By Melanie Loxton, School Teacher
Welcome back to the medication debate: for or against? Two articles ago we looked at the various interventions that pupils may need, and last month we honed in on a common, contentious one : inattention and concentration issues. Please refer to these previous two articles for some background as they provide the context for this discussion. One should not make decisions about medication without looking at the whole picture.
When it comes to medicating for concentration, in my experience, the score is generally Teachers = For; Parents = Against. Both have good reasons. There are, of course, many exceptions to this generalisation, but I will discuss it from this mindset. I am well aware that many will disagree with my views, but I have seen strong opinions change plenty of times over the years, so please read with an open mind.
The generalisation of teachers being pro-medication comes about because we have seen it work. The generalisation of parents being anti-medication comes about because 1) they fear that teachers resort to medicating to avoid the ‘harder’ work of dealing with struggling children; 2) they are in denial that there is a problem; 3) they are against using medication in general, eg. even headache tablets are avoided, and 4) they have read horrible stories about the side effects of medication, usually on the internet.
Let me also be more specific about medication : I am referring to scheduled scripted medication which can only be administered by a doctor, not over-the-counter. I am not including herbal or natural medication because (a) many herbal medications have had less testing done than scheduled medication and some even lack the components to be accepted as a scheduled drug and so remain ‘natural’, whereas a drug like Ritalin has had 40 years of research. Just because a drug says ‘herbal’ does not mean it is harmless. And (b) I have yet to witness a herbal drug being half as effective as a scheduled drug. On a few isolated occasions in my eleven years, a herbal medicine has made a noticeable difference in a struggling child’s progress, and even then, it is never the same one that we can recommend because every child responds differently to different herbal remedies. If we had plenty of time we could experiment with various herbal sources for 10 weeks at a stretch and measure progress. Unfortunately, wasting a term at a time trying different alternate remedies does not help the child in the long run. If a scheduled drug IS going to help them, the results are visible immediately. So teachers are not anti-herbal medication in principle, but they might be hesitant in practice. Often we are forced to let parents run the gauntlet of experimenting until they see no fast and effective improvement and then resort to trying doctor-prescribed medicine, but by then it is sometimes too late to have nipped the problem in the bud.
Let me address some issues point by point:
Teachers have seen medication work WHEN it is right for that child. When I say medication I mean Ritalin, Retafen, Concerta, Strattera, Tofranol and such stimulants. We have also seen it NOT work when it is not right for that child. The proper way to test these drugs is to do a blind trial, wherein the child takes a placebo for 2 weeks and the drug for 2 weeks. Neither the teacher nor the parent knows which 2 weeks is the placebo and after the 4 weeks, the teacher sends in her forms containing comments and ratings of progress and behaviour. From these forms there should be a decisive showing of which was the placebo. Only then will the pharmacist say which was Tablet A and Tablet B. If the difference between the two was not what they call “Day/Night” then there is not enough motivation to put the child on that medication. Sometimes, however, changes are harder to see, for example in the case of a child with attention deficit, but not hyperactivity. Then one might do a trial period of medication to see if progress improves (task completion, fewer careless errors etc) because there may be no visible difference in their behaviour. Some ADD (attention deficit disorder) children APPEAR to be busy and not day-dreaming but their minds are not focussed on their work. In ADHD children, medication trials often show Jekyll and Hyde behaviour. Unless the behaviour is chronic or disrupting the class so much so that lessons are affected, behaviour alone is not reason enough to medicate a child. A child’s progress may also not improve overall in a day/night manner because they may have such a backlog that they will still need much time to catch up. eg. going onto Ritalin will not suddenly teach them all the Spelling and Phonics sounds that they missed out on while they were not able to concentrate, but if they try the medication, all the new work learned should stick a lot better, and they have a better chance of catching up in remedial lessons now that they can concentrate. Putting an ADD child in remedial alone will not solve the problem because they will still not be able to retain the lessons. So a positive trial may still not mean a sudden leap in progress, so don’t leave it too late while a backlog builds up.
Often a teacher can see that Ritalin is being effective, even if the Spelling is still weak from months/years of inattention, in the handwriting and spatial organisation on a page. Not that the goal is ever ‘prettiness’ but a more organised page with more consistent handwriting is a good indicator of the mess being sorted out in the brain. I have photostated ‘before’ and ‘after’ copies of childrens’ work when on Ritalin, just to show that seeing is believing.
I do agree that teachers can be lazy in not wanting to deal with ‘naughty’ children, and so too many children are medicated instead of managed. However, much ADHD behaviour looks exactly like naughty behaviour because of the lack of impulse control in these children. They fiddle, shout out, walk about, get into fights, cause accidents, cannot work quietly or productively, and so are often confused with genuinely naughty children who COULD control themselves if they had the inclination or if they had been taught better social skills by their parents. Many ADHD children have begun to suffer from being labelled ‘naughty’ by other kids, and being constantly blamed when trouble arises. Some are so relieved when their behaviour can be modified by a tablet and their self-esteem can be restored. Little children especially say things like “I knew I was good” and beam with pride at the end of a school day where their teacher praised them instead of reprimanded them. Those that have never run a classroom will chorus in with “Maybe if the teacher tried positive reinforcement from the beginning instead of reprimands, the effect would have been the same”… Friends, all teachers started off with the same idealistic thought. Perhaps we even revisited that thought after a motivational speaker or course challenged us to feel that same passion for finding the best in every child that we felt when we started our careers. We DO believe in finding the best in every child. We DO try to praise where we can. But positive reinforcement alone will not defeat a disorder. And the reality of running a class of nearly 30 children makes it a near-impossible task to devote only positive energy into those going against the flow of a smooth-functioning classroom.
