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.
Point:
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.
Counterpoint:
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.
Conclusion:
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.
-Dixie Yid
(Picture courtesy of adhdtreatment)
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27 comments:
Nice post, and I agree with a lot of your points, although it has been shown that there are alternate modalities of treatment that work well for ADHD, but they are more time-attention-energy-(money) consuming for parents and teachers than many can afford.
One point you glossed over was the eventual weaning off of the meds. It is not true that every adult transitions out of their meds easily. Hence the continuation of prescriptions into college and beyond (because they "improve functionality"--of course they do, they're speed), and attendant abuses like med trading and selling among friends, and just plain sticking with it because speed happens to sharpen you up nicely as an adult. I have known plenty of adults who kept up the Ritalin habit way past its time for just this reason. Not a pretty picture. Something to consider.
Rebbetzin Golshevsky,
Thank you for commenting. Just like one should only start the medication when necessary and after considering all the options, the same thing should be applied when getting off the medication as an adult or young adult. Just like any thing that is good in its proper place, it can be abused or used wrongly. Although when it is needed, the mere posibility of future abuses should not cause parents to withhold it from their children, you are right that these possible abuses in the future should be known and compensated for by making sure the kids know when it's time to stop.
You are right on a technical level that these medicines are "speed." But this can be a bit misleading in the case of ADHD. The medication, which is a stimulant, can make regular people hyper. But people with ADHD have the opposite reaction. The brain's ability to focus and control attention is underactive, causing the attention deficit and inability to control and focus energy, also leading to the hyperactivity aspect of it. The ADHD medications are a stimulant and therefore stimulate the brain's ability to moderate and focus its self. That's why these stimulants have an ironicly calming and focusing effect on people with ADHD.
Kol tuv, thanks for the support and the he'aros!
-Dixie Yid
If it were up to me, I would actually use this effect as the diagnosis criterion for ADD. Regardless of which med the doctors prefers to use full time, first try Ritalin or another caffeine-related drug. If the child slows down rather than bounces off the walls, they need real help.
There are psychiatrists who base their entire diagnosis on what the mother says when they get to the office. In fact, it's hard for a psychiatrist to get much other data to work on. Therefore, the slippery slope is inevitable -- unless we have a hard-and-fast criterion. (A decent metaphor for why halakhah requires shiurim.)
I'm not sure Dixie Yid's explanation, which is the usually given one, entirely explains why stimulants slow down the child who has ADD. One of my sons (HS age) recently fell asleep in shul on Friday night because he was groggy after the can of Coke he drank before we left. Lethargy, not focus.
Which brings me to another issue... Medicating a child to help them manage through school is only a difference in degree from my cup of morning coffee to manage work despite sleep debt, or a chassid who uses a bisl mashke to help him drop barriers and fully experience the spirituality of the religious experience?
Once one makes it an either-or, by saying we're medicating rather than dealing with fixing middos, one has raised a question about these crutches as well.
-micha
PS: Why does it take so many Arabic letters to spell "Yid"?
Micha, I hear what you're saying. There is a relationship between crutches like caffeine or "ah bis'l mashkeh" and medication. Though in those situations when it would seem that medication is warranted, the distinction between those crutchdes and medication is more pronounced. When a kid needs the medication, *in general* his problems aren't ones that he could get rid of just by trying harder or working on his midos. They're more of an actual *inability* which would distinguish it from people's uses for caffeine & mashkeh. Of course none of this precludes the fact that with tefillah, Hashem sometimes nullifies nature and makes nisim for people, as is known by Tzadikim like Reb Zusha.
I would be curious how anti-ADHD medication people would explain that inconsistency that you point out in their position.
You're correct in pointing out that in general, a good barometer of whether medication is really warranted for a certain child is whether they "speed up" or "slow down" with the medication.
Another big big threshhold test in this issue is whether the child is falling far behind in school and his or her inability to focus/concentrate is *that* unadaptive for functioning in school.
