ritalin actually increased physical activity when the child was increased in a sport (i.e. it’s not just a “sedative”). In the sports activity, ritalin increased physical activity because the kids were able to remain on task in the activity (which involved movement).
The problem with the simple rule of thumb, though, is that it’s also possible that ritalin-like drugs improves everyone’s (or at least many people’s) ability to concentrate (say, like caffeine keeps most people awake). Then it’s possible that everyone would “benefit” from ritalin & the question you’re really answering is whether the benefits outweigh the side effects (independently of any neurological deficit). I think that’ a real issue we face with all pharmacological interventions for neurological issues: the fact that some people may be working from a deficit/atypicality of neurological, and benefit from the pharmacological intervention, doesn’t mean that others may not benefit from it, too. Many complex behaviors driven by the brain (and the brain circuitry that underlies them) will lie on a continuum, with no clear line to draw for a deficit.
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Who coaches 9-year-olds and doesn’t expect at least half of them to stand there and do nothing?
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I once had a very prominent ADD researcher tell me that she thought that everyone would benefit from ritalin. We all laughed, but it’s also true that MDs/neurologists medicate on this basis themselves. I can attest to seeing prescription drugs being offered in conferences frequented by those types. Though, maybe that happens at the MLA & political science conferences, too? For example, if you say you’re anxious about your talk, will your neighbor offer you beta-blockers?
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“However brain functioning is measured, these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience. ”
I went back and read read the Srufe article. Independent of whether it’s the appropriate decision to medicate any particular child, I think this article is drop dead accurate through the paragraph above. After that paragraph, Srufe gets more prescriptive about what he thinks we should do, and I think those questions are very complicated.
But, he accurately summarizes the research on stimulant medication: short term benefits on repetitive attentional tasks, for many individuals, and not just those with incidentally diagnosable ADD; benefits that wane with time; brain differences that can be explained by differences in the measured behavior — rather than being the cause of it; the growing knowledge that the brain itself can be changed by experience — both in bad ways, like with ADD developing environments, or in good ways, like continuing to talk to the child who won’t talk to you.
(I’m annoyed that the 2009 study isn’t cited and will need to track it down).
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Jackie, I didn’t mean to substitute the Bad Parent theory for a Bad Teacher theory. It’s the 8 to 3 school day with its highly structured classroom model that just doesn’t work for some kids. Rather than change the kid, I think we should change the classroom model.
bj, no, I haven’t never been offered drugs at a conference before, though I think it’s a cool concept.
I have seen too many families where one kid has ADD and another kid doesn’t to put too much stock in the ADD developing environment stuff. It just doesn’t pass the common sense test. On the other hand, I do think that kids with ADD or other neurological impairments can make real improvements when they are in the right environment.
I think that there is a shift happening. Our neurologist who has always been so drug-happy that we nicknamed her the Drug Dealer, told us last week to secretly take a certain kid off of his ADD meds. The side effects, which she never acknowledged in the past and never went away, bothered her. The drugs cause him to rip out his hair, btw.
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Wow. Helaine, good post. 🙂
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It’s neither just neurological nor environmental, it’s the interaction of those two things. A sibling set might include one child able to watch tv, while music plays, and their parent is intrusive for many hours and then switch to another task with ease while for the other all of that stimulation on an everyday basis causes a long-term inability to concentrate. Absent those negative triggers though and the second child might not develop attention problems or the severity might be milder. So it seems like the question is the weight given to the various neurological and environmental factors when it comes to treatment. Right now, neurological factors are given heavy preference likely due to the ease of the treatment method as compared to behavioral therapy. Sroufe seems to be arguing for greater focus on interventions that address environmenal causes due to the long-term inefficacy of attention drugs, and there I agree with him.
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Don’t forget two other things:
1. Much time on classrooms is spent on busywork because 15+ children will not all work at the same pace and there has to be some way of keeping them “together” so that they can move on to the next subject as a class. In my experience children recognize busywork and many resent having their time wasted and stop paying attention. Over time they will even stop paying attention to the “real” work.
2. Children need to be physically active. Not just twice a week for PE and for 15 minutes of recess at some point in the day, but frequently. They jump out of their seats and wiggle because we are asking them to be still for too long based on their developmental stage. We neither train them to sit still before throwing them into school (where their wiggling is called hyperactivity) nor do we provide enough outlets for their natural energy.
In a small classroom it’s no big deal to have the children stand up and jump or take a step forward or backward every time they spell a word correctly (for example). When you have 20 or more students that is simply not possible.
