ADHD, what is it?

‘Attention Deficit Hyperactivity Disorder’ is a neurological disorder that becomes apparent in children early in life, about three to five years old. Parents or carers of such a child begin to notice aggressive behaviour and an inability to concentrate on a given subject for more than a moment.

The condition was first diagnosed in the 1950s but was not widely recognised as an illness till the early 1990s. ADHD mainly affects boys but there are some cases of girls being affected, usually though they are described as a ‘tom boy’ or similar boyish names and are quite often given treatment later than boys because of this.

ADHD does not go away as the child reaches adulthood though many sufferers learn to control it, many do not.

An ADHD child’s brain is like a dynamo that can never be switched off, everything that happens around the child is a distraction. They are very disruptive at school and often require a special support teacher to try and keep them focused; a student opening the classroom door to go to the toilet, the girl at the front sharpening her pencil, the teacher opening the window; all these type of things no matter how trivial burn in the child’s mind as topics for investigation until something else happens in the next few seconds, yet it is very difficult for them to focus on any particular distraction.

Note that ADHD sufferers are not mentally deficient in any other way, some are extremely intelligent and others are not so bright, just like ordinary children.

Very often in school the child needs to be given very specific instruction, if the teacher asks the class to do questions one to eight the ADHD child is very unlikely to respond. Often the teacher would have to speak separately to the child and say ‘I want you to first do question one, then two, then three…’ and so on. With the help of a support teacher the tasks can be achieved in a lot of cases, but if the child is too distracted no amount of coercing will produce results.

The child can become so disruptive that the class cannot continue and he or she would have to be removed until they can calm down.

Treatment:

There are a number of different possible treatments. But as the condition is relatively new there is still a long way to go before anyone finds a complete cure.

The most widely used drug is Ritalin (generic methylphenidate); an ADHD child has a small part of the brain that controls focus and concentration which is not receiving the required oxygen and Ritalin somehow helps the affected area gain more oxygen, which in most cases helps increase concentration.

No one yet knows why Ritalin does what it does, all they know is that it works and doesn’t seem to do any damage.

Some parents or carers and doctors are not so sure that giving young children drugs on a regular basis, for a length of time measured in years is wise.

Children’s young minds could be vulnerable at such an age when their brains are developing and nobody can know for sure what the long-term effect of Ritalin or other drugs may be.

Some people opt for alternative treatments like meditation, hypnotherapy, aromatherapy or calming music etc.

As already mentioned, one thing is for sure: if it is not treated it will never go away and in most cases drugs like Ritalin have an often nearly instantaneous visible and positive effect on the treated child.

The dosages vary, some take a tablet in the morning then one early in the afternoon and one more in the evening. Others take one SRT or SRC, slow release capsules, in the morning because it does away with the child having to remember to take the tablet and also some children don’t like the taste or just don’t like taking medicine so it is better just once a day than three.

As the tablet begins to wear off, when it is approaching the time for the next dosage, it is often possible to see the child becoming more and more distracted. This is not because of an addiction to the drug and the body wanting the next ‘hit’, it is the child’s brain returning to the state it would be in without the drug.

Furthermore the drug’s effect appears almost miraculous when as little as ten to fifteen minutes after taking a pill the child’s concentration visibly increases.

Below is a chart that tries to demonstrate the pros and the cons of taking medication or using alternatives.

Taking Ritalin in School

It has not become a huge problem in most parts of the world but in the USA it is an issue.

In schools in America up to one in seven children are diagnosed ADHD and are prescribed Ritalin, in other words in a moderately sized school with one thousand pupils there are seventy children walking around with dangerous drugs in their pockets. While Ritalin may be a wonder drug for an ADHD sufferer, in many cases some subjects would not be able to function in daily life without it, it can be very dangerous for someone it is not prescribed for.

As well as the obvious problem of taking medication you are not prescribed, drug abusers tend to take higher doses than doctors recommend. Because of its abuse potential Ritalin is classed as a Schedule II drug, Class ‘A’ in the UK, which is the same as cocaine. When abused, Ritalin can increase blood pressure and heart rate with potential for stroke or heart attack.

