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As you know, thanks to the FDA banning pemoline, Miss Teresa now has only three drugs to combat narcolepsy, the most effective one no longer being available.
One of her others is Ritalin. Now the FDA’s drug risk committee had a meeting and:
The advisory committee voted unanimously to recommend patient guides, and it voted 8-to-7 to suggest that stimulant labels carry the most serious of the Food and Drug Administration’s drug-risk warnings something called a “black box.”
Y’see, they found that some people who take Ritalin have heart problems. Gee, ya think? That’s something that stimulants do. You want to see some ectopic beats? Hook me up to an EKG after I’ve had my morning coffee. But these nice fellows don’t want anyone to have an increased risk of heart problems. Hot news flash for the FDA: Over time the death rate from “living” is 100%! The big question is quality of life while you’re still alive.
“I want to cause people’s hands to tremble a little bit before they write that prescriptions,” Dr. Nissen said.
Hot news flash for Dr. Nissen: Neurologists’ hands already tremble, because the DEA likes to drop in on them and screw with them just for fun. (Chasing neurologists is lots easier and lots safer than chasing the guys from Cartagena. Neurologists are listed in the white pages and don’t carry machine guns.)
Marketplace from American Public Media had a big propaganda scare story on Ritalin yesterday.
We’re looking now at what pemoline faced in 1996. So, in 2016 will we see friggin’ Public friggin’ Citizen petitioning the FDA to ban Ritalin, and the FDA rolling over for it? Sure, I can see that.
If you need Ritalin to maintain your quality of life, the time to fight this nonsense is now, not when you show up at the pharmacy one morning with your scrip in your hand, only to discover that there’s no more to be had.
Ritalin has, of course, long been in the sights of a lot of creepy people and organizations.
In a saner world I'd be willing to grant that it's perfectly okay for the FDA to mandate non-coercive "black-box warnings". But in this world it's hard not to suspect this sort of thing is part of a process meant to lead to further restriction and prohibition.
Y'know, given their new-found concern for cardiac risks in adults who take Ritalin: maybe they should have flippin' thought of that before they took pemoline off the market.
Ya think?
Ritalin, as an amphetamine, already is about as restricted as you can get. There is one hope on the horizon, however. As the use of ADHD drugs increases, more drugs in this class will become available. (Note that ADHD drugs are often used for narcolepsy.) The latest is Strattera, which isn't even a controlled substance.
So long as you stick with one pharmacy, and they have your diagnosis, they can probably make an effort to keep you supplied with what you need, as long as it is available. This is one of those areas where it's worthwhile to cultivate a patient/pharmacist relationship--especially now, when she is forced to switch physicians.
Based on what I heard on NPR last night, I think they have their sights on Adderall also. (Apparently, Canada has already banned the long acting form?)
What I find kind of odd is that the FDA is behaving like my sister and I did when my mom was fighting Non-Hodgkin's Lymphoma. For a while, we kept looking for the perfect drug to use for chemotherapy . i.e., no side effects, 100% effective, to the exclusion of everything else. Needless to say, it didn't exist. This is behavior I expect from two people who know next to nothing about medicine, not the FDA.
At the end of the day, I'm not so libertarian to say that people should be able to make their own decisions without any government intervention. If nothing else, there should be government regulation to insure that we (and especially our doctors) know as much about the efficacy and side effects of the drugs we consider as possible. But if we ban every drug with a potentially dangerous side effect, there will no drugs left with which to treat disorders. The right drug strikes me as being a very individual decision and a complete ban strikes me as being not useful unless it's a strike with truly no redeeming qualities.
BTW, I realize that this is the wrong thread, but chances are good that I will be at Boskone. As a frequent lurker and infrequent poster, I look forward to meeting you all.
Bloody hell! *facepalms* Honestly, it does feel like you need to keep running as fast as you can just to stay in the same place.
The best lack all conviction, while the worstSome of my thoughts are with all those working on The Pemoline Crisis, but they're spread around those also working on all the other crises too. Good luck to all of you.
Are full of passionate intensity"
Ritalin has, of course, long been in the sights of a lot of creepy people and organizations.
Of course, same old story. Better that a thousand people suffer debilitating symptoms than that one teenager gets high.
Aw, jeeze--here's my darling husband battling fourth-stage cancer and the only thing that breaks through the fog of the pain meds and keeps him alert and capable during the day is--yep! Ritalin.
You know, a sudden heart attack is not something we are worrying about. There are days when he'd actually look forward to it. Luckily hospice is on the job. They, at least, will keep the spice moving. Er, Ritalin.
Jane
Ritalin's an easy target. It's a stimulant, very easy and desirable for people to abuse. It's predominantly prescribed for ADHD, a condition which a lot of people believe doesn't really exist ("it's just an excuse for badly behaved children" is something I've heard several times), and which has in the past been used as a get-out diagnosis when doctors want to get badly behaved children out of their surgery. It is a dangerous drug that may be dependency forming and has rather negative side effects. Many people, having only seen borderline cases and misdiagnosed cases, believe ADHD is best treated by therapy alone. Banning Ritalin would be a popular move.
Well, schise. The idiocy can stop any time now.
Yeah, you can get Ritalin black on campus. The people you hear about using it most are the ChemEs and the med students. It's evidentally a 'major' problem in residencies at the hospital...where the people can prescribe it to themselves.
It is also one of the very few drugs to control Daddy's ADD. This is going to be a not-fun call here shortly.
Damn.
I have three kids, all with ADHD, and all taking Ritalin (in various dosages). It, or some other ADHD drugs, are vital to their being able to be successful at all in school, much less in life.
Fucking nanny state culture.
And while I'm at it, let's not forget Tom Cruise and his ilk shooting at this stuff. Dare I say it? Scientoligists. Or however those nutbars spell it.
You know what's odd-- I watched House (first time) the other day on tv. (Because I was too stressed to sleep). The episode was about a supermom who gets into a car accident because of arm twitching. They find out she's popping her kid's Ritalin. (Among other things).
Then yesterday I read about the FDA Ritalin labelling thing.
Seems like an odd coincidence.
One (possible)Good Thing:
This drug is a money maker; pharm sells a lot. Big Pharm will want to keep making it.
Politics and bedfellows...
Step 1 - Get released from liability
Step 2 - Get black-box warnings on drugs before they go off patent
Step 3 - Launch new drug targeting same market
Step 4 - Launch direct-to-consumer TV campaign to create demand for your diagnosis of choice
Step 5 - Get old drug banned just after it goes off patent
Step 6 - Watch generic manufacturers fail after spending big to make drugs that get immediately banned
Step 0 - Continuously plant stories in the media and lobby (bribe) Congress to do things your way.
Sounds like a pharma business plan to me.
Is Ritalin available in generic? If so, for how long? If not, when does it go off patent?
I should add that at least they're having a hard time with step 1. But they seem to be willing to bear the litigation costs as a cost of doing business.
I saw the report in the Washington Post this morning. See Warning Urged for ADHD Drugs if you're interested.
I can understand -- and share to some extent -- your anger. It really is long past time to end the damned drug war, not to mention all the other assaults on human liberty that we're seeing anymore.
There is, though, one very interesting comment in the Post article. From the article:
"On the surface, it is hard to believe," said Curt Furberg, professor of public health sciences at North Carolina's Wake Forest University Medical School, who voted for the black-box warning. "What is also interesting is this condition is not really recognized in other countries -- you wonder what we are treating. I am sure there are patients who need these drugs, but it is not 10 percent of all 10-year-old boys."
An article in the APA's Monitor on Psychology from October 2001, "Sleep deprivation may be undermining teen health" gives me pause. Yes, our oh so wonderful educational system could be a significant factor driving ADHD.
So, while I don't support the screwballs who want to stop people from using Ritalin and instead try talk therapy, I'm not exactly fond of the people who want to prescribe Ritalin rather than reform the schools.
On the issue of whether or not ADHD exists:
From the very moment Emma was born we Kathy and I knew, somehow, that something was, well, not wrong, but somehow different.