When I worked with troubled teenage boys one of the biggest changes we made to their lifestyle was the amount of physical activity. Not only did they have PE regularly during school and also after supper (it was a residential program) we also would have them do jumping jacks, run laps etc. when they became antsy or started loosing focus. Frequently we were able to reduce or eliminate medications.
Yes, it was a more stable environment and that made a difference but so did the activity.
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I don’t know how relevant this article is to the subject at hand, but I just came across it and found it interesting and tangentially related. I would not be surprised if the inner voice in my son’s head was a whisper at best. On the other hand, the 12 year old in my family, has an inner voice that is often an outer voice (and running commentary on everything) as well, which is how I can tell she has a very healthy inner voice.
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I just wish there was a drug to give the schools that would help them be less boring.
There is: money. Lots and lots and lots of it. Buckets and helicopters and dump trucks full of it. And then some more.
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“It’s the 8 to 3 school day with its highly structured classroom model that just doesn’t work for some kids. Rather than change the kid, I think we should change the classroom model.”
I know I’ve said this before, but this is the kind of classroom (non-structured) I was in from 4th to 6th grade. Don’t know why they got rid of it, to be honest. We never had homework; we had due dates, and we worked on what we had to work on when we had to work on them.
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I’m concerned with overmedication — because I think often it’s an out for the authorities who don’t want to admit that there’s a bigger problem. When I was a military wife, I figured out early on that the preferred medical solution was to medicate the wives rather than to actually investigate the problems that couldn’t be fixed. In other words, the wife is “depressed” because they have 4 kids under 6, they live in an apartment in a foreign country where she doesn’t speak the language and her husband is gone a lot (and she suspects he might be involved with someone while he’s deployed). Sometimes he forgets to deposit his paycheck so she can buy groceries. Who wouldn’t be depressed? But is the best solution really to give the wife Xanax? At one point my husband came home with PTSD and he was pretty violent and I was scared. I mentioned to the GP that I was feeling “stressed” and rather than taking the time to really listen, she gave me a prescription for Xanax. I think it may be the same with the schools. It’s too hard to admit how widespread the scope of our systemic failure is. It’s just easier to medicate the people who complain.
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“I just wish there was a drug to give the schools that would help them be less boring. There is: money.”
My 4 year old’s preschool is so awesome and so not boring. It has everything that I could possibly want for my child for his education. The realization has hit me that he has peaked, that this will be the best instruction that he will receive from here on out. It’s depressing.
With testing I think it is so hard for public education to try out different models, the stakes are too high if it’s a failure. Charter schools were supposed to be labs of innovation but mostly they’re just making small changes not trying anything drastically new. The current model just doesn’t work well for a lot of kids but it’s becoming more entrenched rather than less.
Something something Finnish education system something. Gotta go but I need to dig up some of the interesting articles I’ve read about the Finnish education system and how their model might be a good fit for engaging ADD kids.
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I wouldn’t say that my daughter has ADD but she is a kinesthetic learner. Coupled with being six and the youngest in her grade 1 class (I think any attention issues are more due to age/developmental stages), she would have a very difficult time in a traditional classroom.
Luckily she has gym three times a week plus three recesses a day with a huge, expansive playground to burn off steam and play. And even though she is in a class of 20, she can work in a small group of 3 or 4 each day with a teacher that teaches to her style. For example, they throw beanbags around while working on math or English.
She’s in a dayschool and Hebrew is taught in so many different ways – acting it out, puppets, oral learning, dvd’s, writing, reading, memorization – that at least one way will “stick” with each child.
Of course this is a private school and I sooo appreciate the privilege that we have to send her there. If she was in a regular public school with 25-30 kids in class, she’d be lost in the shuffle and feel stupid. And medication would be recommended.
I don’t know many grade one kids at all who could handle the seatwork that results from larger classes and teaching to exams.
Net net, there is such a range of educational experiences and the divide between the haves and the have nots grows even larger…
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Our daughter has ADHD and has been taking medication for years. It isn’t due to a chaotic environment: two homes in 18 years, married parents, one school for 12 years, lots of time in the country, lots of time in camp where electronics are prohibited, etc. Possibly her babysitter picked her up from behind, but that seems like a rather fanciful explanation.
