In ADHD debate, no right answer
Sally Swift of Worcester knows how it feels to get the you're-a-bad-parent look because of your out-of-control child. Her son Andrew was diagnosed with attention deficit hyperactivity disorder in third grade. When the family would go to the amusement park, Andrew would try to unbuckle himself and climb on top of the ride. In kindergarten, he ripped papers off the wall. In third grade, he threatened a teacher. In seventh grade, he was expelled for bringing a knife to school.
And yet, Swift has been criticized for putting Andrew on medication. He first went on medication in the third grade, then went off it for a period in seventh grade because of side effects. After he was expelled, he took a new medication. Now, Swift's son is an accomplished high school freshman who earns A's and B's and plays on his school's football and basketball teams.
"I've heard many people say, `I wouldn't put my kid on medicine,' " she said. "But you don't know until you are there."
The debate over how to treat children with ADHD is not new. But reports describing how drugs like Ritalin are being abused is resurrecting the debate over whether it is necessary to give children such strong stimulant medication.
Those who oppose using the medicine say parents who medicate their children use the pills as a shortcut to getting compliance at home and school. Those in favor of the medicines say other parents are acting skittish and are avoiding the problem facing them.
Who's right? There is no single answer.
Each child is different. Some can cope without medication, while others -- such as Andrew -- rely on Ritalin or something similar to function. Swift said putting Andrew, now 15, on medication was "scary," but the change along with other efforts has made a difference. The family focused more on his behavior and helped him organize his time. Before, he had trouble making friends because he could not sit still long enough to play a board game. As a result, his self-esteem sank.
"Now kids come over and hang out," she said. "He feels like a normal teenager."
Andrew said he fidgets in class if he is not on the medicine. "It allows me to concentrate on my work instead of everything around me," he said.
At the heart of the Ritalin battle is the perception that the attention deficit disorder is not real, that some youths just act out in rigid classroom settings. Dr. Timothy Wilens, a researcher of the disorder and child psychiatrist at Massachusetts General Hospital, said ADHD rates are consistent worldwide at 6 to 8 percent of children, which he said is evidence of a biological root.
But Dr. Leonard Rappaport, director of the Developmental Medicine Center at Children's Hospital, said there are many reasons children have trouble paying attention.
"There are almost no symptoms of attention deficit disorder that other kids don't have," he said.
Rappaport, a former teacher and principal, has seen children with ADHD who never took a single pill, and Wilens noted that studies show that concerted efforts to manage behavior are about 30 percent as effective as medication.
He said medication similar to Ritalin was first given to children with behavioral problems in 1933 at a Providence school. Despite rumors to the contrary, no studies have linked childhood Ritalin use to increased problems later with drug or alcohol addiction. During his school years, Rappaport opposed using the medication. Now, he believes it is a boon to some children.
But medication still is just part of the picture and just for some children. Schools also must make adjustments in the classroom environment to help students better function in class, said Carol Daynard, assistant superintendent for pupil services in Newton. Daynard said children with the disorder need breaks built into school days. Teachers can also erect barriers to create classroom workspaces that limit distractions.
But some parents, educators, and others worry that teachers, already stressed by all they have to do, may rely on an ADHD diagnosis and Ritalin-type medicines more than they should.
"Public schools are under so much pressure that kids who don't readily fit in, that don't get with the program and sit still and cooperate are big problems," said Chris Mercogliano, author of "Teaching the Restless: One School's Remarkable No-Ritalin Approach to Helping Children Learn and Succeed."
Mercogliano, also codirector of the Albany Free School, simply accepts that children are different and does not use the ADHD label.
"We don't consider that certain kids have something wrong. Some kids are more energetic, more distractible; some kids are angrier than others," he said.
For some parents, trying alternatives is the best solution. Toby Alvarez's sons, 12-year-old Alan and 14-year-old Alex, both have been diagnosed with the attention deficit disorder. Alex, who is in the eighth grade, has never been on medication. Alan, a sixth-grader, was on Ritalin from third through fifth grades.
The Shrewsbury mother has helped her sons focus on behavior. But she also tried some alternative approaches that research has not proven effective, including watching her sons' diets and taking them twice a week to a chiropractor. She regrets ever putting Alan on medication.
"It never stopped him from moving or doing or talking," she said. "It didn't make him pay attention. It just took the life right out of him."
