Blogger asks: To Ritalin or not to Ritalin?
Interesting timing: After reading today that many kids diagnosed with ADHD may not actually have it, I came across a moving first-person piece on the disorder.
Unlike some of the children in the aforementioned research, it seems clear that writer Joe Newman most definitely did have ADHD: In his MomsRising essay, he tells of being a difficult, aggressive toddler (“By age three I’d learned how to use the screwdriver and began taking everything in the house apart’) and an even more difficult, aggressive grade-schooler (“By first grade I was getting into fights every day at school.”). He was put on Ritalin in the second grade, and he shares in the piece how he viewed his disorder and treatment as an adult:
Ten years later I still carried the shame of being A.D.H.D. It had been a secret no one but me, the doctors and my parents knew. Ritalin was the disguise I needed to survive behind enemy lines. Every time I took that pill, I also swallowed the belief that I was broken, disordered and not like everyone else. But the last ten years had begun to teach me something else.Instead of being the one who couldn’t sit still, I was the one who kept moving and got a lot done. Instead of being unable to focus on one thing, I was able to do several things at once and adapt quickly. Instead of being too impulsive and aggressive, I was spontaneous and driven. Instead of asking too many questions, I was a good problem solver. Instead of being unable to follow the rules, I was creative and unafraid to take risks. The flip side of those characteristics that had been called a disorder, and needed fixing with medication, were actually my strengths.
Newman, who now works as a behavioral specialist for children, doesn’t come across as particularly pro- or anti-medication – but he encourages parents to think carefully when making the decision about treatment. Ritalin is “a two-edged sword and not a silver bullet,” he says, and today’s parents – unlike his own – have other options.
Photo by FGMB
August 17th, 2010 at 8:37 pm
After reviewing the new book, Mistaken for ADHD, I was especially interested in this new study showing that 1 million kids are misdiagnosed. Most likely the number is far higher because there are 52 conditions that mimic ADHD. As the mother of a child diagnosed with ADHD, who later discovered he did not really have it, I have to say that this book is required for every parent.
August 18th, 2010 at 9:23 am
Hello,
I don’t think most parents need to be encouraged to “think carefully” about the decision to pursue medical strategies for their children’s medical condition.
Many have been scared out of their minds by so much mis-and disinformation on the Internet. Amidst all the fearmongering noise and admonitions along the lines of “don’t medicate away your child’s gifts!”, it’s a wonder any of them can make a balanced decision.
I would like to say I am surprised to read such a naive perspective on a Stanford blog, but sadly, I am not. Stanford has a very poor track record when it comes to ADHD, as far as providing knowledgeable evaluations and treatment to members of the public seeking help there. Especially adults. And the Bay Area, in general, is like the Third World of ADHD expertise. We look to the East Coast — Harvard and UPenn, in specific — for that.
It has been very popular the last decade to view ADHD as a “gift.” And while that has brought some amount of needed balance to the issue, it has also increased a sometimes-too-frequent way of viewing the issue in a binary way. Gift or Disorder. Medication or behavioral strategies. Often, the wiser perspective is “both and.” That is born out by the studies.
In fact, “black and white” thinking is not uncommon people whose ADHD symptoms remain unrecognized and unaddressed. And so the Gift message has been eagerly embraced by those who feel all “Disorder.” And that’s especially true for those whose care in childhood was, to put it mildly, not done in the most enlightened manner (“Here, take this Ritalin, so you can be tolerable.”)
The answer, however, is not to pander to those who have either developed “emotional baggage” around ADHD due to poor treatment of it or to prop up “self-esteem” by spinning deficits as gifts. What breeds self-esteem and even a strong self-concept, which is often lacking in people with unrecognized ADHD, is success, say the top ADHD experts. And that is done with evidence-based strategies, not feel-good pablum.
The answer is to be very clear on the facts of ADHD and to take each person’s manifestations of its symptoms on a case by case basis, humbly but knowledgeably.
The very idea that a Stanford blog would still talk about Ritalin when so many better delivery systems exist for stimulant medication shows that your information is very outdated. And, if you haven’t read the study yet (about children being wrongly diagnosed with ADHD because they are younger), you really need to do that first before re-stating it as fact. You are, after all, writing a medical blog, right?
Ritalin is not a “two-edged sword.” The stimulant medications that are the first-line choice for ADHD can remarkably reduce problematic ADHD symptoms, when properly prescribed and titrated. Trouble is, many physicians are too haphazard in both areas. Thus, “flattened affect” and other unnecessary side effects. And many parents are too cowed in the presence of an MD to do their own research and advocate for their child. (The fact that many parents of children with ADHD also have this highly heritable condition, but don’t know it, often adds to the confusion.)
