Thursday, October 9, 2008

ADHD: Drugging kids out of a fog

I recently read a post about ADHD on Jenn's Journey and it brought back memories of my childhood. My response to her post was so long I decided to blog about my experience with ADD.

I was never very good at paying attention. The first time this came up was probably in four-year-old kindergarten. I went to a little Christian school where we learned to read and write some simple words. I remember tracing over the letters of the word "cat." The simple tasks the teacher set before me would somehow get garbled in my brain and I'd end up forgetting to do something or being confused as to how she wanted it done. I wasn't trying to be difficult; I genuinely wanted to do it right. Most of the other kids blazed right through the tasks. She would lean over my desk and sigh, and then I'd sigh, and she'd re-explain and correct and try to help me. She was one of my best teachers.

My inability to focus continued into kindergarten and affected me during class. My mom also enrolled me in dance class and I fell short there as well. The southern belle teacher pulled her aside one day to ask "Honey, can she hare?" My mom explained that yes, I could hear, but I had trouble paying attention.

First grade was horrible. We had worksheet after worksheet of math problems to do that year, and I frequently had to stay in at recess to finish mine while the other kids were out playing. (I wasn't the only one and I think this practice was wrong.) When papers were graded and sent home, my parents noticed something strange. On many of my worksheets, a row of problems would be inexplicably left blank. My mom sat me down to ask "WHY? Why would you do that?" And I didn't know. I thought I had written answers for all of them.

Sometime during the beginning of second grade, my parents decided to take me to a doctor to find out if I had ADD. (At that time, it was widely known as attention deficit disorder; now, if memory serves, it is listed in the DSM as attention deficit hyperactivity disorder without hyperactivity. I will refer to my diagnosis as "ADD" to save time.) We filled out a questionnaire with anecdotes and details about the difficulties I was having, and then went to see the doctor. He handed me a piece of paper and a pencil and asked me to "draw a picture of myself and write down my name and address." I drew the picture and put my pencil down. "There," he said. "See? She did the big thing but forgot to do the other." So it was settled; I was ADD and needed medicine to fix it.

From then on, I had to take Ritalin in the morning and, worse, at school. This involved parading to the front office every day around lunchtime and everyone knew what I was doing. The problem was, I didn't think the medicine was helping. I still couldn't focus. I took Ritalin all through third grade and it was my worst year ever! I asked my mom to let me stop taking it, but she insisted she could tell a big difference. My work in elementary school was mediocre, and I took Ritalin for most of those years, if not all of them.

One night in elementary school I came home with such a giant pile of homework that I had no hope of finishing it by bedtime even if I worked straight through dinner. I eventually became overwhelmed and started crying, and my mom became angry with the teachers for requiring us to do so many repetitive problems. Math was the main culprit; that year I had the same teacher who had tangled with my older brother when he was in fifth grade (and he is 17 years older than me). So my mom met with my teachers to discuss a 504 plan. Under this plan, I could get extra time on tests, do less homework, and have other helpful accommodations. Being a teacher herself, my mom knew all about 504 plans, and she really deserves a gold medal for this one. It even helped me through high school.

I struggled to stay a B student in middle school. Ninth grade was a turning point, because my geography teacher was a complete witch. (For details on her ridiculous methods, please see my post on why I want to homeschool. She's under #5b.) My mom gave that woman a piece of her mind, too. I realized at that point that I had to find some way to pay attention and get things done the way everyone else could.

That's when I went to our family doctor and got a prescription for Dexedrine. If you are determined to give your child meds, don't make it this one--at least not as a first choice. It's one of the strongest things you can get. Some kids sell or trade these types of pills and this one is a prime candidate for that. I took a pill one afternoon and finished a difficult homework assignment in a snap. I got an A on it and I felt great! I felt so great that I wanted to take another pill the next day and was incensed when my mom told me she had hidden them because she thought I acted weird when I was on it. (I think mostly I was excited to finally have a little focus. This is a common reaction to a first dose; one person says it felt as though "someone pulled the fog away," giving him the best day of his life.) When she refused to divulge the location of my pills, I started yelling and called both my parents a**holes. While this was out of character, it was not just the Dexedrine talking. They had started me off on meds at age seven against my wishes and without the benefit of counseling, so I didn't know how to cope without the drugs. Then they wanted to pull my meds when it seemed they were finally working. My mom said she thought I was "dependent" on them, but that made no sense because I hadn't taken the drug long enough to build a dependency. I was understandably angry. They took me back to the doctor to get a different prescription.

