March 19, 2007
The Return of Squirrel Boy
So we've been dosing our son with drugs.
All for his own good, of course! Alan has mild ADHD. It's not crippling, but it's definitely an issue. It's hard for him to concentrate. When he's having a bad day, he can't stop moving, wiggling, talking -- and he won't meet your eyes, which drives his mother crazy.
We've tried various things. Routine, routine, structure. That helped some. Dietary supplements -- fish oil, for the fatty acids. That helped a bit. Avoiding certain triggers. (7-Up soda. Makes him totally manic. No idea why.)
But there are limits to what you can do, and more limits to what you can do in Armenia. There are some wonderful new physical therapies out there for ADHD kids. Not available here. (Hell, Armenian doctors aren't really aware that ADHD, like, exists.)
So, drugs.
First we tried Ritalin. That actually worked pretty well. It calmed him down, helped him focus. We were a little freaked at first -- we're drugging our child! -- but that passed. Because he was happy.
Ritalin wasn't perfect. It seemed to depress his appetite. Alan eats like a bird to begin with, so that wasn't good. And while unmedicated Alan -- aka "Squirrel Boy" -- could be pretty high maintenance, still, we weren't entirely comfortable with putting him on a daily dose for the rest of his life.
Ritalin had one other big drawback: you can't get it in Armenia. Armenian medicine tracks Russian medicine. Russian medicine knows nothing of this ADHD nonsense, but it does know that you can take Ritalin to get high (if you eat it like popcorn), so it's simply not available here.
So, Step Two: Strattera. Strattera is a non-stimulant ADHD medication. Not controlled like Ritalin, so you can buy several months supply at once. Helpful! We switched from Ritalin to Stratera in January. That seemed to work okay, too.
But over several weeks, we decided that Strattera wasn't as good as Ritalin. He was a bit more focussed, but he was still Squirrel Boy a lot of the time. And Strattera has problems too: it's expensive, it's relatively new (meaning no long term studies yet for side effects) and you have to give it consistently every day.
So, we could have gone back to Ritalin. But by this time we were getting a bit blase about this whole drugging-our-kid thing. (It is amazing how fast that can happen.) So, we decided to try Ritalin AND Strattera.
In our defense, we asked the doctor who scripped us the Strattera, and he said it would be okay. Still... one kid. Two drugs. Was this really a good idea?
Well. Ritalin plus Strattera?
It works.
It works really well.
Alan got very focused. He could color an entire page, inside the lines, by himself. (Unheard of. He has never done that before.) He dressed himself from scratch -- went to the dresser, got the clothes out, took off his pajamas, got dressed. A whole sequence of scripted actions which, as a just-turned-five year old with ADHD, had been as far beyond him as calculus. He even did all the buttons on his shirt -- which, since it requires both small motor coordination and patience, was something he'd never quite managed before.
At school he finished all his tasks in the alloted time.
When he came home, he went into his room and played quietly, building something. He didn't even make a mess, much. All day long, he didn't spill anything, break anything, trip over anything, fall off of anything, or run into any walls.
He was like a different kid.
But.
This different kid... was really a different kid. Like, not Alan.
He was serious. He hardly smiled. (Understand that Alan is a boy who laughs and smiles constantly.) He seemed to have something tied in knots inside him -- stiff, a little angry. He frowned a lot. When balked, he didn't cry much -- also unusual -- but he got very frustrated and a little aggressive. At one point he snarled at us, which is so not-Alan I'm still a bit creeped just remembering it.
We talked to his teacher in the evening. She said that he'd done all his work perfectly. But she (and all the other teachers) had noticed a difference. He was competent, very competent, but morose. Focussed, but unhappy. On the playground, where he normally skips and bounces (and falls), he was obviously not enjoying himself.
It was chilling, she said, to see him like that. She used that word: chilling.
So.
We'll probably go back to the Ritalin. But, boy, we'll be more careful now. This was educational. And a little... no, more than a little disturbing. We gave our kid a completely new personality, even if only for a few days. Hello, brave new century. What's next?
Meanwhile: tonight he was off of everything. And he was totally manic. Talking constantly. Bouncing off the walls. Some sort of rebound effect, it looked like. In bed he was twisting himself into odd positions -- feet up the walls? Hm, now let's try sideways -- until he finally, poof, fell all at once asleep.
And he was smiling. And laughing.
Squirrel Boy was back.
And welcome.
Posted by douglas at March 19, 2007 07:27 PMMy parents never put me on drugs when I was a kid. They probably should have. I'm still struggling with a legacy of rock bottom grades until college and social ostracization since middle school.
From my friends though who were on ritalin back when they were young, they tell me that long term use of the medication through childhood and into puberty can wreck havoc on metabolism. You probably know better than me, so is there any truth to the anecdotal data I have? I'm hesitant to use the net to find out considering the moral panic behind childhood meds.
