ADHD Study: Meds Stunt Growth, Ineffective Long-Term?
My two teenage children have ADHD, and both have been on stimulant medication from a very young age--first grade and kindergarten, respectively. So it got my attention when I saw headlines suggesting that long-term medication doesn't work and in fact stunts children's growth.
The origin of this disturbing information is the NIMH-funded Multimodal Treatment Study of Children with ADHD, or MTA. The most recent findings of this long-term study, released in March in the Journal of the American Academy of Child and Adolescent Psychiatry, have received a flurry of media attention—mostly missing the point.
The Washington Post headlined “Debate Over Drugs For ADHD Reignites: Long-Term Benefit for Children at Issue.” The article fronts a fight between two researchers on the study, William Pelham and Peter Jensen, about the hot-button issue of whether Ritalin and other stimulant medications are effective over time.
But the effectiveness of medication really isn't the issue, nor was it a main focus of this study. I'm a parent, not a researcher, so bear with me as I briefly summarize:
- In the original study, 579 children from multiple sites were randomly assigned one of four treatment groups: medication, intense behavioral therapy, medication and behavioral therapy, or treatment based on their individual doctors’ and parents’ guidelines (community care).
- The results of this treatment phase, reported in 1999, revealed that intensive medication management alone or in combination with behavioral therapy worked better to relieve ADHD symptoms than behavioral therapy or community care.
- When the study ended, the intensive treatment provided as part of the investigation also ended, and everybody went back to community care. Researchers continued to follow the participating children to see how they did on various behavioral and academic measures, however.
- Data on how kids were doing came out periodically, with big reports published in 2007 and this March painting a picture of diminishing returns on the original 14 months of intensive treatment. At this point, 8 years out from the original investigation, there are no significant differences among children in the different treatment groups.
Although the primary purpose of the study was to compare the effects of the different treatments, the media find two results from the follow-up after the main study irresistible: The first, actually reported in 2007 but revived and presented as new, is that children who took stimulant medications continuously for 36 months were on average an inch shorter and and 6 pounds lighter than those who did not. Second, and the kicker--kids who are not on medication appear generally to be doing as well as those who are.
Surprisingly, even William Saletan, whose science blog in Slate I admire and who is quite capable of interpreting a research study, spotlighted these two provocative findings without providing meaningful context.
I can't argue with the finding that medication reduces children's height and weight, though I feel terrible if my own children's growth has been compromised. Even so, uncontrolled ADHD symptoms can wreak havoc on a child academically and socially, and many parents may feel the tradeoff for a better quality of life is worth it. I know that's how I feel.
I don't dispute the second finding, either--that at this point, kids who participated in the study are doing about the same on or off medication. This does not mean, however, that medication is ineffective over the long term.
To put this finding in context, please realize that each child with ADHD has different mix and severity of symptoms. One kid may daydream during class while another can barely be peeled off the ceiling. One kid might have a problem talking at inappropriate times while another’s interpersonal difficulties could be so severe that they make him or her a social pariah and the target of relentless bullying.
Add to this the fact that the picture of ADHD generally changes over time as children become adolescents, with symptoms like hyperactivity lessening and symptoms like inattention and organizational problems coming to the fore. Clearly, treatment isn’t like a vaccination—it must be continued and adapted to a child’s needs over time.
The children in this study came to it with a wide range of symptoms--some severe and some not so severe. If you keep in mind this fact and the fact that the mix of symptoms is a moving target for each child, doesn’t it stand to reason that children with the most severe ADHD symptoms would keep taking medication because they needed it, while those who didn’t need it as much stopped taking it? And that when viewed as a whole, the groups taking medicine and not taking medicine might look the same?
As the recent MTA report states, the findings "raise questions about whether medication treatment beyond two years continues to be beneficial or needed by all.” What they mean to me as a parent is that I need to continually reevaluate the role of medication in my children's treatment plan. But they do not prove whether or not medication is the right thing for my kids or anybody else's.Parents of kids with ADHD have to make very hard decisions about their children's health and education, often with incomplete information. They must weigh conflicting advice from educators and doctors and sometimes fight to get the services their children require. Sound bites, flashy headlines, and misrepresentation of facts don't make our jobs any easier. We deserve unbiased reporting of scientific evidence concerning this difficult disorder.