-Dixie Yid
P.S. I don't know. But that's how Google translator says you say "Southern Jew" in Arabic. :-)
DY, this was a great post. Thanks so much.
Oh...I fall into that "adults who use coffee"
The coke might make your son crash because of the ten teaspoons of sugar in one can. They send you sky high and then you crash. The caffeine is a different thing.
Thanks DY for your concern for our kids. However, I cannot agree with what you wrote.
1) You had a cute story there where Yanky had trouble in school, he took his drugs and lived happily ever after. Real life doesn't always mimic such fictional tales however. Also, you describe a very extreme case. How many of the multitudes of children who are drugged with an ADD 'diagnosis' are in such extreme situations ?
2) I see that you are very invested in this. I assume that it is due to personal experience with it.
3) You are right, people should not be drugging themseves with coffee either. Those of our houses of worship that have turned into coffee bars should get rid of it and clean up their act.
4) For a good look at what is going on, I highly recommend the book 'Our Daily Meds' by Melody Petersen, a former NYT reporter (see www.ourdailymedsthebook.com).
L,
It seems like you missed the point at the beginning specifically written regarding your point number 1. Where did I say that all kids who are given medication need it? I specifically said that it shouldn't be given if the kid doesn't need it *for that child's own benefit.* But nor should kids who need it have it withheld from them just because other children are given it when they shouldn't be.
Reacting in a knee-jerk way against medication even in a scenario where it was clear that there were evaluations, many options were tried, more than one opinion was received, etc. indicates that you fall into the one-size-fits-all blanket no medication rule.
I cannot condone such an approach which places your personal anti-medication ideology over the needs of an individual child. It would be good if you came to understand that not all answers are right for every single kid.
-Dixie Yid
A well-regarded proponent of natural medicine once said, "We know that caffeine is used as a drug, because it's the only 'food' whose consumption people describe as: 'I'm a three (or whatever) -cup-a-day person'."
That's not a food comment, that's a prescription!
Dixie Yid, the exact mechanism of how the stimulants work differently has less to do with ADD/ADHD responses and more to do with childhood. A number of drugs invert their effects when taken by children. The unpredictability of individual responses is also why drug regimens aren't fixed, and why sometimes a kid is rotated through several drugs before the right fit is found. (This is true of all psychiatric meds--you only know if the fit is good after a trial period.) So what worked one way during childhood can work differently in adulthood.
Anyway, speed *is* a focuser--for adults too. That's why people like amphetamines. B'kitzur, caveat emptor when it comes to medicating children--these are powerful chemicals.
p.s. One thing no one mentioned is the out-of-the-ballpark imbalance between ADD/ADHD in boys as opposed to girls. Some might say that the mass medication of boys is because of the overall feminized expectations of school systems, something that many educators agree has changed over time. Young boys are expected to be as manageable as young girls, a demand that seems a little unreasonable considering the testosterone load. Separate education also means that teachers should be better able to focus on the particular educational needs of their charges. I would hope that this means that fewer children (boys) are medicated in the yeshiva system, but based on what I see I'm not so sure.
I personally know of a teenager whose life was changed with the use of ADHD medication. Before the medication he was desperate, he couldn't learn in school, he was facing life as a school-dropout.
A kind doctor told him that he was "extremely intelligent" but needed some help in the concentration department.
He took the medication for 4 years, his last years of school. He managed to get thru these last 4 years of school, his self-esteem rose to new levels, and he is now a mensch. All because of a little pill that enabled him to focus in the classroom.
It was the doctor's words as well as the medication that brought about his change. ADHD kills self esteem. The medication can restore not only the ability to concentrate, but the way the child feels about himself and his abilities which have been suppressed to to the ADHD.
Another note to L,
From the Q&A section of the book you referred to: "But can’t medicines help us? - They absolutely can – if you get the right drug at the right time. The problem is not the medicines." She goes on to discuss the problems with how drug companies market the drugs, which I also addressed in the main post. And like I said there, it's nonsensical to make blanket-anti-drug rules when the drugs are not the problem. Inappropriate prescriptions are the problem. So one shouldn't let their kid get perscribed if it's not appropriate!
