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ADHD- Ritalin

TheBigPinkLad 18 Nov 05 - 03:02 PM
TheBigPinkLad 18 Nov 05 - 03:03 PM
Mark Cohen 18 Nov 05 - 09:30 PM
Sorcha 18 Nov 05 - 10:13 PM
number 6 18 Nov 05 - 10:22 PM
GUEST,Art Thieme 18 Nov 05 - 10:29 PM
Mark Cohen 18 Nov 05 - 11:32 PM
LadyJean 19 Nov 05 - 02:08 AM
Georgiansilver 19 Nov 05 - 04:43 AM
Dave'sWife 19 Nov 05 - 05:22 AM
GUEST,*daylia* 19 Nov 05 - 09:17 AM
Sorcha 19 Nov 05 - 09:56 AM
LadyJean 19 Nov 05 - 09:59 PM
Sorcha 19 Nov 05 - 10:30 PM
Mark Cohen 20 Nov 05 - 02:15 PM
dianavan 20 Nov 05 - 05:59 PM
The Villan 20 Nov 05 - 07:17 PM
goodbar 20 Nov 05 - 09:16 PM
Dave'sWife 20 Nov 05 - 09:37 PM
Mark Cohen 20 Nov 05 - 09:39 PM
bobad 20 Nov 05 - 10:10 PM
Peace 20 Nov 05 - 10:15 PM
Peace 20 Nov 05 - 10:17 PM
bobad 20 Nov 05 - 10:25 PM
Mark Cohen 21 Nov 05 - 02:42 AM
The Villan 21 Nov 05 - 04:40 AM
Cats at Work 21 Nov 05 - 05:02 AM
TheBigPinkLad 21 Nov 05 - 11:33 AM
GUEST,robert 21 Nov 05 - 11:37 AM
dianavan 21 Nov 05 - 08:41 PM
goodbar 22 Nov 05 - 01:49 AM
The Villan 22 Nov 05 - 07:24 AM
TheBigPinkLad 22 Nov 05 - 10:54 AM
Mark Cohen 23 Nov 05 - 03:14 AM
The Villan 23 Nov 05 - 08:52 AM
Ebbie 23 Nov 05 - 11:50 AM
Mark Cohen 24 Nov 05 - 02:28 AM
The Villan 24 Nov 05 - 04:06 AM
dianavan 24 Nov 05 - 09:11 PM
Dave'sWife 24 Nov 05 - 09:39 PM
InOBU 24 Nov 05 - 10:12 PM
Ebbie 25 Nov 05 - 01:38 AM
The Villan 25 Nov 05 - 02:10 AM
Mark Cohen 25 Nov 05 - 03:23 AM
dianavan 25 Nov 05 - 02:02 PM
Mark Cohen 25 Nov 05 - 02:48 PM
Sorcha 25 Nov 05 - 03:35 PM
dianavan 25 Nov 05 - 04:55 PM
Mark Cohen 26 Nov 05 - 12:27 AM
Dave'sWife 26 Nov 05 - 01:02 AM
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Subject: ADHD- Ritalin
From: TheBigPinkLad
Date: 18 Nov 05 - 03:02 PM

Worth a look before subjecting your kids to ritalin:

http://www.adhdfraud.org/frameit.asp?src=http://www.adhdvideo.org


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Subject: RE: ADHD- Ritalin
From: TheBigPinkLad
Date: 18 Nov 05 - 03:03 PM

Sorry, maybe this should be in the downstairs threads ...


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 18 Nov 05 - 09:30 PM

Here we go again. I didn't wait around for the video to load. Maybe I will, later.

ADHD does exist, and thousands of children and adults are leading more satisfying and productive lives as a result of diagnosing and treating this condition. Many of them are my patients, and I've had many, many parents and children thank me. Sure, some people are overdiagnosed, and put on medication they don't need. Others are frightened away from what could be necessary treatment because of fearmongers like this. The statement "psychiatrists don't know how to diagnose ADHD" is simply wrong.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: Sorcha
Date: 18 Nov 05 - 10:13 PM

I can only say that it helped our son until he was old enough to choose his own way. At Grade 7, he declared that he didn't want to be a 'retard'anymore....and refused to go to the school nurse for his meds.

NO way I could force them down his throat...so he had one hell of a time graduating from HS, but he did finally. Also, that was after 8 mos in jail too....while 'med free'.... He is now on Prozac instead of Ritalin....his wifes' descion, not mine.

I KNOW what Ritalin is....very very similar to meth...BUT, with an acetelcholine defciecncy in the brain, it acts differntly. NO, it is NOT for every child. I know that, but, yes, it IS for some.

Thre is a big difference between an Active Child and an OverActive child...just wait until YOU see it.


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Subject: RE: ADHD- Ritalin
From: number 6
Date: 18 Nov 05 - 10:22 PM

" Thre is a big difference between an Active Child and an OverActive child...just wait until YOU see it."

I'll back you up on that Sorcha!!

sIx


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Subject: RE: ADHD- Ritalin
From: GUEST,Art Thieme
Date: 18 Nov 05 - 10:29 PM

I had severe fatigue due to my having Multiple Sclerosis. My neurologist put me on 20 milligrams of Ritalin twice a day---morning and noon. As a result I don't nod off every five minutes---and general overall fatigue is much less now. Still, though, I can't overdue the activity and must pace myself, or I'll pay the price.

Art


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 18 Nov 05 - 11:32 PM

Just a little clarification. There are two types of stimulant medication that are commonly used to treat ADHD. (By the way, ADHD or Attention-Deficit/Hyperactivity Disorder is the currently "correct" name for the condition, which can be present with or without hyperactivity/impulsivity.)

The first is methylphenidate (Ritalin is the most common brand name). The other is amphetamine, which is usually prescribed as the d form, or dextroamphetamine. The long-acting medication Adderall is a combination of salts of d and l forms of amphetamine.

Both these medications, if taken in excess, or taken by people who don't have ADHD, can produce a sense of euphoria and also dependence. In the doses we use to treat ADHD, we are simply replenishing neurotransmitters (dopamine and norepinephrine, mostly) that are present in inadequate levels in an otherwise normal brain. They are not sedatives, children are not "drugged" (unless the dosage is too high, in which case they can be sleepy or "overfocused"), and there is no dependence--the dose can be skipped completely for a weekend or a week, with no adverse effect, except for return of the ADHD symptoms.