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Nowadays, the idea that it is an individual's responsibility to develeop the interanl and external resources to cope with adversity is considered absolutely ludicrous. I am appalled at the extent to which people have allowed themselves to be infantilized by a Medical-Industrial Complex which makes the snake-oil salemen of the nineteenth century look like Mother Theresa by comparison.
I think an inch of growth may be worth sacrificing for many kids with ADHD. The finding that differences between the groups fade away are more interesting, in my eyes. But I still don't think they constitute a decisive argument against medication. After all, if pills makes a kid better between the age of 15 to 18, that in itself may be of enormous value. It may be what enables that kid to finish school with decent grades rather than dropping out. Catching up later on may not be a real substitute for treatment when it is most needed. It's like pain relief: Would you turn it down after an injury because the effect will be short-term and the pain will be gone in a few weeks anyway?
As someone who was diagnosed with ADHD as an adult and is currently on medication, I often feel frustration when I read news storys and blog posts about the horrors of such treatment. These pills are not party drugs, and they are not a chemical lobotomy. If the dose is right, they simply help you to focus - rather like an extra cup of strong coffee when you're tired. That is obviously important for children of school age.
There's also the old fallacy that "people didn't take drugs for ADHD before, and they did alright!" Actually, people have always been taking drugs for ADHD. It's just that they used to self-medicate with illegal drugs or alcohol. And they didn't do alright, either. Prisons and rehab clinics are chock full of people who have ADHD, although many of them don't know it and never will.
Sure, there are people who are misdiagnosed. But the real problem is still that most people who have ADHD receive no proper treatment for it. ADHD is real, and it can be a debilitating disorder.
has never known someone who has a tragic, totally disabling physical mental illness that has not responded to many other interventions for many years
Thanks for this. Two of my children took medications for (very different) attentional disorders. In both cases, the meds seemed to help them gain back their confidence and sense of themselves as learners. But in both cases, I had very mixed feelings. I knew a lot of my peers thought I was being a bad mom, but that didn't matter to me as much as my kids' development.
I think that kids who take meds also need social and emotional support, and careful monitoring. It's not all about just giving the kid a pill.
This is taken from the study's summary, and I think it reiterates what you say. People with ADHD differ significantly, and the degree to which any of them are served by treatment (of whichever kind) is going to depend on the severity of their case to begin with along with other uncontrollable factors like socioeconomics and even cognitive factors.
I appreciate your clear-eyed view on this subject. My experience is that most people who offer simplistic explanations don't have direct experience with ADHD. I agree with you that the media runs with the most provocative headlines, including the one a few years back connecting poor attention span and television. Well, the uninformed jumped to an ADHD and TV-watching connection, not really understanding that "poor attention span" is simply not the right summary for ADHD. That study had nothing whatsoever to do with ADHD, which amounts to a deficit in self-regulation, or decreased electrical activity in the prefrontal cortex, the seat of executive functioning.
I find it particularly ironic when the critics of stimulant medication can't themselves function without their morning coffee. In fact, scientists recently suggested in an article in the journal NATURE that methylphenidate (Ritalin), as a central nervous stimulant just like caffeine, should be treated in the marketplace just like caffeine.
I have no idea if it works. JUst passing it on.
All this means that a child who daydreams all day in school and a child who jumps on desks can both have ADHD. They are both indulging in the present, unable to bring themselves to make a plan about their next few minutes, their day, their week, their year, their life. Needless to say there is a continuum on which most people find themselves. Think of it as an impulsivity continuum: At the one end is extreme restraint; at the other end is extreme impulsivity. I think it's mostly a personality and not unlike other continuums of traits. The problem is that our society has moved from agrarian to industrial, so there is this emphasis on schedules and tasks. Finding the right mate and job make a world of difference for people with this personality, which has as its strength a remarkable penchant for honesty.
My feelings are very much like yours, and I think you sum up the experience of most parents of children with severe ADHD--meaning to the point of seriously impacting the child's day-to-day life and that of the immediate family--with this observation:
"Clearly, treatment isn’t like a vaccination—it must be continued and adapted to a child’s needs over time."
Many people misunderstand medical treatment of ADHD assume that a child is handed a prescription for a powerful antipsychotic drug and let go. Not so. Finding the right medication for my child at the the proper dosage was a baby-step by baby-step process. And of course, as soon as the 'right' medication is found and the right dosage determined, the child experiences a growth spurt and the experimentation starts again.