A study in Wisconsin found that one in five students have tried taking Ritalin at some point.

There seems to be a misconception that getting a high off prescription drugs is less dangerous than taking street drugs like Acid or cocaine.

In actual fact these drugs can be just as dangerous or worse and many street drugs were once upon a time used as medication.

Students are not the only abusers of the drug, many teachers have been found to be stealing Ritalin out of children’s lockers. In Salt Lake City, Utah, Principal Gerald Smith, 50, was arrested for stealing Ritalin from his pupils. The drug is also being obtained from pharmacy robberies.

Most typically though Ritalin is being given or sold by an ADHD or ADD (attention deficit disorder) person. In this situation the person is at risk of being charged with selling controlled substances or possession of a controlled substance with intent to sell.

Not only are they breaking the law, if they are giving away their tablets it means they can’t be taking them themselves, which would result in a lack of concentration and bad marks in class.

There is the added possibility that the abuser may die, causing great upset for many people, maybe leaving the child with feelings of guilt on top of all their other problems.

Studies in America have shown that Ritalin abuse goes up during exams, they seem to be using it as a study aid the same way some people use coffee.

It is possible that if the medication is having a positive effect and enhancing concentration that those people are undiagnosed ADHD sufferers. In which case the child should see a doctor and psychologist to see if they are ADHD, if so they could receive medication legally.

It needs to be taught that Ritalin should only be taken by the prescribed user as described by their doctor. Taken this way it is a positive and helpful drug.

After more than thirty years of research scientists have reaffirmed that Ritalin is a safe and positive drug to take for children and adults who have ADHD.

People who are not prescribed Ritalin and abuse it are at serious risk and in danger of death.

How Does Ritalin Work?

Although Ritalin has been around for over 40 years no one is yet really sure how it works.

Most experts agree that methylphenidate affects the midbrain, the part of the brain that controls impulses.

In a person with ADHD the child cannot filter out surrounding distractions, the drug helps them focus on the task at hand.

Some carers remark that it is like a switch has been flipped in the child’s brain. The medication takes effect in as little as 10 to 15 minutes and peeks at about 45 minutes then wears off in 3 to 4 hours.

Typically a child would take a pill after breakfast and after lunch then sometimes in the evening.

The slow release version of Ritalin has far less dramatic effects and changes in behaviour are much slower in becoming apparent. There is no peak, the pill will take effect in about 90 minutes and carry on taking effect for about 6 to 8 hours; though the drug will stay in the system a good deal longer, a good 2 or 3 days after a person stops taking it.

There used to be a theory that a rare possibility existed of stunted growth with long-term use, for which many carers stop the usage over weekends and summer holidays. Though the theory about stunted growth has been mostly disproved these days.

Possible Side Effects for prescribed user

As with many forms of medication there is always a chance of side effects that often go away once the body adapts but in some cases they may not, if the following side effects persist a doctor should be consulted:

More common

Loss of appetite; nervousness; trouble in sleeping (trouble sleeping is very common and some people on occasion forego taken their final tablet of the day in order to help them sleep, with varying success)

Less common

Dizziness; drowsiness; headache; nausea; stomach pain

The following side effects are more serious and a doctor should be consulted immediately if any of these occur:

More common

Tachycardia (fast heart); increased blood pressure

Less common

Blood in urine; chest pain; fever; joint pain; small red spots on skin; skin rash or hives; uncontrollable movements of body; obscure bruising or bleeding.

Rare

Blurred or any change in vision; uncontrollable vocal outbursts and tics.

With long-term use at high doses

Mood or mental changes; weight loss.

Many carers may worry about overdose, the following is a list of the possible signs of an overdose:

Agitation; confusion (severe); convulsions (seizures); dryness of the mouth or mucous membranes; false sense of well being; fast and/or irregular heartbeat; fever; severe headache; increased blood pressure; increased sweating; large pupils; muscle twitching; overactive reflexes; seeing, feeling or hearing things that are not there; trembling; vomiting.

The Pill, what’s the big deal?

One might wonder why so much attention has being placed on the medication. With most conditions taking medication is just something you do, it may be a bit of a nuisance but once swallowed that’s it till next time.