Today’s parents, unlike Newman’s, do have “other options.” But lest they be deceived, most children with ADHD do not outgrow it. And, while you can control a child’s environment at home and at school, providing external structure, you cannot do that once a child leaves home. And that, unfortunately, is when unaddressed ADHD symptoms can truly create trouble. I know many, many parents of adult children with who look back with regret that the did not take the medical remedies more seriously.
Remember that during the teen years, the human brain reorganizes itself on a monumental level, stripping away pathways needed for childhood development and readying for those of adulthood. It could well be that, not given a chance to internalize certain developmental milestones, there is little chance later. THAT is something to think seriously about, too.
Please also keep in mind that “denial” is a common component of ADHD. It is easy for some people with ADHD to “spin” their deficits into gifts — as long as there is no independent corroboration. ADHD is not ADHD unless there is impairment. That’s required for the diagnosis.
Please try to do better medical research for your medical stories. It is important.
Thank you,
Gina Pera, author
Is It You, Me, or Adult A.D.D.?
August 18th, 2010 at 12:54 pm
Thanks for the comment, Gina. I linked to Joe Newman’s piece because I thought it was an interesting and well-written perspective. His views are his own (they’re not Stanford’s, or even mine) and whether you agree with them or not, they’re obviously thought-provoking.
August 18th, 2010 at 5:10 pm
Hi Michelle,
Yes, I understand that you saw Mr. Newman’s perspective as “thought-provoking,” but that’s the problem.
This “perspective” has been hashed and re-hashed in the media and online for many years now, and there’s as little substantiation for it now as there has been for many years. It is most often found among people who are selling an “alternative strategy.” Always unproven and typically idiosyncratic.
The fact that you call Newmann a “behavioral specialist for children” is equally disturbing. Did you vet your source? On Mr. Newman’s webpage, it says he received a masters degree in organizational management from Antioch University. How does that qualify him as an ADHD expert?
He has taken his own apparent experience as a child with ADHD who was given Ritalin years ago and made it into a cautionary tale for parents today, who have access to much better information and evidence-based strategies for ADHD. This is not responsible.
What he does is his own business. Maybe he’s very helpful to children. Maybe not. But the point is that, as a blog representing a medical school, research on sources and studies should be a little more rigorous. This is an important topic, and should be treated with respect.
Thank you.
Gina
August 19th, 2010 at 5:06 am
Full marks to Stanford for doing your bit to keep the debate on ADHD/Ritalin going, it’s right that the subject is debated, and debated by a wide variety of people not just one or two experts.
From a European perspective, we perceive that doctors in the USA have a tendency to over medicate to overcome problems, generally as well as specifically.
Here in the UK many parents are encouraged to make changes to their children’s diet to alleviate/negate symptoms associated with ADHD before doctors prescribe medication. Apparently with some success in some cases.
I see less of this in the US, but I spend less time in the US these days so my opinion may be out of date.
One thing I think we’re all agreed on is the need for further investigations on the effects of long-term methylphenidate use by children – we don’t have all the answers and some of the questions are quite profound such as when/how to stop the medication.
August 19th, 2010 at 6:09 pm
For Gina – What you seem to be missing here is that this article is only talking about Ritalin, not other medications. It seems that you’ve jumped down the throat of the wrong lion here. In researching your background, I could only find credits to your being an editor. I believe you might be a good editor(except for many typos in paragraph 5 that made it quite confusing to read), and maybe a fine researcher, however what kind of medical credentials do you have? Are you a person who has this condition? Do you speak from the heart like Mr. Newman? He seems to have an open mind about ways to deal with ADHD, and I certainly think any idea that is thought provoking is a good idea, on any subject. I’ve followed some of Mr. Newman’s blog entries as well as videos, and while he might not be a behavioral specialist for children, everything I’ve read or seen from him hits right on, and I’d say his own experience with having ADHD and working one on one with kids who are diagnosed as well, makes him much more of an expert than an editor. Forgive me if I am wrong, but I’d assume that if you did have ADHD or any medical background, it would be on your bio page as to why you’ve shown such and interest. I appreciate that you’d like a more professional view from Stanford, but some of us enjoy all kinds of views, a quite enjoyed this article, and its origin.
August 23rd, 2010 at 5:18 pm
I’m a tad late to this train, but if you’re still interested…
I’d like to pose the question—which is worse:
1) taking stimulant medication at an early age and “suffering” from a flat affect and perhaps feeling “medicalized” by not feeling like all the other kids, or;
2) suffering from the inability to focus long enough on any given goal, such that positive structural habits involving achievement are not formed, most likely resulting in serious mental illness as an adult from not having developed the focusing skills necessary for long-term success?
