Tuesday, February 18, 2014

Days of Our Work Lives: An unvarnished look at work today: Part III: Adam's Saga. Episode 1: ADHD? Ritalin?

Part III: Adam's Saga  

Episode 1
ADHD? Ritalin?

In Part I we saw too-intense David die. In Part II, his wife Susan succeeded...moderately. Part II ended with Susan wondering how to decide when good is good enough. 

And that applied to her nine-year-old son, Adam, who while kind by nature, was also active by nature, and despite Susan and Ben's efforts to be good parents, was still challenging at school.

Thud! Adam's chair hit the floor. His teacher sighed, "How many times do I have to tell you to not tilt your chair?!"

He loved that game. It gave him an adrenaline rush: "How far can I tilt without falling?" Of course, he'd occasionally go too far. 

Embarrassed, Adam picked himself up and tried to avoid further criticism by cleaning the mess on his desk. Papers were always spewing out of his desk and the same could be said of his backpack.

Alas, just minutes later, Adam had relaxed his vigilance and was back to "multitasking:" This time, while paying attention to the teacher's spelling lesson on "there," "their," and "they're,  he tickled the kid next to him and was concocting another of his "tests" that he would pass around the room. 

Adam's previous creations included a three-question "Intelijence Test" and a "Populerity Test:" "Write who you think is the most popular boy and girl in our class." 

That day's offering was a three-question "Sex Test: How Much Do You Know About Sex?" As usual, before his kid's-version of a Cosmo quiz made it halfway around the class, the teacher intercepted it and was about to read it aloud to embarrass Adam until she read the first question, "Where does a boy put his peepee into a woman?" 

She had read Adam's record and noted that last year's teacher had urged that he go on ADHD medication but "The father (David) refused. He blamed the teacher: 'If only teachers would meet active boys' needs and make lessons more interesting, you wouldn't need to put him on a Ritalin leash!'" After school that day, she called Susan.

And the teacher convinced Susan to take Adam for an evaluation by a physician specializing in ADHD.

He said, "Two-thirds of kids who try an ADHD drug show significant improvement  and quickly. Ritalin has been around forever so it's proven safe, it's as or more effective than the newer drugs, it's short-acting so he can take it only so it will help him during school hours. And it's available as a generic so it's cheap. There's little to lose by trying it for a month.

Susan wasn't convinced.  "What about side effects?"

"We'll try a low dose, and especially because it's the short-acting Ritalin, he should have little if any side effects."

Ben was not sold: "But if he takes uppers, he'll be deprived of the opportunity to learn how to adapt to his natural self, so he'll be forced to stay on them for life."

Susan added, "And over time, won't he'll build up tolerance so he'll have to keep taking more? Being on uppers for life, an ever stronger dose, can't be good for you."

The doctor responded, "While yes, some people stay on ADHD medication for life, some kids outgrow ADHD enough by adolescence to stop taking it. And the evidence is mixed on whether kids do develop a tolerance to it. Right now, we are 100 percent certain Adam needs help. It's worth a one-month trial. You can always stop it but why not see if he is one of the lucky 2/3?"

And he was. While no one could call Adam laconic, a fairly low dose put his activity level in the normal range: He was far more able to stay focused, not bother other kids...much. And he was glad to be taking it: "I didn't realize how out of control I was." 

But not everything was happiness and light.

The next episode is HERE.

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