The Road to Ritalin

neer_mazeAs I sit down to write this I am thinking: “Whoever looks at the title of this article is going to judge me.”  I am afraid that you, dear reader, are thinking “This mom is drugging her child to make her life easier, to make parenting easier, etc…”  These are things I have said to myself.  I will admit that putting my son on medication for ADHD actually has, to a certain degree, had that effect (easier life, easier parenting, etc…), but we would not have kept him on medication for those reasons alone.  It is the affect on our son’s life that has given us validation for our choice. Our son, G, has gone from social isolation to being able to cultivate friendships. He has grown from a formerly wiggly and challenging classmate to a (mostly) focused student. Read my story and if you still judge, that is okay. We, as parents, each have to make our own decisions as to how to best serve our children. This is how it unfolded for us.

Our son’s first 18 months of life were fairly typical, he was energetic and constantly on the move, but so were most of the other toddlers we came across, so we suspected nothing. Sure, we had our fair share of running after him on the playground but so did many other parents of toddlers.

At one point, during these toddler years, we found ourselves surrounded by families with beautiful little girls. They wanted to have their hair clips put in and they wanted to sit and draw (the sitting part was totally foreign to me and my son at that age).  Compared to these girls, my son, G, seemed extremely active. My husband and I felt concerned, but told ourselves “he’s just all boy”.

As I sit down to write this I am thinking: “Whoever looks at the title of this article is going to judge me.”

Time passed and we started looking at preschools. That is when we realized that our son was a handful. We never wanted to be “helicopter parents” but we had no other choice. We needed to be ridiculously attentive to him, just in order to keep him out of trouble, to keep him safe, and to keep others safe. If we took G. to the playground he would find a way to get in some sort of trouble whether it was with other children or on his own. He was different. G was unable to keep his body to himself and when we tried to get him to change his behavior he often escalated to a level far exceeding what was appropriate for the situation. Bringing him back down to a “manageable state” required physical removal from the location because he just couldn’t “change his tack” on his own. I’ll tell you, we got A LOT of dirty looks on the playground! We started feeling like we had OUR hands full in a way that was different than the other moms and dads around us.

We finally got accepted at a preschool in San Francisco (no easy task) and, at age three, preschool started for G.  We went to a wonderful and supportive preschool, however, we often found ourselves having the 20-30 minute “conversation” with the teacher 2-3 times a week.  G did this; G did that, and on and on it went. In those many conversations we had with the teacher, we didn’t tell them that for every issue they were having with G, we were having more of those same issues (and others) at home. Home life was a challenge, to put it mildly.

At home, we planned our days around how few times we had to get in and out of the car with G.  Each transition, even to fun activities, was a wrestling match inside the car to get him buckled in, get him settled, etc. All the while, we just kept thinking “he’s a boy” or, on the more challenging days, he’s a “spirited” boy. Finally, we started getting some assessments done for “spirited” children and got some sleep advice (oh, did I not mention that we couldn’t get him to sleep without nursing…which we had stopped at age two). Let me tell you, he had the stamina of a thoroughbred when it came to the “cry it out” method!!!

“Your son is profoundly different from any other child we’ve ever had at this school.”

When G was four, my husband and I decided that we couldn’t live in a fourth floor “walk-up” flat in San Francisco anymore. It was just too much of a battle getting G to climb up the stairs, getting G to climb down the stairs, getting G to get into his car seat, getting G to walk around the city with us and especially going grocery shopping. Everything was a battle and at the end of every day we just needed a break. We couldn’t manage to get him to comply with any basic request or task. The sticker charts and other incentive based programs that other moms talked about didn’t seem work for us.

So, we moved out of the city (to a house with no stairs) and we got him into a new school which we thought was a perfect fit for our family. The school went from pre-school all the way through 8th grade and we thought our search for schools was over until High School! But the “sigh of relief” was short lived. It didn’t take more than a couple of weeks at the new school when the teacher, after having daily conversations with us about his behavior, finally said “Your son is profoundly different from any other child we’ve ever had at this school.”

My husband and I were very angry at this statement; however, it actually set in motion the beginning of our search for answers to why our son’s behavior was so challenging. G was having problems at school, problems with socializing, and he was especially having behavioral issues at home. His melt downs were frightening. We did not know what was happening to him. I suppose our “Road to Ritalin” began on that day his teacher labeled him “profoundly different” from his peers. But medication was by no means the first thing we tried for our son.

My husband and I were ready to find a solution to our son’s challenges. The first steps we took were to take G to an Occupational Therapy* evaluation and a Psychological Evaluation (which indicated red flags for many diagnoses but he was too young for many of them to stick). We hired a behavior therapist to come to our home and work on behavioral issues. We did a sleep test to eliminate apnea from the list of potential causes for hyperactivity. We participated in P.C.I.T**(Parent Child Interactive therapy). We tried social skills groups, and changed his diet; eliminating specifically High Fructose corn syrup, corn starch and red fruits; all which we had observed having an affect on him. Even G himself noticed how it affected him. He told his Kindergarten teacher one day while she was handing out treats “I can’t have those if they have corn syrup in them.”