In my daughter's case, managed by a neurologist, we found that Adderall was the only medication that controlled her symptoms--and by that I mean the only medication that made it possible for her to make it through a school day without a referral or suspension. She began taking medication in 3rd grade. First "regular" Adderall tablets, then when it was found she was pretending to take her meds and instead hiding it from the nurse. She was discovered trying to bury it in a potted plant in the office. We then moved to the XR timed release formula with great success.
Unfortunately, by her early teens, the dosage she required would have meant she would have had to take 2 of the lowest dose capsules instead of one of the highest. Our insurance put a stop to that by refusing to authorize more than 30 capsules. And so the experimentation began again. During this period, she failed 8th grade due to truancy and the fact she spent the days she did make it to school in the Principal's office attempting to explain herself.
We have found a replacement medication for her which is working as well as the Adderall. I have sacrificed her college fund to enroll her in an private school specializing in children like her and if the money doesn't run out, she will graduate from their upper school with a valid H.S. diploma. A year or two ago I had given up hope of her ever finishing school. I'd begun bracing myself to be ready for the day of her 16th birthday--the day she'd be "allowed" to drop out of school.
I agree with Norwonk in that medicating for ADHD is not new. In
in 1867, Scottish toxicologist John Harley tested hemlock on himself to establish its symptoms, and later recommended it as a treatment for hyperactive children. (I am not advocating the use of hemlock.) There is more than ample evidence of self-medication in cases of 'hyper' teens and adults self medicating with illegal street drigs and one can not discount the rush of extreme risk-taking seems to be characteristic of these children as teenagers and young adults.
I will never know if her taking medication for so many years has stunted my daughter's growth. I can tell you that she is taller than I am and wears a size 10 women's shoe. While medication certainly does affect her appetite, it has worn off at the end of the day and she eats heartily--perhaps too much so. She began puberty at the late side of normal, perhaps an effect of the medication, perhaps not--impossible to determine.
She is most certainly not "stunted" in size or appearance nor "deformed". Her head and the rest of her is in proportion and absolutely normal.
I am obviously a proponent of medication as treatment for ADHD. Counselors, therapists, a child psychologist, pediatric neurologist and our family doctor are all part of our treatment team.
Those who claim there is no such thing as ADHD, and it's just a case of "kids being kids" are invited to witness a day in the life of my child when she's avoided taking her medication. They are invited to inspect the damage she alone has inflicted on my home. They are invited to witness the emotional carnage of what is left of my family. But they are not invited to judge me or my child or her doctors, counselors and teachers.
You have left out the most important part of your "test".
Allow the child to play the video game for that hour or two (and yes, anyone here with an ADHD child will agree that's not only possible, but likely). Now try to get the child to STOP playing that game.
There's your test.
The fascinating (and not unexpected) thing about the comments here is the insistence by some that ADD or ADHD is just being a normal kid. True ADD/ADHD is hell for the childhood sufferer. My husband's ADHD wasn't diagnosed until he went to rehab. Being put on Ritalin almost brought him to tears. So this is what it's like being normal...able to think.
I do agree that ADD, bipolar disorder, ODD and other conditions are being overdiagnosed in children and adults improperly. The number of decent child psychiatrists/developmental pediatricians in the country is shockingly low. Waits to get into my old center for an ADD evaluation were on the order of 8-9 months. As such, there are others, less well trained perhaps, or less rigorous in their diagnostic criteria who are giving diagnoses on these children/adults a little too quickly and without proper follow up. And that can be the problem with an entry in a chart: it can take on a life of its own.
One physician/therapist questions whether a patient might have ADD. The next therapist sees the entry and reads it as the kid has ADD. And if the kid's visits/evaluations are sporadic at best, some docs might find it easier to just prescribe more meds than to actually have a come to Jesus meeting of all involved parties to determine what the kid's actual needs are today. Mental health care is in a sorry, sorry state in this country.
And then there is the pill/behavioral intervention option. It's like when I practiced with teens and had to do obesity/healthy living counseling. The teen would tell me that s/he wanted to lose weight, and then I would go through dietary changes and ways to increase exercise. After which s/he would look at me and say, "can't you just give me a pill?" The knocking you'd inevitably hear was my head banging against the desk.