Methamphetamine, also known as meth or speed, is a drug of abuse, not a pharmacologic agent. Saying that methylphenidate is "very similar" to speed is technically true, but not very meaningful. Testosterone is "very similar" to estrogen, but, fortunately, they don't have quite the same effect.

Aloha,
Mark

PS, for those who don't know, I've been a pediatrician for 25 years, and I now have a position as a developmental pediatrician (I'm Board-certified in both Pediatrics and Developmental-Behavioral Pediatrics.) I'm also a perennially mediocre guitarist and singer, which is just as much fun as my day job.


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Subject: RE: ADHD- Ritalin
From: LadyJean
Date: 19 Nov 05 - 02:08 AM

I used to babysit for a little girl. The way to sit for her was to pile a stack of story books within easy reach, ditto a glass of water, and read, and read, and read. That kid was a story junky. She could listen for hours. Well, in the middle of the year, her mother moved to the southwest, and she went from a magnet school for middle class kids to one were most of her classmated didn't really speak English. Shortly afterwards she was diagnosed with ADHD and they prescribed Ritalin. You ask me she was bored out of her gourd.

I cleaned for a psychiatrist. His home was filled with little goodies from the drug companies, post it notes, pencils, clock, telephones etc. But the real prize were the medical conferences, in places like Hawaii, sponsored by those companies, and Oh so tax deductable. Yeah, I think ADHD exists. I think it's overdiagnosed, and I think psychiatrists are a little too fond of pushing meds.


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Subject: RE: ADHD- Ritalin
From: Georgiansilver
Date: 19 Nov 05 - 04:43 AM

After a 30 year Child Care career and having seen many 'hyperactive' children, some with very strong behavioural difficulties which can begin at a very early age....I am glad that something can be done using drugs. The type of child who parents 'put into care' were often those who they could not handle and we were expected to do so professionally. Ritalin has made many peoples lives easier by controlling severe problems with behaviour so whatever we say it has been of benefit.
ADD or ADHD gives a name which is identifiable to something which is perhaps not so definably identifiable so perhaps there is a margin for mistakes in diagnosis......but like all other illnesses/diseases/conditions.....someone has to diagnose and I'm sure that is not easy.
I am personally glad that something can at least be done. I also used methods of discovering food allergies and reactions in children which once identified can 'ease' behaviours and perhaps this is something which needs more investigation. Some investigation has taken place in the US but very little in the UK. Just needs someone to get sponsored to do it....someone who has the qualities and position......
Best wishes, Mike.


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Subject: RE: ADHD- Ritalin
From: Dave'sWife
Date: 19 Nov 05 - 05:22 AM

Mark Cohen - thanks for that explanation of the didferent medications.

- My husband was having a very rough time after 9/11 (we lost someone close and had some others injured) and then a dear friend was killed in a triple Homicide. He was also having a terrible time concentrating and staying focused at work. We assumed Depression.

After a fairly long evaluation period, a very good Shrink had him looked at for ADHD. He was put on the extended release form Adderal and what an IMMENSE difference it has made. We went back and had his parents re-evaluate his childhood symptoms and based on what they had to say, it appears he might have benefitted from treatment back then. He's lucky in that he went into Film where a creative temperament is tolerated!

He's doing very well on the dosage and is monitored closely by both the Shrink and our Primary care Physician. Nobody wants this to be forever, but we are so grateful for the diagnosis. He lost some weight,began sleeping better, stopped thrashing about at night, gets work done easily and without stress, feels terrific and relaxed. He is better able to enjoy his free time than he used to and he took back up hobbies he had set aside years ago.

You'd think being on Adderal, he'd be hyper, but it has had the opposite effect of grounding him. Before treatment, he was nervous, prone to grinding his teeth from worry, slept badly and couldn't keep his mind in one place very long. He says now he feels as if he's been set back on the tracks after having jumped a rail.

it may have been the combined effects of everything that hit us all after 9/11 that made his condition apparent. I don't know. I just know he's happy, productive, healthier and more serene. I believe in the diagnosis and I;m glad our doctors took the time necessary to arrive at it. They didn't rush into any one conclusion.

It may be an over-diagnosed condition, but it is a real one!


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Subject: RE: ADHD- Ritalin
From: GUEST,*daylia*
Date: 19 Nov 05 - 09:17 AM

My twin sons practiced kung fu in the womb 24/7 for at least the last 12 weeks of pregnancy. By 7 months, they could crawl across our big living room and make it down the hall in about 10 seconds flat. And when they finally had the time to learn to stand up unassisted (at about 15 months), they never walked - honestly, they RAN!

Shoulda kept them on a double-header leash all those years, but at least chasing after them in two directions at once kept me in half-decent shape. They were like this double whirlwind from the moment their eyes opened in the morning till they dropped off in exhaustion at night. Running up a storm one minute, curled up sleeping on the floor the next - never seemed able to "nap" in the conventional manner. ANd the television just didn't exist for them - the only time Sesame Street ever caught their attention was when they were strapped into their high chairs (the only way I could get them to sit long enough to finish a meal).

Worn out and worried, I asked my doctor once if they might be "hyperactive". He asked me a lot of questions, and when he learned that they COULD sit quietly for half and hour or so when I'd read to them (which I did a lot, believe me - it was the only time I got a break!) and that they did quite often sit long enough, on their own, to work a simple puzzle or put a few lego blocks together, he said no. They were just "active", and not "hyperactive". No drugs, no 'therapy' - I'd just have to deal with it!

Well, I did that as best I could over the years, by getting them involved with sports as much as possible. I filled their days with soccer, swimming, skating, biking, skiing - it's the only way I kept my sanity. They always did fine in school though - and bY the time they were in their mid-teens they seemed to have grown out of it. 23 now, they are anything but "hyper-active".

I'm glad now my doctor was scrupulous enough to insist there was nothing "wrong" with them, to encourage me to give them a chance to grow out of it without putting them on heavy drugs. Can't say the same for some of the students I've taught over the years.