Additionally we noticed that G’s “Hanger” (Hypoglycemic symptoms) played a role in his behavior and we fed him on a strict schedule to keep him from “losing it” (of course, his actual blood sugar levels tested normal). We tried and we tried, we tried everything and finally somebody said you should go to see a Developmental Pediatrician*** and hear what they have to say.

We were now on to our third preschool and this one supported an “inclusive” environment. Even at this school, we observed that the children and their parents were avoiding us like the plague. Our son was either bothering their children, bothering the parents or some combination of the two. Our son really couldn’t attend a play date without some sort of incident happening. Mind you, he wasn’t aggressive or violent, but he was provocative and non-compliant. We used to call him an “emotional amplifier” because he follows the energy of the group and then pushed it “to eleven.” Once again, we found ourselves, and our son, very isolated.

I haven’t mentioned this up until now, but all the evaluations and appointments we scheduled had huge wait lists with months between visits. These wait times did not help our social isolation as a family.

I haven’t mentioned this up until now, but all the evaluations and appointments we scheduled had huge wait lists with months between visits. These wait times did not help our social isolation as a family. All the time we spent waiting to see the specialists, G was cementing a reputation for himself as a “problem child.” This did not do any good for our general anxiety levels.

When we finally got in to see the developmental pediatrician in San Francisco, the first thing G did was crawl underneath the doctor’s desk, pick up the table with his legs and knock every single toy off the surface of the table onto the floor. The doctor, who had already reviewed our son’s file, said, “Well there’s no doubt in my mind this is ADHD, he has the behavioral temperament and clearly the activity level for this diagnosis, everything points to it.”

We had our “Aha!” moment. Now in retrospect, because hindsight is 20/20, I think, “Of course he has ADHD, of course that is his diagnosis.” And that was only the first few minutes of the appointment. We went on to explain to the doctor all that we had tried and all that we had gone through before we came to see him. We explained how exhausted and upset we were and he suggested that we consider putting G on Adderall. What he then said was shocking and enlightening: He said, “As much as I want to see G succeed, I also think that you need to try giving G medication for the sake of all of you as a family.”

g_thrutetris-wallThat statement from the Developmental Pediatrician gave us hope. However, it also gave us a feeling of self-judgment and fear that other people will think, “This mom and dad are drugging their child….”  We also had fears of the drugs possibly having a negative impact on our son’s life. Then there were the side-effects questions. Questions like; will he grow? Will he eat? He was already a pretty picky eater. I wanted to know about the possibility of G becoming addicted to his medications. And I wanted to know in what way will these drugs impact his health and life for years to come? All of these questions were overwhelming and frankly, some of these questions are unanswerable. Even now, 4 years later, as I write this down, I still have some of the same concerns. This is why we didn’t come to this decision lightly.

The last thing we ever wanted to do was put our son on medicine for his ADHD. But with his social isolation, our social isolation and our family feeling out of place at pretty much every activity and environment, we finally made the choice to try Adderall at a very low starting dose. We had to try and see if the positives of this medication could actually outweigh the fears we had concerning the medication itself.

Over the next few weeks, his preschool teacher, who we were very close with, discussed the differences she was observing. The children in G’s classroom had been learning many social lessons in preschool like the “personal space bubble,” sharing, taking turns, etc. The teacher thought that G was struggling to understand these social lessons. As soon as he started taking Adderall she noticed that he had actually learned those lessons he just had been unable to apply them to social situations because his impulsivity got in his way.

Fast forward to Kindergarten. Though we had noticed many improvements in G’s ability to generalize his social lessons from preschool, Kindergarten was much more complicated for him and the Adderall didn’t seem to be helping. He was struggling to make friendships and whenever I was in the classroom I would almost cry because, to me, he stood out so much from all the other children. He was being the naughty one, the unusual one, and I often felt other mothers’ eyes burning onto the back of my skull. I was sure they were thinking, “Who’s that Mom with that kid?” “I sure hope they don’t ask us to play.” At one point in the year it was so bad, G couldn’t even stand in line outside the kindergarten door with the rest of the children at school drop-off. We told the teacher we just couldn’t watch our son bother the other children anymore. It hurt too much to see and we couldn’t stop him. He would be disruptive, he would poke at other kids or give them unannounced full body hugs or generally not contain himself.  The more we tried to redirect him, the more he continued to escalate his behaviors.

I tell you this because I wish we had known earlier how different medications affect different children. We, of course, knew that there were many products on the market. Our doctor preferred to start with Adderall and work from there. We saw so many improvements in G’s behavior that it didn’t even occur to us that we should keep searching. Dosage, duration, and medication type all play a role and there isn’t a magic solution.

