General discussion - Mom and Dad Esq.

[dtb]

Originally posted by Atticus Grinch

While thankfully this is still a hypothetical question for me, I'd like to think that I would never be cowed into medicating a child today because some child psychologist says it might lead to drug abuse later.

It wasn't a child psychologist, but a child psychiatrist (and a personal friend -- not one treating any child of mine, and with no particular axe to grind either way). You make it sound like some quack with an agenda wants to put a kid on medication, just for the hell of it. Hardly.

Ritalin (and other amphetamine derivaties) has been used for 40 or 50 years as a pediatric medication. It is one of the most (if not the most -- I was going to say "the most", but do not have perfect clarity of that recollection) studied drugs for pediatric use. The phenomenon of children WHO HAVE ADHD and are not treated for it being at higher risk for later drug abuse is a studied subject -- not some psychologist making something up.

For someone as analytical as you, I find it hard to believe (and, dare I say it, yes, I dare -- disappointing) that you would so flippantly dismiss the risk.

Originally posted by Oliver_Wendell_Ramone
I wanna talk about Montessori!

I can't speak from experience, because my own children did Quaker pre-school (keeping them blissfully free from school-generated holiday hype).

But when I was looking at schools, I heard this criticism of Montessori. Maybe it is true, maybe not. All of the Montessori games are like puzzles, and they are all intended to have a single correct answer. Naturally, this is good for developing certain problem solving skills. But the M. school near us did not allow for play that didn't have an answer - like throwing together a bunch of costumes; or building legos.

So although the M. play is unstructured in the sense that one can pick and choose at will, it is very much structured in how one interacts with the objects available in the classroom.

[Greedy,Greedy,Greedy]

Originally posted by Threads
I can't speak from experience, because my own children did Quaker pre-school (keeping them blissfully free from school-generated holiday hype).

But when I was looking at schools, I heard this criticism of Montessori. Maybe it is true, maybe not. All of the Montessori games are like puzzles, and they are all intended to have a single correct answer. Naturally, this is good for developing certain problem solving skills. But the M. school near us did not allow for play that didn't have an answer - like throwing together a bunch of costumes; or building legos.

So although the M. play is unstructured in the sense that one can pick and choose at will, it is very much structured in how one interacts with the objects available in the classroom.

The school my kids have gone to (not Montessori) allows for plenty of dress up, etc. - but this play, too, is structured; spaces are set aside, teachers seek to encourage dress up to become acting, and legos to be used to develop pre-math skill.

But that is all good; my life is filled with purposeful play (indeed, on a good day that is how I think of what I do for a living), and that is far better than any available alternatives. If my kids start now with purposeful play, perhaps their lives will be filled with it as well.

[Atticus Grinch]

Originally posted by dtb
It wasn't a child psychologist, but a child psychiatrist (and a personal friend -- not one treating any child of mine, and with no particular axe to grind either way). You make it sound like some quack with an agenda wants to put a kid on medication, just for the hell of it. Hardly.

I appreciate the distinction. One has gone to medical school and the other hasn't. One can dispense drugs and the other can't. I believe this is some cause for mild antipathy between these groups, and a difference of approach, or at least a difference of first resort.

My natural skepticism often compels me to regard the medical profession's love of meds as something like the IT department's love of gadgets. "Oooh, look what this one can do --- it's miles ahead of the last one!" Not to mention the fact that MDs have been at the forefront of a massive shift of health care spending to pharma companies, partly because the incentives to prescribe --- some monetary, some more subtle --- are regulated by nothing more than an individual doctor's Hippocratic Oath. (Which, by the way, I respect.)

No slam on your friend --- individual doctors do wonderful things within the context of a health care system that's fucked up. I do not doubt the sincerity of his position and the desire to treat the whole person --- the adult who will grow from the child. I have less faith that studies will bear out that this generation of pharmacalogically treated ADHD children will avoid adult drug use in greater numbers than non-treated ADHD children. Diagnoses and medication have both skyrocketed in the meantime.

The phenomenon of children WHO HAVE ADHD and are not treated for it being at higher risk for later drug abuse is a studied subject -- not some psychologist making something up.