I remember teaching one little boy who was on Ritalin for years. Didn't seem to help him much - from his first lesson on, at about age 8, I had to spend about half his lesson coaxing him back onto the piano bench either from under it or across the room. HIs mom said the lessons were "good for him" though, even though his musical progress left a LOT to be desired - apparently she thought music lessons "forced" him to "focus".

HA! I think without my experiences with my own twins, I'd never have found the patience or understanding to keep 'teaching' (??) him as long as I did.

Funny thing is, it wasn't till he was 17 and taking his final month of lessons with me that I realized the kid had perfect pitch!   Working on ear tests (again!) one day, suddenly he started getting all the intervals correct for the first time in his life.

Stunned, I gave him a little test: "Turn around, close your eyes, and listen real carefully Peter ... what note do you think I'm playing?"   

Well, he got 10/10 on that "pitch test"!   And here he'd been testing my teaching strategies and trying my patience for SO LONG, flunking every ear test, in fact barely scraping through with passing marks on his playing too, for years!    :-O

He didn't seem much impressed, though. ANd I remember what his mom did when I told her, all excited after that lesson, that her son definitely had "perfect pitch", and asked her how / why he could have "hidden" it for so many years?

She just shook her head real slowly for a minute or two, and said "Go figure!"


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Subject: RE: ADHD- Ritalin
From: Sorcha
Date: 19 Nov 05 - 09:56 AM

Thanks, Dr. Mark.....yes, I think it is over used, over diagnosed, but I also know the condition exists. Drugs can help some. Drugs never help all. They are not a cure all.


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Subject: RE: ADHD- Ritalin
From: LadyJean
Date: 19 Nov 05 - 09:59 PM

The girl I was writing about transferred from a Science magnet program, where she had had no problems to a school on an Indian reservation, where many of her classmates were learning basics she had mastered in pre school. She was the child of a single mother from a blue collar background, and I'm sorry, but psychiatry is a subjective science. An orthopedic surgeon is not likely to mistake a sprain for a fracture because of cultural bias. A psychiatrist can decide that the child of a licensed practical nurse couldn't possibly be intelligent.
In 1963, my mother was "neurotic" because she didn't like being a housewife and missed her job. By 1973, she was perfectly sane. Not because her attitude had changed, she still missed her job.
40 years ago, I could have had my sister comitted for being in love with a woman. Now, she's "in therapy" but not because she's gay.   
ADD and ADHD are not diagnosed with an X ray or a blood test. I know of one catter whose child was misdiagnosed with ADD, when what he had was a mild form of autism.
I know another child who has been diagnosed with ADD and has real behavior problems. I do wonder what he'd be like if his mother didn't spoil him quite so much. But I'm quite willing to agree that part of the problem is physical.


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Subject: RE: ADHD- Ritalin
From: Sorcha
Date: 19 Nov 05 - 10:30 PM

You have to deal with any problem on many fronts...behaviour modificaton, drugs, therapy...lots of things.


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 20 Nov 05 - 02:15 PM

LadyJean, I know many people whose fractures were misdiagnosed as sprains and vice versa, and sometimes cultural or other biases were part of the reason. All of medicine is inexact, and it depends to some degree on interpretation, human decision, and educated guesses. Yes, psychiatry is less "exact" than some other branches of medicine, and often involves more subjective judgment.   But that doesn't make it worthless or ineffective.

You know, millions of people each year are inappropriately prescribed antibiotics for viral infections, which don't respond to antibiotics. There are a variety of reasons for this, some reasonable and some not. Some of these people become seriously ill or even die as a result of reactions to the antibiotics. Does that mean that we should stop giving antibiotics to people with serious bacterial infections, in which they can be lifesaving? Of course not. But that same reasoning is often used to argue against treating children for ADHD.   

The fact that some things are gray doesn't mean you can't distinguish between black and white.

Sorcha is absolutely right. Most people with ADHD need more treatments than just medication, especially because many of them have other things going on in addition to ADHD, like learning disorders, anxiety, or depression. But in many if not most cases, those other treatments become much more effective if the ADHD symptoms are controlled with medication. It's a lot easier to provide educational interventions for a child with a learning disability if he's able to listen to what his teacher is telling him to do, instead of trying to see how far he can roll his pencil across his desk.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: dianavan
Date: 20 Nov 05 - 05:59 PM

Mark -

A few questions:

When first prescribed, isn't there usually a trial period?

During the trial period, who records the observations?

Are these observations ever considered?

I have found it very difficult to teach new concepts to children who are taking Ritalin. Yes, it enables them to produce written work based on what they already know but when it comes to new info being assimilated - what studies have been done?

Are you aware of any therapy or counselling that can be helpful to a child with ADHD?

As a teacher, I have my doubts about the number of children that are using medication at a very early age. Aren't they learning that they need drugs to control their behaviour? Does it lead to drug dependence? What are the statistics?


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Subject: RE: ADHD- Ritalin
From: The Villan
Date: 20 Nov 05 - 07:17 PM

We had great difficulties with one of our daughters (who we new was ADHD) but decided to do nothing about it, unless she lost her self esteem.
She was referred to the various professionals and they very quickly diagnosed her with ADHD. They encouraged us to put her on Ritalin, which we were very reluctant to do.
Eventually we reluctantly agreed.
It was awful seeing her character being taken away. As time went on and we got to know more about Ritalin, the more horrified we became about some severe side effects.
One day her teacher called us in, and begged us to get her off the Ritalin. He said that he would rather have her without the Ritalin and said he could live with her problems in class. Our dentist was also horrified when he knew she had gone onto Ritalin, and he urged her to come off.
After a year we told the specialists that we would no longer let her take the drug, and took her off.
Its been bloody hard dealing with her, but we would never let her go back on Ritalin.
Do you know the worst thing about having a child who has ADHD, is the way your own family has a go at you for your inabilty to handle your child correctly. It caused severe family issues and for many years we broke contact with all of them.
Now, although she has problems, she is growing up into a well mannered young lady. OK she gets hyper and that is difficult to deal with becuase it always happens when she is most excited and cannot come off her perch.
All I would say to parents, is make sure you are doing the right thing for your child when you let them go on Ritalin. Don't let the pros talk you into it. Find out fully what the side affects are and don't let the pros fob you off with weak answers to that.


