ADHD & MEDICATION: BEHIND THE HEADLINES

ADHD is a relatively ‘new’ condition - it’s only been around for the past 50 years! - which has surfaced over the past five years to grab headlines and raise issues that were previously never really of that much interest to the media. ‘Kids on Drugs’, ‘Doctor accused of drugging children for naughty behaviour’, ‘Ritalin – the new mind-drug for naughty kids’. Interesting stuff eh?

So much of the publicity surrounding ADHD has been negative. Sure it is headline grabbing and makes for good reading, but what really lies behind the headlines - could parents be drugging their kids just because they won’t do as they are told?

ADHD children can be both a joy and a challenge to parent – there are four main types of ADHD:

• 1) Primarily Inattentive 
• 2) Hyperactive-Impulsive 
• 3) Combined 
• 4) ADHD Not Otherwise Specified

This last type means that there are lots of the features of the condition but they do not meet all of the strict criteria for giving a diagnosis. It is the Hyperactive-Impulsive type which have recently been shown to have levels of ability often in the superior range, but they are really the most challenging of children.

I guess it is because you cannot actually SEE the disablement which ADHD causes that some people find it hard to accept that this is just what it is – a disability. The Hyperactive-Impulsive types are always on the go, both mentally and physically. They are often called ‘High Stim’ (short for stimulation) types in the USA because they are always looking for excitement and stimulation – in a child this can take the form of causing a fight or confrontation in the playground and in adults bungee-jumping, having extra-marital affairs, or other types of high-risk activity! Unfortunately some teens with high-stim ADHD often look for stimulation and excitement in areas such as crime and substance abuse – it is after all quite exciting being chased by the ‘cops’ in a stolen car through narrow suburban streets!

Parents often find these Hyperactive-Impulsive type children so challenging that, after they have tried all the possible alternatives such a behaviour management, alternative therapies, dietary modifications and other avenues too numerous to mention, they eventually agree to try medication.

Medication usually takes the form of a stimulant such as Ritalin or Dexamphetamine; anti-depressants have also been useful in treatment of ADHD. We are still unsure exactly how these medications work, but work they do! The publicity surrounding stimulant medications has not exactly been conducive to parents being able to make an informed choice about their use. When working with parents as a Coach I take the approach that this has to be their decision, that if their child were to turn to them in 15 years time, what would they want them to be saying? The reply is often the same – that they have tried everything else and it didn’t work so this is a compromise, the best they can do with the knowledge that they have.

Giving your child medication is not an easy choice, especially when you know that it may have side-effects (there is much evidence to disprove this). Medication may also be a lifelong support for people with ADHD and I work with many adults who also take medication, having been diagnosed late in life, and cannot believe the difference it makes.

For us with Noah, medication was and still is a compromise: yes it does make him a little more subdued at times than we would like and yes it does suppress his appetite and make it difficult to get off to sleep. But he can concentrate in school, make friends, be accepted and lead a relatively normal, healthy life the way a bright, active 12 year-old should! For this we are so grateful. He really does not like to be different so we ensured he had the longer-acting (6 hours) form of Ritalin so he only has to take one tablet in school. Noah tells boys who enquire what he is eating that they are mints or Asthma tablets! Ideally he should have another tablet but this is too difficult for him to disguise – so again we have compromised; maybe he could get better grades in school if he had another tablet, but for us his self-esteem is more important. So we make do with a score of 88% in tests instead of a probable 96% on more medication – not bad eh!

Medication for ADHD is advancing rapidly – there is now a 12-hour form of Ritalin available and there are now ways of detecting just how suitable your child would be for medication by scan. Often it is trial and error to determine the right dose at the right time for your child and one aspect of my role is to support families going through this stage.

Parents often ask me what happened when I gave Noah his first tablet. He was barely six years old at the time, it was just before the long summer holidays and I knew that I couldn’t cope any more without some form of support. We had tried everything and were so low we just knew that this was our last hope. It was a warm summer evening in July and my GP listened patiently as he had always done in the past. I poured forth with events, situations and episodes which I could no longer handle, I admitted that I was so afraid that I would hurt him. My frustration exploded in a torrent of tears – I had given in and admitted defeat, I truly felt as if I had failed. My GP knew Noah well; he also knew me as a Children’s Nurse and was so supportive. One phone call to a Consultant Child Psychiatrist later and we were walking out of the surgery with what was to prove our lifeline, the window to a future for our family, something I had gravely feared would be closed to us forever.

I waited until Buzz (my husband) came home and tearfully explained that this was something I just could not do, and he said he would give Noah the first tablet. I watched in a mist of despair, sorrow and hope, trying desperately to hide my tears as Buzz explained about the tablet and what it would do. I watched my trusting son take the medication that we had pinned so much hope on. He accepted the explanation, quickly swallowed the tablet and skipped upstairs. That was it, it was done, there was no going back.

Buzz and I were talking about the medication and what we expected would happen when all of a sudden I realised how much time had passed since we had given the tablet. In a panic I bounded up the stairs – it was too quiet! He could be dead, anything could have happened! I scanned the top bunk – he wasn’t there OH MY GOD – my eyes darted to the window (I should add that we had recently found him in the windowbox outside his bedroom). ‘Hi mum,’ a small voice squeaked from the bottom bunk. Noah NEVER slept or even played on the bottom bunk – it wasn’t high up enough or exciting enough for him! I staredmouthed, hardly daring to believe the sight which met me. My son was lying stretched out on the bed READING A BOOK! ‘Mum, are you okay?’ I must have been staring too hard with my mouthfor too long! ‘Yes hon, I’m fine, what are you up to?’ I could feel the tears pricking my eyes – Noah never read a book, or laid down and concentrated on anything for more than a few minutes – this was truly a first! ‘I’m up to page 6 mum, and it’s really good, can we buy some more Roald Dahl books like this?’ I nodded my head in silence, too emotional to speak.

I leave you with these thoughts until next time:

That day, we found our little boy – a wonderful, lively, intelligent child with fantastic ideas, a great sense of humour, creative and spontaneous and a true love of reading – what a window of opportunity had beend for all of us and for this I will be truly grateful for the rest of my life.

Jan Assheton RGN RSCN is an Attention Deficit Hyperactivity Disorder (ADHD) Coach and Learning Mentor and the mother of a child with ADHD. She will be sharing the benefits of her personal and professional experience every two weeks.