I don't believe I said he was "making it up." And I apologize for not making the distinction between the choices faced by a parents of a child with unmanageable ADHD and those faced by others. Right now, I have the luxury of being in the other camp. And I hear stories about parents who just want their child "fixed" and resort to medication without exploring other therapies.

My position on this is biased against medication because I think we're becoming overmedicated as a society as a whole.

For someone as analytical as you, I find it hard to believe (and, dare I say it, yes, I dare -- disappointing) that you would so flippantly dismiss the risk.

I don't dismiss the risk. I'm just not optimistic that medicating today will reduce self-medicating tomorrow. If I met your friend at a cocktail party, I'd probably cave more quickly.

[c2ed]

Originally posted by Atticus Grinch
Not to mention the fact that MDs have been at the forefront of a massive shift of health care spending to pharma companies, partly because the incentives to prescribe --- some monetary, some more subtle --- are regulated by nothing more than an individual doctor's Hippocratic Oath. (Which, by the way, I respect.)

The Stark laws also discourage that. Not saying that all docs now are free of bias in what they prescribe, just pointing out ...

I have less faith that studies will bear out that this generation of pharmacalogically treated ADHD children will avoid adult drug use in greater numbers than non-treated ADHD children.

Studies are inconclusive at this point, but this article is fairly interesting on the subject, and the author does admit that they were interested in whether medicating a child with ADHD could increase the possibility that the child may use other drugs later as the child was used to medication as a means to feeling good.

My position on this is biased against medication because I think we're becoming overmedicated as a society as a whole.

I have no dog in this particular fight (no kids yet), but I agree with you. If I ever am blessed with children and one has ADHD or a similar disorder, I know it will be gut-wrenching to decide whether to medicate the wee one.

Edited to add another interesting article that I found on ADHD medication and later drug abuse.

[baltassoc]

Originally posted by Threads
But when I was looking at schools, I heard this criticism of Montessori. Maybe it is true, maybe not. All of the Montessori games are like puzzles, and they are all intended to have a single correct answer. Naturally, this is good for developing certain problem solving skills. But the M. school near us did not allow for play that didn't have an answer - like throwing together a bunch of costumes; or building legos.

Do want to raise a scientist/doctor/lawyer or an actor?

NTTAWW being an actor.

I know, I know, a lot of people will say that they just want their kid to be happy, and if that means being an actor, so be it. But that assumes that someone naturally wants to be an actor and not a scientist. Montessori pushes in a direction (arguably - but arguably not in other ways), but that doesn't mean that it's bad to do so. We make choices for our children, and deciding to put them in prgrams that emphasize role playing pushes in one direction, while programs encouraging problem solving push in another. Most programs (including Montessori) try to deal with this issue by balancing the activities, but it's hard to say that a particular emphasis is wrong.

[c2ed]

Originally posted by Oliver_Wendell_Ramone
And a thread-hijacking bastard as well. Start your own meds/ADD discussion; I wanna talk about Montessori!

Oh, and thanks to all those who have offered their thoughts.

Another thought, third-hand evidence. A very good friend of mine put her 3-year old in Montessori recently. The daughter is still there and loves it, but the experience can depend on the teachers. For instance, a couple of the older, really good teachers left that school (pay issues). My friend was recently told that her daughter is now a "problem child" because the newer, younger teacher approached her and said "you can't walk around and eat your carrot at the same time." The girl handed the teacher her carrot and continued to walk around the room, although the teacher was trying to get her to sit down and eat the carrot. I thought that was brilliant of the child. She quickly assessed her priority, chose the appropriate action, and went on with it. To the teacher, this was "not listening to authority." I thought it showed perfect attention and decision-making capability. But my friend and her spouse are now carefully watching what is going on, and may decide to place their daughter with another Montessori school.

And regarding the kid who said "can't, had a spell on me," that's genius. I love that. Might not have high-fived the kid if he were mine, but definitely would have chuckled inwardly.

[dtb]

Originally posted by Atticus Grinch
I appreciate the distinction. One has gone to medical school and the other hasn't. One can dispense drugs and the other can't. I believe this is some cause for mild antipathy between these groups, and a difference of approach, or at least a difference of first resort.

My natural skepticism often compels me to regard the medical profession's love of meds as something like the IT department's love of gadgets.