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Subject: RE: ADHD- Ritalin
From: goodbar
Date: 20 Nov 05 - 09:16 PM

two of my band mates are ADD and they don't take their meds and our drummer is on prozak.

long story short, we never get any shit done.


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Subject: RE: ADHD- Ritalin
From: Dave'sWife
Date: 20 Nov 05 - 09:37 PM

Dianavan - in the case of my husband - there was a trial period and it was quite long. I was asked to fill out evalutions separate from his and our family doctor also filled out evaluations which we didn't see. The Psychiatrist used that information to rule out Depression and other potential diagnosis.

In addition, my husband was required to have a sleep study to make sure that he had no underlying sleep disorder. Nobody rushed to put him on Adderall, which is a different medication than Ritalin. Also, once on it, he was very slowly tapered upwards until stability was acheived.

If any parent accepts an instand diagnosis of any disease and a one-size fits all dosage with no period of observation and adjustment, then they are negligent parents. Of course, my husband was an adult and capable of asking for such oversight, but in the case of children, that is the parent's responisbility.

I posted about our experience simply to provide a concrete example for people who might be tempted to believe that ADHD is merely a fad diagnosis.


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 20 Nov 05 - 09:39 PM

Dianavan, every time I prescribe stimulant medication for ADHD, it is a trial. I ask the parents to call me within a few days (not in a month or two, as some doctors unfortunately still do) and let me know how things are going. The dosage often needs to be adjusted, and this can be done on a daily basis, if needed, since the medication does not take a long time to have an effect, and does not "build up" in the system. Sadly, many doctors who make a correct diagnosis of ADHD, and prescribe medication, are unaware of the subtleties of using the medication.

And I also tell parents (and suggest that parents tell teachers) to choose something that can be easily measured, such as how long it takes the child to do his homework, and use this as a guidepost to the effect of the medication. I can tell you, though, that in the vast majority of cases, the results are so clear and so positive that that kind of formal measurement quickly becomes unnecessary.

Again, treatment of ADHD with medication is replacing something that is missing in a child's brain. If a child is nearsighted, we don't tell him that he should be able to "do it on his own"--we give him glasses. If a child has diabetes, we don't say, "Hey, just be careful about your diet and you don't need that drug"--we give her insulin.

Villan, I'm sorry your daughter and your family had such an unfortunate experience. I wonder if her doctor ever suggested trying a lower dose, or a different form of medication. Many children get put on too high a dose of medication, and have adverse effects or a bad result, and the parents then join the chorus of those who say "Ritalin is poison!" Which could perhaps have been avoided by good communication between physician and parent, and better explanation by the physician in the first place. Unfortunately, as I mentioned, lots of docs who prescribe the medication don't really know how to use it effectively. Believe me, I've seen it.

In my experience, the children whose parents complain that they are excessively sedated, or become "zombies," or are irritable, or have other negative changes in their personalities when they are on Ritalin, are almost always getting too much medicine, or are having problems with "rebound" effects when the medication is wearing off. If the dose and the dosing schedule is correct, the ADHD symptoms are generally improved without a significant change in the child's personality. That is to say, without a significant negative change --   I don't consider it a bad result when a child becomes happier, feels better about himself, and is better able to make friends, get along with his family, and succeed in school.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: bobad
Date: 20 Nov 05 - 10:10 PM

Mark

I'm curious as to the diagnosis timeline of this condition. I, nor any friends in my age group (56) I've asked, ever recalls seeing ADHD throughout our school years. Is this a new condition or a newly described condition ?


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Subject: RE: ADHD- Ritalin
From: Peace
Date: 20 Nov 05 - 10:15 PM

Timeline here, Bobad.


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Subject: RE: ADHD- Ritalin
From: Peace
Date: 20 Nov 05 - 10:17 PM

History of ADHD in Time Line:
_1902: The first clinical description of ADHD appeared, labeled as
"Morbid Defect of Moral Control."
_1922: ADHD gets a new name, Post-encephalitic Behavior Disorders.
_1930s: Amphetamines introduced to treat hyperactive children.
_1956: Ritalin introduced as a treatment for hyperactivity.
_1960: ADHD gets another new name, Minimal Brain Dysfunction
_1968: And another, Hyperkinetic Reaction.
_1980: Attention Deficit becomes an official disorder with the National Institute of Mental Health naming a group of characteristics as Attention Deficit Disorder +/- Hyperactivity.
_1996: Adderall gains FDA approval for the treatment of ADHD and Attention Deficit Disorder.
_1998: The American Medical Association called ADHD "one of the best-researched disorders in medicine."
_1999: Concerta gains FDA approval for the treatment of ADHD and Attention Deficit Disorder.
_1999: Metadate gains FDA approval for the treatment of ADHD and Attention Deficit Disorder.
_2001: Focalin gains FDA approval for the treatment of ADHD and Attention Deficit Disorder.
_2002: Strattera gains approval for the treatment of ADHD and Attention Deficit Disorder.

from here.


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Subject: RE: ADHD- Ritalin
From: bobad
Date: 20 Nov 05 - 10:25 PM

Thanks Peace

According to your link it seems that it's only since the 1990s that attention deficit has become widely studied, discussed, debated and diagnosed.


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 21 Nov 05 - 02:42 AM

Not really, bobad. I learned about it as a medical student in 1975, and have been diagnosing and treating children with it since 1980. I would say it started to become more commonly diagnosed in the 70's, which is one reason we Boomers don't remember many kids with the diagnosis. When they were in our classes, we just called them troublemakers, or annoying...or, unfortunately, "dumb." The prevalence of ADHD does not seem to be increasing rapidly, as does that of autism, for example. What has happened since the mid-1990's, which no doubt makes it seem more prevalent, is the Internet.

As a point of terminology, the phrase in Peace's post above, "ADHD and Attention Deficit Disorder," is incorrect. "ADD" is no longer part of the official lexicon, though it's still widely used. Current approved terminology is Attention-Deficit/Hyperactivity Disorder (ADHD), of which there are three types: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined. In reality, the second type, hyperactivity and impulsivity without inattentiveness, is quite rare. The hyperactive symptoms often resolve by adolescence, but the inattentiveness and difficulty with organization seem to be lifelong.

