Sunday's article about the kid who hanged himself after getting hooked on Adderall was a big topic of conversation around here. Ian is on a low dosage of a different ADHD drug right now. He gets a patch on his butt every morning. After he eats his Cheerios, he drops his pants. I stick it on and press it into his flesh for a count of 30 in French. It comes off at 3:30 every day leaving a big square welt on his butt.
As the article pointed out, it is extremely easy to get these drugs. His school practically insisted on it, because they think it helps him sit properly in his mainstream classes. His neurologist is just a prescription writing machine and really doesn't do anything for him except take his blood pressure and hand out the drugs.
He doesn't take it on the weekends or holidays, because he doesn't need it then. He needs it to concentrate on boring stuff at school. That's it. He's able to pass for normal at all parts of life. So, really the drug is just about making the kid conform to school. That makes me a little sad, because the drug isn't without its side effects.
Ian is on a super low dosage. It's really for a kid half his weight, but still there are side effects. If it doesn't come off promptly at 3:30, he can't sleep at night. It makes him pick at his t-shirts. I have to toss out his t-shirts after six months, because he pulls about the lining of the shirts or he bites holes in them. It increases anxiety, depresses appetite, and slows growth. But we keep him on the drugs to be good citizen-parents. Schools just aren't set up for kids like Ian.
Apt. 11d 
That Adderall story was horrifying, but it was the story of an adult addict. He was functional enough that he could convince doctors — though, admittedly, there’s an assymetry there in that doctors get the patient to go away happy when they write the prescription and have to deal with things when they don’t, so they have a built in incentive to write the prescription (the asymmetry is a reason for all the federal regulation of drugs).
Adderall is more thing issue (performance enhancing drugs) for us to worry about when neurotypical but pressured kids are going to college (along with the recreational binge drinking and drug use). I have heard of people using these drugs like coffee, and I also know that there are many psychiatrists who consider stimulus medication to be no more dangerous than coffee.
Another thing to worry raised by the young adult stage and the tensions between parent and child when the law considers the child an adult. A theme that runs through that article is how limited parents are in taking care of their children once they’re past 18 and how confused parents get when encounter the limits of the law. I wonder if there are any reasonable ways to moderate the transition — for example, could coverage under one’s health care policy include a boilerplate form that could be (voluntarily) filled out that would give parents some right to access medical records of the child?
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One problem with many of these drugs (as well as many others taken for psychological issues of all sorts) is that it often becomes necessary to treat the “side effects”. (All effects are equal, really, despite how they are sometimes discussed by manufactures and less smart doctors.) The worst case, which I’ve seen in people I know well, is when the doctors don’t seem to understand they are treating the effects of the drugs they have prescribed. So, you get a stimulant, but then the person is agitated or can’t sleep, so you get an anti-anxiety drug, or a sleeping aid, and then the person has lethargy, or lack of affect, and needs something for those symptoms, and so on. And, they are addictive, but sometimes people, including doctors, mistake the with withdrawal symptoms for evidence that the drug is _really_ needed. Obviously, this doesn’t always happen, but it’s not at all unusual, and is worth being careful about.
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I have to say our experience has been nothing but positive. My kids feel better, work better. They tell us the difference. My daughter used to say that when she forgot her pill, she was “thinking about all the things in her head” and when she took it she “could think about the things outside her head.” We’ve kept them on a really low dosage, given medication vacations and always come back to them at the kids’ request.
I’ve never heard of a patch though. Interesting. My kids always take it orally.
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Laura, have you seen this documentary? It’s about a very different kind of school.
http://augusttojune.com/
The teacher spoke here last year and it was quite something. Not a lot of these schools out there, unfortunately.
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I just finished reading Marbles (a graphic novel about the path through treatment for bipolar illness).
It’s fascinating, at least partly because of the detailed description of going through the “drug balancing” that gets the author (Ellen Forney) to manage her illness. She’s opposed to drugs in the beginning, talks about the side effects, realizes that she becomes non-functional without the medication, and then goes through a multi-year process of balancing drugs until she’s on a path she’s comfortable with. And, yes, the balancing of the drugs includes taking sleep aids on top of stimulants and a complex mix while also managing physical health concerns (like platelets). She’s very thoughtful about her experience, so there’s a window into the treatment that you don’t get (say, with a child, or someone who is less contemplative).
For serious mental illness (as with chemotherapy for cancer) the plan that one will treat both the symptoms and the side effects of drugs is understood. And, different individuals feel differently about the different side effects — one person might not mind the memory lapses, like with word retrieval, that can occur with lithium, but Forney was destroyed by it.
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I’m intrigued by the idea of what kind of school might be better (and, also better for boys, in general). Christine Hoff Summers is re-releasing her book: “The War Against Boys” with a new subtitle (no longer blaming “feminists”), though she hasn’t changed the book.