Upon the diagnosis of ADHD in 1st Grade, she did a turnaround in behaviour once we had our Ritalin scrip. It's like light and dark; it's an obvious difference.
It made the difference in her being able to attend school at all (she'd have been too disruptive otherwise).
Are Kathy and I just "parents who won't discipline their kids?" No. We had already raised a daughter who at the time Emma started 1st Grade was 19, and she has turned out just fine. The idiots who deny the existence of ADHD I welcome to come to my house and take care of Michael, Emma, and Kolby for a week. They'll leave believers.
I don't think Pharma is the boogy-man here. I think the real power movers behind this are (a) all the various conservative types who think that it's Evial to be dosing our kids with Drugs!(how *dare* we actually take care of them ourselves, when we're the folks closest to the problem, as well as, um, being the fucking parents?!), and (b) the "Church" Of Scientiology.
Tim: I don't doubt the existence of ADHD; I do question whether it's as prevalent as some of the diagnosing officials seem to think. I suspect that if Ritalin doesn't slow them down, the diagnosis should be questioned.
Jane, David's one of my favorite people in the whole world. I'm sorrier than the language can bear to hear that he's doing so badly. Tell him I send my love.
I certainly remember a time when Ritalin seemed to be the universal cure for problem children.
Some people fuss about food colouring and artificial sweeteners.
All three seem to have a genuine effect on _some_ children. All three have suffered from a bandwagon effect.
I can see the point of wanting Doctors to be worried enough to wonder whether they've found the right treatment. But how do we force this FDA committee to wonder if they're jumping on a bandwagon?
Tim,
Yes, there is such a thing as ADHD. From what you describe, I can believe your children do have it. The issue I and others (including some parents who have children diagnosed as ADHD or ADD) are raising is the extent of the problem. Some schools are, in effect, getting away with systematic child abuse. There have been schools that have adjusted their practices to reflect real research. The fact that behavioral problems have decreased in such schools tends to support the hypothesis that ADHD is overdiagnosed and is driven in part by the schools.
Yes, antidrug conservatives give me a pain, too. So do the Scientologists. I can say the same thing about educators who blame everyone else for their own screwups.
One of the problems with ADD is that it's very difficult to diagnose definitively. The way the disease works is that when a person who has ADD attempts to concentrate a part of his brain stops functioning and prevents him from holding focus on anything for very long. (There is a paradox here: the harder he attempts to concentrate on something, the less he'll be able to succeed.) This is why Ritalin, a stimulant, will help patients who suffer from ADHD: the stimulant keeps that part of the brain "awake" and so patients are able to hold focus and thus not be hyperactive.
Unfortunately, the only way to see this cessation of activity is with expensive and relatively risky brain imaging techniques. It's much easier and cost-effective in many cases to prescribe an ADD medication to a person to see if it has an effect on her; if she improves, she likely has ADD.
From the reading I've done, approximately 1 in 25 people has some form of ADD. This number is consistent across cultures and geographic regions. This statistic is slightly misleading, though, because it is for ADD as a whole and not just ADHD. In some people, ADD manifests itself as an inability to concentrate that results in a person decreasing their activity level. Unable to concentrate on anything they end up doing nothing. (These people usually end up being tagged as lazy instead of poorly behaved.)
Anecdotally, the number of children in the school where I work who are on some sort of ADD or ADHD medication is closer to 1 in 25 than the 1 in 10 mentioned upthread. I'm not sure what percentage of kids are prescribed Ritalin, but I suspect that it's much lower than the popular concept of every other kid being hopped up on something.
Some schools are, in effect, getting away with systematic child abuse.
Chuck, I'm curious as to what you mean by this. What are some schools doing that you would call systematic child abuse?
Hey y'all, from this longtime lurker and secret admirer of Teresa, Patrick, and Jim.
You can see which drugs Public Citizen wants to save us from at:
http://www.adrugrecall.com/html/recalled.html
Thank goodness for Public Citizen, because I am incapable of weighing risks and benefits, and making such hard big-girl decisions. I will be much happier as a zit-faced suicidal bag of snot with high cholesterol and toe fungus.
I find it deplorable that a medicine is being withdrawn from people who need it and that the same forces seem to be at work to make another medicine less available.
Adam, I think that the controversy is that some children require more individual attention than others in school. I'm not talking about the children with ADD, but just high maintenance kids who need a lot of guidance. These children can be kept in their seats if they are put on medication, which is cheaper than staffing the schools, but not always the best solution for the children.
I don't think the solution to this is to ban Ritalin, that won't fix a thing.
Adam,
I'll refer you back to my first posting in this thread. There's a link to an article on the APA's web site.
Very briefly: When I and my parents went to high school, the day started at 8:30 AM or 9:00 AM. We lived so close to school that long bus rides (if we got a bus ride at all) didn't happen. Result? We were waking up naturally around 7 AM. Today we haul teenagers out of bed as early as 5:00 AM (some parents yank their kids up at 4:00 AM for the benefit of special programs). Schools start between 7:00 and 8:00 AM -- usually closer to 7:00. This kind of schedule has been causing problems for years. Students sleep through many classes. That didn't happen way back when. How bad is it today? One local high school actually put up on their outside sign "Sleep is for slackers." I think the adminstrators of that school should be fired.
That's just one example of what schools are getting away with. The sleep issue has been better documented than most. There are more. Some present day educational reformers are trying to reverse the reforms of thirty and forty years ago because they turned out so badly.
Chuck - My most recent experience with public school schedules was around 1990 when I had to take my nephew to elemenatry school. His school day started at 8:15, and the school was only a 10 minute stroll away, so wake-up time for him was about 6:45.
Crazy me, I went to high school in The Bronx but lived in Brooklyn so I was out the door every morning at 6:15 to make a 7:45 first period (this was in 1981). I napped on the train alot. (I also should have gone to Stuyvesant instead of Science, but that's a different story.)
We also had activities before 1st period, but I never particpated in them, instead choosing the occasional afternoon activity.
Still, nobody in the administration would ever have posted a sign castigating students for sleeping.
Back on topic, as for the drug thing - the whole reason that we have prescription drugs is so that doctors can control who gets the stuff that might be dangerous. Why is that so hard for so many people to understand?
Less life impacting, but when they pulled PPA (a cold medicine) from the market because it was related to heart attacks in some women, I asked my doctor about it and stocked up because it was the only thing that worked and didn't make me feel funky. Couldn't they just have put the stuff behind a prescription wall?
Adam,
One other point. Some schools actually do have a fairly high percentage of boys on Ritalin. There's also the tendency of authoritarian institutions to blame either the less powerful or outsiders for their problems. I don't know anything about your school or even what you do there. The APA article should raise some concerns. The APA might not be perfect, but the article is based upon real research, not the prejudices of one group or another.
Onward to ranting about drugs.
JC: They're going after Adderall too? [String of expletives.] And they're going after the long-acting i.e. time-release i.e. less physically stressful version? [Longer string of adjectives.]
What the f*ck are these idiots trying to do?
They're using the same logic they used when they took Phenylpropanolamine off the market a few years ago:
Phenylpropanolamine has been used for many years and a very small number of people taking the drug have had strokes. The Yale study helped show that the number of people having strokes when taking phenylpropanolamine was greater than the number of people having strokes who were not taking phenylpropanolamine. Although the risk of hemorrhagic stroke is very low, FDA has significant concerns because of the seriousness of a stroke and the inability to predict who is at risk. Because of continued reports to the FDA of hemorrhagic stroke associated with phenylpropanolamine and the results of the Yale study, we now feel that the risks of using phenylpropanolamine outweigh the benefits and recommend that consumers no longer use products containing phenylpropanolamine.It's a stimulant. You may have known the stuff as DexaTrim. It was primarily sold as an appetite suppressant, though I sometimes used it to patch through periods when for one reason or another I didn't have adequate prescription medications.
(You know, I'm actually finding it difficult to type these remarks without including socially unacceptable intensifiers in almost every clause.)
Here's the heart of it:
None of this is news.