This time it was Concerta, an extended release med that I would only take in the morning. It worked like a charm. I was focused all day long and finished my homework easily in the afternoon. When I took it in tenth grade, I got straight A's and barely had to try. The drawbacks? My family and friends sometimes remarked that it was hard to spend time with me because I was so intensely focused that I didn't feel right unless I was working on something. I was also underweight. People were wondering if I was anorexic, but I wasn't; I was just too busy to eat a lot of junk food, and the calories I did get were burned off in a heartbeat by my sky-high metabolism.

The beginning of my junior year went well, as I was still taking Concerta. But then, sometime during that year, I discovered that the military would not accept anyone taking a mood-altering drug. I was in Junior ROTC and my dream was to become an officer in the Air Force, so I was crushed. After asking the ROTC instructor for advice, I was relieved to learn that if I stopped taking them in high school I could still go in with no problem. When I stopped, as I predicted, my grades took a little dive and plateaued around a B- average. I gained a few pounds and was actually pleased with my new look! My senior year wasn't my best. I ended up with a C in Physics at least one semester and I know I could've done better if I'd been taking Concerta.

I was accepted at the only university to which I applied (Clemson). I enrolled in Air Force ROTC, but quickly realized that the real-world military wasn't going to be anything like what I remembered from high school. I dropped out of ROTC after one semester. Since I wasn't going to be in the military and I was having a little trouble keeping up in my math and science classes, I decided to resume taking meds to help me along. My doctor prescribed me some generic amphetamine pills. They were cheap and effective and I took them as needed for most of my four years of college. I ended up with only three B's in four years of A's and graduated summa cum laude in the honors college.

During one of my last doctor's appointments, long before I had any plans to become a mother, I asked the doctor if pregnant women could take the type of meds I was on. When he said no, I knew it was time to adjust to life without them. Surprisingly, it wasn't that hard. After college, I no longer needed the intense focus required to, say, write an honors thesis. I didn't miraculously lose my ADD when I graduated, though. Even now I frequently think, for instance, I'm going to the kitchen to get some water, and by the time I get there I've forgotten why I went. There are lots of times when I'll forget a meeting or a change of schedule. I also have trouble paying attention when people are talking, but as an adult I've learned to minimize these things.

I know some people think ADHD is "fake," but I disagree. It is fake for some people--people who are misdiagnosed with it when the real problem is their environment or some other issue. It was real for me. "ADHD" is nothing more than a label someone placed on a problem. The DSM is full of labels, but the problems under them were always there and when you are experiencing them it's pretty hard to deny they exist. If a person says "I have chicken pox," people tend to believe him because the evidence is right there on his face; if someone says "I have ADD," people sometimes think he is just flaky or lazy, because there's no proof to be seen. That makes it feel even worse.

The reason I think medicating is a bad idea, except in the most extreme cases, is because it sends the message that the child's best effort is not good enough. Many children with ADHD experience symptoms that interfere with interpersonal relationships, and when medication is given for these symptoms it can damage a child's self-esteem. Some children might wonder if their company is only tolerable when they are drugged, which is a sad and pathetic thought. There are also teachers who see a misbehaving (or distracted) child and want the parents to get a diagnosis and meds prescribed. It certainly makes things easier for everyone to have a quiet, cooperative kid rather than a flighty unpredictable one. I think we're in a culture of busy in which parents dole out the pills and figure, why do we need hours of counseling if the pills are working so splendidly? I think these kids need counseling because the pills are working so splendidly. It's important to take the time to listen to a child's feelings about being medicated.

It is so, so important to note that the drug companies themselves recommend using the meds in conjunction with other therapy, and even as a final resort. In GlaxoSmithKline's prescribing information for Dexedrine, they state:

DEXEDRINE is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all patients with this syndrome... Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician’s assessment of the chronicity and severity of the patient’s symptoms.

Does this sound like the thought process of most doctors? No. They scribble out an Rx and ask questions later. Drugging a kid for ADHD and not engaging in any other kind of therapy makes about as much sense as taking a diet pill and then lounging on the couch all day eating potato chips and cupcakes.