It’s just the way she is. If she had lived 100 years, she would have beeen a flibbertigibbet, and wouldn’t have done very well in academic pursuits, which wouldn’t have prevented from marrying a man with 10,000 pounds a year, or whatever. Unfortunately, the modern world doesn’t offer a lot of desirable options to people who don’t meet some minimal academic standard, which is why she takes medicine (I forget which one).
I am hoping she can stop taking the medicine in college, on the theory that even high-level colleges are MUCH less demanding than high-level high schools. (“The only thing harder than getting into Harvard is flunking out of Harvard.) Obviously she should never take a job like mine which demands long concentration on the details of boring documents, but she can certainly do well in a sales-type job with lots of varied personal contact. Unfortunately, you can’t get those jobs without a college degreee.
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y81 said:
“Possibly her babysitter picked her up from behind, but that seems like a rather fanciful explanation.”
No kidding.
“…but she can certainly do well in a sales-type job with lots of varied personal contact.”
My young adult relative with ADHD (and a multitude of other issues, including some brain damage with short-term memory loss) was very happy working at Starbucks, probably for that exact reason. That’s not quite the level that you’re aiming for, but I think “sales-type job with lots of varied personal contact” is probably a good job category for your daughter.
MH said:
“Who coaches 9-year-olds and doesn’t expect at least half of them to stand there and do nothing?”
I’m pretty sure the coach wasn’t having that same conversation with half of the parents of the 4th grade class girls, although I think your observation did have some merit at the beginning of the fall volleyball season.
I wasn’t dying to devote my life to 4th grade basketball, so it’s in some ways a lucky escape. Also, less selfishly, C would stand a pretty good chance of spacing out and getting hit in the head with a basketball because she wouldn’t be able to keep up with the location of the ball.
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y81, even a sales job will require her to come up with plans, follow through on billing, etc.
I know several adults with ADD who are medicated. It’s not that their jobs are boring, it’s rare to find a job that doesn’t contain an element that requires concentration at some point.
I don’t blame it on schools. I really do think it’s chemistry. Think how many people require coffee (a stimulant) to focus, or in previous generations- a cigarette. We’ve been dependent on chemicals to help us think for a long time. It’s just easy to make Ritalin a scape goat and ignore the rest of the ways we deal with lack of focus.
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One of the main issues that Srufe states for ADHD medications (and, that is borne out by the studies using repetitive attention tasks in the lab environment) is that the efficacy of the drug wears off over the course of a few years. If that’s not the case, and if side effects aren’t significant, I simply don’t see a moral issue about the question of medication. Amy has decided that her fear of possible addiction is greater than anyone’s desire to play basketball (though, that doesn’t seem to have been the exact trade off). Y81 has decided that the benefits of medicine to the education they think their child needs is greater than whatever side effects are worrisome. I see no moral issue whatsoever in either choice and don’t see why I see the issue discussed that way in so many venues.
I think one possibility for the friction is that there are people who don’t want to medicate their child, who don’t like the side effects and potential consequences, but are told they have to in order for their child to attend school (and not just an extracurricular).
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“y81, even a sales job will require her to come up with plans, follow through on billing, etc.”
I believe it’s not uncommon to find people (for instance contractors) who are super energetic and good at what they are paid for, but struggle with the organizational side of their business.
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Would a classroom where any child was allowed to move from their chair and walk around the classroom work better for children with ADHD/attentional issues? Or would that classroom be even more disruptive to them? Are we really talking about a classroom where every child has an adult shadow who helps them stay on task (which might be how the system functions in a small class with aides)?
I have, I have learned over long experience, extremely focused children (atypically on the other end of whatever continuum of attentional function exists). This makes them excellent students in classrooms with high expectations for individual focus (including being still, or playing basketball). They hate it when other kids pop out of the chair to talk about meiosis (when the subject is mexico, or mitosis) (well the older one hates it, the younger one can jump in, but would learn more if he didn’t).
As we’ve discussed in other threads, I think one of the issues we face as parents of children is that we live in a society (our local environment; I’m sure the issues in other SES classes are different) where everyone gets compared to the extremes of skill, and the classroom level gets ramped up to something above the median level of performance you can expect from a nine year old.
(I’m guilty myself — I did expect nine year old’s to be far more focused than they are, because I only knew one nine year old — who has recently been accused by a friend of not really being a child, because she can sit still for however long is necessary)
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“Amy has decided that her fear of possible addiction is greater than anyone’s desire to play basketball (though, that doesn’t seem to have been the exact trade off).”
“I think one possibility for the friction is that there are people who don’t want to medicate their child, who don’t like the side effects and potential consequences, but are told they have to in order for their child to attend school (and not just an extracurricular).”