So Phenylpropanolamine, Ritalin, and Adderall slightly increase your chances of a cardiac incident or stroke? Well, NO F*CK*NG KIDDING!
THEY'RE STIMULANTS!
STIMULANTS DO THAT!
IT'S CHARACTERISTIC OF THE WHOLE FLIPPIN' CLASS OF DRUGS!
Newsflash: Heavy-duty painkillers build tolerance and are frequently addictive!
Antidepressants are tricky to prescribe!
Immunosuppressants make you susceptible to common infections!
The only people who have problems with insulin shock, a potentially life-threatening condition, are insulin users!
And so forth. By this logic, all stimulants should be taken off the market. In a sane universe, if someone's at risk for strokes or cardiac problems, you DON'T GIVE THEM STIMULANTS!
Criminently Christmas! I get given plenty of other drugs that cause problems. I once spent the better part of a week half out of my mind with anxiety-related delusions because I'm in the tiny fraction of the population that's driven into wild anxiety, shaky hands, tachycardia, the works, by Biaxin, a popular antibiotic that's often prescribed for respiratory infections. If I hadn't had a lot of experience coping with neurochemical weirdness, very bad things could have happened.
Why stimulants?
What the f*ck are these idiots trying to do?
How about, they've bought into the 'Partnership for a Drug-free America' idea, without stopping to think that drugs are not necessarily bad? These are the same people who don't want to prescribe morphine as pain-relief for terminal patients, because it's addictive (hey guys, what part of 'terminal' do you not understand?).
Talk about science-illiteracy! Can we get a required set of science classes for business and politics? One that will teach them probability and statistics, as well as inference and deduction? Or is this to likely to give them headaches from the unaccustomed exercise?
Chuck,
I know that several years ago the Minneapolis school district tried to change high school scheduling to reflect the research you mention, and they were prevented-- by parents, who needed their high school kids to be getting off school early enough to pick up and watch their younger siblings. And also by students who wanted that time after school for sports and other activities, or who worked and needed the afternoon hours.
I certainly don't want to characterize your experience, but mine has been that public schools are caught between a whole web of imperatives and directions (and unfunded mandates, but we won't go there), and the school system serves and reflects a wide variety of needs, and objectionable practice is more often a result of trying to make a Swiss Army knife out of a toothpick than any malice on the part of educators.
Get out, get active in your community, write to politicians, write to newspapers, write to bureaucrats. Educate yourself and others.
Silence isn't an option.
Can't we get them all worked up about prescription dihydrogen monoxide or something? Sigh....
If people are misdiagnosing ADHD and misprescribing Ritalin, then what we need to work on is the way they deal with students, and their use and understanding of Ritalin. Blaming the drug is just a way to avoid addressing the real institutional problems.
I know quite a few people whose lives were made hugely more difficult by ADHD, and immeasurably improved when they were given medication for it. Ask Jim Frenkel. Ask anyone who works with Jim Frenkel. While you're at it, ask Chris Hatton and Jon Singer.
Growing up with ADHD isn't easy. As I say, I know people who did it. What I wonder is how many people I don't know because their childhood ADHD was bad enough that they went down in the scrum -- were labeled unteachable, treated like they were worthless, and got angry and frustrated and never got over it.
It's not good that kids who need attention are getting Ritalin instead. But you know what? If you don't have a condition that responds to it, Ritalin's pretty mild stuff. Sure, there are some people out at the end of the bell curve who'll be perceptibly overstimulated by it. Good news: it's easy to spot them. For the rest, it's not going to do a lot of harm.
I used to know a woman -- kind of weird and naturally jittery, but essentially sane -- who was put on Thorazine throughout her childhood. I know a man who grew up thinking it was normal for his parents to dope him and his sister with Seconal on the family's driving vacations, so that the the kids would sit quietly and stare out the windows all day. Back in the 60s, I knew an entire family of kids whose parents would casually hand out a Miltown to a child who was inconveniently upset.
Neglect is by far the commonest form of child abuse. Getting rid of Ritalin won't do a thing to fix that. In the meantime, there are people who really truly do need Ritalin. There's no virtue in depriving them of essential medications so that we can pretend we're addressing a problem we aren't.
Stephanie,
The Minneapolis (and Edina, I believe) school systems are cited as places where the schedules were changed to positive effect. I don't know what the current situation is. Yes, there has been resistance on the part of some people. Sleep in Fairfax is an activist site with a good bit of current information.
My high school experiences are over 40 years ago. That's why I escaped the current nonsense.
I don't attribute the actions of educators to malice. My point is that we've seen a variety of actions undertaken without regard to reality -- and when reality bites back, denial sets in. Some of these actions have been promoted by educators. Consider, for example, James Bryant Conant, Harvard President from 1933 to 1953.
And another thing:
If you take Ritalin, Adderal, Cylert, etc. off the market, what a lot of people will switch to is bathtub amphetamines. Those are much, much nastier if you've got cardiac problems.
Would I be among them? Since I'm speaking for public consumption, I'll of course say no. After all, they're illegal. But given a choice between being an unemployable, morbidly obese, fuzzy-headed, and profoundly depressed unmedicated narcoleptic, and being on nasty illegal drugs that let you have a life, however unsatisfactory, I'll bet a lot of narcoleptics would instantly choose to self-medicate.
I hope I didn't come across as being in any way in favor of depriving anyone of needed medication. I was just trying to explain what some of the anti-Ritalin folks are on about, not defending the move to ban stimulents.
I think this anti-stimulent hysteria is somehow tied into the crystal meth thing. I read somewhere, maybe here, that the crystal meth epidemic is being vastly overblown and sensationalized. It's like a new Red Scare, only the reds are tweakers and now anyone who took a diet pill is being tarred and feathered.
Teresa,
I think we are in almost complete agreement. Ritalin, et al., should be available for people who really need it. People -- even young people -- should also be allowed to live their lives in reasonable ways. That could solve -- or at least ameliorate -- quite a few current problems.
Teresa - I hadn't really thought of PPA's stimulant effects as having therapeutic use, but rather as more of a side effect, and one that for me was substantially less then for pseudephedrine, which I can't take at all. Me and my current head cold really would like some PPA right now.
Of course, pseudephedrine is already behind the counter in WA, part of the War on Drugs™. It'll probably be banned soon, too.
Don't worry--Ritalin won't be banned until the patent expires and there are generic comptetitors. And I'm sure Ciba-Geigy will have a much superior product waiting to take its place. If it doesn't work so well for your problem, that's scarcely their fault.
Right?
I'm getting tired of living in CorpoAmerica.
Based on a lot of what I see in public policy these days, there's a great deal of blindered (as in a horse's blinders) wishful thinking going on. If we cut down on the number of legal, prescribable stimulant drugs available, then these drugs will not be abused. If we cut down on the number of powerful painkillers available by prescription, these drugs will not be abused. Needless to say, in both cases, people will find substitutes. However, the wishful thinkers can't see that far ahead. It's sort of like letting levee maintenace lapse because we haven't really needed to depend on them in a while, or not making serious detailed plans for the occupation of a country we've invaded because they'll great us with flowers and...
There's a whole school of thought at work we might as well call the Jiminy Cricket School of Public Policy (which has subgroups in military affairs, climate issues, and plenty of other areas of public concern). Their theme song is "When you wish upon a star".
I've worked handling Social Security and SSI disability claims for over 20 years. Many of these claims have involved substance abuse of one kind or another. An amazingly large number of people with this problem seem to have started out self-medicating, whether for pain, stress, anxiety, depression, or the need to get up and get more done than flesh and blood could manage alone. I don't question the notion that substance abuse is a bad thing, and harmful to the individual, their family, and society in general. However, before you can do somthing about the problem, you have to deal with "Why does it happen?" and in all too many cases the substance abuse followed a problem that wasn't being dealt with satisfactorily--and all too often it's a medical condition that is either not being treated, or is not being adequately treated.
