Saturday, April 7, 2012

Ritalin, chocolate and other forbidden medications

It's Easter Sunday here, and I am manfully, or womanfully, trying to forgive and forget in true Christian spirit. There are all sorts of people I need to forgive but let's start with my husband bringing home HomeBrand (unbranded, like Tesco Value) from the supermarket yesterday. To be honest, I am struggling. There is Christian tolerance but there are limits.
We've just had our Easter egg hunt, the annual confirmation that if developmental milestones were measured in ability to hunt down chocolate, our boys would be not just discharged from the paediatrician's care but possibly enrolled in a Gifted and Talented cohort study. There is something wonderful about small nappy-clad children wandering around a garden shouting "Egg! An egg!" and waving sticky, foil-covered fingers at you. Mumsnet, I note, is this year filled with parents insisting that their children only NEED one bite of chocolate, the rest of the Easter spirit joylessly supplied with one knitted egg from Traidcraft or whatever. In further evidence of my Christian backsliding, I believe that Easter is about fun first and restraint second. We supply plentiful eggs in this house, and then if they aren't used up in a few days I make chocolate cornflake crunch with the leftovers. (Again, I realise, it is one of the benefits of children with SN. You stop worrying about the possible moral connotations of too much chocolate and just enjoy the fact that they have ALL understood the idea of finding stuff in the garden, and that no one has wandered in having eaten cat poo by mistake. Although given my husband's clear lack of taste in tea, perhaps I should not be so sanguine, for all I know he might have mistaken weedkiller for chocolate this year).

It's been a complicated week. My eldest had his IEP on Monday - which was a bit alarming, as he has been so happy and settled I was expecting good reports all the way. They were lovely, and all agreed he was lovely - which he is, like a great big cuddly talkative teddybear - but suggested we revisit the whole ADHD question.

This should not have shocked me as much as it did. In realistic terms, I could not have been more prepared. At our last paediatric meeting before leaving England, the paediatrian sighed at the fact he had been discharged from ADHD clinic without diagnosis and asked me please, please, please, to get this reinvestigated when we arrived in New Zealand. So this should have been a gift, but in fact it was a blow in the stomach, because I had been rather hoping we'd dodged that bullet and that his issues had magically improved. (I am not immune from the parental disease of denial). I was astonished at how low I felt. I thought I was past that dreadful diagnosis-shock, I complained to a couple of friends. But of course, as they pointed out, every new diagnosis is about going back to the beginning, revisiting your view of what the child needs and what strategies are going to help.

Which brings me to the big bad elephant in the corner: Ritalin. As it happens, I am pretty sure my son won't need it. He is happy, he is learning, and we are managing him well enough at home. No reason to put him on Ritalin that I can see, and school agree. Diagnosis, if it happens, will be about strategies, support, qualifying him for extra help. But I've been shocked by the number of people who have said to me, as soon as I have mentioned that yet again ADHD is a possible diagnosis "But my God! What are you going to DO? You're not going to medicate! I mean, Ritalin is a DRUG!" as if I had proposed to throw my son off a cliff. Even more judgemental than those who don't want their children having a morsel of Easter chocolate this year.

Ritalin is what it is. We all know it's a drug, it's not ideal, it's the last resort, messing with a young child's brain chemistry at an age when they are unable to give consent, yadayada. But I would do it in a heartbeat if I thought my other children were at risk, his education was being destroyed by his behaviour, or I felt he was not safe to keep at home. I would do it because I believe foster care and illiteracy are known harms. Ritalin is a potential one. As a parent, you have to weigh up the pros and cons. There are of course cons to Ritalin, big ones. I am sure that in the States in particular it is often overprescribed, a first resort rather than a last. Even in the UK, Ritalin is too often prescribed BEFORE the serious behavioural therapy that the National Institute of Clinical Excellence recommends, you know, the type that is underfunded and completely lacking in most areas. So my ideal prescription for these kids would be more behavioural therapy.

But the parents I have known who use it, by and large, aren't idiots. Most have tried other strategies, seen them fail. The doctors who prescribe Ritalin aren't doing it for fun, or because they haven't noticed that it's a drug. They're doing it because they have taken a pragmatic decision that the known harms of violence and despair and failure outweigh the potential harm, longterm, of a still-new drug.

They may be wrong. Who knows? But I am not going to judge any parent who has taken a deep breath and said, at the end of a long battle with the alternatives, "actually, yes, medication may be what my kid needs." The people who "don't believe in ADHD" tend not to know what they are talking about. I know that, because I used to be one of them. Working with American schoolkids as a tourguide, I was horrified to see these really bright kids with a diagnosis. But they were so intelligent, I would say. They were the interesting ones. How could THEY be a problem? Of course, I was childless and cocksure. I didn't have the responsibility of raising them, I didn't see what they were like in the routine of a classroom as opposed to on the European trip of a lifetime. So this possible ADHD diagnosis is a bit like karma, if us Christians believed in karma, or divine judgement, if us Christian liberals believed in God sending us nasty surprises just to give us a fright. I guess what I should call it is "awkward." So you know, I have suspended my previously firm belief that medication was always, in every situation, a bad idea. I have looked at the evidence, of the families I know, and seen the mums at their wits end - often on medication in order to cope - the dads who leave, or take medication in order to cope - the kids who are beaten up, because every single sensible parenting strategy has failed, and even decent parents get to the end of their tether and lash out - and I try to take a rounded view.