Rebb. Golshevsky,
You're right that it's serious business. That's why, like any perscription medication, it should be monitored for changes in effect and changed, dosage reduced or increased as needed. Furthermore, there has to be a cost/benefit analasis of sorts. The parent needs to look at the benefits and costs emotionally/psycholgocially/educationally/self-esteem-wise in not using the medication, as well as the side-effects and benefits of the medication. If, for a particular child, the side-effects and risks of the medication are large relative to that child's need for them, then it would be a bad idea. If however, the costs of staying off the medication are much worse than the side-effects of going on the medicaiton, then it would be important to start the child on that medication.
But you're right that the factors that you mention must be in the mix of considerations.
-Dixie Yid
DY - I have been watching this matter for some time. Please do not refer to my reactions as knee jerk reactions, when they are very considered and the product of much thought, observation and study.
I know a doctor (MD) in Brooklyn who, a number of years ago, wrote in a Jewish newspaper about the problems he sees with kids who have been given stuff like Ritalin. He said that it was often a gateway drug, and kids on it, often went on to illegal drugs.
Re the book I recommended - I recommend that interested readers get their hands on the excellent book. A brief look at the website is not an adequate substitute. If they can't do so right away, they can listen to some interviews with the author online.
I consider the drugs very dangerous. Just because they seem to 'work' in the short run at times, doesn't mean that they are not doing serious long-term damage. Perhaps the klal of שומר פתאים ה can be invoked here, but that can be questioned.
May Hashem help us.
L,
It sounds like you are confirming that you are opposed to medication regardless of the nature and benefits to the child. And although you lack objective evidence of any long term damage that would outweigh the risks in cases where the medication is needed, you still oppose it dogmatically.
All I can say is that you should remember that "bari v'shema; bari adif."
-Dixie Yid
I think anytime we consume to feel better, we are opening the door for more. Does that make it a bad thing? I don't know the answer to that. That's why I don't get the concept of 'gateway' anything. It's just meaningless to me.
I know two adults who believe they have ADD/ADHD. I can see why they have both been labeled this way. One is medicated legally and has also engaged in a bunch of the illegal stuff.
The other has never been medicated because his parents wholesale rejected the idea that kids should be medicated. Historically he has taken large amounts of intense, illegal drugs, in wreckless ways.
I agree that in some cases there are side effects to not medicating that can be worse than the meds.
"although you lack objective evidence of any long term damage that would outweigh the risks in cases where the medication is needed"
On what do you base that statement on? For one thing, I just cited to you testimony of a doctor who operates in a very frum area in Brooklyn. What is he - chopped liver ?
The pharmaceutical industry and and its allies are under a cloud of suspicion and have lost their chezkas kashrus, which can be loosely translated as presumption of innocence. Their credibility has been severely compromised by recent revelations about their sneaky, dishonest, and manipulative practices for short-term gain.
We have had some other big bubbles burst recently (stocks, real estate) and it hasn't been pretty. I would recommend that people heed the warning signs now and stop assuming that big pharma knows best, rather than wait until it gets worse.
L,
While "big pharma" uses aggressive tactics to sell their products (all products, not just ADHD medications - are you going to stop using heart drugs too because of drug company marketing?), your mistake is relying on the idea that all information comes from the drug companies themselves. Psychologists (who can't prescribe), special ed teachers (in addition to MDs), the FDA are not big pharma nor are they paid by them. Aside from a doctor in Brooklyn (who can't be a source of scientific info; they read journals and data, they don't create the data), you haven't brought scientific long term data. You just have "this feeling" that there's a long term risk. But again I say to you, "bari v'shema, bari adif."
Alice,
You're very right that the side effects of not treating can often be much more serious than the side effects of treating. I think those are the only situations, to begin with, when the medication should be used. (Whether it be ADHD medication or medication for anything really.)