Right -- but what you said was "I'd like to think that I would never be cowed into medicating a child today because some child psychologist says it might lead to drug abuse later." Are you saying that this is not a flippant dismissal of the empirical evidence? I don't think I said it was the only consideration to be taken into account -- just another factor in the decision-making process, and one I found to be compelling.

What gives you the impression that doctors are out to prescribe drugs to children for no reason (or at least, for something-less-than-pure-medical-analysis reasons)? You read it somewhere? Anectotal evidence (read -- as good as no evidence at all)? Because you've pointed out now several times that it's not from personal experience.

Furthermore, Ritalin (&c) is not "the latest thing" -- as I think I mentioned, it's one of the most-studied and longest-prescribed pediatric drugs.

Originally posted by Atticus Grinch
No slam on your friend --- individual doctors do wonderful things within the context of a health care system that's fucked up. [...] I have less faith that studies will bear out that this generation of pharmacalogically treated ADHD children will avoid adult drug use in greater numbers than non-treated ADHD children. Diagnoses and medication have both skyrocketed in the meantime.

I'm not insulted by any slam (and did not perceive one) on my friend; just pointing out that this information was not received in the context of making a medication decision for my own child and as evidence that the factoid was not offered as a "cowing" tactic to get me to medicate my child, but as a point of information in a non-diagnostic conversation.

And again, this is FAR from the first generation of children taking Ritalin. You may not have any faith in future studies; I don't have a view about future studies. All I am talking about are past studies (and apparently there are quite a number of them), which do lead to the conclusion that children with ADHD who are not treated have a GREATER RISK (i.e., it's not a certainty) of drug abuse later in life. I don't believe I made the assertion anywhere that those ADHD kids who are treated will avoid drug use/abuse in every case (and I know that's now what you're saying); but according to two child psychiatrists and one "regular" psychiatrist (who, just as an added tidbit, had untreated ADHD as a child), the studies out there do show a correlation between untreated ADHD and drug use/abuse later in life (adolescence, I think).

Originally posted by Atticus Grinch
I don't dismiss the risk. I'm just not optimistic that medicating today will reduce self-medicating tomorrow.

And yet, 50 years of empirical studies say otherwise. But, eh, studies, schmuddies; go with your gut.


[Edited for clarity.]

[rufus leeking]

Originally posted by dtb
What gives you the impression that doctors are out to prescribe drugs to children for no reason (or at least, for something-less-than-pure-medical-analysis reasons)?

an article in the local paper claimed that school districts got extra $$$$ per each special needs kid, and every ADHD (or other acronyms) kid rang the cash register. The docs in question are employed by the school district. There is at least the potential for over-prescribing. anyway, 5 years from now when this wave of kids from the posters here are just moving out of 3rd grade, maybe we can revisit the question.

[Greedy,Greedy,Greedy]

Originally posted by rufus leeking
an article in the local paper claimed that school districts got extra $$$$ per each special needs kid, and every ADHD (or other acronyms) kid rang the cash register. The docs in question are employed by the school district. There is at least the potential for over-prescribing. anyway, 5 years from now when this wave of kids from the posters here are just moving out of 3rd grade, maybe we can revisit the question.

Actually, we've watched school districts fight classification heavily, because service obligations also come with the designation, and in many cases the services are already strained. It is often parents fighting to GET the classification.

Where are you that the school district has docs on the payroll? We're lucky to have a nurse in the building a few days a week, and are in one of the top school districts in our state.

Originally posted by rufus leeking
5 years from now when this wave of kids from the posters here are just moving out of 3rd grade, maybe we can revisit the question.

At least in our school (SF/SV area) I haven't seen a big push for meds among the grade school boys (the older child is in 5th grade and I am unaware of any children in the school taking meds, although it may be blissful ignorance on my part).

There is, though, a huge emphasis on intervention for any kind of small learning disability. Speech, handwriting, dyslexia . . . any sort of minor issue becomes grounds for special classes with the speech therapist, reading counselor, etc. etc.

There are pluses and minuses to the approach. The school does make sure no child falls between the cracks, if at all possible.

But this is a school district that prides itself on extraordinary performance in state tests; and it seems that there is no room for a little variation on skills, and an unwillingness to let children grow out of problems themselves.