And you know what I have learnt, talking to real parents who have used it? Responsible parents don't try Ritalin without having given EVERYTHING else a good shot first. Moreover, many of them don't want to drug their kid indefinitely. Which is great, because for short-term use it can be transformative. Ritalin doesn't have to be a lifetime sentence. From the cases I know, it can be the opposite. It can be about giving a kid a short-term boost, allowing them the breathing space to learn the behavioural strategies to manage longterm. And it can sometimes save a parent's sanity, or a sibling's emotional health, or a marriage. In short, in small doses Ritalin can be a godsend. Like chocolate at Easter.

Of course, some marriage-threatening problems can't be solved by medication. Sadly for our marriage, I know of no pharmaceutical preparation which would cure my husband's taste for revolting tea.

8 comments:

  1. Happy Easter - hope you and your boys overindulged on lots of chocolate :)

    ReplyDelete
  2. Oh, how stressful for you *again*. The Ritalin question is an interesting one. A friend recently gave in & put their eldest on it for ADHD and said it has helped considerably. A very bright, academically advanced child. Still something of a trouble-maker, mind you, but very spirited.

    All that said, I thought it was interesting that you talk about ritalin for short periods. I read an interesting article a couple of months ago, about short-term vs long-term success of ritalin etc. for ADHD. http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?pagewanted=all if you are interested.

    (I know far too little about it all to have a really informed opinion; what stood out with this article was how it takes a different line from most American press on ADHD & drugs).

    ReplyDelete
  3. Aussie - Oh we did, thank you :-)

    Yes that is an interesting article isn't it. But I think it is unreasonable to say that it had no longterm impact. They weren't measuring the number of times the kids got into trouble at school, or were yelled at at home, all that sort of thing. I think that educational outcome is a very abstract measure. Ultimately what you really have to look at is the whole family and the child's wellbeing holistcally, and i don't know any test that can magically measure that!

    ReplyDelete
  4. I worry about over prescription US-style, where it is used to fit kids into the perceived norm (a friend's child spent a year in the school system there, where schools can insist on meds or make you leave) and also about it in the hands of irresponsible parents (and GPs who don't care enough). I am quite sure that my SD's mother would have had her on it if it had been around then. And it would have been totally wrong for her, just a convenience thing (she used to dose her nightly with phenegrens).

    That all makes it much harder on the parents who do need to use Ritalin, and have made a reasonable and responsble descion to do so.

    One thing that strikes me though is how very little things have changed. When SD was little, some of the medical profession, and the media as well as other people, really did believe that hyperactivity was a made up thing. If we did talk about it, then the person we were talkign to would come back with stories of just how much energy their little Johnny/grandchild/kid next door has, and isn't it just incredible how much energy children have subtext: you're too thick to get that children have energy.

    ReplyDelete
  5. LOL yes absolutely. And that old advice "They are like dogs, they just need lots of exercise" Drives me MENTAL. It's often when he's exercising/been exercised that our eldest is at his worst. In fact, I think I can feel another blog post coming on....

    ReplyDelete
  6. Might need to hold hands on this one Cumulus. DS about to start Ritalin this term too. I'm going to hold off for a couple of weeks as he has a new teacher and will be too difficult to monitor behaviour. Feeling very nervous but agree with what you've written, and think I owe it to him to give it a try. It might be the best thing for him.

    ReplyDelete
  7. C- yes, that's a good point. And the other challenging thing is: if a child's behaviour gradually improves such that they get yelled at less at home, does that mean the drug did it, or did they just mature, or both? And how do you know which bit to attribute to what, so to speak?

    G - wholly agree with you.

    ReplyDelete
  8. Given that we don't get children's consent for putting their limbs in a cast or giving them grommets for their ears (which H might be getting) I don't think we should be so hung up by Ritalin when, as you say, it's a considered and LAST option rather than FIRST one.

    My concern with it, going back to my teaching days, is when it becomes the 'solution'. I'm thinking of a child I encountered who was on Ritalin (don't know why I knew, I wasn't teaching him, surely there should be some confidentiality?) and heard a colleague pretty much say that [the child] should behave perfectly now he was medicated and it was just an excuse so that we couldn't give [the child] detentions. Doh! I SOOOO wish that educational professionals could be slapped! Then educated. Good luck with whatever you decide (and remember, unlike on the xFactor, no decision is final)!

    ReplyDelete