We live in a society where we want the maximum results for the least amount of effort. So yes, there will always be some parents/patients who will choose a pill over a behavioral intervention. However, for those parents/patients who have had good evaluations over time, have adopted behavioral programs (or have had behavioral programs fail because of the severity of the ADD or other disorder), choosing meds is a reasonable addition to the treatment plan.
As for duration of effect, regardless of this type of study, the length of time someone should be continued on meds should be an individual decision. Most of my kids with ADD had med-free summers. We then had the decision in the fall to restart or see how things went. The key is proper follow up and feedback from all parties.
As for the issue with height, I would want to see other studies (I didn't have the time to search myself) verify that such stimulants stunt growth. Might validate what your parents always said about drinking coffee will stunt your growth!
Thanks for this discussion.
I'd be interested in reading studies that compare children diagnosed with ADHD who take medications and those, also diagnosed with ADHD, who do not. Otherwise, it seems like as long as the condition is being treated somehow, it works out. I agree with you that this study doesn't tell us very much about medications per se. The physical growth side effects are sort of interesting, but I imagine most parents see shorter stature as a small price to pay.
I also have two kids (and a husband and a brother) with ADHD. My kids take stimulant medications, one since kindergarten, and the other since second grade. My husband and brother still struggle as adults with various ADHD issues. And over time, kids with ADHD morph into adults with ADD... and have problems with organization, time management, and money.
Honestly, I get so tired of articles and experts immediately assuming I must be a lazy parent, an uninvolved parent, an un-interactive parent who would rather watch her soaps than raise her kids. When we went to a specialty clinic for additional diagnostic services outside our usual pediatrician, I remember the doctor saying "Wow! You have the strongest family history I have ever seen in 20 years of practice!" It was such a relief to have a person I trust acknowledge that this is genetic. I did not cause it any more than I caused my son's blue eyes or his freckles.
Yes, there's a component of this problem that our school system forces kids into unnatural lives. But lacking the resources to quit my job and homeschool, I don't have many options. And I have witnessed first-hand seeing my children's behavior at an order of magnitude outside the bell curve of their peers. One kids is the "peel him off the ceiling" variety, the other is the "dreamy and spacey" variety. Sure, every kid is like this at times. But when my kid is the one in the principal's office, the one with no friends, the one who can't learn, can't pay attention, can't finish ANY schoolwork, then we had to act.
The medications are completely trial and error, and take constant monitoring between home, school, and doctor to get it right. One or the other child might outgrow their medications some day. They might not. For now, for us, for my children, I see these medications like insulin, glasses, or crutches. I wouldn't dream of withholding glasses from a child who needed them, saying that too many kids are wearing glasses these days. I've seen my kids with and without medications. I want to have my own personal party every time my fifth grade son gets a birthday party invitation, because I know what it means to not get them. With medications, my kids can do all kinds of non-academic they couldn't do without meds. This includes participating in sports, scouts, playing in the neighborhood, getting along with friends, and so on.
If it's true that over time my children will sacrifice an inch of height in order to have success in school and in life, it's a trade off I'll happily make. When they're old enough to understand, I'll explain.
I must say however, that the comments by people who have never dealt with a child with ADD is incredibly frustrating to me. As frustrating as dealing with a bright daughter who would take 25 minutes to get dressed for school just because she decided to play with her stuffed animals instead and has no concept as to why she was in her room to start with. Or dealing with my lovely daughter who would get up to sharpen her pencil at school and take 20 minutes as she noticed a cool mark on the carpet and missed out on a lesson. Or how about spending 2 days on a book report only to receive a zero because she forgot to turn it in and it sat in the bottom of her backpack for a month. My husband and I spent months observing our daughter both at home and at school (FYI: she could sit for hours in front of the tv or computer and be incredibly focused, her issue was being removed from those situations and being able transfer to other activities) before consulting our pediatrician and eventually an ADD specialist. Both of whom applauded us for our detailed journal we kept of her behaviors as well as telling us that girls are often overlooked in ADD and that undiagnosed ADD in girls is the number one cause of depression in teenage girls. We agonized over giving our 8 year old medication, medication I might add that is basically equal to the stimulation of a few cups of coffee and leaves her system after 8 hours. We did and I have no regrets; as she told her Dad and me: "I felt like I was in a fog and now everything is clear and I feel like me!" She is now 13 and doing exceptionally well in school and the starter defensive setter on her club volleyball team. She is happy, funny and above all able to do things as she says, "like the other kids".