For years I resented being medicated, but recently I thought back and asked myself why. The medicine didn't make me sick, and it didn't seem to make my symptoms worse either. I think the reason I hated it was because it made me feel like there must be something terribly wrong with me. If I was being medicated it meant nothing I tried was good enough to fix the problem. It also sent the message that all the problems I'd experienced--some of which were hurtful interpersonal issues--were only as big as that little yellow pill. I thought, you mean to tell me this little pill is going to help me make friends? (FYI, it didn't.) I know this is not what my parents intended, but it's hard to frame it any other way. I also sometimes wonder if the good things I accomplished while on the meds was my own work or if, like an athlete who takes steroids, I was cheating. I wish I could have adapted without pills, and I wonder if this would've been possible with counseling or changing my school environment. A pill lasts for a day, but the skills to adapt last a lifetime. I think I'd be better off now if I'd never taken any meds.

While my ADD has been a challenge, I don't believe it's an illness which should be beaten down with pills. I know some people argue that vaccines or diet or environment cause ADD, but I doubt that any of those are true for me. As far as I know, this is just the way God made me, and I don't think there's any pill for that.


Anonymous said...

Great post. Scott took Concerta as an adult and he hated it. The focus was there but his incredible creativity was gone. And he became depressed. We were both relieved when he found other (non-medical) ways of coping.

Melissa said...

Before we had a definite diagnosis for our daughter she was given the dx of adhd combined type. We were against meds for her at first but we felt so pressured to give them( now with all the experiences and lots of self-education I know much more) We started out on one and she stopped eating and loss way too much weight. Then we switched to aother one that kept her up all night and they wanted to give her clonidine. Then when I thought that was too much they tried another that put her in a manic state for 8 hours. This was all before the FDA came out with a black box warning that these drugs in some children can cause mania and they should not be prescibed them. Those crazy doctors thought because she had mania that she must have bi-polar disorder and wanted to put her on lithium. This is when i said we are done and no way are you ever giving her meds again. First she was not that hyper and In my opinion did not "look" like the typical child with ADHD so we went to see a neurologist and that is when the Asperger's dx was first mentioned. ADHD and Asperger's is so similiar, especially if your child is like mine and at the very high end of functionality. To be exact they only have two things that seperate the two. I agree with you that people act like ADHD is a myth or an excuse. My husband has ADD and is very helped by wellbutrin . It helps his anxiety associated with the ADD. I have read so many books on the disorder and get so aggrivated when they still classify this as a psych disorder. Why is Asperger's a neuroloigal disorder and not ADHD. It has been proven with functional MRI that the frontal cortex of the brain is affected and that it is the direct cause of the disorder. It is not the persons choice to behave like they do or out of some habit like they suggest in the books. It is a neuro disorder and cannot be helped alone with meds. This disorder should be given the same helpers and base as Asperger's. Because of the stigma that the child chooses the behavior, we were actually releived to get the correct dx of Asperger's because the view is so different with teachers, doctors and others. I feel for you and understand your frustration. This disorder is real and exist as a neurological disorder in the frontal lobe of the brain and is a loss of function of the exectuive functioning center. It should recieve the real base and help the people affected by it deserve. A good book I love is called: The ADHD Autism Connection

Heather, Queen of Shake Shake said...

What I've always found interesting is when talking of attention deficit disorder, the ball is always thrown at the child.

I ask who really has the attention deficit? The child? Or the teachers who won't give individual attention to the child? I know teachers are working in a system and can only do so much. I know that. Yet the "system" hasn't given any attention to new ways children might learn and, instead, still think in old ways. Who actually has the attention problem? Ha!

And perhaps we, as a society, put too much emphasis on letter grades instead of education. Letter grades could go out the window for all I care. They're a measurement of schooling and not education.

BTW, not only are the behaviors between ADHD and Aspergers very simliar, the behaviors between those and gifted children are eerily similar. So much so that doctors can't tell me where one begins and the other ends for my son.

So, we decide it's gifted behaviors and not the others. I mean, if "experts" can't decide, then why not us?

Eli's Lids said...

I really liked your perspective in this post. Thanks.