For an ADHD child the tablet can be an all-consuming stigma that seems to loom over their whole life. For one there is the unpleasantness of having to take the tablet in the first place.

And for those that have to take them at school it singles them out as being different from the rest of their class or, in some cases, their whole school; they might be called names like “pill-boy/girl” or told they are crazy which is why they have to “keep taking the pills”.

Because the pills have to be taken at the same time each day it doesn’t take long for everyone to notice, before he/she might just have been the guy who’s a bit hyperactive and disrupts the class a lot, maybe a bit of a laugh, but he/she suddenly becomes the guy who has to take pills to be normal.

Because the pills are so effective it is often difficult for carers or teachers to see past the pill to the child. If they do well at school it’s blamed on the pill; if they do bad they may be accused of not taking the pill, possibly sent home with a report card along the lines of “….was so bad in English today we thought that she hadn’t taken her tablet.”

They are being constantly asked if they have taken their tablet or pill, in some cases there may be children who wonder if they really are bad, if when they are being good it’s the pill that is being good and not them. Often as they get older, in their teens, the child will become increasingly aware of their difference from other people their age and proclaim that they don’t want to be like they are any more and just want to be normal; but very often the emphasis is on not wanting to take those ‘stupid pills’ anymore.

Children are brought up to believe that drugs are bad and taking them is bad; because of this many children think they are bad which is why they have to take the medication.

So, through self-fulfilling prophecy, it is possible that the child may grow up and be bad which is exactly what they don’t want and the reason why they are taking the pill in the first place. It is a very difficult and complex situation that one has to toil with when thinking of putting a child on Ritalin.

When the child is faced with taking their very first tablet they can be very nervous; they would most probably have taken pills for headaches before but never something that is supposed to alter their personality. It can feel like a bomb is going to go off inside their bodies.

Low Self-esteem:

As already pointed out the children feel bad about themselves because of the pills but in a lot of case there is also a general attitude or signal that is being sent to them by the adult.

The child may have been good for two or three days in a row and a teacher might say something like, ‘see you can do it if you really try and want to.’ This kind of reaction to their good performance over a short period suggests a feeling that they have a moral defect within themselves that can stick with them for the rest of their lives.

What is being suggested is that if they take their pills and try hard everything will be okay, which is not the case; as stated near the beginning ADHD does not go away, it is not a fanciful label for overly naughty children.

It is a real condition of the brain that, as yet, science has been unable to cure or fully understand.

Because of the attention deficit it is often very hard to get the child’s full attention, a teacher or whoever will often have to raise their voice, and in many cases shout very loud indeed. The child will notice that other people around them only receive raised voices when they are naughty; therefore the ADHD child will always be thinking, "God people are shouting at me all the time, I must be really bad".

It is not so difficult to imagine how any human being might be affected by this situation, being yelled at all the time. Also because they are shouted at when their attention is required, they are being trained into thinking that when someone is speaking to them at a normal level it is not important/not worth listening to.

In many cases the child will keep saying ‘pardon’ in normal conversation because their brain has been trained to think that speech at that level cannot be directed at them, so that it is very difficult to focus and pick up the words.

It is not easy to strike a happy balance between discipline and positive energy towards the child but one thing is for sure, these children do need teachers to be trained in sending better signals towards them and everyone involved in dealing with ADHD needs to be aware of all its aspects.

Then again one could ask if this is asking too much of teachers to learn about and cope with ADHD on top of teaching children and teenagers, which is difficult enough already? The answer to this should be no, teachers should be provided with the resources to deal will all the children in their school.

The pupil-to-teacher ratio should be considered, often an ADHD child will have their own support teacher but the support teacher might be roped into coping with other pupils as well.

At the moment it is difficult to find any business that invests so little in staff training; there may be three to five teacher training days a year with a chance of some disabilities related topics, but the chances of any teacher learning, without going and doing it themselves, about ADHD are very slim right now.

The school system needs to embrace all the pupils' needs, concentration should not be focused on fixing individual children but rather on developing a system that allows all the children to grow and learn in as natural an environment as possible.