Yeah, it would be totally different if our 4th grader were underperforming academically or was in danger of getting expelled from school. The stakes would need to be much higher.
From my reading (Deirdre Lovecky’s Different Minds???) and from what I think I’ve heard, it’s typical for children/adults with attention issues to hit the wall at different ages or academic levels. One individual might be unable to meet the academic/organizational requirements of elementary school, while another might reach the same point in high school, while another reached that point in graduate school. So it’s important to keep watching and evaluating the situation.
I’m not sure exactly what diagnosis I would have gotten had I gone to school 20 years later than I did, but I had terrible attention problems in early elementary school, peaking in 4th grade (which is when school finally gets serious). I’ve mentioned before that it was like being in a fog–I’m kind of surprised I learned anything in the classroom in those years. For some reason (puberty?), the fog started breaking up in the following years, and from 6th grade on I was quite a model student.
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“I’ve mentioned before that it was like being in a fog–I’m kind of surprised I learned anything in the classroom in those years.”
That’s very interesting. I told a friend of my kids’, who acts exactly like that (foggish, and then she comes out of the fog, and can be brilliant) that I couldn’t supervise her during an activity, because I lack the attention to detail that someone supervising her in and out the fog would need. Of course, I couldn’t do that if I were a teacher. I feel guilty about it even as a volunteer/friend/coach, and will revise my comment to ask her how we can work together with both of our abilities and deficits the next time around. But, in the moment of frustration, I just didn’t know how to do it.
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bj – “everyone gets compared to the extremes of skill, and the classroom level gets ramped up to something above the median level of performance you can expect from a nine year old.”
And I wonder if a cause of the push for meds/diagnosis of ADD is the pushing down of academics. Back to the Finns and how they don’t start grade 1 til kids in Finland are 7 – more wiggle and play time. I wonder what the rate of ADD diagnoses/meds are in Finland compared to Canada/US?
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“I wonder what the rate of ADD diagnoses/meds are in Finland compared to Canada/US?”
I remember reading (I forget where) that the Finns put a lot of kids into the special ed/special help category (but maybe just temporarily to get them through a rough patch). This blogger says that by high school graduation, half of Finnish kids have had special support.
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Via PubMed, which I can only get through my affiliation by marriage to an Ivy employee:
“Acta Psychiatr Scand. 2011 May;123(5):360-7. doi: 10.1111/j.1600-0447.2010.01607.x. Epub 2010 Sep 23.
Use of ADHD drugs in the Nordic countries: a population-based comparison study.
Zoëga H, Furu K, Halldórsson M, Thomsen PH, Sourander A, Martikainen JE.
Source
Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland. hez2@hi.is
Abstract
OBJECTIVE:
To compare national use of attention-deficit/hyperactivity disorder (ADHD) drugs between five Nordic countries.
METHOD:
A population-based drug utilisation study based on nationwide prescription databases, covering in total 24 919 145 individuals in 2007. ADHD drugs defined according to the World Health Organization Anatomic Therapeutic Chemical classification system as centrally acting sympathomimetics (N06BA). Results: The 2007 prevalence of ADHD drug use among the total Nordic population was 2.76 per 1000 inhabitants, varying from 1.23 per 1000 in Finland to 12.46 per 1000 in Iceland. Adjusting for age, Icelanders were nearly five times more likely than Swedes to have used ADHD drugs (Prev.Ratio = 4.53, 95% CI: 4.38-4.69). Prevalence among boys (age 7-15) was fourfold the prevalence among girls (Prev.Ratio = 4.28, 95% CI: 3.70-4.96). The gender ratio was diminished among adults (age 21 +) (Prev.Ratio = 1.24, CI: 1.21-1.27).
CONCLUSION:
A considerable national variation in use of ADHD drugs exists between the Nordic countries.”
No idea what any of it means.
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PubMed is free to all, but doesn’t have the full text of every article. PubMed Central has full text but isn’t nearly as extensive.
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That particular journal put the full article in pdf and this is linked from PubMed. I downloaded it from my phone without logging into anything.
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Tie the least using Scandinavian ADHD drug country (Finland) to Amy’s comments about 50% of Finns having had specialised education help by high school and one COULD loosely surmise that the Finns choose modifying the environment over prescribing drugs.
Can’t help thinking that doing the latter (excluding the extremes of any bell curve of ADHD that would require meds) would also be beneficial in teaching some self management/self regulation. In other words, more self knowledge as a child grows about what suits them and what doesn’t in terms of school/work environments and strategies to deal with challenging situations.