I couldn’t get a handle on the “Open school” and what a day would look like with it, and I don’t know what changes one would make in school to help the (theoretically — I’m not convinced of the data) boys perform better, or what the goal would be. What would a “boy friendly” school look like?
Recently, while watching the boys and girls work on a long term project together, I was struck by the girls’ organizational skills, which were miles beyond the boys and had a moment of considering whether this difference actually remains, as a gender difference. Are women, o average, better managers of large groups and projects? Or is it a developmental difference.
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Living in Europe at the moment, where the college completion ratio is actually 60/40 female/male at the moment (vs. our 55/45). It’s interesting to see what happens when women begin to form a critical mass in the university. I have been in a number of meetings now where women do indeed run the show, do all the organizing and when the men try to dominate they get shut down. Very interesting . .
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In the Marbles books, Forney confounds the complications of balancing her medications by 1) regularly smoking marijuana but not telling her doctor about the frequency, because she doesn’t want to stop and 2) in one period where she experiences both “up/down” symptoms at the same time, using cocaine, and forgetting about it. She realizes the cocaine might have contributed to one episode and then realizes that while adding more psychotropics to her list of balancing medications, that she was doing that without considering giving up the marijuana. She achieves balance in the book by giving up all her drugs, except the prescribed ones, and carefully balancing those.
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We had the same situation. I would have preferred that our daughter not take medication, but it seemed as if she would have to switch schools, which wouldn’t make her happy either. So I regretfuly acquiesced to the ADHD medication. She complained sometimes about the side effects, like having trouble sleeping, and she remained very thin, but her grades improved markedly, and gradually (like over six years) she got used to the medication. I am not sure that was a good thing, and I’m not sure we did the right thing, but it’s hard to know what’s right.
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We have a young relative who 1) needs Adderall but 2) is addicted to it and left to her own devices, would take much more than she’s supposed to.
When dealing with a disorganized person, it’s easy to believe stories about losing or misplacing medication and needing more NOW, because the story seems so much in character.
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Our son is on Prozac and is actually in the process of carefully weaning himself, under a doctor’s supervision. He doesn’t like the side effects, and wants to try to manage without medication, but agrees that he might need to try something different. His doctors have always felt that he could likely go without, that medication was something to get him over major rough spots. We’ll see.
That story was horrific. It made me very sad for many reasons. I don’t recall there being so much pressure to perform when I was in school/college. There was always that one kid who was an overachiever, but most of us did the best we could and lived our lives. I just handed back exams and had students crying over getting Bs in the class. Bs! I’ve had to say more than once, “A B is a perfectly fine grade, above average still.” I truly worry about some of those kids. As a colleague of mine said last year, “As a society, we need to be okay with average again.”
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Exactly what Geekymom said. I am extremely worried about the stress level in kids these days. That law school graph isn’t something to cheer about. Kids have no idea what jobs will exist for the B students in the next few years and are under pressures from us and the schools to be perfect all the time. We’re making a conscious effort to not be too hard on Jonah for making silly mistakes. We pushed him too hard and it backfired. My neice, who is the perfect A student, has anxiety problems, too.
My grandmother who lived through the depression had life-long habits that came out of that experience. What scars are our kids getting from living through this economic down turn?
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I don’t know how useful this bit of information is—but, one of my sons–who was not on ADHD medication, always chewed through the wrists and collars of his clothes. He still does, actually. So maybe it’s not the medication that is the cause of it.
My experience has been that knowing what the right thing to do for your children is extremely hard–maybe impossible. And I do agree that society today is very intense and demanding on kids. And for what?
Anyway, good luck, I am always heartened not only by how much you try to love and help your children, but that you put so much thought in AND are willing to change–like backing off the pressure on your older son when you see it’s counter productive.
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I expressed some concern elsewhere about Adderall abuse at the college after reading this article and I was interested in the response: people who feel the drug has been very helpful for them personally felt that the article in the Times was somehow attacking them or not showing the full story.
We have got to work our way towards being able to not hear our own personal stories negated by a different story. Part of the problem is the fear that policy is made by anecdote, which isn’t unfounded–all it takes is a few ninny-headed NYT columnists writing about whatever it is that they read yesterday and demanding action to create a sort of chattering-class groundswell. I feel somehow that it shouldn’t be hard to talk on one hand about the problem of abuse and addiction, on another hand the problem of Big Pharma’s suborning of clinical medicine, and on the other other hand talk about the hope that many drugs and treatments have brought to people with conditions that were otherwise unmanageable. But it is hard–the conversation flashes over quickly into anger and anxiety.
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But it is hard–the conversation flashes over quickly into anger and anxiety.
Little Xanax takes the edge off that.