IT's a shame that your two friends are using illegal drugs on any level.
-Dixie Yid
Dixie, why denigrate anyone who disagrees slightly or challenges you? To me this exhibits a dogmatic, hoity-toity, knee-jerk attitude!! But we don't want to chase away other opinions do we Dixie, we are open-minded Dixie aren't we, and we also know when to give credit when credit is due, don't we?
This is the type of article you should have written back when the first detractors to your position posted instead of head-on butting our personal feelings and thoughts on the matter. I mean, after all, Hashem gave each and every one of us a brain to channel our neshoma knowledge through.
Allow me a criticism: 'kids' are CHILDREN (a microcosm of you and I as adults), 'kids' do not belong to a newly discovered genus in the hierarcy of creation.
That aside, some of the symptoms you are attributing to CHILDREN under 5 is behavioral, not mental. To me, this means that their chemical composition is disturbed. I would immediately apply nutritional corrections to this child's diet. A baby that is hungry cries, screams, and has a tantrum; children exhibit behavioral symptoms when they are undernourished. The typical frum diet for children includes enormous amounts of sugar from a very very early age. Unfortunately, the typical so-called kosher diet is far from healthy*.
Kosher standards are "numero uno" (number one)! But our lifestyle has developed into, and I will apply the following to, 'instant', 'disposable', 'expedient', 'entertaining', 'micro-second distractions' and 'avoidance'. This has ramifications to how we raise children, to how we live our daily challenges (which are sent to us by Hashem), to how we choose a profession, and how we cultivate our future Torah scholars. It is precisely our ability to 'communicate' on varied levels.
When the human body is injected with more 'quick fuel' than it needs, the processing of it creates in SOME CHILDREN a short-circuiting (ouch) of sorts, and this sparking energy needs to go somewhere. It goes into behavioral distractions. (Yes, there are so-called 'experts' that disclaim this effect and debunk the nutritional approach.)
Because they process this energy differently their behavior is different.
Their brains are exceptional.
Their brains need to be spoken to. They don't need physical control; their brains needed the PROPER NUTRITION during the first forming years (which I must say were in their mothers womb), and continues into the first several years of their lives.
If you examine the typical frum diet you will find it mostly devoid of nutrition. This is a whole other topic - but we are what we eat, and this totally affects our everyday moods, behaviors, and thought processes. No one (children, TEENS, adults, geriatrics) is immune to this phenomenon. Hospital and nursing-home foods are usually devoid of any nourishment, unless they give you an apple or orange on your tray.
The first several paragraphs of your POINT, are where the child's behavior is screaming to everyone that he's having difficulties (however, I'm sure it showed up much earlier, but do to other factors, was overlooked, AND is where it should first be addressed). It is at this point that the teacher has been prepped by societal norms to suspect a possible medical (ADHD) issue with a pharmacological solution. After all, if something hurts, everyone takes a 'pill' (instant, expedient, avoidance). So there must be a pill for this child's distracting behavior! We have been brainwashed into thinking there is a 'pill' to answer every annoyance we experience.
Ok, by now you are probably a bit animated over my response. I AM SAYING THAT SOMETIMES MEDICATION IS NECESSARY, NOT THAT WE SHOULD NEVER USE MEDICATION. However, I am also saying that you are coming from one side of the equation and I am on the other side. That's all.
I think it absolutely necessary that parents begin before they start bringing children into the world to FOCUS on what they are eating, and what they eat while pregnant. Our DNA is chemical, our bodies are chemically nourished, and they need the medicine HASHEM proscribed, which is natural FOOD. Foods contain elements to address all of our chemical needs. Before using artificial medication to obtain a goal, fortify the body with Hashem's nutrition. Artificial chemicals are not natural to our bodies even if they produce the desired results.
People in general are not paying attention to the way they live. The world around us has an inexplicable habit of infiltrating our psyches. One commentator to one of Akiva's posts thinks that going back to natural farming is an alternative to all the confusion that exists in the world.
