Chicago Community Kollel Interactive Parenting Column #6

Shmuel:

During the past decade or so, the use of ritalin and other ADD/ADHD medication as a behavior-modifying drug for restless children has skyrocketed. Proponents tout its ability to transform hyperactive children into focused students who are able to function properly throughout the school day. Others maintain that the drug is helpful but over prescribed. And there are some who claim that medication should never be given to children in order to help them succeed in school.

For a layperson, it is confusing and often intimidating to digest all this information from these diverse points of views. For although there are many excellent books written on this subject, the opinions of the writers range from denying-children-medicine-that-can-help-them-is-akin-to-not-letting-a-nearsighted-child-wear-glasses all the way to giving-children-medication-is-like-handing-them-narcotics.

From my vantage point, I strongly feel that medication can be extremely helpful in assisting many ADD/ADHD children (and some adults) succeed in school and in life. And with all the advances made in understanding brain function, I feel that children should be given every possible chance to succeed – including medicating them if necessary.

Having served as eighth-grade rebbi for fifteen years, and as a school principal for ten years, I personally observed the positive effect that medication has had on many students. It helps them concentrate, complete their work, follow instructions, improve their grades, and has an overwhelmingly positive change in their overall school experience.

Are there side effects to medication? Surely there are. But there are ‘side effects’ to not succeeding in school as well. And those are often far worse than those of the medications. In fact, there are side effects to nearly every medication we ingest. These are factored in, but they rarely stand in the way of taking the medication unless they are overwhelming. After all, most people take Novocain before getting a root canal – despite the side effects.

So, all in all, Shmuel, I would give you a green light, or at least a blinking yellow, to pursue the medication angle after you have carefully consultated with trained professionals. (Disclaimers: I have no training in ADD/ADHD evaluation or treatment. And, for the record, I do not own shares in the pharmaceutical companies that produce Ritalin, Concerta, Dexedrine, or other ADD/ADHD medication.)

Dosage, School Day, and Information Sharing

There are many factors that are considered by a physician when determining the appropriate dosage of ADD/ADHD medication, and the proper time(s) for taking the pills. In most instances, the doctor will suggest taking one pill at home following breakfast. Aside from the fact that this time usually precedes the start of morning classes, there is an additional consideration. Ritalin often causes appetite suppression, and therefore should be given after meals, whenever possible. For older students, who have a longer school day, perhaps an additional dose would be administered after lunch. There are time-release medications available as well, which makes it possible to administer one dose for the entire day.

Due to the fact that the effect of the medication wears off after several hours, you, and perhaps the teacher, can be helpful in informing the doctor of the critical times of the day that require the most concentration of your child. Careful examination of your son’s school schedule might warrant deviating slightly from the right-before-boarding-the-school-bus medication schedule. If your son arrives in school at 7:30, it may not be wise to give him his first dose before leaving home, as the first hour of his school day may be spent davening and eating breakfast – where enhanced concentration may not be as critical.

During the first week or two, you might consider coming to school during the lunch break to administer the second dose of medication yourself. This will allow you to monitor any possible side effects, and to limit the number of people who will be informed regarding this matter. However, when you and your physician decide that your child will take the Ritalin on a regular basis, the school administration must be informed. Inquire as to the school policy regarding the dispensing of medication during school hours. If there is a school nurse on the premises, she will be very valuable to you, both in giving the medicine, as well as monitoring your child's reaction to it.

It is crucial that the teacher be informed of your decision to medicate. Firstly, he/she will be in the best position to allow your child to take the medication in a discreet manner. Additionally, if any side effects arise, or if you forget to administer one dose, the teacher will be able to assist your child. In fact, many physicians will actively involve the teacher in determining the appropriate dosage. Having the teacher fill out a form called “The Conners’ scale” generally does this. This describes, in great detail, your child's behavior and attentiveness during that time period. The doctor will then use this data to adjust the dosage of the medication, if necessary. Without this critical information, it is quite difficult for the physician to accurately gauge the efficacy of the treatment.

Any child who is taking Ritalin will rightfully be self conscious of this matter. The overwhelming majority of teachers will treat this sensitive information with discretion, and perhaps can be helpful in alleviating your child's concern regarding the Ritalin, by sharing with them anecdotes about other children who were greatly assisted by taking the medication, and were able to maintain their anonymity while doing so.

Shmuel: two final points. Firstly, there is a significant role for parents to play in the raising of well-adjusted ADD/ADHD children. Perhaps in a later column I will address some practical tips for parents of ADD/ADHD children to help their children function better – at home and in ‘life.’ In the meantime, read some books on the subject of parenting ADD/ADHD children. If you have Internet access, spend some time doing research on the topic. (An excellent website is CHADD, at www.chadd.org) After all, with this, as in so many other areas, knowledge is power.

Secondly, always keep in mind that ADD/ADHD is a ‘package’. And along with all the challenges come opportunities. ADD/ADHD kids and adults are generally charming, outgoing, intelligent and ready for action. Their drive for excitement and stimulation, if channeled correctly, can produce high degrees of success later in life – in the communal arena, in business, and in other areas that require quick thinking, quick action and creativity. ADD/ADHD adults are often the ones that can run full steam ahead and still have enough energy to walk (or rather sprint) a few miles at the end of the day.

So; continue to do your very best to help them through childhood and adolescence. Hopefully, in a few short years you will be able to sit back and share in the joy of their accomplishments.

Best wishes for continued nachas.

Yakov Horowitz

© 2006 Rabbi Yakov Horowitz, all rights reserved