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It may also be the case that the Finns and the Icelanders represent somewhat different gene pools, with the latter being more prone to attention issues. The Finns may be descendants of people who were very happy to stay at home, whereas the Icelanders (like Americans) may well be much more the descendants of people who were on the move. This wouldn’t apply to every single person, but it might explain at least a chunk of that disparity in use of ADHD medication in Scandinavia–the Icelanders may really have more attention issues.
Catherine Johnson has an interesting post here where she quotes a snip of an article on the ethnic and genetic dimensions of ADHD entitled “why Americans need precision teaching: we’re hyper.”
http://kitchentablemath.blogspot.com/2012/01/why-americans-need-precision-teaching.html
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Sorry–that’s the name of the post, not the name of the article.
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Misplaced modifier!
Uh, sorry. Been grading a lot lately.
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(At one point in the article, he says the side affects are serious and permanent, but later claims that the side affects are temporary. Confused.
From the article, he claims the effects on behavior are temporary, perhaps 4 to 6 weeks, as the body develops a tolerance to the drug. The side effects, such as stunted growth, can be serious and permanent.
Amy P, I’m not a scientist, but I’m wary of arguments which try to tie phenomena such as immigration to diagnoses.
However, using google with “finland medical insurance adhd” led to this UCLA press release: http://newsroom.ucla.edu/portal/ucla/new-thinking-revealed-about-adhd-43193.aspx
Apparently, Finland has a very low rate of stimulant usage for ADHD symptoms. Thus:
Researchers also found surprising results regarding the effectiveness of medicine in treating ADHD. In contrast to children in United States, youth in northern Finland are rarely treated with medicine for ADHD, yet the ‘look’ of the disorder — its prevalence, symptoms, psychiatric comorbidity and cognition — is relatively the same as in the U.S., where stimulant medication is widely used. The researchers point out that this raises important issues about the efficacy of the current treatments of ADHD in dealing with the disorder’s long-term problems.
“We know medication is very effective in the short-term,” said Smalley, who authored or co-authored each of the papers. “But the study raises important questions concerning the long-term efficacy of ADHD treatment. Here we have two different cultures and two different approaches to treatment, yet at the time of adolescence, there are few differences in the presentation and problems associated with ADHD.”
Thus, if the wide use of medication over long periods of time does not improve the outcome for ADHD kids, why should families risk the side effects?
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Has anyone ever tried slipping tiny nicotine patches on the kids? That’s a proven short-term concentration booster. The side effects, for adults at least, don’t seem to be very big once you let pharma ruin the tobacco.
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“Researchers also found surprising results regarding the effectiveness of medicine in treating ADHD. In contrast to children in United States, youth in northern Finland are rarely treated with medicine for ADHD, yet the ‘look’ of the disorder — its prevalence, symptoms, psychiatric comorbidity and cognition — is relatively the same as in the U.S., where stimulant medication is widely used.”
That looks pretty definitive. Very good.
“Thus, if the wide use of medication over long periods of time does not improve the outcome for ADHD kids, why should families risk the side effects?”
Medication might still be useful for certain high-need times (around the SATs or AP exams or while settling into middle school, for example).
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Well, my kid had been sent to the principal three times for fighting in the month before he was diagnosed and started Ritalin, then once in the three years afterward. Made a huge difference in his feeling that school was really possible for him, rather than being a mug’s game rigged against him.
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OK, I’ll bury this information in a comment section….
We’ve been playing with Ian’s meds. On the one hand, it does help him focus, and on the other hand, it causes him to rip out his hair and stop laughing. He’s been on the same dosage for a year and the effects have never worn off. I have serious ethical problems with me using my kid as a test tube. One week, we’ll try a half dose and another week, we’ll go cold turkey, trying to see how to minimize the side effects, while keeping him in line at school. His school is very regimented and strict.
I would prefer that he learned less at school and wasn’t on the meds, but that’s not an option.
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Here’s another complicating factor for international comparisons: a lot of other developed countries have a much shorter official school day than we do.
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The data in the Zoega (cool name, BTW) study is very interesting. It’s also interesting how they stay miles away from attributing any causation at all to the huge differences they see in ADHD stimulant use among the different Scandanivan nations (though they do slip in that the populations are likely to be similar, economically, culturally, and genetically).