But, we can help our own lives by stepping back a little, stop running around so much, slow down, put the brakes on, not so many evening simchas that take parents away from CHILDREN, not so much fancy "in" clothing, crossing the tznius barrier - back to basics, plainer healthier foods, more time at home SHARING WITH FAMILY MEMBERS, and there are more things we can do if we put our minds to it.
What's happening in every sphere of life (medicine, food, clothing, entertainment, et al.) exhibits the detrimental effects of the Yetzer Hara to confuse and confound our Yiddishe neshomas.
One cannot ignore what is happening all around us. The world is like a pot of water set on top of the fire to boil. While it is getting hot and hotter, one does not see a change in the water, but nevertheless it is getting hotter. Slowly little bubbles can be seen under the surface. Before too long, those bubbles burst above the surface of the water and escape into steam. My analogy is that the world is bubbling under the surface right now. What happens next only Hashem knows.
-----------------------------
* Even the production of our foods have fallen victim to 'profit' 'expediency' 'instant' 'sweet gratification' and 'ADDITIVES'.
One must READ every label on EVERY product one buys. It is not sufficient to look for the kosher symbol; it only starts there. Usually after the first few ingredients, one will find a list of 'other' additives that make up the rest of the ingredients, of which there are chemical names that few are knowledgeable of, and which by themselves are deemed (by the experts) unharmful, but when put all together in this one item, and then all together with all the other foods containing the same or other additives, we arrive at a cocktail of chemical additives. My point is less additives, more REAL FOOD.
There are additives use in bakeries to create 'pretty' 'fluffy' 'soft' 'colorful' delights. One would be better off with their own bread machine, and the (gasp!) old-fashioned wifely making your own plain ordinary sheet cakes, with minimal and healthy ingredients.
The kosher food world has its advantages and dis-advantages. The main advantage from all of this expansion, is that believe it or not, some foods are being created for specialty diets (diabetics, gluten intolerance, and behavioral issues) that contain kosher certification -- but on the whole are not found in your local neighborhood grocery/makolet. This is partly because some of the well-known kosher brands are in such competition with one another, in order to profit and stay in business. Then there are the distributors (middle-men) who also need salaries; who distribute certain products with certain 'incentives'. The business of FOOD is such a BUSINESS!
Neshoma,
Many people have their "one issue" that kind of colors how they see everything else, and in their eyes, everything comes back to that one lens through which they see everything. For you, that's nutrition. To a great extent, you're probably right about the need to have better education, and you may (or may not) be right about the far reaching consequences of bad nutrition. As I said many times, all other reasonable options should be tried before going to medication, just like with any other medication. That may include behavioral, nutritional, therapy, tutoring, resource room, etc. However, after all of those things have been tried, and *if* they don't solve the major difficulties associated with real ADHD (as opposed to classroom/home management alone), then ADHD medication should be used.
For those kids who don't need the medication, of course they shouldn't be one it and it may be overprescribed. For them, nutrition or other things may be involved. Even though you did acknowledge that some cases exist where medication is warranted, you're also sending mixed signals. You also claim that those cases are really behavioral and not part of people's inherent chemistry. Unfortunatley, to the extent that you make that assertion about kids with real ADHD, you are ignorant. For some kids, no matter what you try, it will not work because you're not dealing with the underlying *inability* to concentrate or moderate energy and focus. For those kids for whom the other options don't work, it would be cruel to withhold medication from them.
Baruch Hashem it may be that you generally deny the reality of this condition because you yourself don't have it and perhaps no one in your family has. That's great! Since you can't relate to it, you may project your reality onto others and think "They really could control it if they wanted to some other way... Through nutrition, behavioral methods (or whatever...). It must be that they just want the easy way out."