I realize people have strong opinions on this subject but please hold your judgement until you have really walked in another's shoes. My family has not been sold a bill of goods from the "Medical Industrial Complex" we tried many other "natural" options which we continue to do but medication has steadily worked the best for her.
Also, note that not all children suffer from the "H" (hyperactivity) part, my daughter has none of the hyper component. Her case and many others are not just about drugging kids to stay in their seats and be compliant but about helping a child be able to focus and participate in learning in a positive way. My daughter was miserable because she could never find anything or was always late with everything; she lived in a constant state of disorganization and stress. If my daughter had diabetes no one would question the use of insulin as one of the ways to manage her disease why is this any different?
Jessabelle, you said this: I'd be interested in reading studies that compare children diagnosed with ADHD who take medications and those, also diagnosed with ADHD, who do not.
Well, on my way home tonight NPR News had a story about a recent study that said children with ADHD who took Ritalin did better in school and on standardized tests than their peers (other children diagnosed with ADHD but not on medicine). So, your wish is my command! (I have a hard time believing there are two recent ADHD studies commanding a national audience, so maybe there's something in the one we've been talking about that says this. If so, it goes to show you how a single study can generate all kinds of disparate headlines!)
Hells Bells, so sorry to have completely monopolized your blog! Feel free to come over to mine and take it over for a day :)
As for the "bill of goods," that would be many of the alternative treatments suggested for ADHD; for example, there have been 10 well-controlled studies that have failed to find any benefit to the Feingold Diet, a restrictive diet often billed as helpful to alleviating symptoms of ADHD (German psychiatrist Martin Winkler, Web4Health). I did discover (when I did research on this topic for a paper in my master's program) that a couple of alternative ideas bear out or require further study: supplemental zinc, white noise, and more time outdoors.
Now, lets think for a minute.
One person asks, why is medication for ADHD any different than medication for diabetes? Well, first, the vast majority of diagnoses of Diabetes in children under 10 is for Type 1 diabetes. (Children 10-19 show more type 2 diagnoses, but Type 1 is still the majority and the Type 2 statistics show obvious influences of poverty and diet) Diagnosis is not a matter of judgment or opinion. If you don't treat it--particularly Type 1, severe organic illness and early death are the result.
ADHD is a syndrome. It is not a disease. Its diagnosis is based on behavioral criteria, which very much reflect the culture in which the child is raised. You can read the DSM-IV ADHD diagnostic criteria on wikipedia. I would summarize all of them as "the kid is hard to deal with in school and certain social settings." No one has ever died from ADHD. Any suffering caused by ADHD is suffering caused by social comparisons. "Janey sits quietly and learns, but Johnny fidgets and daydreams and talks out of turn." (Janey and Johnny could be reversed here, but 2/3 of all ADHD diagnoses are for boys--another clue.)
You can also read on the CDC website's ADHD page that genetics is the main suspected cause of the ADHD syndrome. Now, genetics could also be the cause of diseases like Diabetes, but, again, they are diseases, not behavioral syndromes inconvenient to society.
It seems evident that our current social organization, in which white collar jobs are the only way to advance socially, is a huge contributing factor here. In a society in which physical work gets you nowhere, anxiety over our child's standing in elementary school increases. When I was younger it was much more expected that some kids would go to college, but if they worked in the lumberyard or something, it was not a great tragedy, since you could still raise a family and buy a house as a person who did something physical for a living. In the US today, we import poorly paid immigrants to do those things. The rest of us just manage the fruits of their labor. Now it's usually: "learn to sit at a desk or accept yourself as a failure."
Now, lets talk treatment. You can give it fancy names, like "medication," but what the treatment for ADHD is, is SPEED. For those of us who know something about speed, it surprises us not at all that it will stunt growth. (I will predict other future problems also. Speed is a vasoconstrictor. Prepare for issues with blood pressure, sexual dysfunction, etc.) Finally, on this topic, let it not be forgotten that there is lots of money to be made pushing speed.
So, to summarize: Because roughly 5% of the population--mostly boys--are born unsuited genetically to go to the schools our culture has chosen to make the arbiters of success, we will give them speed and stunt their growth to get them into the middle class. This is what I read in the post and many of the comments above.
Live with that if you like, but let's not pretend it is like diabetes. I suggest homeschooling or a special school with more activities, or anything else.