However, this is an area where all to often those who set policy, in addition to the Jiminy Cricket planning (cut off supplies of pseudephedrine for meth cookers = increase in imports of Mexican-made meth) suffer from a worldview that says "If you did this it is because you are weak and evil" not "You had a problem and this appeared to be the best solution available to you". Oddly enough, this "defective human" reasoning doesn't seem to apply if you're wealthy enough and well-connected enough--after all, Betty Ford is a heroine of the recovery business, and Rush Limbaugh is an unfortunate victim of chronic pain and bad judgment--no doubt we could add other names to that list with minimal effort and research. However, until we kill off the Jiminy Cricket School of Planning as well as working harder to erase some of the more unfortunate results of Calvinist thinking from the national consciousness, improvement is unlikely. Oh, and let's see about making it easier for people to grasp that they may have mental problems and improve their chances for finding effective treatment. And reform the health-care situation in this country in general.
No, I wouldn't like a pony as well. I wouldn't turn up my nose at a self-cleaning house, though, and self-shelving books.
Also, let's not forget that Ritalin and Cylert/pemoline are older drugs that aren't making the manufacturers and patent-holders as much money as shiny new drugs will. The inconvenience to the users of these drugs is no more relevant than the Iraqis' desire to have safe streets, clean water, and reliable electricity and a governemnt free of foreign interference.
On the subject of ADHD diagnosis--many children with problems ranging from depression, anxiety, and abuse through some physical conditions (and reactions to asthma medications) can exhibit symptoms that can look like ADHD to non-specialists--which category includes family practitioners and teachers. One reason for the popular assumption that every child who acts outs and seems inattentive is hyperactive is that this isn't well-understood. Also, ADHD is fairly easy to treat, and everyone likes dealing with a simple problem rather than a difficult one, which it comes to children with problems. ADHD is also a fairly respectable condition--nice, middle-class parents can have children with ADHD, so it lacks the stigma that might be associated with raising the issue that a child might have behavior problems because of abuse or "problems at home", which could mean anything from "the parents have both been laid off and everyone in is depressed and worried" to "this child is upset and has abandonment issues because his parents are divorcing" to "this family unit is in total and complete collapse on all fronts".
Pseudephedrine is still available in CA, but it's behind the counter. All you have to do is take the card to the pharmacist, and they'll hand it to you. But it's easier to tell how much is going out legally. Whether it does anything useful about the cookers is another story (and whether there are many in urban areas is a third story).
I have a child with inattentive-type ADD who initially found school to be a horrible struggle. Ritalin turned out to be a terrible med for her. So did Adderall (both sent her into uncontrolled, violent rages). Eventually we took her off all meds, homeschooled for a year, then enrolled her in a new school where she was put in honors classes--duh, it's a lot easier to pay attention to INTERESTING WORK than to a never-ending supply of worksheets. Since then she has coped well.
I do believe ADD/ADHD exist, though I'm not sure either "deficit" or "disorder" is an appropriate label across the board. In my daughter it manifests more as a different brain organization; more akin to being left-handed (which also used to be seen as a disorder).
Anyway, without nattering on all day: these drugs were unequivocally BAD for my daughter. That doesn't mean they're bad for everyone; I have a family member with narcolepsy for whom Ritalin has been a godsend.
It seems to me that the appropriate precautions are:
1. Find out what the side effects are, and make sure both prescribing physicians and the public are aware of them.
2. Make reasonable efforts to prevent off-book abuse of the drugs that lend themselves to such (down here in the South at least, Ritalin is often stolen from schools and sold on the street).
3. Stop trying to cure everything with a damn pill, stop pretending everyone is the same, and stop acting like anyone who can't sit still in a hard chair 9 hours a day while doing boring work and being taunted by his/her peers is going to be a dismal failure in real life. It's NOT TRUE.
Er, generic Ritalin (properly, generic Methylphenidate) has already been available for quite some time -- I remember when I was active on the Compuserve ADD Forum, back in 1995, it was common to see posts about how the generic didn't work for some folks as well as the name brand, etc. etc.
Indeed, when I just now googled the terms "ritalin patent" I spotted an item that had "Ritalin has been off-patent since 1964" right up in the first two sample lines on display. So whatever is driving the current agitation to black-box our ADHD stimulant meds, it's not patent expiry. (Not on Ritalin, anyhoo)
Don't worry--Ritalin won't be banned until the patent expires and there are generic comptetitors. And I'm sure Ciba-Geigy will have a much superior product waiting to take its place. If it doesn't work so well for your problem, that's scarcely their fault.
Right?
I'm getting tired of living in CorpoAmerica.
Ritalin is an old drug. IIRC the patent expired before I was born (and I'm 28). Dexedrine (also with a long since expired patent) is the longer acting form of Ritalin. I'm not sure how Adderall relates to them, but it is longer acting than Dexedrine. According to Wikipedia, Ritalin is methylphenidate and was patented in 1954 (huh, I was right about just how damn old the stuff is). Dexedrine is dextroamphetamine, and was available generically when I was in HS. Adderall is a cocktail of amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate, and dextroamphetamine sulfate. Adderall is the only one that might still be under patent. All of them appear to be Schedule II controlled substances. There is no stricter form of control by the FDA... A Schedule I controlled substance is an illegal drug.
For me, they were a very bad choice of drugs to control ADD. Thing is they do work, and work very well for other people. Me losing 20lbs I couldn't afford to lose meant I kicked up a fuss until the doctor let me go off it, since there weren't alternatives that would be safe for me at the time.
I'm not sure why the FDA would cherish the delusion that these drugs need to be *more* strictly controlled. Pharmacies can only get a limited supply per year. The prescriptions can't be for more than a certain time period's worth of pills. The prescription can't be "called in", and I seem to recall that you can't get refills on them or the number is restricted. IIRC the doctor isn't supposed to prescribe or do a refill without examining the patient.
BTW, it was standard practice for doctors and psychiatrists to advise kids on Ritalin or Ritalin derivatives to *only* take the medication on school days. You can "get used" to the standard dosage, and taking days off from the medication helps alleviate that. Judging from the Wikipedia articles, this is still a common recommendation.
Sharing some of my experience with Ritalin over at Suzie's place:
I was dosed with that crap when I was a ‘hyperactive’, fifties speak for ADD, five year old. Prescribed later in life for over ten years to counteract my narcolopsy, until I figured out it was actually making it worse - it may be funny to watch someone fall asleep while lifting their coffee cup from the table to their lips, it ain’t when it’s you. Falling asleep is a relief compared to the catatonia - try explaining to a cop, a Rez cop no less, that you ran off the road when you swerved to avoid a sand worm straight out of Frank Herbert’s Dune.
No Drugs*. No alcohol*, no caffeine (I’m working on the nicotine thing). Hydrate, green tea, very little if no red meat. Schedule not only sleep but activities for when unable (you have no idea how funny I, personally, find the pajama clad blogger stereotype).
No detraction, Ms Hayden, my uncle had it so bad we (my sons and I, the only caregivers) eventually had to put him in a home (something my children will not, can not, afford to do). I still have some problems - any longer than an hour in a staff meeting listening to some Reichwing administrator blovate starts a catatonia that can take hours to overcome; so to I cannot drive for more than a couple of hours - I've already been run off the road once by a sand worm, not 'gonna go there again. Just sayin', fifteen years aago I found away to get a handle on it without big pharma.
*I do enjoy an occasional toke now and then, and each afternoon my buds' and I meet down at The Group W Bench** for a single pint of Bachelor Bitter. **It's a VFW thing, got nothing to do with and in fact predates Our Mad King George.
Emily -- before that. My check shows that Ritalin (Methylphenidate) went off-patent in 1964.
Emily: With regard to controls on Ritalin prescriptions, my personal experience is that refills are not available; new prescriptions must be written every thirty days and delivered by hand from the doctor's office to the pharmacy.
Chuck: The thing of it is, problem children who are given Ritalin do not respond positively to the medication. It's a stimulant, not a sedative, and so will not calm those children down. My experience is that children who are given Ritalin whose behavior does not improve are taken off Ritalin.
