My eight-year-old daughter needs to take nineteen pills a day. Nineteen. Every day. But there is only one pill that people feel obligated to question. My eleven-year-old needs to take an injection everyday. She also uses an inhaler and when the pharmacist showed me how to use it I said "basically, I'm teaching my kid how to take a bong hit?" He confirmed that is exactly how to use this inhaler. Yet again, it is the pill she takes that have people concerned enough to openly wonder if I am endangering her.
No one ever expressed concerns that Kgirl1 would become a heroin addict when she began growth hormone injections. No one was concerned she'd start smoking marijuana when she learned to use an inhaler. No one was concerned that Kgirl2 will turn into an addict because she must take several pills each and every time she eats. And yet one green and white pill is certain doom.
My kids have ADHD and I choose to treat it with medication.
I rarely talk about ADHD, even with the closest of friends. I used to, but I learned in dramatic fashion it is a highly charged, rather emotional topic even for those with relatively little familiarity with it. At a party, a friend and I were discussing my decision to have Kgirl1 tested and someone I had never met overheard our conversation. She joined us to say "Girls don’t get ADHD, only boys get it." As I tried to correct that misconception, she interrupted "I don't know what I'm saying" (a moment of clarity, maybe?) but then continued "boys don't get ADHD either – it's a made up disease for lazy parents who are raising brats." And with a dismissive wave of her hand, she was off. I was stunned into silence and have remained quiet for many years. Five years later, it remains a hot button issue. I have begun to talk about ADHD again.
I understand the raging controversy is not just the existence of ADHD, but the decision to treat it with medication. I did not come by my decision lightly. I tried numerous discipline techniques; I used incentives to encourage good behavior. But ultimately, this was not about a disobedient child. Kgirl1 was impulsive; she was energetic and highly spirited; she ran off in a thousand different directions. She was adventurous and curious and determined. And while these were wonderful qualities for a little kid, it proved to be problematic in elementary school. The school took a wait and see approach, but she was struggling to learn to read and simply couldn’t solve the most basic of math problems – and it was already taking a toll on her confidence.
Kgirl2 always moved just for the sake of movement. She shook in my lap when I fed her bottles; she would spin in circles as a toddler for the joy of the motion. By the time she was in school, her teachers would hold her on their laps in a bear hug, trying to calm her completely out-of-control body. Her constant movement got her tossed off the gymnastics pre-team (I may still be bitter.) She was impulsive and anxious and the stress was debilitating.
Why is treatment for ADHD considered a direct link to future drug abuse, but any other medications are okay? The few people I confided in all had concerns that I was setting my kids up to become addicts, but I was more concerned about what would happen if I did nothing. In the book "Learning Outside the Lines", the authors Jonathan Mooney and David Cole describe in vivid detail how difficult it was to go through school "outside the norm." "Simply put, you are considered lazy and stupid. You are expected to fail." Kgirl1 declared she was "dumb" and "couldn’t learn" at six years old. She simply could not do the things her classmates could do and she realized she was being left behind. Couldn’t that lead to drug abuse just as easily as taking a pill? A study cited by webmd looked into the link between ADHD and substance abuse.
Does Taking Stimulants for ADHD Lead to Substance Abuse Problems?
Many parents are concerned that giving their children stimulants to treat ADHD might lead the children to start experimenting with other types of drugs. Several studies have set out to investigate the possible link between ADHD stimulant medication and substance abuse problems, and there doesn't appear to be any connection.
One of the longest-term studies, which followed 100 boys with ADHD for 10 years, showed no greater risk for substance abuse in boys who took stimulant drugs compared to those who didn't take the drugs. An earlier study by the same authors even suggested that stimulant use might protect against later drug abuse and alcoholism in children with ADHD by relieving the ADHD symptoms that often lead to substance abuse problems. The earlier the stimulants are started, the lower the potential for substance abuse down the road. (emphasis mine)
I am not in any way advocating that all children with ADHD should take medication, but it was the right choice for my daughters. I cannot understand the toll this takes on them, how difficult it is to just get through the day. But I am learning. PBS’ "Misunderstood Minds" gave me a small glimpse into what my daughters experience. This is trying to focus with ADHD. This is trying to follow directions with ADHD. But a quote I read from a 12-year-old boy with ADHD gave me the best glimpse yet: "It's like my mind is a television set, but someone else is working the remote control. Sometimes my life just gets all scribbly."
While medication is a huge concern, it is by no means the only criticism I hear. At "Coffee with the Principal" meetings I attend, I hear a lot of anger about how parents are getting extra privileges for their kids by having them diagnosed with ADHD, making it easier for them to get into college. Apparently, all the affluent areas are having this problem and it hurts the kids who are honestly trying to do their best by draining resources away from them. (Kgirl1 was diagnosed five years ago and the only accommodation she has received thus far is extra time on the MCAs test which has nothing to do with college – and since no one has figured out how to slow her down enough to use the allotted time, it hasn’t done any good.)
