I would like to respond to a number of articles that have
appeared questioning the advisability of using medication
(particularly Ritalin) for ADD (Attention Deficit Disorder)
and ADHD (Attention Deficit Hyperactivity Disorder). I feel
that it is important to understand another view on this issue
in order to allow parents and patients themselves to make
reasoned informed decisions without feeling guilty.
However much one `understands' what it must be like to live
with a hyperactive child, most of us conjure up in our minds
the worst of the boisterous behavior we see in our neighbors'
sons. But ADHD is another dimension of constant energy and
motion, and although this energy can be channelled and coped
with to a certain extent, these children can be next to
impossible to keep busy and controlled. Unless you have lived
with this, you cannot judge how difficult it can be.
These children live as part of a family, and they can absorb
so much of the parents' time as to leave no time or emotional
energy for the other members of the family. Normal household
routines like mealtimes and bedtimes, which are often
difficult times in any household, can become nightmares, as
without constructive focus for their energy, the child
becomes destructive. Although it is all very well to
understand that the child is not acting out of intention to
aggravate -- aggravate they do!
But the poor parents and teachers are not the only people to
suffer. The child himself suffers the most. ADD/ADHD people
suffer a very high degree of frustration. One's behavior
causes such negativity that his self esteem is bound to
suffer. When ADD is present without the hyperactivity, it is
often undiagnosed, but the child still suffers the
frustration and uncomplimentary labelling. Even when they are
highly motivated and really want to do somehting, such
children have an inability to keep their attention on the
task and this undermines all their efforts. The onlooker can
be forgiven for believing the child is uncooperative,
unmotivated or lazy. The child himself will wonder what is
wrong with him, and will think that maybe he really is stupid
or lazy (or crazy).
Contrary to popular myth, one does not grow out of ADD or
ADHD. It is a neurological fact of life that these people's
brains are wired differently. What happens as they grow
up, like all adults, is that they can control their impulses
better. They can also learn to use their energy in non-
destructive ways and learn strategies to help them be more
organized and better able to stay on task. However, they stay
with high levels of unfocused energy (if they have ADHD), and
find it a constant frustrating struggle to complete tasks and
remember where they are and what they were supposed to be
doing. Often, very intelligent and talented people are
failing in jobs and relationships because of ADD.
Whenever we use medicine to help a condition, we have to
weigh up the pros and cons. For example, a sufferer of
migraines may be given a medication that is known to cause
weight increase as a side effect. This may have long-term
implications about how the person feels about himself and
carry other health risks. However, this does not exclude its
use. It depends on the degree of suffering (frequency, pain
levels, duration of attacks) and the effect that the attacks
have on the person's life, compared with the disadvantage of
the weight gain. We have to make these kind of choices when
using medication.
There are many reasons to object to the use of drugs to help
this condition but I feel they are premised on certain
misunderstandings. Firstly, ADD and ADHD are very often
misdiagnosed. This means that it is either missed altogether
because the practitioners involved know too little about it,
or they `don't believe' in it. Or it is overdiagnosed in
people whose symptoms can be explained by other things, like
sensitivity to neon lights, caffeine dependency, emotional
problems, overstimulation from computers, undiagnosed
learning disorders (a high proportion of ADD/ADHD children,
although of high intelligence, also have learning problems)
or a vast array of other problems that can create
distractible, impulsive and difficult children.
Not every child who is difficult is ADHD, but it is often
a handy label to place on a child; and then used for
justifying the use of drugs. Using a drug on someone for
a condition they do not have will obviously not be good for
them, and will not work the way it is meant to, and this
gives the drug a bad name. This brings us to the second
point, which is that often medication is being used for the
benefit of the teachers because of the difficulty of having
these children in a classroom. Are the children being
`drugged' in order to control them?
This is surely an objectional matter. However, if the people
involved are primarily concerned with the good of the child,
then you get a different outlook on it. Here is a child who
could be achieving, who is not coping with life at school,
has no friends, or only has friends who enjoy his crazy
behavior, and poor self esteem. They find themselves
constantly unable to remain focused on the things they want
to do. They can't complete assignments, even when they know
the material, and their life is made up of endless
frustration, for them and their parents and teachers.
School life is characterized by punishments, mindless
activities to keep them busy or wandering the corridors
because they constantly disrupt the class. And don't be too
judgmental about teachers; unless you've taught a class with
such a student, you can't imagine how hard it is. Should all
the other students suffer because of this one? Perhaps we all
should be more tolerant, patient and knowledgeable as parents
and teachers, but let's inject a bit of realism into the
argument.
There are many different drugs available to treat this
condition, not just Ritalin, and if there are unpleasant side
effects, or it simply doesn't work, then you should look at
other options. Each person is unique and needs a competent
and knowledgeable person to help them decide if and in what
way to medicate. Like all medicines, there are unknowns, and
possible side effects and these have to be put into the
equation. Sometimes, it can take some time before the right
type and dosage of medicine is achieved. Medication can have
very positive effects, very often with no or tolerable side
effects. The gain can far outweigh the loss.
How do you feel about antidepressents? If someone suggested
that you would cope better with them, how would you react?
Well, it would depend on how badly you feel you are coping
now, and how it would affect your family and job. With
professional guidance, you will balance this against the
possible side effects and possibility of addiction.
Sometimes, people are closed to the idea of these types of
drugs for very unclear reasons. A great prejudice exists
against them. People have to seek advice because sometimes
only others can see the situation for what it really is,
while the person him/herself is blinded.
The drugs used in treating ADD/ADHD are having their effect
on the brain, and should be handled with care, but you should
not exclude their possible use, because you may be denying
someone the chance of a more fulfilling and productive life,
especially in the formative junior years.
People fear drugs that affect the brain and emotional
balance, but really, these drugs release the individual from
the trap he is in, in as much as he cannot control his
impulses, focus, behavior or emotions, the same as a
clincially depressed person cannot just `pull himself
together' and `count his blessings.' The negativity is beyond
their control and sometimes needs medication. With the right
medication for ADD/ADHD, individuals now take more control of
themselves and their lives and can achieve what they are
capable of.
One shouldn't think it's the ultimate panacea either.
This is also a common mistake and gives the drugs a bad name.
Medication or not, ADD/ADHD individuals need to be taught
many coping strategies, and the patient, family, teachers and
friends need to become as knowledgeable as possible about
this condition, to learn what to expect, and how to cope. Try
to get good professional advice that you trust, from someone
who understands this condition well. Unfortunately, this is
often unavailable, and drugs are being used inappropriately
as a `quick fix.'
In many places, competent diagnoses and treatment do not
exist. Doctors who are not experts but consider ADD to be a
possibility, and having no one to refer to, may decide to use
a drug and `let's see.' Many people may object to this
approach, and that is fully understandable. However, one
needs to understand the position of parents and sometimes
adult patients themselves who suspect that they have this
condtion and that the quality of their lives and their
families' lives can be greatly enhanced, but for lack of
trained professionals, do not avail themselves of this
possibility.
Used carefully, with the guidance and supervision of a
physician, this may be a way forward.