Actually, to be more accurate, the teachers and staff members who work with the students encourage those students' parents to have their children taken off Ritalin. Educators, by and large, work with the children that are brought to them. They are not able to prescribe drugs to students (obviously) and have limited influence over parents in getting parents to have their children prescribed medications.
So far as start-and-end times are concerned, they could certainly use adjustment but, as was pointed out, there are so many competing interests at play in determining when children start and end their school days. There are extracurricular activities to consider, work schedules for students, work schedules for parents, and so forth. Unfortunately, older models for when students should attend school assume that there is a parent at home so that students aren't unsupervised; this is the case much less often today. It's a complicated situation that is difficult for school districts, students, and parents alike to navigate.
I'll tell you honestly that I don't know how to improve it.
Lila: those are common reactions to Ritalin and Adderall. I'm happy to hear, though, that your daughter has been able to live well after changes in her situation.
Is pseudephedrine the same thing as pseud_o_ephedrine -- nasal decongestant in the cold remedies? My Walgreen's in San Francisco still has those on the shelves. I bought a (*sniffle*) box of Tylenol Allergy Complete last week. I'm still resentful of the ban on the PPA decongestant that came before pseudoephedrine. They pulled that one on the claim that bulemics were using it and giving themselves hemorrhages.
This is as nothing, though, compared to what they want to do to Teresa. Sympathy, and stay in touch with your local Great Rumrunners representative.
Interesting points, all.
While I was out swimming, a few thoughts came to mind. Out swimming? Yes.
OK -- to help people understand some of my reactions it might help to know a bit more about me than is evident from the kinds of comments I've made here so far.
What are my health problems? Well, I'm allergic to some cats. There are a few foods that give me more than a bit of indigestion. When I lived in New Jersey, I suffered a bit from hay fever. My drugs are aspirin (occasionally), antihistimines (even more occasionally) and alcohol (wine at meals, sometimes scotch, beer when I'm in the mood). I'm extremely healthy by most standards. Oh -- I did finish the Marine Corps Marathon 10 years ago. I'm also a bit brighter and better educated than average.
You would think my life is problem free. Well, I don't have anyone trying to take needed drugs away from me. The bullies who are trying to deprive Teresa and the others who have come forward here still manage to go after me as well. Why? I have this wicked habit of thinking for myself and acting independently. I do work well with others, but I'm hardly a fawning sycophant. You would not believe -- or maybe you would -- the kind of trouble this approach to life has gotten me. When the bullies go after Teresa and the rest of you, they claim they're doing something good like "fighting drug abuse." It's much harder to get away with that kind of excuse with me.
I tend to take a different position on the demands that are made on people today. I do understand that people want to do lots of things. Unfortunately, we can't do all that we want to do. I might be a bit more sensitized to that since I am a high mileage, somewhat competitive runner. Some of my limits are higher than most people's. When people try to approach or exceed those limits, I generally advise caution. So do my athletic friends. Well, most of them. We understand better than most the very real limits people have. Ignoring them can lead to significant problems and make our lives worse, not better.
I go back and forth on the school start time thing. Back then, I was in favor of starting later-- but we had late-start days sometimes that began later rather than ending later, and it messed up all the buses. The problem with our district is that we want the kids back home by dinner time-- the furthest you can push the elementary schools back is about an hour and a half, which puts at least some kids waiting for buses and walking home in the dark. If you switch the little kids and the high school, they're still in the dark, but in the morning. We don't have enough buses to run everyone around at once.
Stupid babysitting drug-controllers. Everything has side effects. Food will kill you. Sugar will kill you. Oxygen will kill you. Time will kill you. It's better to let people weigh the consequences themselves.
Lenny - I've seen pseud(o)ephedrine spelled both ways.
With regard to controls on Ritalin prescriptions, my personal experience is that refills are not available; new prescriptions must be written every thirty days and delivered by hand from the doctor's office to the pharmacy.
My experience is 12 years out of date :). I was about 16 when I went off Dexedrine. So I honestly didn't remember the exact rules, just that I ran out once in December and couldn't get the prescription filled til my mother had tried multiple pharmacies. They were all out of their year's supply and couldn't get more. The explanation of Schedule II controlled substance on Wikipedia didn't do much to fill in the gaps in my memory.
Emily -- before that. My check shows that Ritalin (Methylphenidate) went off-patent in 1964.
I cited my source. Please give them corrected information, I can't correct them since I don't have appropriate references to do so. I admit I haven't cross-checked with the US Patent office, as I don't recall the details of how to handle searches on patents prior to 1976 when you don't have the patent number (and I seem to recall that it requires having a known patent number for a similar object). It is entirely possible that 1954 was the date it became available to the public, and the patent date was earlier. It's all speculation since my references are limited to what I can find online.
I'm still stumped why an organization would attack Ritalin. It's certainly not a drug suitable for all problems, but it's also about as close to generally recognized as safe as you're going to get with a stimulant. The side effects are well understood, the contraindications are also well understood, and with proper monitoring it's a good treatment for conditions like ADD and narcolepsy. That's *why* doctors use it as the first treatment to test whether a child has ADD.
I have ADD and a sleep disorder (circadian rhythm disorder -- I'm wakey in the evenings and loggy in the mornings, and my schedule sort of slouches later and later until I can't go to sleep before 10 in the morning or wake up properly before 6 at night, at which point I'm missing sleep left and right in a futile effort to put things back together.)
I'm finally starting to get things put right with the circadian rhythm problem by making sure there's light in the mornings.
I imagine that if someone illegalized the Sun, I would be EXTREMELY pissed off. So, Teresa and others, you have my every sympathy.
How do I cope with ADD? Well enough to function, not well enough to function perfectly. I make sure my schedule is deadline-based, which always seems to kick me into overdrive. I self-medicate some with what's available. My brain is not totally cooperative all of the time, or in fact a lot of the time. I do what I can to create windows of good brain time and use them as well as I can.
Reading these threads is starting to convince me that I might want to actually see a doctor after all these years. But a part of me is balking. Not necessarily a very rational part.
When I was a teenager, they gave me ritalin for a while (which caused migraines) then switched me to dexedrine. The dexedrine didn't give me migraines. I was supposed to be taking it on the days I went to school, which was all right with me. Even at that age, I was very carefully self-observant about the effects of mind-altering drugs: I noticed that while I could concentrate more thoroughly, I wasn't quite as creative. I couldn't make the logical jumps that are my personal standard of good thinkin'.
This was OK for school, because I was going to a public school that just didn't operate on my level in the first place, and my accomplishments at that place largely consisted of reading Terry Brooks under my desk.
My mother, however, saw me reading on Saturday, asked me to clean my room, and when I wouldn't, came in with a pill and a glass of water, determined to feed it to me so I'd be more tractable.
"Slippery slope!" cried Small A.J. Luxton, who had possibly already read Brave New World by then, and jumped ship totally.
I'm sure I'm not the only one, and I'm guessing that backlashes from people who went through something like I did and then assumed that their experience was EVERYONE'S experience have something to do with the current set of problems.
The government just can't get it right.
There is a difference between "don't force-feed Ritalin to everyone" and "make Ritalin unavailable to everyone." But they can't see that difference. As far as the group mind is concerned, if it is good for one person, it must be good for everyone, and if it proves to be no good for everyone, it must be good for no-one.
I mean, you see the same thing in the fringy end of the health-food/herbal medicine communities -- because celiac disease is being discovered as a problem in a wider sample of people, there's a subset who believe that wheat is bad for everyone.
Us-or-them logic! It's not just for judging PEOPLE anymore! If that pill made you feel bad, it should be OUTLAWED! Sigh.
The problem with Ritalinis not that it doesn't do what it's supposed to. The problem with Ritalin is that school administrators with no particular medical knowledge have been demanding that parents give it to any child who doesn't adjust well to the high-pressure, low-stress-relief (budget cuts? Gym goes first) environment that our schools are forcing on our children.
Children aren't born with impulse control, and a lot of them (particularly boys, who are the commanding majority of Ritalin users) aren't taught it, because boys will be boys and all that.