Posted by: Spike Gomes at March 19, 2007 10:35 PMThis must be tough; either you're dealing with local doctors who don't know the disease, or (probably) anti-ritalin backlashers among the other expats.
I've witnessed some really weird reactions to anti-depressant combos as well as wild rebounds when one or both drugs is dropped. Unfortunately, experiment is the only way to discover what really works.
Posted by: James Bodi at March 20, 2007 05:21 AMFor all we know (and I'm wearing my PH hat here), Ritalin is a very safe drug. Doesn't build up in the body, acts only for a very limited time. It is said to stunt growth but this seems mostly to be connected with the appetite depressing factor. This can be worked around - give a good breakfast before giving Ritalin, feed the child copiously when he comes off. (In fact, those combo-days, Alan would eat five slices of pizza or three bowls of cereal in the early afternoon. More than he usually eats.) What I also like about Ritalin is that since it works so quickly (about 20 minutes), and works for such a short period, you can give Ritalin when you really need it and leave it off on weekends and "good" days.
As for the metabolism - I haven't read any papers that address this issue. (And I've read a lot of scientific papers about ADHD.) I'll look into it because it sounds worrying.
Mind you, ADHD kids and adolescents have very high risk factors for substance abuse, criminal behavior, addictive and oppositional defiant disorders, social stigmitazation... Tough choice, the possibility of that, and Ritalin on the other side.
The thing about Ritalin is, if you don't have ADHD, it's not a safe drug at all. There is definitely a factor of over-prescribing, of it being a wonder drug for parents who cannot handle their kids.
This is not us. Alan's symptoms are clear, he has a hereditary component, and when on Ritalin alone, he's happy and able to live up to his possibilities. Happiness, in my eyes, is important in a five-year-old.
Posted by: claudia at March 20, 2007 06:06 AMJust because you don't mention it, have you considered adding some seriously aerobic sports, like soccer? That always helped channel my energy when I was young, and it would boost his metabolism too.
Posted by: nd at March 20, 2007 07:58 AMIt's pretty hard even when you do it to yourself as an adult too. "So, I've just given myself a new personality, and this new personality must decide if this is a better personality than the previous personality, but it looks at the old personality through the light of the new personality . . . " That pretty Philip K. Dick-ish when you think about it and it's something millions have to decide all the time.
I know it sucks, but trial and error really is the only way to find out what works and what doesn't. Just too many variables in individual brain chemestry that we don't have a clue about at the moment.
Best wishes to you all, I know this can't be easy,
Mike
Have you tried teaching him chess?
You might need to be on the Ritalin to do it, but once mastered it's a big help in practicing focus. And fun, too.
Well, I thought so, at any rate.
Of course, just reading your blog I probably have no business commenting, but having raised two boys (25, 26) who had some of the same problems--and having just discovered that my oldest, Sean, had a form of autism, now called Asberger's syndrom, I would like to offer a small bit of advice. Take it easy, be very cautious to introduce new meds. Read everything you can get your hands on. ADHD is a very complicated and misdiagnosed SYMPTOM. It is important to remember that it is a symptom--of several conditions. Also, do not let your son interalize "something is wrong with me". They are only young for so short a time. After my son was grown, he was able to tell me how my search to make things better made him feel. He loved me anyway!
I found your blog thru a search for vinegar pie, and liked what I read so found your current writing. It sounds like you are living a wonderful life. And that you are great parents, with great kids. Keep it up.
kate
I was interested in your blog, you guys are good parents, but if Ritalin works give it a chance. I have been on Ritalin for sixteen years, my grades in high school went from a .27 gpa to a 3.5 gpa in one semester, but my parents had the same feelings you did. They felt I wasn't the same kid, fortunately that was true. I wasn't getting into fights, I wasn't throwing temper tantrums, but I was acting very serious. This is a result of increase focus, and its not a bad thing. When I first started Ritalin I could do all kinds of things I could never do before, it enabled me to use skills that I had but was unable to utilize at first. I read everything I could get my hands on, I started writing creatively, I improved in sports and musicianship two things I had been good at in the past and eventually I chilled out. I sort of phased out of the super serious thing, and became the guy everyone gets along with. I did lose weight when I was on ritalin, but I grew out of that fairly quickly. I completed college sucessfully, I have three degrees at the age of thirty one and work at a hopital where I'm in charge of a department. I'm married, my wife is a physician, and other than some occasional disorganization Ritalin has kept most of the problematic ADHD traits in check. I offer these thoughts more as encouragement than advice, remember that every medicine works differently on everyone. If ritalin is making your child unhappy, then its probably not worth any gain that it might make. Hope this helps, feel free to e-mail if you have any questions or concerns and good luck.
Dave Long
Posted by: D Long at March 31, 2007 05:55 PM