ADHD: What Ritalin can and cannot do

Though nearly a million children are regularly given drugs to control “hyperactivity,” we know little about what the disorder is, or whether it is really a disorder at all.

On my first visit to a special school for boys “with emotional and behavioural difficulties” I asked how many were on medication. “I’m not sure, around 60% I’d say” replied the Head teacher. When I enquired about the liaison between the school, families and prescribing doctors aroud this medication the answer, unsurprisingly was ZERO.

Perhaps you don’t think that there is any problem with giving medication to healthy children whose behaviour is a concern to the adults around them.

Many think Ritalin (methylphenidate) is safe, or mild, because so many children use it. The bad news has to do with side effects. The US government classifies the psychoactive drug with cocaine and morphine because it is highly addictive.

How does Ritalin work?

Doctors don’t know exactly why Ritalin produces the effects it does. A US study in 2001 indicated that Ritalin significantly increases levels of dopamine in the brain, thereby stimulating attention and motivational circuits that enhance one’s ability to focus and complete tasks. Most research on Ritalin is animal-based and there is no consensus on why the drug works differently in different people.

What is overwhelmingly obvious when you start reading research papers about how Ritalin works, is the complete lack of any identified pathology in the first place.  A teacher recently told me that one of her pupils was going to be “tested for ADHD”.  I asked her what she thought this testing consisted of, and she thought that perhaps there was a blood test or perhaps a type of standardised cognitive assessment that highlighted abnormal brain activity. I wonder how many others share this delusion?

As I have in the past taken part in a number of “ADHD clinics” with Paediatrician, Psychotherapist and Psychiatrist colleagues, I am familiar with the techniques they use for diagnosis and, as one Psychiatrist put it, “There are more stories than pictures involved in the diagnosis of ADHD” by which he meant that a child may behave typically for their age when they come to the clinic and it is the reports of parents and teachers that are predominantly used as diagnostic data.

Alfie Kohn (1989) gives a good account of the Placebo effect of Ritalin and the temporary nature of the positive effects compared with the long-term detrimental unwanted effects (My brother, who is a General Practitioner, reminds me that I taught him to rebrand the Pharmaceutical Industry’s wooly term “side effects” with the phrase “unwanted effects” when talking to patients).

One of the effects of medication that I have seen over the years is to do with Locus of Control. What I hear from children with a diagnosis of ADHD and their parents is that their “condition” is either inherited or “organic”, whatever that means ( all behaviour is organic in as much as bodily chemical states are continually involved in our thinking, acting and emotions). Bivens (2000) looked into Locus of Control as a focus of treatment with ADHD-diagnosed boys, which deserves a look. What I starting to conclude is that children are likely to get a diagnosis of ADHD if they have a poor internal locus of control and receiveing the diagnosis and being medicated reinforces their perception that their behaviour is not under their own control.

How to help children who have been told they “have/are  ADHD”?

  • It is a parent’s decision and responsibility to make decisions about medication, not the teachers’ so don’t start to feel responsible for decisions around medication.
  • You can, however, read up about the effect of medication and make your own mind up about the politics of ADHD and Ritalin.
  • Help children and parents to understand where the drive to behave in a certain way comes from – helping a child to understand their innate physical and psychological needs is no bad place to start.
  • If  your pupils are on medication, you can work in partnership with parents to help the child to understand what the medication can do for them and what they can do for themselves.
  • Read up about Attribution Theory and Theory of Planned Behaviour and teach the child to look for the relationship between their own decisions and behaviour and the positive outcomes they experience as a result of their actions.
  • Teach and use Plan-Do-Review approaches to help the child to learn the skills of planning and reflection.
  • Teach relaxation to your class and use it as a group, building it into your lesson routines.

Now Read: 9 Questions About Detention

References:

Kohn,A. (1989) Suffer the Restless Children. The Atlantic Magazine. Nov 1989.

Bivens,M. (2000) The Relationship between attention-deficit/hyperactivity disorder and perceived locus of control in boys Doctorate Thesis. Curtin University. (click on link and then open the PDF for Mark’s Thesis chapter-by-chapter)

 

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