By the way, I once heard a lecturer give an interesting explanation for why ADHD seems to be so much more prevalent in the US than in the UK. We know that there is a strong genetic component to ADHD. We also know that one of the characteristics of ADHD is a sense of restlessness and insatiability, the feeling that what's "over there" has got to be better than what's right here. So, back in the 18th and 19th centuries, when there were ships sitting at the dock waiting to go to America, who was more likely to get on board--the person who was content with his lot, or the person who was sure that there had to be something better "over there"? Those traits, then, which were often associated with ADHD, tended to be more highly represented in the American population than in Europe. Seems reasonable to me.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: The Villan
Date: 21 Nov 05 - 04:40 AM

Mark
I hear what you say.

However, we reduced her dose but it didn't help.

Maybe you are correct, that the pros did not know how to deal with it properly.

However, noboy is prepared to come out and state clearly what the dangerous side effects can be.

Stunt growth in children, Can affect their blood and I don't know what else.

Whilst her sleep pattern was always poor, Ritalin seemd to make it worse. Lack of sleep is a nightmare not only for the child, but also for the parents.

Our daughter falls into the combined. She is 14 now but still gets the hyperactivity and that is so difficult to handle when it happens.
Fortunately she has 3 friends who seem to understand and tolerate her when it goes wrong.

You may be interersted to know that our younger daughter who is 10 is on the higher end of the Autistic Spectrum. We have to pay a lot more attention to her, but its like a timebomb, as the older duaghter gets very upset at the attention the younger one receives and cannot and will not understand why. Nightmare.

Cheers
Les


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Subject: RE: ADHD- Ritalin
From: Cats at Work
Date: 21 Nov 05 - 05:02 AM

I work with students who are ADHD. For some, Ritalin or its variants work, for others it doesn't, but whatever you have it is essential that it is backed up with a behavioural modification plan with input from behaviour specialists to help the students understand what they are going through and to help their behaviour.


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Subject: RE: ADHD- Ritalin
From: TheBigPinkLad
Date: 21 Nov 05 - 11:33 AM

It's a pity you didn't bother to watch the video, Mark, but I appreciate your professional opinion and input.

Did anyone at all bother to actually watch it? be honest ... there'll be questions at the end ... ;o)


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Subject: RE: ADHD- Ritalin
From: GUEST,robert
Date: 21 Nov 05 - 11:37 AM

As a guy who was Diagnosed with ADD (or ADHD without hyperactivity if you like, it means the same thing and its simpler to say "ADD"), I studied the subject through middle and high school, and came to the conclusion that the whole thing is a mess. We have way more opinons about it then are nessary from varying points of view experiance and actual knowedge of the subject. The medical and psychiatric communtiy's authority on it has been undermined greatly by their focusing on the negativity of the symptoms and the apperant (however real or imagined) wide-spread pushing of medications for treatments above life style changes of the person diagnosed or social/enviromental changes for that person, by diagnosers.

The thing is ADHD won't kill you. It can make things difficult but there are many many many ways around difficult things. Medication for ADD is... complicated. I was medicated in middle and highschool but dropped it my junior year of highschool and went through all four years of college quite sucessfully without it. That this is because I grew out of it, or I never "really" had it in the first place is doubtful. I am still impulsive and often inattentive. For instance I have picked up five instruments (banjo, guitar, uke, accordion, bagpipes) in four years (not a diagnosis worthy fact, but indicitive anyways). Pint being I don't take medication. I consider it a personal choice. My younger sister takes medication (concerta) for ADD (again that is ADHD withoug hyperactivity) and she is doing just fine too.


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Subject: RE: ADHD- Ritalin
From: dianavan
Date: 21 Nov 05 - 08:41 PM

Mark - Can you please answer this, "I have found it very difficult to teach new concepts to children who are taking Ritalin. Yes, it enables them to produce written work based on what they already know but when it comes to new info being assimilated - what studies have been done?"

I am also surprised to hear you say, "...treatment of ADHD with medication is replacing something that is missing in a child's brain."

Can you please tell me what is missing?

Is there a lab test that can measure this?


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Subject: RE: ADHD- Ritalin
From: goodbar
Date: 22 Nov 05 - 01:49 AM

i know a guy who's not ADHD but he's taken aderoll in order to be able to stay up all night to do his homework.

that's why i want to blow up my school.


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Subject: RE: ADHD- Ritalin
From: The Villan
Date: 22 Nov 05 - 07:24 AM

So, nobody dare say what the dangerous side effects are then!!!!!!!


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Subject: RE: ADHD- Ritalin
From: TheBigPinkLad
Date: 22 Nov 05 - 10:54 AM

The guy in the video does. And more besides.


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 23 Nov 05 - 03:14 AM

It doesn't stunt children's growth. Well, if you consider less than half a centimeter to be significant stunting (by the best estimates and most accurate measurements possible) then I can't argue with you. The belief that it causes significant growth impairment is based on very old and unreliable data. It doesn't affect the blood. Of all the drugs doctors prescribe, methylphenidate has been subject to more and longer study than almost any other, and is remarkably free of significant adverse effects. (Note that it's possible for any individual to have a serious or even fatal reaction to ANY medication, just as it's possible for the same thing to happen with almost ANY food or other substance. Water can kill you, in a number of different ways. But I still drink it.)   

I will try to find time this weekend to watch the video, and promise to keep an open mind.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: The Villan
Date: 23 Nov 05 - 08:52 AM

Mark
Maybe the pros do not provide enough medical evidence to the people who have to face going on Ritalin.

Why do they constantly measure the persons height - they say becuase the drug can impair growth in younsters.
Why do they do occasional blood tests - they say becuase it can affect soemthing in their blood.
Why can't they sleep at night - this causes diabolicle issues for the rest of the family - put them on an extra drug to help them sleep.

These are the sort of things that we see as families affected by ADHD.

Why did we have to go to the hospital 10 miles away to get the Ritalin, because the chemists wern't allowed to provide them. - Something to do with the classification of the drug. Scary.


