September 20, 2005
Shut up and take your pills
The easy way to help hyperactive children is to give them medication - but it is often unnecessary
Yet sometimes I wonder whether future generations may not look back at our habits and shudder in their turn. One of them in particular grates on me: it is reported that prescriptions of the drug Methylphenidate — commonly sold as Ritalin — have risen sharply in a decade. Last year in England there were 359,000, the vast majority to children under 16. This is a mind-altering drug, described by its most bitter opponents as “ prescription crack”; in the United States 6 per cent of all children take it.
Here it is less than 1 per cent, but rising fast: for this is the cure-all for the fairly newly defined condition of “ADHD” — attention deficit hyperactivity disorder.
The amphetamine-based drug is claimed by its many adherents to improve concentration and calm children’s behaviour. Parents who use it are violently defensive of their decision. The ADHD lobby has claimed, controversially, that one in twenty children today suffers such a behavioural “disorder”. Yet it is routinely prescribed to children whose age or circumstances might just as easily explain their erratic behaviour.
In the US babies have been given the drug: here, it is more likely to be administered to a nursery or school-age child who is not interested in what his teacher says and disrupts both class and home with destructive boisterousness.
I say “his” for good reason. Most children diagnosed with ADHD are boys. There is no hard clinical diagnosis or medical test for the condition; neurological theories contradict one another or fade under close examination.
So it is generally diagnosed on the basis of mere behaviour — restlessness, fidgeting, outbursts of temper, unwillingness to take instructions or concentrate (which means failure to concentrate on what adults and the national curriculum want you to concentrate on).
Indeed, the more descriptions of the symptoms you read the more images swim into your head: Alastair Campbell, Piers Morgan, Sir Alan Sugar, Mark Twain, Horatio Nelson, Thomas Edison . . . It is hard not to feel an uneasy suspicion that this is a conspiracy against boyish boys.
In the heavily feminised, mimsy tick-box culture and educational system that now runs children’s lives, with fathers often working for long hours or absent altogether, the very nature of boyhood attracts disapproval. Or the very nature of childhood, indeed: one woman interviewed about the marvels of Ritalin complained that before it her three-year-old was always asking questions, and going on to another as soon as one was answered, which drove her mad. Well, it drives us all mad: “Why is the moon? Can sheep fly?” But if we are wise, we rejoice in it.
There are strong lobbies against Ritalin too, some of which describe it as pharmacologically similar to cocaine and brand psychiatrists as dupes of “irresponsible pseudo-science”.
But calmer voices express unease, too. Professor Sir Alan Craft, president of the Royal College of Paediatrics, admits that it is “concerning”; Professor Peter Hill, a specialist in ADHD at Great Ormond Street, is quoted as admitting: “While Methylphenidate undoubtedly works for some children, clinicians are under increasing pressure from vast waiting lists to see people as quickly as possible, resulting in some medicating where it is perhaps not necessary . . .”
Incidentally, our propensity to drug children rather than meet their awkward emotional needs is also underlined by the fact that Britain has one of the world’s highest rates of prescribing antidepressants to under-16s. Thoughtful doctors go so far as to say that pharmacological solutions are popular because they offer parents an alternative explanation for bad behaviour, removing any suggestion that inadequate parenting, family breakdown or bad food are involved (an experiment in Co Durham found that if you give a daily dose of fish oil to poor children who eat junk food, it has almost as much effect as Ritalin in improving concentration and behaviour).
Without being Luddite or hysterical, we should certainly be worried. In the US there is a strident middle-class lobby for the use of the drug, with websites encouraging children to “feel good about themselves” when they take it.
In Britain it is less explicit, for I have a hunch that if you took a social profile of ADHD prescriptions, a disproportionate number would go to boys from poor and ill-supported homes, without attentive fathers. Note also that when a child is diagnosed (and doctors’ definition of severe ADHD is subjective), the parents are eligible for disability benefits. So the family gets a bit more money, the child is outwardly calm, the school can function better despite its huge classes, lack of outdoor space and prescriptive learning targets. The doctor has the family off his back. The drug company doesn’t do badly, either.
Again, let us have no hysteria. There is such a thing as destructive hyperkinetic disorder. Sometimes it does go beyond normal boyish high spirits into an area of real mental illness. Sometimes, after exhaustive and responsible experiment, it is clear that the cause is not emotional neglect, bad diet or too much screen time. Sometimes Ritalin is a boon.
But are there really so very many British children intrinsically disordered in their brains? So ill that they must take a psychoactive drug for 10 or 15 years of their young lives, with unknown long-term side-effects?
You would think that a country that obsesses for days about a rich adult supermodel snorting a bit of cocaine would be more worried about this. "curus38639.104849537fantastic!!! i love it!!
She's a good reporter, and so is Sarah Boseley of the Guardian.
Another insight into British Culture - and humor re the DSM IV and psychs drugging just about anyone for anything shows in this email:
" New Diseases Requiring Psychopharmacological Treatment.
Refrigerator Door Disease (RDD)
This disease is characterized by standing in front of the refrigerator with
the door wide open, staring blankly into a collection of fuzzy jars of grape
jelly, half-eaten margarine tubs with bread crumbs, and something that used
to resemble fresh fruit (but might actually be meatloaf). This disease
strikes only at night, and is accompanied by light sensitivity that makes the
refrigerator light seem ten times brighter than normal so that it pierces closed
eyelids like the flashlight of God himself.
Language Obfuscation Disorder (LOD)
Striking mostly doctors, surgeons and oncologists, Language Obfuscation
Disorder causes its victims to speak in unintelligible medi-babble while
imagining their words make perfect sense. People afflicted with this disease
literally speak in Greek, substituting normal-sounding English words (like "liver"
and "inflamed") with words made of Greek elements ("hepato" and "itis" or just hepatitis.) Interestingly, two or more victims of LOD seem to be able to understand each other perfectly well, although no one else has any idea what they're saying.
Obsessive Hosiery Dislocation Disorder (OHDD)
OHDD is characterized by a frantic household search for the other sock of
any given sock pairs. Victims of this disease, when finding only one sock from
a pair, feel the universe has fallen into a state of great imbalance that can
only be restored through the recovery of the missing sock. Victims may also
become sock-dependent, whereby they repeatedly buy new socks in the hopes
that sheer sock volume will make up for the universal imbalance caused by
dislocated socks. In advanced stages, this disease causes people to safety-pin
their socks together in the wash. "
I'm not sure how groovy this one is LOL, but here's a site (Brit - I think - humor again) with a prescription mainly meant for 'pharma psychiatrists' - I can't find any other prescription in there
and is a take on Dr Benbow who works/worked for GlaxoSmithKline and helped promote paroxetine (Paxil) in Europe using phrases that are almost recognisable in some of it:
Never a good idea to disilluion a psychiatrist by inferring he/she is not acutally an awesome god and an oracle of universal wisdom, most of them are very sensitive creatures.
I gotta go do some work
Nice talking with you
curus38639.2693865741enjoy excellent probe into british culture...