I hate to break it to everyone, but the number one element in a life of success (no matter what you choose to be successful in), is the ability to focus on your goal and meet sub-goals along the way over a long period of time (sometimes years). Without focus, it’s nearly impossible to achieve much of anything.
Developing good focusing skills in grade school is crucial, since the longer one goes with poorly developed achievement skills, the longer those poor skills are engrained in a person’s psyche–both psychologically and neurologically.
While simply taking a pill is not *sufficient* to ensure success, for those who really do suffer from ADHD it is absolutely *necessary*. We are talking about a neurochemical process that cannot be changed via cognitive-behavioral therapy alone. It’s a structural thing–in the chemical sense–which needs a chemical change to be introduced.
I’d rather see children over-diagnosed than see the ones who truly suffer from a horrible, life-long mental disorder go untreated and unhelped. If anything, stimulants may serve as a cognitive enhancement for the kids who may not have ADHD, which is less a problem for *them* than it is unfair to the kids who really do suffer.
I’d rather not feel like everyone else as a kid than not feel like everyone else as an adult…
August 24th, 2010 at 2:46 pm
S. Conner — Google my name and that of my award-winning, bestselling book, which has many endorsements by top medical and psychological experts as well as the foreword supplied by the preeminent research scientist in the field of ADHD.
The book title is “Is It You, Me, or Adult A.D.D.?”
And I stand by all my statements. I suggest you continue to educate yourself on this important topic. You might like “all kinds of views,” but on a medical school’s blog, I prefer views that are evidence-based.
August 24th, 2010 at 2:53 pm
DREVILEPHD –
I agree with you, to a point.
I’d prefer to see improved diagnostics and treatment regimens, so that each child receives the type of treatment that is needed, whether it is behavioral, nutritional, allergy-related, or ADHD.
As it is, the standard of care when it comes to ADHD alone is, for the most part, deplorable. We give more attention to foot orthotics and eyeglass styles, it seems, than to the protocols required for administering ADHD medications properly.
In fact, it seems that most physicians do not even know there IS a protocol for ADHD medications, which is why I included it in my book (as provided by a top ADHD expert, Margaret Weiss, Ph.D., M.D.). My hope was that readers could take the information to their physicians and encourage them to read it.
I would also like to see a greater degree of functional medicine applied to people diagnosed with ADHD. Some physicians seems to know even less about vitamins and minerals or food sensitivities than they do about ADHD medications, and that is deplorable in a wealthy, educated society (and I’m talking specifically the Bay Area, not the hinterlands).
An excellent blog on these topics is that of Dr. Charles Parker, who has also written an e-book on “Paying Attention to the Medications for Paying Attention” — http://www.corepsychblog.com
Gina
August 24th, 2010 at 3:00 pm
Sanitizer —
I have to say your words betray woeful ignorance on this topic.
There is an international medical consensus on ADHD as a legitimate medical disorder, not “one or two experts.”
Keep in mind that one obstacle to better treatment in countries with socialized medicine is a desire to keep the costs down. This desire is unfortunately short-sighted, as untreated ADHD leaves a person vulnerable to a variety of adverse outcomes — including substance use disorders, traffic accidents, on-the-job injuries, divorce, bankruptcy, under-education, and under- or unemployment.
I believe you in the UK have an epidemic of alcoholism. You’d do well to look at the associated between untreated ADHD and addictions.
We know very well the “side effects” of untreated ADHD, and the stimulant class of medications is one of the most studied — over 50 years.
Gina Pera, author
Is It You, Me, or Adult A.D.D.?
http://www.ADHDRollerCoaster.org
August 27th, 2010 at 1:25 pm
I would like to comment with regard to the three posts from Gina Pera regarding my blog entitled “To Ritalin or Not to Ritalin.”
I am encouraged that so many thoughts and feelings are raised because of a two-page blog. But this subject is so explosive is because the stakes are so high. We are dealing with the development of the next generation and all opinions are strong because the people involved care deeply about the outcome. I deeply respect the people who explore this topic every day. I am also a person exploring the many paths we are on and, perhaps, could be on with regard to raising the next generation.
Ms. Pera speaks as if looking at your dynamic with your child makes you a bad parent, or that suggesting parents look more closely at this dynamic is blaming the parent. I would suggest looking at parenting in another way; as a relationship that needs work all the time. If a person was to run into trouble with their husband or wife and decided to seek counseling, on every occasion the counselor would encourage the person to look at their own dynamic in the relationship – is there something they could do different? Are their expectations realistic? Do they need to say what they mean more? How are their boundaries? As we would respect a person who could take a good look at themselves when they were unhappy with a mate, let’s respect, and encourage, the parent who can look at their dynamics with their children and try to facilitate a more healthy relationship that nurtures the child’s growth. After all isn’t the relationship between a parent and a child at least as complex and important as between husband and wife?