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Subject: RE: ADHD- Ritalin
From: Ebbie
Date: 23 Nov 05 - 11:50 AM

Medicated Family
Guy (Buddy) Tabor

They say that I'm hyper and bounce off the walls
And I can't keep a straight line when I walk down the halls
The teacher has a hard time to make me sit down
'Cause I can't hold still, I'm spinning around
I'm eight years old and they say I'm a freak
'Cause I can't stop talking or stay in my seat
I can't seem to keep my hands to myself
I'm a target for the bullies and everyone else

My memory's all scrambled, I can't do a thing
I'm such a young failure, I feel so ashamed
Other kids can read but I can't catch on
My brain's out of balance, my motor skills gone
My teacher don't like me, can't take it no more
So I sit by myself just outside of her door
I'm lonely, forsaken and all by myself
'Til the school nurse medicates me from the pharmacy shelf

My mommy's on Prozac; it helps her to cope
When daddy's stressed out he smokes lots of dope
He washes it down with 12 cans of beer
It levels him out and drowns all his fears
We're a medicated family in 2003
Thank God for Ritalin, made a new kid of me
When they give me my pills they think I'm all right
But I get bad dreams and can't sleep at night
Can't sleep at night
Can't sleep at night…


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 24 Nov 05 - 02:28 AM

Villan, I think you may have been seeing doctors who haven't kept up. I don't keep measuring height, and don't do any blood tests. There is sometimes a problem with falling asleep, but once asleep they don't keep waking up. If they do, then it's not the medicine--it's some other problem, like depression or a sleep disorder. Problems getting to sleep and decreased appetite are the most common adverse effects we see with stimulant medication, and usually they can be managed with creative dosing or other "workarounds" like feeding the child at a time when he's hungry, and letting him just graze at family mealtime. Sometimes switching medications will help. But I never use "sleeping pills" for children who are having trouble falling asleep because of the medication. Sometimes I will recommend melatonin, which has a good track record and is extremely safe. All the above recommendations are fairly standard, at least among American pediatricians and child psychiatrists who have experience and expertise in treating children with ADHD. That's based on information from the American Academy of Pediatrics' Developmental-Behavioral Pediatrics board review course I took last year. (And I passed the Boards!)

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: The Villan
Date: 24 Nov 05 - 04:06 AM

Mark
I am not questioning your capabilities.

More the capabilties of people in UK.

However or whatever is said, I still consider it to be a dangerous drug.

Les


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Subject: RE: ADHD- Ritalin
From: dianavan
Date: 24 Nov 05 - 09:11 PM

I am still waiting. Can anyone answer these questions?

"I have found it very difficult to teach new concepts to children who are taking Ritalin. Yes, it enables them to produce written work based on what they already know but when it comes to new info being assimilated - what studies have been done?"

I am also surprised to hear you say, "...treatment of ADHD with medication is replacing something that is missing in a child's brain."

Can you please tell me what is missing?

Is there a lab test that can measure this?


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Subject: RE: ADHD- Ritalin
From: Dave'sWife
Date: 24 Nov 05 - 09:39 PM

Mark - I want to than k you again for conintually and pateintly asnwerint the questions posed here and providing such accurate information. Everything you have said matches our experience. My husband's biggest problem was innattentiveness - to the point where it really did hold him back in his career.

As for docs not telling you side effects - our doc was kinda the opposite. When that canadian studdy on Children taking Adderall came out, he called us in to discuss it! It really didn't apply to Dave, but he wanted to discuss it as well as the importance of Dave taking off a few pounds through excerise and diet. His family has a history of High Blood Pressure and even though his BP is fine, the Doc just wanted to remind him that his family hisotry plus Adderall means he has to be extra vigilant.

I couldn't be happier with my husband's doctor. His practice is well-run and responsive to out needs and concerns. I can speak to the Doctor or his assistant whenever I have a concern. At the begging og my husband's treatment, we spoke every few days until he was stable. I guess I took the role of the 'parent'.

I can't tell others what to do, but to dismiss treatment with medication out of hand is just as irresponsible as just say "yes OK Doc, whatever you say." Ya gotta look at it from all angles.

We hope my husband will not always be on medication and our doc is supportive of that eventual goal. He has helped my Hubby figure out how to take weekend 'vacations' from the meds every now and then. Most weekends, he reduces his dose and on some holidays, he is able to skip them altogether. It's something he's worked out with the doctor - not something he does on his own.

Well, again, Mark - many thanks


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Subject: RE: ADHD- Ritalin
From: InOBU
Date: 24 Nov 05 - 10:12 PM

Hi Kids... As some of you know, I come from a long line of folks who made there way in the world because we have ADHD. It is not a dysablity unless we don't learn to use it, ballence it with a lot of self control, and I am of two minds about meds. Never used them myself, know some who do... haven't tried it, wont. EBBIE! I loved yer song...
Well, I think the problem is that a lot of teachers find it easier to drug kids into "normality" without concidering WE are part of normal... just more entusiatic.
More latter...
YES there is such a thing as ADHD Yes it is misnamed, two ,it can be really wonderful.
lor

PS SOmetimes it does hurt... but those dark nights of the soul make us who we are...


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Subject: RE: ADHD- Ritalin
From: Ebbie
Date: 25 Nov 05 - 01:38 AM

Thanks,Lorcan. It is actually Buddy Tabor's song.


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Subject: RE: ADHD- Ritalin
From: The Villan
Date: 25 Nov 05 - 02:10 AM

Research has found that A.D.H.D. children have a deficiency in dopamine, a chemical in the brain necessary for several vital brain functions. The dopamine system is involved in the reward-seek behavior, sexual behavior, control of movements, regulation of the pituitary-hormone secretion, and memory functions. Dopamine has been shown in young animals to exert a protective influence against hyperactivity. It is thought A.D.H.D. children have too many molecules that use up the dopamine before it can be used for its vital functions. Ritalin binds to these molecules allowing the dopamine levels to increase in the brain and be used for the normal vital functions.

