Day 26: ADHD, Drugs, and Spina Bifida?

This week I’ve been talking about learning issues that are often found in children with Spina Bifida.  It’s time to tackle the ADD/ADHD issues often associated with children who have Spina bifida, but also on the rise in society at large.  Please understand two things:

1. I am not a medical professional nor do I play one on this blog.  These are my own opinions based upon research, prayer, and parenting 7 children, five of whom are boys.
2. If you choose to medicate your child for ADD/ADHD symptoms that is your decision.  I assume it was an informed one.  Either way, it is none of my business.  You are parenting the best you can, as am I. 

To really understand my thoughts we need to begin with the medical definition in the United States of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder.  I will refer to it as ADHD because it is simply two sides of the same coin.  According to the American Psychiatric Association the symptoms of ADD/ADHD are inattention, hyperactivity and impulsivity in some combination. (1)  According to the American Academy of Child Adolescent Psychiatry (AACAP) this can be displayed by children who:

• seem to be in constant motion—squirming and fidgeting and moving around the room
• show impulsive behavior – such as blurting out comments without thinking
• have unrestrained displays of emotion – either positive or negative excessive emotion
• lose focus often – their attention wanders unless the activity is personally relevant and interesting

Are you thinking yet that this sounds like a normally-developing young child?  That is exactly right.  According to the above groups the issue with ADHD is that these natural behaviors cause problems at home, school, or with peers.  Their solution is to medicate the child to control the behaviors, which I will come back to in a moment. 

Normal Childhood Behavior

A child naturally pays attention to what interests them and moves on from things that do not.  They are not mature adults who willingly choose to do an activity they are not interested in because it is expected by someone else (their employer, for example).  If a child cannot see the relevance of spelling, history, or math to things they find vitally interesting then their attention will wander.

A child naturally is energetic and usually in motion.  God created us to move and children are not socially inhibited enough to squelch that energy by choice.  If they really feel like dancing, singing, running, or hopping they are going to do it.  Sitting down in a desk or at a table for hours is unnatural behavior for a child but is the socially decreed ‘acceptable behavior’ in school.  Children have energy and it needs an outlet. 

Impulsive behavior such as saying every thought that comes into their head or openly sharing the full extent of their emotions is natural and normal for a child.  Again, they are immature children not mature socially conscious adults.  Self-control has to be developed and like every other developmental skill is mastered at a range of ages.

All of these ‘symptoms’ of ADHD are natural, normal behaviors for children.  Like any other developmental or social skill a child can gain self-control and ability over time.  What I have learned with Mason’s physical development applies here.  Just as Mason has needed specific help learning to control his body for rolling over, crawling, and sitting because of the physical effects of Spina bifida, some children will need specific teaching, practice, and help to reach the developmental skills considered socially acceptable in attention, activity, and impulsiveness.

Drugs for Normal Childhood Behavior?

When you look at it like that the entire question of medicating a child for these normal behaviors becomes redundant.  There is nothing medically wrong with the child in need of medication.  Even worse, the drugs commonly used to treat children for ADHD are mostly stimulant class drugs in the same class as cocaine (they are amphetamines).  Ritalin is the most common.  Basically, Ritalin and cocaine do the exact same thing – increase the dopamine level in the brain by blocking a dopamine transporter protein.  Over time this changes the brain’s structure and chemical balance (and yes, it can lead to addiction).  When the brain becomes used to a new level of dopamine through drug use a few things happen.  It begins to require this higher level to feel ‘normal’.  The child is now living on a drug-induced high and without it, or with a reduced dose in their medication depression or other psychotic problems follow.  A few more lovely side effects according to the FDA include panic attacks, aggression, and violent behavior.

Even the non-stimulant ADHD medication Strattera has specific warnings that it increases psychosis - suicidal thought and actions - in children who take it.  Some children are given antidepressants to combat these side effects.  All of this, plus less severe side effects (decreased appetite, weight loss, insomnia, physical tics, headaches), come when a child did not physically need medication in the first place.

What does a child need?  Time to mature and specific coaching to develop the skills of attention, sitting still at appropriate times, and thinking before they speak.  Exploring things such as the relationship between diet and behavior would be wise.  Reasonable expectations would help too! 

For example, while it is socially expected that a child in the US today will sit still for 7 hours of school beginning in Kindergarten at age 5 that is an artificial social construct.  Adults who are on the high energy and movement end of the spectrum have the CHOICE to pursue careers that work with their skills – perhaps coaching athletics teams, construction, military, or any physically active and demanding profession.  Children on the high energy and movement end of the spectrum are not given the same choice to work with their strengths, but are expected to do something unnatural – sit still for extended periods of time happily and quietly. 

Children who have trouble paying attention in math, history, or other lessons they find uninteresting or unrelated to them personally are considered to have an attention deficit.  Social expectations are that they ‘sit down and study it anyway’.  Think about it, do we force adults who want a career in writing to take 12 years of high-level science classes instead?  Or do we require adults who are mechanically inclined and can build, fix, or create to spend years in class focusing on history and geography?  Adults can seek learning in areas that interest them.  Children are expected to sustain focus and attention whether the subject interests them or not. 

In Conclusion

If you made it this far I hope you found my thoughts worth reading.  You may or may not agree with me, and that’s fine.  I’m not interested in debating these issues and reserve the right to delete any comments that pursue a debate.  The most important thing is that you do your own research and find the answers that are right for you and your child. Don’t take my word for it.  Don’t take the doctor’s, the teacher’s, or your neighbor’s word for what you should do in raising your child.  Don’t assume that in the money-driven drug and medical industry that you’re getting information without bias.