Good luck, and God bless you and your family.
She's a smart kid who got mostly in the high 90s in percentiles on standardized tests. She's come very close to failing out of school.
I'm not ready for meds, because between me and the school, she is doing okay, but she would fail without continual intervention. And a failing kid is miserable.
She has trouble finishing hobbies, too. We have a house full of unfinished projects.
My son has issues, too. He has trouble sitting in his chair through dinner. In fact, I'd say less than once a month he manages to sit in his chair through a short meal, not including dessert.
However, he's doing okay in school. He gets plenty of recess and runs off the energy. He's smart and he generally likes schoolwork. I have to monitor him to get his homework done, but it's not the battle royal it used to be with my daughter -- a battle that was not healthy for the family.
It's all how the kid's problem affect his life.
Thank you for sharing this and for writing it so well.
It's damned frustrating to continue to see the ignorance which surrounds a subject so close to my heart.
I can't even describe the size of the boatload of money I would pay if I could re-do my childhood with Ritilin. I was diagnosed with adult ADD and cried like a baby when I got the results. *Finally*, a complete understanding of why school was UTTER HELL.
I grew up with a brilliant ADD mother so she didn't notice anything amiss with my sister(who has ADHD...and chooses alcohol and hard drugs to self-medicate) and I. We had a very high energy and creative household. I had a great childhood.
Except for the fact that my brain was and still is not wired like most people's. My body does not manufacture or use natural adrenalin like normal people. ( Overly-simplistic explanation. Look it up.)
I had the total capacity and desire to be a brain surgeon. Easily. Except for the damned fact I am built different. If school could be taught while walking, standing, lying on the carpet, I would have been at the top of every class I was in. School is designed for the majority("normal"). My mom was not rich, she worked full-time. No money for tutors, fancy private schools, or personal coaching.
Not my fault I'm wired this way, but oh! the years upon years I thought it was!
If I had a kid with ADD/HD, *FOR REAL*, I would consider it abuse to *deny* something that would help a child think in a "normal" manner.
Even after diagnosis, I tried for years to treat it with diet(I was already- and still am- very active)but to no avail. *Believe me*, if there was a way to stop taking Ritilin and keep my socks out of the freezer, my bills paid, not hardboiling eggs for 2 hours because some how I'm in the backyard pulling weeds because I initially went out there to get my flip-flops, then damn it, I would.
By the way, omniado, who the hell cares if it's a condition, a syndrome or a disease?!? If medication can be given and taken responsibly in a way that is life changing/saving who can deny people for wanting to live reasonably normal life or be able to offer that to their children?
(I must say, the thought of "normal" students taking it so they do well on their exams pisses me off to no end!)
As for comments about nobody dying from ADD/HD, well, WOW are you uninformed. People might be scared by the longterm use of Ritilin but that is an un known. What *is* known is the fact of living with undiagnosed/untreated ADD/HD turns into depression and many turn suicidal. I could write *volumns* about my sister.
And finally, society thought for years that various medications were/are dangerous and you know, some turned out to be not so good but others have been prolonged life and provided people with a better quality life.
How cool is that?
http://www.salon.com/env/feature/2009/04/27/autistic_culture/
You seem like a reasonable, educated and well informed individual and I respect the time and effort you put into your post.
But, and you knew there was a but; what you and others here fail to understand is that this is not about "fidgety" kids or kids that "don't fit the ideal model". This is about kids who can not perform up to their god-given abilities. My daughter tests profoundly gifted but has never passed a standardized exam, despite being given every "accomodation" available to a child with an IEP. I sat in her classroom in 1st grade assisting her teacher with clerical tasks and watched her during a math lesson. The class followed along, yes some more attentively than others, to a lesson involving counting. Their workbook featured drawings of cars and they were adding them up in various sets. My daughter however, spent the entire lesson, and most of story time which followed immediately afterwards, coloring in, in great detail every blessed car illustration on that page.
This is about children who are so out of control in their rages involving transitioning from one activity to another are routinely suspended for fighting and or using profanity with a teacher. And it's worse at home. I have not invited anyone to my home in years. Why? becuause while most of my home appears perfectly normal, my daughter's bedroom and often her bathroom look like a zoo animal has gone berserk in there. There is no door on her bedroom. I can no longer afford to replace them. She now seeks privacy behind a torn shower curtain.