I understand that schools are in a bind having to address the behavior of those children. I don't see how giving children who only fit the profile of an appropriate patient by being "disruptive" what is basically speed is going to help anyone concerned.
A brief, heartfelt message to the parents of the kids with ADD who are reluctant to resort to medication:
Unless you are the most flexible and understanding parent possible - which given the venue I assume you are, or close to it - and can provide a school situation in which the majority of instructors have a progressive and helpful attitude regarding ADD, and your child has a relatively mild form of the syndrome, her life will suck.
I mean, really suck. Eight hours a day of trying to force her mind to do something it cannot do, and then homework. And honors classes, as mentioned above, or any other way of making the work interesting and compelling, are a great idea. Hell, every kid should have a more vibrant school environment regardless of his neurochemical state. But that universal human right is at best a palliative. Unless we're hyperfocusing, we cannot, unmedicated, focus for long even on interesting or challenging stuff.
I went to a school at age eight that delivered me to college at age 14, so I have a bit of experience in the "enriched curriculum as an ADD palliative" area. AP biology at 11, electives of Hindi and Russian and our school was I think the first one in the state of New York with a laser in its physics lab... and it was hell.
Coping strategies are important, but for many kids with ADD - including this kid at age 46 - coping strategies are part of the chamber of horrors. Instead of worrying about whether you remembered all your homework, you worry about whether you wrote down all your homework on the "to-do" list. Each failed coping strategy - and there will be hundreds over your child's life - will be a talisman of failure.
And you kid will smile, and say it's helping, and maybe she really will think it is. And she will be hoping you don't notice the blank spots on the to-do list. or the fact that she used up her "floating" grade in calculus on the test she flunked because she took it while trying desperately to stop working on that poem in Latin.
And absolutely. Yes. Kids that don't need Ritalin are being prescribed it in ill-advised attempts to streamline the schooling-industrial complex, and No Child Left Behind policies being inflicted on public schools could cause a wax dummy to present with symptoms of ADD, and some drugs won't work for some kids, and no drugs will work for some kids and no drug completely works for anyone.
But oh my fucking god, I wish someone had reflexively prescribed me Ritalin 35 years ago instead of working on behavior mod or curriculum enrichment or rewards or penalties or coping strategies. Because the stuff that causes your kid problems paying attention in algebra will very likely cause her to feel stupid, or useless, or - and this is the best case scenario - prompt her to take unnecessary sexual or physical or emotional risks as an adult, and there''s not a coping strategy in the world that will prevent those.
And the drugs stand a better chance than any other course of action of actually doing something to fix it. Sure, some schools overprescribe this particular metaphorical set of eyeglasses. But nothing works as well for the kids whose vision needs correction.
Please. Please don't make your kid go through what I went through, the feeling like the lowest piece of shit on the earth and the suicidal ideation and the constantly setting the lowest possible sights and the assumption that you don't deserve to succeed in what you do, the "lazy" and the "fuckups" and the "space case" shit.
That stuff is the real poison, and you can hand a lifetime supply to your kid with the best intentions. My parents did, and I will never get it out of my system, but if the Wellbutrin fucks up - and so far it has only and markedly helped - I stop taking it, and in two weeks it's gone.
To Emily:
"I'm not sure why the FDA would cherish the delusion that these drugs need to be *more* strictly controlled. Pharmacies can only get a limited supply per year. The prescriptions can't be for more than a certain time period's worth of pills. The prescription can't be "called in", and I seem to recall that you can't get refills on them or the number is restricted. IIRC the doctor isn't supposed to prescribe or do a refill without examining the patient."
For the most part, this is not true. I work at a long-term-care pharmacy, and in fact I am in charge of ordering the Schedule II's (or C2's, we call them). Perhaps this varies by state, but I can order as many bottles of Adderall or Ritalin I like; nobody has ever placed any kind of a limit on me. Our pharmacy services several juvenile mental health facilites, so naturally we have quite a bit of demand for these drugs.
True, a C2 prescription (along with all other controlled drugs) is supposed to last for only six months. However, when we do our refills (all Schedule II's have to be refilled as a new prescription each time) the pharmacist simply verifies the prescription and it is sent out. The only exception to this is when a Schedule II is refilled at an "Assisted Living Facility," as opposed to a CNF (certified nursing facility, or nursing home). We get a letter from the doctor granting permission to fill this prescription each time, but the doctors almost automatically grant such permission. Most patients are seen by their doctors once a year, if that.
True, a lot of our patients are older, but even the juveniles on C2's usually adhere to this pattern; perhaps the dosages are adjusted once in a while, but for the most part these are long-term drugs. They go out as regularly as clockwork. I simply don't see the restrictions on most Schedule II's as you are describing.
It may also be that the FDA is responding to Big Pharma's desire to switch all the ADHD patients and narcoleptics to new, in-patent drugs, which are much more profitable; certainly the firms who hold the patents on alternatives are not going to lift a finger to see generics remain available. In any event, I think the whole thing is rotten, and am amazed at the whole mess; I have gotten far enough from the thinking which created the drug war (and never bought into the big pharma monopoly) that it all seems very remote, painful, and strange to me.
For the ritalin restrictions: there was a shortage of ritalin in the early 90s that lasted for a few months, maybe this is what Emily is remembering? I called or went to many, many pharmacies trying to get that prescription filled. And my prescription was for a 3 month supply, with a doctor visit to get the prescription every 3 months.
On the use of ritalin: I don't take the ritalin any more, and probably I should - but oh, Chris Clarke. What you said. Yes.
Girls didn't get ADD when I was a kid, and I couldn't possibly have had that, anyway, so I was 20 before someone told me that my brain worked differently. And while it made a difference, the knowledge and the ritalin, nothing erases 20 years of believing that you are unmotivated, and lazy, and spaced out, and if you can read that whole book in one sitting you can do this other (impossible) thing - the boundary and approval issues - yeah, what you said. If I had a time machine, and I was feeling selfish, I'd surely slip my younger self some ritalin.
Oh, Gods. What will they think of next. I'm sure there's a certain segment of the population cheering over this, and I want to spit in their Gods-dammed fscking faces.
There's this one gal. Currently on my shitlist. Who, when the subject of ADHD came up during a dinner conversation, smiled sweetly at her husband and said, "We don't use that term in this house. See, we don't believe it exists."
I pointed at my husband and said, "You're looking at someone who's got it. Bad. Oh, and my brother? Would not have graduated without Ritalin. So don't talk to me about ADHD not existing."
She says, "Oh, I'm sure your brother had symptoms which were misdiagnosed as ADHD, but really all it is, is a way to villify kids who just have a different learning style."
This is not the reason she is on my shitlist. But it was one of the early signs that she might get there.
My husband never was on Ritalin for his ADHD (of the non-hyperactive variety--we have a psychologist friend who's told us that's how the DSM refers to it these days: it's all ADHD but some people do not express the H. Whatever). He has been going through a lot of the hell Chris Clarke describes--the billions of attempts at coping strategies, some of which work, some of which don't. His choice, though. He doesn't want to look into the possibility of medication. So he uses his T-Mobile Sidekick to make copious reminder notes, and he tries to attach his various responsibilities to recurring events, like wake up->feed cats or go to bed->plug in Sidekick.
Lately he's been doing some reading on the brain chemistry possibly involved in ADHD, and though I haven't managed to internalize everything he tells me about it, his conclusions do seem generally helpful in any case. I mean, take more C and B vitamins, exercise more, and consume less aspertame--that's good for just about anyone, or in the latter case, anyone who finds that Nutrasweet "makes them feel stupid" and whose mother actually broke out in symptoms resembling MS when she used to drink Diet Coke.
As for my brother.... I think the whole family kind of wishes he were still on Ritalin. He's all grown up now and it's his choice, and he chooses not to. Meanwhile he drinks too much and smokes. Mom is convinced he's self-medicating.
