Today I did the most stupid thing in the world.
Little Man has ADHD and after much debate and alot of soul searching we took the decision to agree to a course of medication for him - this being the slow release version of Ritalin, Concerta XL.
It was a huge decision and probably one we would not of taken had his learning ability not been so badly affected by the inattention and inability to concentrate. At the age of 6 he was reading nothing, didn't know the days of the week, and had little letter and number recognition. As a result we felt we needed to at least try a 6 week course of medication to see for ourselves and give him a chance before writing it off.
Thing is within a week we were not only living with a different child, but we were living as a different family and hadn't even realised how differently we functioned until this point. Within 6 weeks other kids in his class began commenting on his behaviour and how they now liked Little Man or wanted to work with him. Within a term he was beginning to get the basics of writing and reading. I think these results spoke for themselves.
18 months on, we have a happy little boy, who loves school, is beginning to make friends for the first time, and is making slow but steady progress and getting to grips with writing and reading, and I would not take him off the medication right now as a result. He still has a long way to go and is still classed as special needs/learning difficulties but he is making progress and that is the key.
I think out of everyone we were the most shocked by the results, we had a very blinkered view of putting Little Man on medication and did it with a huge amount of reservation. I was worried about side effects and the fact it is in fact an amphetamine.
If you read up on Ritalin or concerta XL it has received some very bad press in the past citing problems with addiction, psychosis, suicidal tendencies and depression if it is withdrawn, a precursor to substance abuse, stunted growth, decreased appetite, and tics to name a few.
It makes it sound pretty horrendous doesn't it? However as a scientist, I tried to keep a level headed view and look at all the evidence and not just what makes it into the press, because after all, it is generally the bad stuff that does. On reading up on Ritalin and its derivatives has been quite well researched (in the short term, sadly there is not much available still on long term effects), and there are studies that have been conducted in both ADHD and non-ADHD subjects. Studies which the press have reported in the past as showing a very negative view of the drug have generally shown bias in their study population, been underpowered to be statistically significant or in the discussion have actually noted problems with the study design. There are also studies reporting positive results and counteracting the above claims. We decided we needed to see for ourselves, we know our Little Man and hoped we would know if he was depressed or anything like that. On the contrary since being on the medication he is much happier and more out going as he can now interact with his peers in a better matter. Prior to medication he was withdrawn as he was always the one in trouble and he use to agree he had done anything when the finger was pointed at him even when he hadn't.
I also have to question whether claims such as suicidal tendencies, depression etc could be due to an inability to fit in, maintain friendships, hold a job down, achieve in school - some of this comes from a very interesting book I am currently reading which I will probably blog about at a later date. The leading to substance abuse again could this be due to a cry for trying to fit in, be part of a gang etc?An ADHD child is very much on the outskirts due to their behaviour, and older ADHD children often say they are so desperate to fit in they will try anything and are obviously easy targets for others.
How does Ritalin or Concerta XL work though? The actual name of it is methylphenidate. It is a stimulant, and works by increasing the dopamine levels in the brain. Dopamine is a neurotansmitter with many different functions including a role in behavior and cognition, voluntary movement, attention, working memory, learning (the latter 3 being major problems in ADHD), sleep and mood. Studies have shown that ADHD patients have lower dopamine and noradrenalin levels than a non-ADHD patient.
As mentioned methyphenidate is a stimulant which we all associate with increasing activity, wakefulness, mental agility, movement i.e. give you a high and a sense of being able to continue without feeling tired, enjoy life etc. I am sure most of us have heard of speed which is a stimulant. However to receive these kind of effects the stimulant is normally snorted as a powder or injected which gives it a very fast access route to the body and therefore brain, creating that feeling of euphoria rapidly and giving the said 'high'. When methylphenidate is given in small controlled doses as a tablet, it takes up to 60 minutes to be absorbed and reach the brain which avoids that instant high and there is no feeling of euphoria, and studies have shown there is no more of a danger of an ADHD child taking a prescribed, controlled stimulant seeking to try recreational/harder drugs than a non- ADHD child.
The most interesting thing about methylphenidate though is the fact there is a belief that in an ADHD patient, it has the effect of calming and focusing the mind. By increasing the levels of dopamine which are low in ADHD, it decreasing impulsiveness and increases concentration, basically allowing someone with ADHD to function to the best of 'normal' abilities. However in a non-ADHD subject there is evidence to suggest that it has the opposite effect and does in fact act as a stimulant and if taken not only does it increase alertness, it also gives a sense of being jittery, being able to continue without tiredness, talk constantly, be on the go and a certain sense of euphoria. There are also studies though to suggest that this is just a myth.
This brings me to my stupid mistake this morning - and having written the above paragraph I am sure you may guess where this is leading. I was holding Little Man's concerta XL in my hand and filling a glass of water, popped what I thought was paracetamol into my mouth and as I swallowed and felt it slipping down my throat realised my mistake. Little Man did as well, and though it was quite funny. I was all ready to ring the out of hours doctor until t'husband reminded me there was a huge issue of student taking Ritalin to increase exam performance.
Now I am pretty sensitive to caffeine, I can't even drink caffeinated tea as it makes me feel very funny (only way to describe it) and if I have more than 3 cups of coffee, I feel pretty shaky. Little Man is on 36 mg. However, now I have done my personal research I can honestly say it does have the effect of a stimulant. I have been racing all day, feeling supercharged (and not in the best way), I haven't wanted to sit down and do anything until now, just wanted to be doing things, finishing things (not a bad thing). However its not been a nice feeling, I really didn't like it. The words jittery limbs is a good description. The feeling I have had today has reminded me of the film Limitless, and I imagine it was a pretty similar effect but to a lesser degree.
This feeling I have had all day has really alarmed me. If Little Man feels like this, then I don't want that. I have spoken to him tonight and asked him how his brain and body feels before he takes his tablet and his exact words were 'my brain spins round in my head and doesn't stop and it is all over the place and very naughty'. I then asked how he feels after his tablet and he said 'after a while my brain slows down and then stops and I like to think then and look at my books because they make more sense'. I think that speaks for itself. Another way to look at it (and this is the clinical scientist coming into play) is I take HRT as I have had a hysterectomy and am too young to be missing those vital hormones. For me, the HRT is giving me a 'normal' level of hormones for someone my age which I would otherwise be missing. If my friend who has her ovaries and uterus were to take them, then she would get bad side effects as she would have way too much oestrogen and progesterone. Or I guess a diabetic takes insulin as they don't produce enough, if a non-diabetic took insulin, then they would end up in hospital.
Anyhow, after my little chat with Little Man I feel a little happier he has a very different experience of the drug to me, but if I ever feel that is changing then he is straight off it. He certainly does not give the impression of someone on speed!
I am currently trying to research more into ADHD, different techniques especially on learning and also autistic spectral disorder which Little Man also has. Although Little Man is making progress in his school work it is very slow, and I am also thinking he may have dyslexia which requires a different method of teaching. To speak to Little Man is a very intelligent little boy and amazes everyone with what he knows, on paper however it is not reflected. We know he has potential and think he just needs a different way to unlock that. He is now becoming aware he is behind though as keeps asking over the summer to read with us and learn things so he can be the 'smae as the other children in my class'.
Please note anything written here about the way Ritalin works, and any evidence I have read is my personal opinion and also my words and interpretation, it is by no means quoting data.