There is an odd dynamic when one spends $1M or so for a house in the "right" school district. A lot of expectations come into the public schools, starting with the kinders and ramping up through the high schools.

[Greedy,Greedy,Greedy]

Originally posted by dtb
Furthermore, Ritalin (&c) is not "the latest thing" -- as I think I mentioned, it's one of the most-studied and longest-prescribed pediatric drugs.


And yet, 50 years of empirical studies say otherwise. But, eh, studies, schmuddies; go with your gut.

I think studies go several different ways, and that the art of diagnosis is critical to the whole effort.

There are different types of ADD and ADHD, and ritalin impacts them differently. ADHD is often linked with other issues, like dyslexia. The average physician doing diagnoses probably can't tell the difference (our kid needed multiple batteries of tests at one of the top teaching hospitals anywhere to get a full and accurate diagnosis, and that diagnosis differed materially from what the very good doctors said was their initial impression after the first examination; the average kid prescribed ritalin would get it after an examination more cursory than our kids' first exam). Most of the studies came before physicians understood the differences, and most don't take account of them. Many of them were sponsored by pharmaceutical companies.

So I think ritalin has been oversold, but I also think there are clearly some cases where it has an important impact. Indeed, when properly diagnosed and prescribed to the right candidates, I believe the success rates are phenomenal.

But a big problem here is providing the level of care that kids should have; the study of ADHD has changed dramatically over the last few years, and it takes literally thousands of dollars of work per child to get a good diagnosis. The health system's approach, however, is to say, Ritalin's cheap, it works for a bunch of 'em, put them on it and see how they do. (And, by the way, it will make all of them easier to handle on the surface, so it works for an overburdened teacher/parent/etc., but that easier to handle kid may now be in a fog instead of having sudden clarity when they are trying to learn).

(Note: our kid, who has ADHD linked with dyslexia -- as well as a high genius IQ, which often goes with those combinations -- isn't on ritalin though some of the first folks who assessed said kid wanted to prescribe it -- what was really needed was some teacher behavior modification and some extra attention and support).

[rufus leeking]

Originally posted by Greedy,Greedy,Greedy
Where are you that the school district has docs on the payroll? We're lucky to have a nurse in the building a few days a week, and are in one of the top school districts in our state.

they aren't on payroll as in fulltime, hired for the consult only. but they are being paid school $$ when doing this.

I think designating as adhd doesn't carry much real service obligations- just line 'em up to go to office for pills once a day. the more intensive special ed is something parents fight for, and schools resist. lots of parents fight for this type spec. ed to avoid the pills solution.

[dtb]

Originally posted by Greedy,Greedy,Greedy
I think studies go several different ways, and that the art of diagnosis is critical to the whole effort.

Absolutely. I don't disagree with anything you said. My only point was that in those cases where there REALLY IS a kid with the condition, it is important to consider medication. And that when medication is properly prescribed (meaning, for a kid that actually suffers from ADD), there are potential harms in NOT giving it to him/her.

Who would disagree with the idea that unnecessary medication is a bad thing? I certainly didn't intend to convey that message, and I certainly am not the opinion that Ritalin should be passed out like candy.

[Greedy,Greedy,Greedy]

Originally posted by rufus leeking
they aren't on payroll as in fulltime, hired for the consult only. but they are being paid school $$ when doing this.

I think designating as adhd doesn't carry much real service obligations- just line 'em up to go to office for pills once a day. the more intensive special ed is something parents fight for, and schools resist. lots of parents fight for this type spec. ed to avoid the pills solution.

There should be considerable service obligations, and there are in Massachusetts, where we are.

If the attention span issues mean that a kid misses significant parts of lessons, they likely need some one-on-one or small group time to make up for it. Some schools will argue the ritalin takes care of this -- it doesn't, and if the kid taking it has one of the ADHD forms that doesn't respond to Ritalin, it may be worse. An increasing number of physicians will literally prescribe special assistance before dispensing Ritalin. In our school district, an ADHD diagnosis gets the kid a mix of one-on-one and small group out-of-the-classroom assistance. That is not cheap for the school districts.

And most times, diagnoses like this are going to be covered by health insurance instead of the parents or schools, unless you do what we did and bring in specialists, in which case the parents pay.