Wednesday, December 10, 2008
ADHD Medication as Emotional, Psychological & Spiritual Lifesaver
In response to my post on spotting AD/HD from Sunday, a blogger I very much respect and some of his commenters wrote many words in opposition to the treatment of ADHD with medication. While some of them will at least acknowledge that some cases do exist where ADHD medication is warranted and beneficial, the whole discussion brought home to me the general issue that there are many people who completely deny the existence of ADHD, or at least the idea that it should ever be treated with medication.
Those who rail in opposition to ADHD medication fixate on the legitimate problem that exists when psychotropic drugs like Concerta, Ritalin and Aderall, which are used to treat the symptoms of ADHD, are used merely for classroom management, to make adults' lives easier. Just like we don't perform surgery on one person to relieve another person's pain, it is wrong to medicate one person (the child) because of the unpleasantness that child's behavior is causing in the adults around him or her.
Furthermore, they focus on the legitimate problem of drug companies financial gifts to some of the doctors who prescribe these drugs. Just as a lawyer is not supposed to receive financial benefit from a third party to influence the attorneys services to his client, according to legal ethics rules, so too it should be considered unethical for doctors to do so, though I know this is the accepted practice.
That being said, myopically focusing on these problems causes people's opposition to not only misdiagnosis of ADHD or overprescription of medication, but also to be against recognition of the reality facing those kids with ADHD in general. They claim that the whole thing is made up by drug companies. Or that it is just the kids choices, and if they would only learn a little self-control, they would be able to pay more attention in school... v'chulei v'chulei v'chulei.
Let me paint you a picture of a child with severe ADHD without medical treatment. This young boy (could be a girl too), from the age of 3, can't sit down in circle time. When they play games, he can't focus on more than the first step of the rules in the game, and forgets everything else. It is therefore no fun for the other children to play with him, since he messes up every game he participates in. He can't focus on the subtle cues given off by other people. So he talks to people, touches them, or relates to them in ways that they don't like without even realizing he's doing it. So other kids don't like to play with him and exclude him for their games. This is the beginning of his social problems, which just continue in similar ways as he grows older.
Academically, he doesn't suffer too much at age 3 and 4 since not much solid learning is done at that age and he has plenty of time to play during the school day. His problems get a little worse at age 5 when he starts learning the aleph beis. While the other kids are practicing and watching the Morah teach the letters, he can't sit still so he makes circles around the room, or is continuously sat back down or punished for not staying in his seat. In either case, he barely learns a quarter of the letters the other kids are learning because he can't focus or sit still long enough to learn them. He's very bright. He has a very insightful mind that thinks more freely, creatively and analytically than most kids his age. But since he can't read the aleph beis and that's the curriculum that year, his insightful and inquisitive nature doesn't get much expression.
Now let's go to first grade. They start building on the kids knowledge of the letters and begin to learn to read words with nekudos and start doing handwriting drills to learn to write. As the kids kriah (reading) and (kesiva) writing progresses, he spends the time either circling the classroom, in time-out for not sitting as he was told, or fidgeting/doodling/daydreaming in his seat. Needless to say, without even knowing all of the letters from the previous year, he certainly can't learn to read.
His teachers call his parents and speak to them at parent/teacher conferences frequently about his inability to function in the classroom, so his parents are getting really worried about him. They send him to get evaluated. The district evaluates him for a learning disability. They take him to the opthamologist to see if he is nearsighted. His parents work with him on getting his homework done every night. They try every form of star chart, weekly prize system and behavior modification technique that they can find. They take him to a therapist to work with him on his inability to do well in school or get along with other kids.
It's now near the end of first grade. He feels dumb and stupid every day in school because he can see that the other kids know how to read and write and he can't. He's embarrassed feels guilty about not being able to do the things the other kids can do. So instead of just sitting there like a failure, not being able to do what he's supposed to do, he runs around, he talks back to the teacher so he can get sent in the hall, away from the assignments he'd have to do in the room. He throws airplanes and makes jokes during class to make the other kids laugh. At least then they're laughing at how funny he is, and not laughing at him because his handwriting is an illegible scrawl or because he can't read the lines in the Sidur that the other kids can read during kriah.