I started to research the ADHD medications and I read somewhere that Ritalin had been known to have a more calming effect on certain children than Adderall. I called his pediatrician and I asked for a change of medication from Adderall to Ritalin. We started at a very low dose that was administered two times a day so that he would have his appetite back for his lunch (Ritalin can suppress some children’s appetite).  Immediately after starting G on Ritalin, we noticed that G was able to be more attentive, sit still and focus on the projects in the classroom. I even saw him being able to sit still on the rug for circle time!!!  By the end of the year he finally had a best friend.

You can’t imagine what it felt like (or maybe you can…), the day that G’s best friend’s mom asked us to go on a backpacking trip with them the summer between kindergarten and first grade. I thought, “Oh my gosh, this is great!” quickly followed by, “Oh my gosh, I am terrified for them to see my child in action un-medicated!” You see, G was only medicated at school from about 7:30am to 4:00pm and while the medication “fall out” was mild (for some it can be intense) his impulsivity and inability to transition from one activity to another were challenging (like when we are leaving a play date where he is having fun).

I just wasn’t sure what this new friend’s parents were going to think of us as we had to navigate our son’s behaviors at every turn.  The camping trip, thankfully, turned out well.  Being out in nature has a special calming affect on G and even though the transitions were not as smooth as we would like, he didn’t really stand out plus the mom was surprisingly accepting.  I admit, I was sneaky about administering meds and my husband I and worked out a snack, meal and medication timing schedule to minimize the possibility for meltdowns.  You see, the meds can be can be a tricky balancing act between appetite issues, times of play dates, etc… we play with them a lot based on when G needs them most, especially making sure they are “on board” for social situations.

Finding a lasting friendship has been a milestone for G. That was the extremely positive thing that blossomed as a result of the medication switch.

Since our switch from Adderall to Ritalin, we’ve adjusted our son’s medication several times from long-acting to short-acting to medium-acting. We’ve added Intuniv, which is a blood pressure medication that has been adapted for use as an ADHD medication.  We use melatonin for bedtime because G has such a difficult time winding down in the evening. With the administration of all of these medications, we are constantly monitoring how his body is reacting to the changes, observing his eating, his sleep, and his growth. Additionally, we are also watching him socially, because finding friends to play with successfully is what being a kid is all about.

Finding a lasting friendship has been a milestone for G. That was the extremely positive thing that blossomed as a result of the medication switch. Prior to the switch, while still on the Adderallin during kindergarten, G created a social stigma for himself that lives on to this day. He is now in 3rd grade! What I didn’t know or plan for were the peer judgments regarding G’s behavior sticking, despite all the improvements. I share this because if you are in the situation where you are choosing to try ADHD medications for your child, it is a process of trial and error, and during this trial and error period, the social judgments of your child’s peers and their parents don’t go away. It is tough, but as I mentioned before, even though the label of “problem child” still follows G, there are, thankfully, some kids that are willing to extend their friendship to my son and accept the person he is. Over the past few years, G has made friends, lost friends and found new friends and we’re just starting to realize that this may be how the relationships will cycle through for a while.

We hope, with the support of parenting classes, social skills groups, support groups, clinical therapy, equine facilitated psychotherapy****, occupational therapy and all the other things we have tried, will work together hand-in-hand and G will finally find himself a group of friends, who will like him and respect him for all of his quirks, differences, amazing thoughts and statements about the world around him. All this work is planting seeds for him to draw on as he grows and the meds will help him access the fruits of these labors. At the end of the day that’s all I, as a mother, care about. Because, really, the happiness we feel is more about the people who we have and love in our lives than it is about a diagnosis.

What I can say is that our “Road to Ritalin” has been a challenging one and an anxiety-producing one, one of judgment, of loss and sorrow. But I’m actually grateful for it. I am grateful because I see my son growing into a wonderful and intelligent young man. He is capable of so many things. The Ritalin is merely a tool which helps him cut through the chaos in his mind so he can access his “true” self — the boy I see who is loving, sweet, intense and is who he is meant to be.

 

*Occupational Therapy: a form of therapy that enhances cognitive, gross motor, and fine motor skills that facilitate everyday life activities.

**P.C.I.T (Parent Child Interactive therapy): an evidence-based therapy for young children (ages 2-7) with emotional and behavioral challenges. This treatment works to enhance a positive parent-child relationship and to change old  and problematic parent-child interaction patterns.

***Developmental Pediatrician: also known as Developmental Behavioral Pediatrician. A DP or DBP is a Pediatrician with advanced training in the physical, emotional, behavioral, and social development of children.

****Equine Facilitated Psychotherapy: EFP is an experiential form of psychotherapy that involves patients interacting with horses. A licensed mental health professional guides the session as or with credentialed equine professionals alongside horses that are chosen for their calm and sensitive temperaments. The horse acts as a large biofeedback machine since they are domesticated prey animals and are extremely sensitive to human beings (predatory creatures) emotions. PATH International (Professional Association of Therapeutic Horsemanship International) is an extremely well-reputed association that “promotes safety and optimal outcomes in equine-assisted activities and therapies for individuals with special needs.” www.pathintl.org

 

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