Look closer around the 'normal' part of my home and you'll start to notice that every remote control and cordless phone handset is held together with duct tape and krazy glue. You won't notice that the sliding glass doors that have been replaced 3X when my child, flesh of my flesh, has hurled one of those handy projectiles straight through them--usually when aiming at me or her brother.
You call this fidgity.
Parents of these children PRAY for fidgity.
But, first of all , I look at those statistics! 5% of ALL children. 5%!
Do you really believe that 5% of all children are severely brain impaired so as to require a drug that stunts growth--and, by the way, why do you assume that is ALL that it does?
I have an 18 year old son, have spent plentyof time with other parents on the playground, and used to teach in an urban school and I know for a fact that children are being given Ritalin for being "fidgety" and "difficult" in school.
Now, with no judgment about the other reasons you have sought chemical amelioration of YOUR daughter's behavior, I must remind you and some others here 1) of the fact that suicide, depression and violent behaviour etc. may have statistical links to ADHD, but are NOT contained in the diagnostic criteria and are not inextricably linked to it by any clinical evidence; and 2) of your own words:
"My daughter tests profoundly gifted but has never passed a standardized exam, despite being given every "accomodation" available to a child with an IEP."
Why do you care so much about test results? Or "academic" achievement? Why do you care so much about "normal," as in "School is designed for the majority('normal')."
Who in this world gets to decide who has the "correct" brain chemicals and who doesn't? Why do all diagnoses and descriptions of ADHD use words like "inappropriate?" Surely, you see the slippery slope we are going down here?
What happens when questioning the teacher and boss (two settings as per DSM-IV) become "inappropriate?"
Parent's who do not allow the insulin for their Type-1 diabetic child would (rightly) be considered cruel and criminally negligible. If I disallow amphetamines for my "inapproprite" child, will I be considered criminally negligent?
Before you condemn my social concerns here, answer those questions honestly.
Indeed, schools can be hell for certain types of people. So much the worse for schools.
At bottom, this is a debate about purely materialistic notions of what constitutes a valid "human being." Is it only "correct" and "appropriate" chemical constitutions? I realize that many here are torn between truly antiquated notions of the relationship between "soul" and "body" and the seemingly more modern and "enlightened" notions of humans as chemical soups that excrete (appropriate or inappropriate) thoughts and emotions--but there are other ways to see us.
I wish you all the best. Do not confuse my social concern with a judgment of you in your situation, but I would suggest that you examine yourself and see if you have tried everything else. I am not talking about diets or some other way to "correct" your "inappropriate" daughter. How about just taking her out of school and letting her play, run, relax as far as possible for a year or two without worrying about whether she conforms to your notions of what a "brilliant child" should do? (I realize that this may not seem possible, from various povs, including financial, but I guarantee you that there is nothing learned in school in the first 15 years that cannot quickly be caught up on at a later date--except of course the notion that we should always conform our chemical selves to socities norms.)
Best to you all.
omniado.
Why on earth would anyone care to have normal brain activity if they could? Fit into a normal accademic structure of any given society?? Better check, your birth-priveledge is showing....again.
For me, the question of being innappropriate was not an issue. I was/am introverted so no one knew what was going on with me as a child. In my day, no one knew what to watch for. I do agree that today there are *way* too many false diagnosis which results in the massive negative backlash. The way kids and and adults are tested and treated *should* bedifferent.
You say you aren't being judgemental? Yet you would like to suggest gwhizz examine herself??? Try other things???
You are assuming here that she has not tried.
That *is* being judgemental.
You got some big ones dude.
Having recently gone through this with Her Maj, medication has been extremely helpful in the school setting. She has trouble shifting between activities and was literally flunking kindergarten when we sought help, and were lucky enough to find something that worked on the second try. She'll have a med-free summer, and she is definitely growing despite the meds. We hope she'll outgrow the ADD, but as someone with only recently diagnosed ADD, I'm not willing to gamble her future on it. I'll always wonder where I'd be if I had been diagnosed back in 3rd grade.
There are behavioral skills that be learned to assist young adults who have ADHD.
I had some testing done by an Occupational Therapist, and she found that I had ADD, but she observed I had developed behaviors to help me cope.
I think finding an OT for you kids would be helpful before they go out in the adult world.