I get very, very, VERY annoyed with those people who think every one of their personal biochemical experiences is Universal To Humanity. The guy who told my friend to stop taking her anti-depressants and just do more yoga. The people who say that everyone should be vegetarian, or vegan, or wheat-free, etc. The ones who think aspertame will affect everyone like it does my mother-in-law. The ones who think that children diagnosed with ADHD and prescribed Ritalin "just have a different learning style" and should never be medicated. Or who think that because a tiny percent of people over many years suffered liver damage, no one should be allowed to take pemoline.
Godsdamned people. It's people who should be black-boxed and then taken off the market, I sometimes think.
(Er. The brain chemistry stuff. That my husband has been reading up on. He blogged it here. Just in case anyone wants to take a gander and say, "Ah, so, how true" or "Are you nuts? This is crap!" or something in between.)
Lila writes: "Eventually we took her off all meds, homeschooled for a year, then enrolled her in a new school where she was put in honors classes--duh, it's a lot easier to pay attention to INTERESTING WORK than to a never-ending supply of worksheets."
The problem is, that a lot of worthwhile self-directed goals (hobbys, long-term ambitions) require a lot of dreadfully boring work in between the fun/exciting parts. Lots of worksheets or worksheet-equivalents.
That's just life.
You can certainly try to arrange K-12 school to be constantly engaging and challenging, but the rest of the kid's life may not cooperate. They may get to college and fall apart, despite being in very challenging, interesting courses.
Emily writes: ". They were all out of their year's supply and couldn't get more."
I think the manufacturers produce a certain limited quantity each year, with increases in the limit being controlled by the DEA or the FDA or something. There have been times when the prescriptions grew faster than the regulators could respond.
12 years ago was about the time when ADD was starting to get covered in the media. (I first heard about it, and recognized myself, in a 1993 Wall Street Journal story, the summer before my senior year of college.)
So it'd probably fit that prescription rates were growing faster than expected, leading to a year-end shortage.
Regarding school start times, to whatever extent it's relevant, it's only relevant to teenagers, who tend to have earlier start times, busier schedules, more homework and later nights.
Yet ritalin prescriptions are not limited to teens, and the controversy over the % of kids being medicated is not limited to high schools.
Emily writes: "The prescriptions can't be for more than a certain time period's worth of pills. The prescription can't be "called in", and I seem to recall that you can't get refills on them or the number is restricted."
No refills, you have to get a written prescription each month. And you're correct that you can only get a month's worth at a time.
"IIRC the doctor isn't supposed to prescribe or do a refill without examining the patient."
I don't think that's the case. My doctors have generally just wanted an annual checkup. In between, I just call in for a new prescription and pick it up at the front desk.
I'm sure the first prescription should follow an exam/interview. But after that, I don't think it's required that each rx be accompanied by an office visit.
I don't think there are enough doctors in the world to do that.
Chris Clarke:
Eyeglasses are a really, really, feckin' good metaphor for ritalin and other ADD drugs. I want to commend you on that metaphor. It checks out perfectly in all the situations I can think of.
There are some people walking around who have trouble seeing. For them, eyeglasses are absolutely necessary and a godsend. They are reduced to lower levels of functioning without eyeglasses. These people must, must, must have their eyeglasses. Keeping their eyeglasses from them would be cruel.
Then there are others who don't have trouble seeing, but let's say they walk like they have trouble seeing. They walk like this because it helps them deal with something similar but unrelated -- maybe their balance centers are a little maladjusted, and they need to run a hand along the wall to get a sense of its presence. Giving them eyeglasses is bad -- it just makes them get headaches.
Then there are people who, let's say, are somewhat nearsighted. They need glasses to make sense of a movie, but they'd get headaches if they wore glasses to read. To extend the metaphor, some of these people want or need to see movies a lot of the time; others don't. Putting glasses on them 24 hours a day might be a boost into the Technicolor world they've missed -- or it might be a horrible disruption of their normal reading habits. What you do here takes discretion and compromise.
I was pretty much in the third category, re ADD, and I was fortunate and loved enough to have parents who might try all kinds of things (including ones more ill-thought than Ritalin) but would always listen to NO, STOP from me sooner or later. And then I was fortunate enough to attend Evergreen College, which offers some great literature classes that -- as far as I can tell -- are based on the "we expect you guys to all be really, really brilliant with a half-teaspoon of attention deficit disorder and a pinch of obsessive compulsive" model.
All I'm really doing, at this point, is sharing anecdotes: because I don't have the magic pill that knows whether the kid needs it. And I don't have the magic flow-chart for the good parent program (one of the various reasons I'm not planning on kids.)
The only course of action of which I can wholeheartedly say "yes -- this WORKS" isn't a course of action a school or government or therapist can take, because it's for all parents to be attentive to the needs of their children, and to their children's existence as real, live, sentient, human beings.
Which they should do anyway.
But, you know, don't tell anybody I said it, or I'll be hiding from the Nobel Obvious Prize committee.
Reading the mention of the length of the High School day as 9 hours, plus travel time, plus homework, it sounds insane.
I hope that 9 hours includes a meal-break.
But it puts me in mind of the Working Hours Directive in the EU.
[Explanation: The EU doesn't make laws. It issues Directives to the member states instructing them to make laws with certain specified effects, and these implementations can have different loopholes.]
9 hours a day, 5 days a week, might break the directive. But there are averaging clauses and exceptions. Some jobs I'm seeing advertised have 12-hour shifts, 4 days on, 4 days off, but add in commuting and I'd be an accident waiting to happen. 12-hour working days are part of what led to me breaking my leg. And commuting isn't counted as working time.
Anyway, I'd take all that as a starting point for a claim that the school system has become abusive. You don't need Bush Warrants, you have reasonable grounds for suspicion.
And Japan is notorious for high-stress education. What's it like there? I do get the impression that there is a tolerance for out-of-hours escape behaviour, of certain sorts. Not loud, inebriated, karaoke sessions for the kids. but what seems to be a sort of alternative conformity.
What escape modes are permitted by parents in the USA?
"Eyeglasses are a really, really, feckin' good metaphor for ritalin and other ADD drugs. "
I guess that's a metaphor for LSD. :)
Re: school day length, when I went to high school, it was something like 7:00 AM to 3 PM. Yes, there's generally a 45-minute meal break in there. What tripped me up was the hours: as someone mentioned earlier in the thread, there's evidence that adolescents aren't generally built to get up before 9 in the morning, and need more sleep than adults for optimal functioning -- and as I mentioned previously, I have a circadian rhythm problem.
I was the kid who thought it was normal to take two hours getting to sleep, and I got nasty migraines on a weekly-or-more basis.
After a great deal of angst and bumbling on the part of everyone concerned, myself included, I dropped out and took the GED, and -- imagine! -- stopped getting the headaches more than once a month.
I have shared my experience so that people with the same experience won't think they're alone, and people whose children are dealing with this kind of thing will know there are reasons and not just unreasonable awfulness. Probably my information will shortly dwindle to re-iteration and rant about people and systems who don't bother to consider the individuality of human beings, so I'll try to keep it from here on out to minor factual points and somber platitudes.
Teresa -- re: the people you don't know because they weren't diagnosed and fell out.
Before I went to Minicon in 2001, I'd only vaguely heard of ADD. At Minicon, I met two people who had it, were diagnosed and coping -- and talking to them, it reminded me more and more of a friend of mine in Lancaster who is a lovely person but either hyper-concentrated or couldn't focus. I'd known him for years. In fact, I'd known him and helped him cope for years -- taking him to doctor's appointments he knew he'd miss, moving him in and out of apartments, making sure he ate. He has a degree (Maths) which took him twice as long to get as normal, and he has never worked, because while he was just about capable of being a student, he really couldn't cope with holding down a job.
I came home from Minicon and talked to him about ADD, and suggested he talk to his doctor about it. He talked to the doctor, who said he thought it was only kids, but he'd find out. He found out, and prescribed Ritalin, which has completely and totally turned my friend's life around -- he's just finishing off a funded PhD and has a job lined up. He's in therapy, because suddenly being able to concentrate after thirty-four years of fuzzing out has made it a different world for him in a whole pile of ways.