I would really like to see more follow-up. Let’s keep our eyes out. The next step would be to examine prescription writing/treatment practices in those different countries and document their differences. The article briefly refers to some differences in prescription practices (Icelanders don’t need approval of a primary care physician to refer to a specialist, apparently). But there’s nothing in the article about differences non-medical treatment, though the data to confirm the bias (hypothesis? we were setting up here that Finland has more significant non-medical treatment methods available through schooling.
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PS: That article (Blackwell publishing) and Acta Scandanavia (which I think is an old journal — don’t know about the psychiatria, which is a specialty journal) is publicly available (free — link through on the pubmed page). That’s good. I think everyone should have access to that article and if I had a child with ADHD I’d find it very frustrating if I didn’t. What’s more, I think that the skill to read that article (which isn’t that hard — no complicated math, just some summary numbers and statistics return in standard clinical paper lingo) should be one that a well educated person in any field should have. Of course, that’s also an example of the demands of our current lives that some may find difficult to meet with assistance/medication, . . .
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The “stop laughing” which I have heard of as a side effect would rip my heart, and I think that where the side effects are significant, and the alternative treatment options are unavailable, there, we have a public policy question that needs to be debated and addressed.
I do think that’s where the “morals” comes in in some of these parenting discussions, when the choices made by society in general interfere/make unavailable/disrupt the opportunities and environment we’d like for our children.
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My son and one of my daughters is on meds for ADD. My daughter is now a teenager. She has a low appetite, but other than that, no side effects. My son, has some problems falling asleep sometimes, but other than that, no side effects.
He was on one drug four years ago that made him zombie like. We tried it for a week, and said no way. Went back to concerta.
The drugs do not take away the behavior problems or attention problems completely. But they do make it so he (and we) can deal with it.
Our school is not regimented. There is lots of opportunity to move around and interact. He still has a hard time not being distracted and wanting to be the class clown, even during stuff he loves. With maturity has come some control, but I really don’t believe he will be able to ever be off meds.
My daughter says it is much easier to pay attention to the tasks around her and not become distracted by her own thoughts. I don’t know if she will choose to stay on meds for her whole life.
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dudes, I’ll be back later. I am rewriting another article for the Atlantic. This one is about autism.
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Congratulations, Laura!
I suppose the individual response to medication varies a lot. I know somebody well who says that Tylenol (!) has a mind-altering effect on him.
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I think I remember that my source also gets unusual mind-altering effects from taking over-the-counter cough syrup according to the instructions.
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This post is generating ADHD medication ads.
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I have a question for the comentariat: When people say that a brain atypicality is a “mental illness” or a “neurological disorder” what criterion are they using to differentiate?
My bias is to consider all disorders/atypicalities of behavior brain related, and thus, I have never really understood what people mean when they something is a neurological disorder, while delegating depression or schizophrenia as being an mental illness.
(the question is motivated by having read Sroufe’s summary of developmental pathophysiology, and thinking about the relationship between the brain and experience and atypical development)
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“My bias is to consider all disorders/atypicalities of behavior brain related…”
That’s not a bad starting assumption. Autism, ADHD, Tourette’s and OCD are related, or at least they often occur in different configurations. Plus, autism may go hand-in-hand with anxiety or depression.
At least some of these conditions can be accompanied by real gifts: unusual spatial ability or other such for autism, energy for ADHD, and clarity of thought for mild depression (although that last item is probably controversial).
http://en.wikipedia.org/wiki/Depressive_realism
Bipolar also sometimes comes with unusual gifts such as energy and creativity.
I can’t think of any positive side of schizophrenia or how it relates to other mental conditions, but I don’t know much about it.
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We noticed a perceptible, long-term difference in our daughter’s academic performance once she started taking Concerta. It’s a little hard to identify side effects in the absence of a double blind control group study. Certainly she didn’t stop laughing. In fact, I don’t really notice any change in her demeanor, although that might be my own obtuseness. She’s a picky eater and very thin, but so was I and so was my wife at that age.
She complains about the medicine sometimes and says it makes it hard for her to sleep, but doing better at school makes her happy, plus of course teenagers often have trouble falling asleep (and getting up!) at normal times. Also, they like to complain and blame outside forces generally. So it’s hard to know what to make of this.
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I have no idea how I missed this:
http://www.jsonline.com/news/statepolitics/emotional-gingrich-discusses-mother-says-hes-learned-lifes-limitations-am3kmg6-136452958.html
A month ago, Gingrich talked about his mother having been bipolar.
That explains a lot.
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