Things go on like this through the lower grades. Every year's skills build on the skills of the year before and he just can't sit still or focus long enough to learn more than a fraction of the information the other kids can learn, despite his intellectual brightness. He soon learns that if he can't succeed in school and get good grades, there really is nothing for him to feel proud about.
As he gets older into junior high, it continues. His parents, teachers, Morahs, Rebbeim, Gemaras, Chumashim and Sidurim and frummie goodie-two-shoes kids make him feel befuddled become the source of his resentment. These things and people always remind him that he can't do what any normal boy can do. They remind him every day that he is stupid and dumb and can't do anything right or learn anything. Therefore, he runs away from davening, learning, Rebbeim & the "good kids" every time he gets the chance.
Maybe he goes off the derech completely in high school or afterwards because everything associated with Yiddishkeit in his life is also associated with rejection, failure, stupidity and frustration. He knows he's smart but the kind of thinking he knows how to do isn't valued, noticed or appreciated by anyone apparently. It could be that he stays "on the derech," but in form only, and not in substance. When he grows up, he gets a job that allows him to be boisterous, use his keen intellect, or move around alot. He certainly doesn't continue learning, unless he can go to a yeshiva or kollel where he can spend all of his time shmuezing, and not learning those dizzying words of the Gemara.
Now let's take that same kid in first or second grade. Except this time, his parents are advised by a couple of therapists that they might want to look into whether he would benefit from an ADHD medication. They look into it. After a couple of recommendations from a Psychologist and a try some ADHD medications. The first one turns him into a zombie with no personality and no appetite. That one goes out the door really fast. The second one they try works. There are no major side effects and they make sure he eats before taking it so that his loss of appetite won't cause him to eat too little. After a week on the new medication, they can see the results already.
In class when everyone sits in their seats learning something, all of a sudden he realizes that he has the ability to sit, listen and concentrate on what the teacher is saying too. He can actually sit and practice the in-school and the homework assignments. They become tolerable and he starts getting "checks" and "check pluses" on his papers. Hey, this feels kind of good. He keeps at it and within six months, he's caught up to his grade level.
This keeps up and as he gets older, in middle school, they start learning Gemara and literature in the English department. Since he can get past the basic language skills on an average level (not the top of the class, just average, though that's okay!), he can actually get into the discussions about the Gemara since he understands what it's talking about. He can actually ask better and more insightful kashas on the Gemara than the other kids, since he can get past the technical skills. He begins using that flying/whizzing mind of his for real analytical problems. The Rebbe is very impressed. He has frequent experiences of legitimate successes every day. He feels good about yeshiva, the Rebbeim, the Gemara, etc.
His life isn't any more perfect than any normal kid, but at least he feels like a normal kid. And one day, when he's out of high school and he can make his own choices about what kind of school he goes to and what he does outside yeshiva/college. He does things that fit his energetic/hyperactive/creative/analytical/outgoing nature. He no longer needs the medication because he's not a kid anymore. He still has ADHD, but he doesn't have to sit in a seat for 8 hours of class and 3 hours of homework every night anymore. He can do creative and exciting things with his life that he chooses and which fit his nature and personality.
Let me just tell you a story from a Child Psychologist friend of ours. She was working with a little boy who had ADHD. She saw him every week, the parents worked with him and eventually his parents decided to put him on ADHD medication. After about a week on the medication, our friend asked the little boy, "Do you feel any different now that you're on the medicine?" He answered her frankly that, "No, I don't feel any different. But boy, this medicine sure is helping my Mom and Teacher!!! They used to be so mean to me and make me do hard things. But ever since I started this medicine, they are so much nicer to me now and they started giving me easier work. It really is helping them!" I think that about sums it up.
Do the above very realistic scenarios mean that every kid with behavior problems should be on ADHD medication? Obviously not. If a kid has behavior issues, but doesn't have the indications of ADHD or is able to keep up with his or her grade level in school, then it's really hard to see any justification for putting the kid on such a strong medication for the behavioral difficulties alone. But for those kids who need it, ADHD medication is a lifesaver, and should not be withheld for hoity-toity ideological reasons, or just because some other kids are getting it even though they shouldn't.
For symptoms/indications and info on treatment and medication, please see THIS POST, where I link to good resources to determine if your child actually has ADHD.
(Picture courtesy of adhdtreatment)
Click here to get Dixie Yid in your e-mail Inbox or here to subscribe in Google Reader.