In the US, with no benefits and no health system, he'd have fallen down a hole and wouldn't have been there to save, or for anyone to know.
I regard the Ritalin in this case as literally lifesaving.
Jon H. wrote:
"Lila writes: 'Eventually we took her off all meds, homeschooled for a year, then enrolled her in a new school where she was put in honors classes--duh, it's a lot easier to pay attention to INTERESTING WORK than to a never-ending supply of worksheets.'
The problem is, that a lot of worthwhile self-directed goals (hobbys, long-term ambitions) require a lot of dreadfully boring work in between the fun/exciting parts. Lots of worksheets or worksheet-equivalents.
That's just life.
You can certainly try to arrange K-12 school to be constantly engaging and challenging, but the rest of the kid's life may not cooperate. They may get to college and fall apart, despite being in very challenging, interesting courses."
When I said "a steady diet of worksheets", I meant a steady diet of worksheets. That is, busy-work NOT DIRECTED TO ANY GOAL AT ALL. See, the school's approach to my daughter's problem was that every time she exhibited a problem behavior (such as not paying attention), they dropped her down to a lower level class. Thus a kid who was even then reading at a college level was being given remedial reading worksheets.
At the same time her school counselor told her--I heard this with my own ears--"If you think school is boring, you're just going to have to get used to it, because middle school is more boring than elementary, and high school is more boring than middle school, and college is even worse." WTF??? I don't know where he went to school, but this is the exact opposite of my experience (and my daughter's as well).
How is this preparation for life, again? I suppose it might prepare her to be one of those GM employees who gets laid off and is then paid to sit in a room and do nothing, but if I had a job like that I'd look for another job.
During her homeschool year this same child made a quilt, wrote a prizewinning essay on censorship for a national competition, and made over a year's progress in algebra and geometry (math being her least favorite subject). All of those involved a certain amount of grunt work.
In the 4 1/2 years since her reentry to the school system, she's maintained a B average in a mix of classes from basic and dull ("computer skills"--mostly typing, which she already knew) to advanced and interesting (honors lit).
Again, I'm not saying that Ritalin/Adderall isn't useful, or even vital, for some ADHD patients. What I'm saying is, here we have a patient for whom those drugs failed to do the job, and for whom the school environment made the problem worse instead of better. When she moved to a different school in the same district (both public schools) and was given a clean slate and an appropriate level of work (not insanely advanced, just appropriate), she was able to function well.
Everyone's mileage may vary, of course. But the huge difference between these 2 schools in the same city (and incidentally, the one she failed at was the "richer" of the two and the one with the better reputation) suggests to me that school policies, culture, whatever can either be part of the problem or part of the solution.
Forgot to add that the "failed" school was the same one attended by ADD Kid's older sister, who sailed through happily and never darkened the door of the principal's office. So it's not that it was a BAD SCHOOL--for some pupils it was obviously fine. But woe to the square peg.
They eyeglasses issues is indeed similar. It used to be that adults were very critical of a child with eyeglasses - as if the kid weren't trying hard enough to see what was PLAINLY IN FRONT OF THEIR NOSE and the teacher/doctor could see just fine.
And that's a mode of thought that is still around: deaf people are STILL criticized as unwilling to learn to adapt when they use ASL rather than lip-reading. The 'they're not trying hard enough" school of medicine and education.
I think that the attitude could be compressed into "Well I am doing it, I can't see why you aren't," or the "I am the standard of normal" school of thought. It leads to gay-bashing ("it's a lifetyle choice"?) and racism ("they're born that way"), to mention just two of the most terrifying problems of our times.
That strikes me as a bigger problem than pharma-companies, though. It seems to be a standard attitude of at least Western culture, if not all human culture. And the only way I've found to combat it amounts to local weeding...
"Reading the mention of the length of the High School day as 9 hours, plus travel time, plus homework, it sounds insane."
I work with teenagers, and insane is the word for their lives.
Most kids I know start school at 7:00 and go till 3:00 - so most get up at 6:00 or earlier to get ready and get in on time. Many go in early for extra-tutoring or to take part in extracurricular activities.
Lunch is about 45 minutes.
If they are involved in Sports, Drama, Dance or other extracurriculars, kids can stay at school for up to 2 more hours.
Home for dinner -- maybe.
Most kids I know then have some sort of outside group they take part in -- Eagle Scouts, karate lessons, volunteer work, anime clubs. The lucky ones get to pick their activity. The unlucky ones have parents who pick for them.
Then -- Homework, usually between one and two hours a night. If the kid wants any free time, they have to take it after homework and before bed. Sacking out after 12:00 a.m. is the norm.
Only to get up at 6:00 a.m. the next morning to start it again.
Weekends are taken up with mandatory (in our school district) volunteer work, and other activities. Athletic kids especially get nailed on the weekend.
It's like an unending hamster wheel of stress and expectations. And the brighter and more motivated the kid -- the more they take on and the more stress they feel.
And it starts younger and younger, it seems. I know 9 year olds with more deadlines and social events than the average 40 year old middle-manager.
I think part of the problem here is that ADHD seems to be not the easiest thing to diagnose. I mean, it's pretty clear that anyone on a stimulant will find it easier to concentrate on what he's doing.
For example, my job right now requires me to work on one, and only one, piece of design full time. I literally can not do this for more than, say, 30 minutes to an hour before I find that I've drifted onto some else. Previous jobs and school allowed me to multi-task so at least I drifted into something else I was supposed to do. An exception would be when the only grad school task left was my dissertation. Writing it was hard because I could only work on it in short time increments before I literally could do no more on it. I resorted to carrying a laptop with me whereever I went (and drinking more than a certain amount of tea). I drove my advisor nuts because I could not maintain and keep to a schedule.
Of course, I can't simply fall further and further behind schedule on my design and expect to keep my job. So for the past month, I've been in the habit being caffinated at work. It makes me feel lethargic and panicky which doesn't do much for my interpersonal skills. I've been blowing up a co-workers occasionally. But I can sit still and stay on one design problem for a couple of hours. I've gotten more done in January than I had in the 3 months before it. I'm in serious danger of not losing my job. (It's also had very weird side effects like I remember to wash my dishes.)
So the point is that if anyone takes a stimulant, he will be better able to concentrate. As near as I can tell, that's what stimulants do. (Caffeine has never kept me awake. Like I said, it makes me feel lethargic. But I think it does sort of level out the curlicues in my thought processes. I suspect it prevents me from being "non-sequitur boy," the nickname my co-workers picked for me at my previous job. My current boss all but called me that in my last performance evaluation so I figure it's not a fluke.) If that's the case, I can completely see Ritalin being simultaneously over-prescribed and under-prescribed. That is, if diagnosis is difficult, then some people who get the drug shouldn't, and others who should don't.
For those who should and do though, I can see why it's a godsend.
My parents owned a Chinese restaurant which is why this particular analogy comes to me. I'm apologizing in advance for its possible triviallity. The movement to get rid of drugs to treat ADHD strikes me as being like the movement to get rid of MSG. Yes, there are people who really, really ought not have any MSG and they shouldn't. (They probably also have issues eating mushrooms.) It's not clear to me though that the correct solution to their problem is to prevent anyone from having MSG. It seems to me that good labeling laws and understanding restaurants (such as my parents') would do the trick.
Likewise, it strikes me that what's happening is that much of the vehemence directed towards drugs to treat ADHD comes from those who shouldn't have been prescribed the drug for whatever reason.
As for the woman Nicole mentioned who doesn't believe in ADHD, which strikes me as like not believing in gravity, it sounds to me like she's trying to bolster the self-esteem of her ADHD afflicted child by calling it something other than a disorder. (However, it seems to me having ADHD doesn't necessariily mean that there's something wrong with you.)
Not Ritalin too! That hits home. They already make it nearly impossible to get the stuff.
As a special ed teacher who works with ADHD kids as part of my caseload, this discussion really nails it home. Officially, the theory is that the best way to treat ADHD in the educational setting
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