My blog encouraged parents to look first at behavior intervention strategies because of the success I’ve had using them with all types of children. Most of the children I’ve seen during the last 20 years had behavior intervention plans that were deeply flawed, based on incorrect assumptions about the root causes of many of the behaviors, and were poorly or inconsistently administered.
When these children were given behavior intervention plans that weren’t flawed, were based on a correct understanding, and were applied properly and consistently – outstanding progress was achieved. In most cases when this is done the need for medication to control behavior is mitigated. In some cases the need for medication is eliminated.
I find it frustrating that most parents don’t yet have access to, or knowledge of, behavior intervention strategies that are effective and comprehensive but his will not be remedied by discouraging them from exhaustively seeking options to medication.
Lastly, as to Ms. Pera’s assertion on the momsrising.org blog that my ““medication regiment” was no doubt sub-sub-optimal. As evidenced by your challenges, including abusing alcohol” and that I clearly lacked any “psycho-education”. My doctor between 1971 and 1977 was Larry Silver, MD perhaps the preeminent doctor in the field at that time. Dr. Silver is the author of more than 150 publications on learning disabilities in children and remains one of the great minds in the field. I met with him every other month during those years for “psycho-education”. And the drinking I refer to in my blog occurred two years after the discontinuation of my medication regime.
While I appreciate Ms. Pera’s vigorous efforts to educate parents about the effectiveness of proper medication for children with ADHD I work toward the day when medicating our children becomes the alternative and effective behavior intervention becomes the first step in addressing their difficulties.
Joe Newman
RaisingLions.com
September 3rd, 2010 at 9:10 pm
Mr. Newman,
Back in 1971-1977 the medication options for people with AD/HD were minimal.
This is 2010, and there are many, many effective medications that can help people live happy and productive lives. My husband has AD/HD and took Ritalin for 10 years. He was diagnosed with AD/HD during his last semester at law school. He compared taking Ritalin for the first time to putting on a pair of glasses. Many times he has told me that he wishes he would have been diagnosed with AD/HD and had begun earlier in life.
Yes, Ritalin was helpful, but it was not enough.
Gina Pera is highly respected by AD/HD researchers throughout the world. Dr. Russell Barkley, who is arguably the preeminent AD/HD expert in the U.S. today and a keynoter at the national CHADD (Children and Adults with AD/HD) conference, wrote the foreward to her book.
After reading Gina’s book and being a part of an online community that she moderates, I sought out a Bay Area psychiatrist for my husband. He agreed to go and was prescribed a medication regimen that has completely turned his life around. He takes Concerta, which is basically a form of slow-release Ritalin, so he doesn’t have to deal with the stress of “coming down” from Ritalin, which he used to have to take several times a day. (Why ANYONE would take Ritalin in the year 2010 when there is a drug made of the same ingredient that only needs to be taken twice daily is beyond me!) He takes another med, Lamictal, along with the Concerta.
I cannot tell you how much of a difference this med regimen has made in his life! He has a very high stress job — he manages 100+ people at a tech company, and last year he received a “general manager of the quarter” award! Over and over again, he has told me that without this current medication regimen — which is much more effective than Ritalin — there would be no way that he would have been able to keep it together at his job.
Yesterday we were both at a doctor’s office when we both saw a magazine ad for a clinic for kids with AD/HD with an anti-medication bent. The title of the ad was “Pills over Skills” He said to me, “Yeah, that’s like telling a kid who with bad eyesight that if they do enough eye exercises that they won’t need glasses. How cruel!”
Biological disorders (such as AD/HD) need biological solutions like medication. You see, I live with a success story, so I’ve seen the evidence.
September 3rd, 2010 at 9:24 pm
One more thing I’d like to say is that I agree with Gina in that the Bay Area is like the Third World of AD/HD expertise. There are no psychiatrists in San Francisco who get AD/HD. My husband has to drive 45 minutes out of the city to the one and only psychiatrist here whose prescriptions for people with AD/HD actually deliver positive results.
The fact that Stanford Medicine would even publish an opinion piece that has no studies to back it up is embarrassing. What’s next? A piece about autism being caused by “refrigerator mothers” (a la Bruno Bettelheim) that’s “interesting”, “well-written” and “thought-provoking”?
I’d much rather see articles and blog entries that are actually grounded in science.
September 19th, 2010 at 8:58 pm
Hi Iowa,
I’m glad to hear your husband is doing well. General manager of the quarter! That’s wonderful.
g