My daughter has been off the meds for 3 years and is functioning well. Her career and her life gives her all the stimulaton and then some. Great post, btw.
WRT to the study. All I could think was - great here we go again. I'm middle aged and medication helps enormously, especially as I experience the lovely female hormone shifts of middle age (ADHD and perio-menopause, a special hell all it's own I don't wish on anyone).
Ritalin ER helps my 13 year old niece - even after 5 years. We went through the phase of her not taking it (the teenage control issue), and she now voluntarily tracks and takes it because her grades took a big drop, and she started getting static from peers about behavior issues. It does not "kill her creativity" or make her an automaton. It does give her room to self regulate and able to see the effect she's having on others and adjust her behavior accordingly. The height issue - well she's 5'8" at 13 so if she loses an inch in final height she's tall enough it's not an issue.
I do wonder if a) all these kids are correctly diagnosed and
b) if there are conditions diagnosed as ADHD due to symptom overlap that are actually something else.
i.e. how careful was the screening, controls, and long-terrm diagnosis monitoring.
Please, please, please. You haven't had my experience and that of my family. Without having ADHD or walking a mile in the shoes of those of us that do, you can't know how painful it is to hear the out of hand dismissals and stereotypes, and the damage they do to those of us that have spent decades coping.
It wasn't that I was a rebellious, extremely physically active girl. It was that I couldn't stop being rebellious and overactive in situations where it was inappropriate, I knew it, and I wanted to behave differently, and couldn't unless every single ounce of energy was focused on it to the extent of not being able to participate, follow what was going on, etc.
Imagine this continuing into adulthood. You can't be in a graduate level class, important business meeting etc., literally sitting on your hands, and missing everything because your internal conversation is "don't blurt out, don't blurt out, don't interrupt, don't monopolize the conversation, etc. There are few things more destructive to self image and confidence than understanding you're screwing up, seeing others effortlessly adjusting, and your best efforts are failing miserably and you're getting beat up over it because "you're so bright and we expect better from you".
Medication calms my brain, and I can actually perceive what's going on rather than sensing somethings going on and I'm missing what it is. It's not a cure-all but it gives me a better chance of some filtering happening before my brain starts firehosing out of my mouth.
We only figured out the rest of us were ADHD after my niece got diagnosed and we started recognizing ourselves in her treatment. To receive the diagnosis was validation, grief, relief, and agony all rolled into one. It was such a huge relief to understand that I wasn't crazy, lazy, or stupid, and a failure as a human being for struggling with things I was told over and over again would work if I would just "apply myself consistently". And why I could make these enormous intuitive leaps but couldn't take care of the day to day project details consistently. (How can you do X the hard part so well and Y the easy part so badly? is a refrain I've heard all the way through grad school and career, and my experience is that women get a double dose of it because often they're expected to be even 'more' diligent about the little details for everyone else).
At the time my niece was diagnosed she was a year below grade for reading level and we couldn't understand how that was possible in a family of non-stop readers that were always asking her to read out loud. Within a couple of months of starting medication and tutoring she was on grade level and in less than a year she above grade level. Plus there were issues with age-inappropriate behavior that largely self-resolved once she could actually perceive the reactions of her peer group. And there is lots of ongoing drills and discussions about planning, goal setting, project management, timely homework completion to work on the executive functions gaps that come with ADHD. She'll start high school as an honor student next fall but we worry since she's struggling with consistent, on-time homework completion, and remembering to actually turn it in (this one I don't get, I'm ADD and getting routine homework done was hell, but I never had trouble remembering to turn it in if I'd done it!)
The biggest difference I've seen. People I know talk about how stimulants rev them up. The stimulants calm me down. Vicodin on the other hand - makes me hyper. They gave it to me when I broke a hand a few years back and the doctor was astounded when after 20 minutes I was pacing and talking non-stop and my answer to "how do you feel" was tight, wound up. He'd never encountered anyone who had that reaction to it, most people are like - relaxed, flying, etc.
Like the other poster - I would redo my childhood in an instant with an ADHD diagnosis. I spent most of it feeling like a failure because I couldn't "crack the code" and I was obviously bright enough I should be cable of it. So much self loathing it would have saved me. I take comfort in the fact that I work hard daily to be the best person I can and to help my niece in learning to manage what will be lifelong challenges without the emotional damage inflicted by well meaning but clueless she will encounter along the way.