Medication debate (part 2): for or against?

By Melanie Loxton, School Teacher

Right, so a blind trial is done. IF the child is not bright enough, ie. they are struggling because their IQ is low, not because they cannot focus, then a drug like Ritalin will make NO difference. It cannot enhance brain ability. I have seen trials done in my own class where I knew the result would not be Day/Night at all, but in the interest of the child, we had to rule out the possibility that he lacked concentration. To me, this is sadder news to give to a parent than if the child has ADD. In effect, if medication cannot help, then the child is doomed to struggle through school depending heavily on hard work in remedial lessons and plenty of extra homework, only to scrape a pass each year if he has been lucky. It is far more promising to be able to say, “yes, he has been underachieving, but we know why, and YES we can fix it”. I always wonder if a child born with poor eyesight would be denied glasses.

But ahhh – the glasses do not have those pesky and apparently life-threatening side effects, they say. I recently fetched the slip of paper from inside a Disprin box… “prolonged use of high doses may lead to anaemia, blood dycrasias, gastro-intestinal haemorrhage, peptic ulceration and renal papillary necrosis” were amongst other very scary-sounding possibilities. Yet people pop headache tablets, indigestion tablets, cold and flu medication, all without blinking an eye because it was prescribed by a doctor or because we trust in the ‘fix’ and the likelihood of scary side-effects is negligible. Do you believe that a doctor would prescribe drugs to your child that is harmful?

Occasionally one of these drugs does have a negative reaction, such as weepiness or a too-high dosage causes a zombie-like state. Then either the medication is not right for that child or the dosage needs to be altered. Speaking for myself, I am not happy when one of my medicated children is too quiet or withdrawn, and I question the dosage with the parents. On the other hand, children that were diagnosed and medicated in a previous year often need to have their dosage looked at for possible increase when their body mass grows to the point of rendering the drug not as effective. I had a case last term where the little boy, who had shown remarkable improvement last year after starting Ritalin, dragged behind in task completion the whole term, becoming despondent and negative about work because he could never finish in time. I had to constantly be “on his case” trying to hurry him even though he was on his Ritalin. It was a simple case of needing a dosage increase, and as soon as this happened, his task completion came right, as did his work attitude… and hence self esteem and confidence and all the other vital life skills that small children are learning about themselves based on the feedback they get about their performance and abilities.

I had one mom last year, highly defensive about her child’s chronic lack of focus, adamant that her mother-voice of positive reinforcement would be strong enough to keep his self esteem intact despite his poor performance. Unfortunately she does not realise that even though there is no audible voice saying “you can’t do it; you are not capable enough” (although in some terrible classrooms, there might be!) he will receive that message through every poor performance on every test and through every time his teacher has to re-direct him to his task, and through every time his friend says “how did you do on your test?” and his mark is less than the average. No one has to tell kids that they are struggling. They feel when they are not coping, even if they can’t put it into those words. That is when the ‘tummy aches’ and “I don’t like school’s” start happening. Parents in denial then blame the teacher and grab onto all manner of reasons for their children’s struggle – the class bully, a personality clash with a teacher, unfair harsh treatment that they wish to complain about, the child’s friends are being nasty to her, etc.

Yes, there are possible side effects to these drugs. The most frequent one we see is lack of appetite. Parents get very ‘freaked out’ when the lunch box returns home every day untouched. However, if the child has a good breakfast before taking his tablet, and eats lunch after school when the drug is out of his system (yes, it is a temporary effect)then missing his snack at break time should not have an impact on physical growth. This is also why the paediatrician monitors and reviews children on medication. If any negative effects are picked up, one would obviously stop and try a different type.
People who don’t believe in medication need to then find some sort of strategy to support their ADD or ADHD child. Some try diet – cutting out all sugars and preservatives, which has limited success and is not a cure, but in general is a good idea for all children to some extent. I personally do not see why people should suffer through a fixable problem where the solution will most likely not have a negative effect, and if it does, a different solution can be tried.

Just last month I saw a mom about her very obviously hyperactive child (not that the behaviour was my driving concern, seeing as I find him charming and can manage his outbursts and impulsivity easily) but it was his obvious underachievement that was the greatest concern. Before the interview I had a glaring headache. I could either continue with the headache, not giving her my best attention because I was distracted by the dull ache in my head, or pop a pill and give her my full energy, the latter of which I did. When I used this as a pro-medication example, she said, “Really, did you take a tablet? I just wasn’t raised that way” as if it was an indictment on my moral character! Incidentally, this boy was moved to my school after she received the same message from his last school, which she didn’t like. Parents often think they can run away from a concentration problem. Within the first 2 weeks I had him in Remedial lessons and noted to her that I was concerned about his ability to concentrate, and this was before I received any records from his former school. Of course, when his file came, it said “inattentive, easily distracted, aggressive, needs intervention, mom unsupportive”. She went on to tell me about her other son who also was on Ritalin, but she had taken him off and he was doing so well. I bumped into her this week and she moaned about having to buy a new uniform because the older son was moving schools… I have a feeling that these poor boys may be moving schools each time mom hears unwanted news.

In this particular case, too, the teacher, the Occupational Therapist, the educational psychologist, and the previous school all said they feel this boy has a concentration problem which needs to be diagnosed by a doctor. So under all this pressure the mom took the boy to the doctor and filled out the forms to indicate that he has no concentration problem. Therefore he cannot be diagnosed as ADD or ADHD because her scores and my scores do not match. The doctor herself found inattention problems in her independent assessment, yet still that mom is in denial. What can I do? Fight for him? In the past I have fought and fought, bringing childrens’ poor performance to parents’ attention and being ‘in their faces’ all year long until they rage against teachers who just ‘want all children on medication’ and tell all their friends and family how lazy the teachers at my school are. These days I am tempted to throw up my hands after one solid attempt. Yet I know I can’t because I have SEEN medication work wonders. I know how this child’s year can possibly be transformed. It has got nothing to do with me having a more pleasant, easier, more harmonious year, although the rest of the class would certainly benefit from that. To me, the risk is SO worth it.

Almost all ‘medication’ conversations start with parents being negative or apprehensive. They either dig their heels in and stick to their beliefs, no matter how misguided or based on hearsay or the internet they are(where anybody can write anything without being an actual doctor) or they decide to put their fears aside long enough to TRY this possible solution. It may not work, but then you can at least say in good conscience that you have tried EVERYTHING for your child’s progress. Hanging onto fear IN CASE something bad happens does not make sense when a child’s progress IS suffering and bad things ARE happening to their self esteem. In my professional opinion, if my own child showed any signs of struggle with academics, even if her progress was just average but I suspected she is brighter than that, I would not hesitate to get that Ritalin script as fast as I could and watch in eager anticipation for positive changes, and I would be relieved that something could help.