There may be more kids in affluent areas being diagnosed (although I have yet to read anything more than anecdotal evidence) but I doubt it has much to do with looking for the fast track to a good university. Getting a diagnosis of ADHD is not as simple as asking the pediatrician for Ritalin. We met with the pediatrician to discuss our concerns. She sent us to a psychologist (one meeting with the parents, two to six sessions with the child for the tests, final meeting with parents). We returned to the pediatrician for a checkup before prescribing medication. Initially we were required to come in twice a year for follow-ups; that was later changed to four follow-ups per year. Probably after complaints from parents and doctors, it was changed again and is now three times per year. Prescriptions cannot be called in or faxed to the pharmacy; caregivers must pick up the prescription from the doctor’s office every month. We have a $30 co-pay for the medication; I have no idea the full price. Can you imagine trying to do this without insurance? Insurance coverage may be a better indicator of diagnoses than where one lives.
I’ve found that no discussion of ADHD is complete until someone asks "if ADHD is real, how come no one had it when I was a kid?" Of course there were kids with ADHD back then, but they were called "stupid" and "lazy" and probably spent a lot of time in the principal’s office. However, I do think that recent changes to the schools have made things a bit more perilous for the ADHD student.
When I was in elementary school, we had five desks pushed together to form a pseudo-table. In my daughter’s class, they sit at a table. It seems like a distinction without a difference, and yet for the ADHD kid sitting at a table presents many perils. We had our own unique space that no one could encroach upon; tables do not have the distinct spacing and the ADHD kid often gets too close to his peers. We kept our supplies in our desks; now supplies are kept in a cubby across the room – with multiple distractions along the way. And quite often, losing focus meant that their supplies were never put away and now they had no supplies when needed. The walls in my classroom were bare; my daughter’s classroom has multiple bulletin boards with brightly colored objects randomly tacked on. We had a chalkboard; they have a computer slide show. We had a small reading group work with the teacher while the rest of the class worked quietly at their desks; now the class works on group projects when the teacher is with a small reading group. School is a much more interesting place for 95% of the students – but for the 5% who are easily distracted, the modern classroom is a disaster.
Even play time has changed. The days of sandlot baseball are long gone. Children have lost a lot more than just some unstructured play. They lost the ability to work things out among peers – and they are the poorer for it. There is definitely a maturing element to figuring out how to resolve conflict and most kids will eventually pick up that skill. But for the ADHD kid, the one who is impulsive and says the first thing that comes to mind? Having an adult step in to resolve conflict often means that they never acquire those skills. There is a real motivation in knowing the other kids will eject you from the pickup game, you learn to fit in. In organized sports, the coach resolves problems; the parents are there to lecture, scold, or cheer as the case may be. We thought soccer would be a great outlet for Kgirl1’s energy. What we failed to notice was how stressful it was to follow the rules and stay focused; it wasn’t an outlet at all. For ADHD kids, there is no down time. What they were able to control a little in school hours becomes all the more difficult with the added hours of lessons, sports teams, and tutoring.
Again, I am not advocating medication for all ADHD kids. Some parents have found great success with special diets. There are interesting studies showing that time spent in natural surroundings have a very calming effect. I see physical changes come over Kgirl1 when we go to the desert. She loves the unobstructed view of the blue sky; she loves the mountains in the distance. She especially loves the golf courses. You can just see the tension leave her body as she drinks in her surroundings. I wish I could give her that everyday because I think she is funnier and smarter and more creative when she's comfortable.
I do not use medication to make ADHD go away. If there was a "cure", I would not provide it. I do not think of this as a disorder, it is a difference. There are many advantages – the creativity, the energy, tenacity, resilience, dogged persistence, intuitiveness, and the boundless joy. Richard Lavoie, the creator of F.A.T. City Workshop (Frustration Anxiety Tension) said "A reporter once asked me, ‘If you could teach America's parents and teachers one single truth, what would it be?’" "Simple," I responded. "We need to understand that kids go to school for a living. That's their job." What if you hated your job? What if your days were filled with conflict and you were misunderstood by your colleagues and superiors? What if you failed at nearly every task you were assigned? How would you react?" I’m trying to make sure my kids do not hate their "jobs"; I want them to enjoy the process of learning. Both of my daughters would like to be teachers one day. Imagine having a teacher who truly did understand how difficult school can be for those who don’t fit in easily, for those who are "learning outside the lines." I can definitely imagine just how great a teacher my kids can be.