Even though Ritalin is the drug of choice for children with A.D.H.D., it has many side effects and presents many risks for the children who use it. A child who is treated with Ritalin is moved from a hyperactive state to the opposite state. Children can develop appetite suppression, weight loss, retarded growth, emotional blunting and detachment; and many parents complain that the child acts like a "zombie!" Children on high doses and chronic use may develop paranoid symptoms—withdrawal, anger, restlessness, and suspicious behavior. It has been shown that adults who abuse amphetamines regularly develop psychotic states with paranoid features. Other serious side effects of methylphenidate are auditory and visual hallucinations, drug abuse, rebound depression, psychic dependence, increased euphoric and cocaine-like activity, insomnia and tachycardia. Also, researchers reported that Ritalin caused liver cancer in mice. No drug that affects the dopamine system is free of long-term toxicity to the motor system. Ritalin may produce disruption of movement control and facial and head tics may appear. Amphetamines are commonly referred to as "speed or uppers" and are one of the most dangerous medications ever discovered. They are chemically similar to dopamine and are the synthetic replacement in the dopamine receptor sites of the brain. Amphetamines have the potential to cause injury to healthy tissue, interfere with growth and development, sleep problems or aggressive and depressed moods in children. And, amphetamine addiction can easily lead to criminal behavior!


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 25 Nov 05 - 03:23 AM

Yes, most of that is true, but many of those effects are extremely rare at the doses we commonly use, and some of that information is misleading. Just to put things in perspective, here are a list of side effects of naproxen (common brand name: Aleve), a non-steroidal anti-inflammatory drug that is available over the counter:

Gastrointestinal: The most frequent complaints reported related to the gastrointestinal tract. They were: constipation*, heartburn*, abdominal pain*, nausea*, dyspepsia, diarrhea, stomatitis.
Central Nervous System: Headache*, dizziness*, drowsiness*, lightheadedness, vertigo.
Dermatologic: Itching (pruritus)*, skin eruption*, ecchymoses*, sweating, purpura.
Special Senses: Tinnitus*, hearing disturbances, visual disturbances.
Cardiovascular: Edema*, dyspnea*, palpitations.
General: Thirst

* Incidence of reported reaction between 3% and 9%. Those reactions occurring in less than 3% of the patients are unmarked.

Incidence less than 1%

Probable Causal Relationship: The following adverse reactions were reported less frequently than 1% during controlled clinical trial and through voluntary reports since marketing. The probability of a causal relationship exists between the drug and these adverse reactions:

Gastrointestinal: Abnormal liver function tests, gastrointestinal bleeding and/or perforation, hematemesis, jaundice, melena, peptic ulceration with bleeding and/or perforation, vomiting.
Renal: Glomerular nephritis, hematuria, interstitial nephritis, nephrotic syndrome, renal disease, renal failure, renal papillary necrosis.
Hematologic: Eosinophilia, granulocytopenia, leukopenia, thrombocytopenia.
Central Nervous System: Depression, dream abnormalities, inability to concentrate, insomnia, malaise, myalgia and muscle weakness.
Dermatologic: Alopecia, photosensitive dermatitis, skin rashes.
Special Senses: Hearing impairment.
Cardiovascular: Congestive heart failure.
Respiratory: Eosinophilic pneumonitis.
General: Anaphylactoid reactions, menstrual disorders, pyrexia (chills and fever).


(And that doesn't count the more recent concern about increased risk of heart attack and stroke.)

Yes, there are adverse effects of methylphenidate. Among the parents of children I've treated, and the children themselves, most of them are very happy with the results of the medication, despite the occasional adverse effects. I know that isn't very comforting to the people who suffer significant adverse effects from medical treatment.

But there are adverse effects of non-treatment as well. My main goal in treating ADHD is to prevent school failure. Not everybody with untreated ADHD is as resourceful and motivated as Little Hawk. Many just do worse and worse in school, feel worse and worse about themselves, and wind up dropping out. That's a waste, and a shame.

In medicine, as in life, we constantly attempt to balance risks vs. benefits. We try to do more good than harm. Most of the time, in my opinion, we succeed.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: dianavan
Date: 25 Nov 05 - 02:02 PM

Mark - As a teacher, it is also my goal to prevent academic failure. That is why I would like to see more consultation between the teacher and the doctor. I would also like to see studies measuring how much 'new learning' actually occurs when students are medicated.

Like I have said before, my observation is that although their behaviour is definitely better and they are able to concentrate long enough to produce assignments that demonstrate what has already been learned; it is very difficult to introduce new concepts. In fact, its often like teaching to a wall but I guess thats. 'O.K' as long as the child is being 'good'.

I would much rather teach children who are hyper than children who are stupified. Dealing with the behaviour is what needs to be learned by the adults in the lives of these children. Doping our best and our brightest does not bode well for the future.

It is interesting to find out that it is a lack of dopamine in the brain that causes ADHD, I will do some research on that. I didn't realize that it was truly a chemical imbalance. Can a lack of dopamine be measured in the lab?


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 25 Nov 05 - 02:48 PM

Dianavan, I'd be surprised if there were educational studies indicating that children with ADHD have a harder time learning as a result of medication. I've seen many children go from D's to A's in their schoolwork after starting medication, and they are clearly able to learn and use new concepts.

I wonder if the students you're concerned about might have had learning disabilities in addition to their ADHD. Sometimes a child's hyperactive behavior is what is most noticeable, then when the ADHD symptoms are improved with medication, in effect he is able to sit still long enough for the teacher to discover that he also has difficulty with some aspects of learning. The good news is that he's also able to sit still and pay attention to the educational interventions that can help to overcome or compensate for the learning problems.

Now, before someone jumps in and says that "these kids don't have learning disorders, they're just lazy," or normal, or whatever, let me hasten to add that there are a number of very impressive studies of brain function, using functional MRI scans (i.e., scans of a person's brain while he or she is engaged in a mental task), that show definite differences in the activation of brain centers and pathways between, for example, people who are good readers and people who have a reading disorder. If you're interested, or skeptical, I'd suggest you check out a book called "Overcoming Dyslexia" by Sally Shaywitz.   

Saying there is a "lack of dopamine in the brain" is an oversimplification, though it's a useful one. (The neurotransmitter norepinephrine is also implicated in ADHD, as well as dopamine.) Doing a blood test to look at dopamine levels would be useless. Brain cells use only a handful of different chemicals to "talk" to one another, but the combinations of connections produce billions of different messages. It would be more accurate to say that the neurons in the brain centers that affect selective attention and executive function seem to be working inefficiently, perhaps because they do not make enough dopamine and/or norepinephrine, or it's destroyed too quickly in the synapse before it has a chance to send its message. When we give medications that increase the amount of available dopamine and norepinephrine, those centers work more efficiently.