Unfortunately, that is not the reality. Those things may work for the majority of kids, but they don't work for everyone because ADHD (i.e. something not rooted in nutrition) *really does exist* much as that may be hard for you to imagine. For those kids for whom this is the case, the "side effects" of not treating with medication are far worse than the side-effects and potential/maybe/one-day risks that exist.
-Dixie Yid
Neshoma,
In my first paragraph, the first time I used the word "education," it should have said "nutrition."
-Dixie Yid
"While "big pharma" uses aggressive tactics to sell their products (all products, not just ADHD medications - are you going to stop using heart drugs too because of drug company marketing?), your mistake is relying on the idea that all information comes from the drug companies themselves. Psychologists (who can't prescribe), special ed teachers (in addition to MDs), the FDA are not big pharma nor are they paid by them. Aside from a doctor in Brooklyn (who can't be a source of scientific info; they read journals and data, they don't create the data), you haven't brought scientific long term data. You just have "this feeling" that there's a long term risk. But again I say to you, "bari v'shema, bari adif."
1) Re your question re heart medication (we should not need it) - I would be cautious, but less so, as heart conditions seemingly tend to be more real than things like ADD diagnoses.
2) It seems that you are not aware of the extent of the corruption involved with big pharma and those it deals with. You may not be aware of it if you haven't been following the many recent damning revelations about the sordid industry practices in mainstream media like the NY Times. If you would see the book (by an award winning former NYT reporter on big pharma, not some quack!) I mentioned earlier, you could get a better understanding of it. It has severely compromised things and has even affected others in the field who you think are immune to the big pharma shochad (bribery), half-truths and total lies. Not always is influence directly asserted. Indirectly, the money skews things out of order far beyond the limits you may suspect. Re the FDA, it has been very weak to ineffective for some time already. Look what happened with Viox and other scandals in recent years. Read the book and see how the FDA was emasculated.
3) The Doctor in Brooklyn shared what he saw in his practice. He didn't just repeat some article he saw in some journal financed by big pharma, if not totally written by/for them.
4) "bari v'shema, bari adif."
a) Your bari is not a full bari, and you are basically repeating the big pharma and mental health industry propaganda.
b) My position on this is quite certain, based on much study and observation, not mere conjecture.
5) "all other reasonable options should be tried before going to medication, just like with any other medication."
Honestly, how often, if ever, is that done?
Dixie, thanks
Guess what, I think if we opened up a clinic together we could help a whole latte children (:-)
BTW I live with chemical sensitivities and gluten intolerance. I am sensitive to other peoples distresses. For myself, I did my own research and 'prescribe' for me what I think would be helpful. I watch my diet and my environment. I would recommend other people also do their own research, in order to educate themselves about their 'sensitivities or disabilities' because often a doctor asks YOU, the patient, what are the symptoms/stimulai you are experiencing, and from that he make a judgment. Well, the more one knows about his/her body/mind the better off they will be able to PREVENT and AVOID many of the causitives, of course notwithstanding critical issues needing real medicine.
I would not accept any doctor's 'prescription' for any type of medicine to 'treat' my own situation. There usually, in most instances, natural methods of helping your own body build up its immune system to do what Hashem created it to do.
It's just awesome how the human body was designed, and how it works. Simply awesome.
Kol Tuv, Dixie, have a delicious Shabbos!
As a teacher, I've worked with a number of students with ADHD and ADD. A few observations:
The parent who drugs the kid for a variety of non-valid reasons and the parent who refuses to medicate a kid who needs it both exist. They are hard people to work with.
Watching a child who opens up with joy when he (or she) realizes the work is possible is amazing.
You need to have a doctor who knows what they are doing, and doesn't try to give one dose to fit all, or leave the child on the medication endlessly if that's not indicated.
I don't buy the idea that schools have been 'feminized'. There's a huge difference between an active, boisterous child who can nevertheless focus and achieve his goals, and the child who can't sit down, can't listen, can't finish anything. And if it's hard for boys, it's even worse on the rarer girls with attention problems, since girls are supposed to 'naturally' be quiet and painstaking, and get endless flack for being masculine, as well as 'bad'.
