Let's not play around with our adolescents!

Methylphenidate (Ritalin) is a very common, in fact the most common, choice for treating attention deficit-hyperactivity disorder (ADHD). One of its major effects is to interfere with social interaction so that people with ADHD are not overly intrusive or disrespectful of normal social boundaries with others. A recent study of methylphenidate in adolescent rats showed that not only did this medication accomplish that goal, it interfered with social and play behaviors considered to be normal for these rats at this developmental stage. In other words, methylphenidate somewhat overshot the mark when it came to inhibiting pre-medicated behaviors.

Of course, to a parent who is frustrated and tired from managing a child whose behaviors have not demonstrated appropriate boundaries, this can be a welcome change. However, social interactions and recreational activities are important for teaching skills important to a productive adult life. Chemically denying a child these learning opportunities may create more problems later in life, when that child does not have the social skills that promote successful relationships, careers, and stress management.

I of course believe there are many options to consider before medication, and they are discussed elsewhere in this blog. If you do believe methylphenidate is the only rational solution to your child's situation, I would at least recommend closely observing your child's social behavior. If s/he has become a wallflower and swung completely in the opposite direction, at least discuss this change with the prescribing caregiver. There ARE other medications and options that can help set your child up for a successful adulthood...which is one of the primary responsibilities of responsible parenthood.

Vanderschuren LJ, Trezza V, Griffioen-Roose S, Schiepers OJ, Van Leeuwen N, De Vries TJ, Schoffelmeer AN. Methylphenidate disrupts social play behavior in adolescent rats. Neuropsychopharmacology. 2008 Nov;33(12):2946-56. Epub 2008 Feb 27.

Who is the real addict?

Friday I participated in a meeting at a chemical dependency treatment center. This is a place where people have been medicating their problems with stimulants and who are learning to use communication, conflict resolution, and coping skills to ride through life's challenges so that life does not defeat them. One of the biggest problems in this population is stimulant use, in the form of methamphetamine.

The message this and other treatment centers are working hard to encourage...is that when you listen to your body, it will tell you if you need to sleep, eat, address a conflict, or participate in a relaxing activity to help ride through situations that cannot be immediately addressed. When you push through feelings and ignore what they're telling you, you can push yourself to a point so low that it becomes tempting to use chemicals to pull out of the situation.

Today, I was reviewing research and ran across an abstract that completely contradicts this point of view. This article discusses the "potential" for treating CFS with neurostimulants, such as bupropion (Wellbutrin), dextroamphetamine (Dexedrine), and methylphenidate (Ritalin, Concerta).

No wonder treatment centers abound. The drug industry is advocating throwing stimulants at problems that very well may best respond to intensive self-care. I'm not trying to say that chronic fatigue is not a genuine problem. I just wonder where the logic is in trying to blast a person out of a fatigued state that may be telling us something very important about the person's overall health, their lifestyle choices, and the way they deal with stress.

It's no wonder our many public service attempts at reducing illicit drug use fall on deaf ears. The message seems to be that if you can figure out a way to present your problem to the doctor in a way that fits with an "official" medical problem, you can legally buy a way out of your problem. If you're less savvy, or don't have access to a doctor who is open to such creative thinking, you can still get the job done. It just might land you in jail at some point down the road.

An addict is an addict, whether legally managed or scoring treatment off the street.

Valdizán Usón JR, Idiazábal Alecha MA. Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate. Expert Rev Neurother. 2008 Jun;8(6):917-27.

Eye see some potential problems with Ritalin

Ritalin has its purpose. But Ritalin is also given to an awful lot of children. In fact, one source I found estimates that as many as 10 to 15% of all children have been placed on Ritalin at some point. Some researchers believe that children who are sleep deprived can act as if they have ADHD. And sometimes they get the diagnosis simply because they aren't behaving. Often, Ritalin is given before any behavioral, nutritional, or otherwise alternative options are considered. What that all means, potentially, is that there are many, many children out there who are at risk for what the researchers in this study discovered.

Twenty-seven female rats were divided into 3 groups; each was given a different oral dose of methylphenidate (Ritalin). Changes in eye tissue observed (at all doses, the degree of change correlated with the dose) included:
(1) degenerative changes of the corneal epithelium, the protective layer of cells on the outside of the cornea. (these changes included the appearance of apoptotic bodies, which are vesicles produced by dying cells.)
(2) increased collagen (fibrous material) production
(3) edema (fluid accumulation) around corneal cells
(4) vacuolization in cell cytoplasm (appearance of vacuoles, which help to
remove unwanted material from cells)

Interestingly, a group of Australian researchers is reporting that children diagnosed with ADHD actually respond better to fish oil than they do to Ritalin. And...hmmm...fish oil can help to preserve eyesight.

I italicized the word "diagnosed" in that last paragraph, because while fish oil can help to improve the biochemical imbalance that is the foundation of ADHD, a child who is misbehaving because of poor parental boundaries including appropriate bedtimes...is not going to change with a single pill or supplement available on the planet. It's called taking the time to be a good parent.

Kids can be snotty, they can be weird, and they can challenge your patience to the max. But when they misbehave, they're not asking for medicine. They're asking you to show them you know they are there, that they are important, and that you have the ability to set the boundaries that help them to feel safe and to be healthy. Not an easy job in this day and age, but the children in our lives owe it to us adults to have a vision for their healthy futures, and to protect their vision in the process.

Gozil R, Take G, Bahcelioglu M, Tunc E, Oktem H, Caglar G, Calguner E, Erdogan D.Dose-dependent ultrastructural changes in rat cornea after oral methylphenidate administration. Saudi Med J. 2008 Apr;29(4):498-502.

http://www.add-adhd.org/ritalin.html

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=391503&in_page_id=1774