The adverse effects of these medications, such as appetite suppression and difficulty falling asleep, result from overactivity of other brain centers, which already have enough of the neurotransmitters, and don't work as well when they have too much. Ideally, we would be able to design a medication that would only be taken up by the problem areas in the brain and no others. But we're a long way from that.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: Sorcha
Date: 25 Nov 05 - 03:35 PM

Thank you, Dr. Mark. Your posts are exactly our experiences. Our Dr. DID warn us, and started him on the lowest dose possible. NO side effects for him at all. He stopped taking it in 7th grade...his choice. You can't force a child that old to take meds. He had a HELL of a time graduating from HS but he finally did it, a year late. He is now on Prozac.....Lexapro didn't help.

Another thing that I think is....
In the 'old' days, school wasn't as mandantory as it is now. A lot of these kids probably gave up on school, dropped out and went to work in the family business....farming or whatever.....


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Subject: RE: ADHD- Ritalin
From: dianavan
Date: 25 Nov 05 - 04:55 PM

Mark - I don't want you think that I am arguing for the sake of argument or that I am questioning your medical expertise or ethics. ADHD is a problem that, as a teacher, I have to deal with every day. I too, hope for a solution. I am just not sure that Ritalin is anything more than the pharmaceutical answer to a target market, mainly working mothers in an urban environment.

I did find this: http://www.cmaj.ca/cgi/content/full/165/11/1475

"To conclude, we found that short-acting methylphenidate was an effective short-term treatment option for children diagnosed with ADD. Yet, this finding may not be robust or completely valid. We also observed that this treatment exhibits a short-term safety profile that requires further investigation. Finally, there is a lack of long-term randomized trial evidence. Collectively, these observations likely reflect a less-than-an-ideal state of affairs given the long history of extensive, and ever increasing, use of methylphenidate for ADD particularly in North America for groups that now include preschoolers and adults."

Although your theory (dopamine and neuro transmitters) is probably the most popular at the present time, there are other theories that make as much sense. Some blame toxins in the environment, some point to an absence of essential fatty acids, the list goes on and on.

This entire thread has only exemplified the wide gap between the medical profession and the teacher. I don't need to read a book called 'Overcoming Dyslexia' because I know that dyslexia can be overcome in the early years. I also know that it is only one of a range of learning disabilities that often fall under that catch phrase. In all my years of teaching, I have never seen a bonafide
case of so called dyslexia. I see number and letter reversals, but if a child is allowed to develop without a bunch of neurotics hovering over him, it gets straightened out by the end of grade two. If not, they can be trained to cope with it. Its not the debilitating disease its made out to be.

I am a learning disabilities teacher, Mark. I can assure you that if a child does have a learning disabilitly beneath the ADHD, no drug will help that child learn. What is more important, the ability of the child to learn or the ability of adults to manage a child's behaviour?

A lot more research needs to be done. Until then, I maintain that counselling, combined with behaviour modification is a far safer, but more expensive, alternative. Lets face it, Ritalin is the most cost effective way to control behaviour. Other than that, its not a miracle drug. In fact, its a dirty drug with many side effects and no proven long range benefits.


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Subject: RE: ADHD- Ritalin
From: Mark Cohen
Date: 26 Nov 05 - 12:27 AM

I guess we'll have to agree to disagree on this one. I would like to correct what I think are a couple of misstatements in your last post, though.

Letter and number reversals are not dyslexia. Dyslexia, or reading disorder, is a condition in which there is significant difficulty with reading in a person of otherwise normal intelligence. There are deficits in specific brain processes, especially those that have to do with phonemic awareness. The brains of people with dyslexia are literally wired differently than the brains of people who are good readers, and there is very good scientific evidence showing that. I admit that I used to be extremely skeptical of people who kept talking about dyslexia, until I read more about it and saw children and adults who had it. It does exist, and it responds well to a good educational program that is based on phonics, among other things. People with dyslexia can learn to be adequate readers, but they generally don't become fluent readers. They learn to use alternate brain pathways, which are slower and less efficient.

Your statement, "If a child does have a learning disability beneath the ADHD, no drug will help that child learn" is accurate, but misleading. It's kind of like saying, "If a child has nearsightedness and a learning disability, no prescription for glasses will help that child learn." Of course the glasses don't treat his learning disability...but he can't see what's on the blackboard without them! (I often tell children with ADHD that the medication is "like putting glasses on your brain--it helps your brain to focus.") Certainly, the treatment for a learning disability involves educational intervention, not drugs. But if he also has ADHD and it isn't treated, he may not derive much benefit from the educational intervention, because he may not be able to pay attention to what his teacher is trying to tell him.

I agree that counseling, behavior modification, and appropriate educational intervention when needed, are an important part of the treatment for ADHD--I always stress that to parents. In my mind, the purpose of Ritalin is not to "control behavior"; if it were, I wouldn't prescribe it for children who have ADHD without hyperactivity. It's to help the child improve his ability to focus, organize his activities, and succeed at school, at home, and with friends.

And I do always ask for information from the teacher, and often speak with the teacher directly. I have a great deal of respect for the difficulty of a teacher's job. I think they're grossly undervalued and undercompensated for what they do. (I think that many of the problems we're facing today could be improved if our society valued education and teachers as much as it values video games, reality TV, and professional sports.) Ideally, treating ADHD should be a partnership between the doctor, the parents, and the teacher. Unfortunately, that seldom is the way it happens.

Aloha,
Mark


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Subject: RE: ADHD- Ritalin
From: Dave'sWife
Date: 26 Nov 05 - 01:02 AM

Dianavan --

I did not read Mark Cohen's recommendation of the Book on dyslexia as being directed at you. Let me edit his paragraph to demonstrate:

>>> Now, before someone jumps in and says that "these kids don't have learning disorders, they're just lazy," or normal, or whatever, let me hasten to add that there are a number of very impressive studies of brain function, using functional MRI scans .........If you're interested, or skeptical, I'd suggest you check out a book called "Overcoming Dyslexia" by Sally Shaywitz.<<<

I read that as a suggestion that someone who doesn't believe learning disabilites are a real physical thing should look at the book. Clearly, from your responses, you made it clear you DO believe that learning disabilities exist.


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