There are lots of teaching techniques you can do in the classroom instead of drugs, or with drugs. They sometimes work well. But that does not mean that medication is not also good.
BBJ - I wonder how well teachers, with a classroom of students to look after, and who only see the youngsters for a fraction of the day, are able to see potential dangerous side effects, present and future, in their young charges. At least parents are with the kids more and longer term and have can give more individual attention to them. Also, the fact that teachers desparately want a quick and easy solution to eliminate disruption in their classes and negative effects on the other students, could blind them to the negative side of the drugging taking place.
Not to pick nits, but there are many teachers who would rather take the time to work through the problem than jump to meds. In fact, when I taught I often argued with parents who claimed their kid might have ADD/ADHD because I sometimes felt the parents were looking for an easy fix. (I could have been wrong in some cases of course.) But there were a few times where I became convinced there was something to their concerns.
BBJ,
I didn't come up with "feminized schools" theory--but you're welcome to disagree anyway!
When I was in seminary, I worked with a 7th grader in a frum school whose considerable LDs were only diagnosed in the 4th grade, when it was "discovered" that he couldn't read English, couldn't focus, and who, miraculously, was on target for his age group in limudei kodesh.
So what was up? The classroom environment, arrangement of material, method of testing, etc., in his kodesh classes worked, but his general studies (which ran along a more "standard" U.S. classroom model) absolutely did not.
It was extremely frustrating for him, he was a bright kid, but that model did not work. Did he need medication? The general studies teacher thought so, but the Rebbi did not. Who was right?
Of course, for a teacher, it is whole lot to ask to tailor the classroom style to the individual needs of every student. This is the pressure that today's teachers must operate under, and I don't envy them.
If Ritalin et al had been in use when I was a kid, there is no doubt in my mind that the teachers would have insisted on medicating me in grade school. But I am extremely grateful that the option did not exist, because I did some of my best thinking while everyone else was working! I can laugh about it now, but I know that it was extremely difficult on my teachers (and parents) that I was so spaced out.
I bore this in mind when we were asked to have one of our children, another "space case," evaluated prior to the administration of medication to help with focus in class in the first grade.
Instead of going to the school-board provided educational psychologist (which would have cost next to nothing), we paid a ton of money that we could barely afford to have an extensive evaluation (6 sessions) done. The expert confirmed what we already knew: bright child, needs time.
When the child was asked during the course of the evaluation what might help with focus and attention, the child said:
"If my teacher could stick a light bulb on my desk attached by a wire to a switch at his/her desk and send me a flash whenever he/she sees me drifting, it could help."
Not bad for a six-year-old.
This child has been, for years, at the top of the class. This remedy is sometimes known as "tincture of time."
Of course, not everyone has a story that works out just that way. And to see children struggling in school is painful for everyone. Again, caveat emptor with the meds and try other solutions first. That's my feeling.
My daughter Ricki has Down syndrome compounded by ADHD. Before starting Ritalin, she was too distracted by everything around her to learn, and her behavior was extremely aggressive and impetuous. The medication has made a world of difference, and , frankly, to NOT give it would be cruel.
However, before trying medication, we:
1. took care of her sleep apnea (that meant she wasn't sleeping well before we did a T&A to remove tissues obstructing her airways)
2. We cut out 90% of the sugar in her diet
3. Tried behavior management
For diagnosis we went to an expert neurologist (who works specifically with the dual-diagnosis population.
Some kids only need better sleep and diet. For some that will not be enough!
But know that meds will not correct bad behavior in and of itself. It will only help get the child to a state that behaviour modification and the like will be effective.
Rickismom,
It sounds like everything you said is really on point and balanced. Medication for ADHD can be invaluable and it can be cruel to withhold it for idealogical reasons. On the other hand, other options must be ruled out first to see if it's really necessary or not. Hatzlacha raba with Ricki and the other kids ba'aretz!
-Dixie Yid
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