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The NY times, talking about dopamine and how different children might react to the pressure:
Why Can Some Kids Handle Pressure While Others Fall Apart?
Like other Po Bronson neuroscience->behavior articles, it is not rock solid science (but is a grand hypothesis built from both established ideas and cutting edge ideas — which might turn out to be wrong). But, it’s a great read. It also talks a little bit about one of my views about education, that there is a “right” kind of challenge/competition/testing that can improve learning and outcomes.
(The study Bronson begins with, on the COMT variants of the dopamine deactivaton gene and test takers in Taiwan is available without the paywall: http://ntur.lib.ntu.edu.tw/bitstream/246246/233044/1/YBRCG2470-Association%20of%20(COMT)%20polymorphism%20and%20academic%20achievement%20in%20a%20Chinese%20cohort.pdf)
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My son also chewed on shirt collars as a kid/preteen. And here we are on the anxiety/depression train. It makes me think that the issue *is* chemical and can be manage with drugs, but it also makes me think that maybe we should be okay with a little shirt chewing as long as its not a huge issue.
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I’ve never seen much shirt chewing. I used to pretty much destroy pens and pencils when I was younger.
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I’m in the midst of a three day binge of YA books and the last two dystopia novels have put me in a black mood. I really shouldn’t be blogging or commenting in a mood like this, but her goes..
I read that stress article, bj. Thanks for the link. I suppose there is nothing wrong with stress in certain situations. In fact, I’m one of those people who thrives on it. However, what bothers me is that we’re making kids stress out over stupid things. Meaningless academic hurdles. And that we’re projecting our own stresses about the unstable economy onto them.
I’m writing an article about YA books right now. I think they give us a clue into what fears are in their heads. It’s dark stuff.
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“I think they give us a clue into what fears are in their heads. It’s dark stuff. ”
I agree, and oddly, had my insight right after reading the Divergent series too (and noting its comparison to Hunger Games, Maze Runner, Player One, . . . .). The books all validate the idea that kids think they are being forced (yes, forced) to play high stress, high stakes, but meaningless games to move to the next level. The SAT as Hunger Games.
There are those who make stepping down work for them, because, unlike the hunger games, no one is drawing people out of a hat in our village and requiring them to participate in the high stakes game of getting into Harvard. I know teens who have, with their parents, achieved balance in their lives and admire them for refusing to play the game. But, sometimes, their parents do worry that they didn’t give them a good enough chance to play the high stakes game, so no decision is cost free in worrying. Unfortunately, I don’t think that simply stepping back is a solution for everyone either. So, I’m always eager for ideas to manage the stress while still playing the game (hence, the article). Fortunately, though the high stakes game does have serious risks (addiction, depression, anxiety, suicide, eating disorders, cutting, . . . .), it’s not as bad as having to fight a group of warriors to the death on a fake battlefield.
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The shirt-biting behaviour can originate in stress reactions. Autistic Youngest began this the year prior to starting high school. We control it somewhat at home with sugar-free gum and reminders.
She’s on no medication at the moment and I’m grateful that she doesn’t need them when I read about side effects such as these.
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My comp class and I were discussing school shootings one year and looking at all the solutions that have been implemented, and we realized they all involve making students do more things (go through metal detectors, submit to bag searches, attend assemblies). They feel so freakin’ powerless–and they *are* powerless.
We just had an IEP meeting that I’m still digesting. We ended up giving up the IEP because E is doing so well. The MS SpEd team wants nothing to do with him next year because he’s functioning so highly. I should be happy, right?
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Mine were all shirt chewers. I just assumed it was an Aspie/sensory integration disorder thing. They did outgrow it though two of them still bite their fingernails (as do I, yeah, gross, I know). We had oldest on Abilify for a while when he was younger and on the verge of being asked to leave school, and I think it ended the shirt chewing — though I’ve blocked a lot of this out because it was just SOOOOO hard and stressful.
Normally, I’d say “yes, who cares about a little shirt chewing” but we were in a school district where everyone was really shallow, including the teeny bopper teachers, and unfortunately, if your kid is doing anything in public that looks like emotional disturbance, it’s going to get your kid labelled and people aren’t going to be able to see past that to the clever way he uses language, or her wonderful sense of humor or anything else.
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“but we were in a school district where everyone was really shallow”
I’ve been patting ourselves on the back about how our kids are strong individuals who don’t mind standing out or sticking out. But it has recently occurred to me how much the dynamic depends on the fact that we are in an environment where nails that stick out do not get hammered down.
When my kiddos were in pre-school, our city played the city of their father’s birth in the superbowl; they wandered around town wearing jerseys supporting the other city. They got occasional comments (but were defended by their teachers). In the other city, at best defending the jersey would have required a lot more emotional energy, and at worst, physical force.
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