Martin Young
Martin Young

Give Ritalin a break

Please don’t misinterpret my title. I did not say “Give kids a break from Ritalin” or “Stop using Ritalin on kids”. I meant exactly what I said. Let’s give Ritalin the respect it deserves.

I write this in response to a series of tweets I saw by a well-known HIV doctor specialist in which she bemoaned the impression that many of her friends’ young children sent to private preschools were either assessed for Attention Deficit (Hyperactivity) Disorder (ADD/ADHD) or actually put onto Ritalin. She felt it was wrong or inappropriate, and there were many responses to her tweets from parents suggesting the same. I suggested via Twitter that she, not being a neurodevelopment paediatrician, was not really qualified to comment in such a public medium where her opinion would be taken as advice. We had a good-natured, short but inconclusive interaction.

I am also not a neurodevelopmental paediatrician. I am an ENT surgeon. But the fact that I am that and not something else may have everything to do with the realisation well into my forties that I have had ADD as long as I can remember. On that basis, I feel qualified to comment and to tell my own story.

Preparatory school was an effortless experience for me. I remember coming top of my class right the way through, sharing first place with another chap who if anything was a little more odd than I was, and who I now recognise may well have had the same condition. Our parents had little to do with our success — we were both boarders, subject to the same conditions and structure, and there was nothing to suggest that our upbringings were responsible in any way.

Despite winning a scholarship to my chosen private high school, the effortless ease with which I had succeeded at prep school soon evaporated. I struggled to concentrate, to remember details and facts, doing better in methodological and analytical subjects like English and maths, never realising the promise with which I had left junior school. I started skydiving when I was 16, seeing my mother age 10 years in the year that followed. I hovered among the top 10 in class, never being first, but nevertheless getting a good enough matric to see me take my place in university as a first-year medical student.

The main reason I went to all my lectures in first year was that I had a girlfriend in the same class. We were inseparable for nearly two years, and she would have seen my bunking lectures as abandonment. She was a better student than I was, and her marks reflected this. The year we broke up I stopped going to lectures almost altogether. I saw little point in spending time writing down notes and fighting boredom when there were textbooks that could give me what I needed to know. I saved my enthusiasm for the exciting stuff, volunteering in casualties at night and over weekends to fix and mend broken bodies long before it was expected of me. I wrote important exams on some occasions learning half the annual syllabus by pulling an “all-nighter” through until the exam itself. By some magic I passed.

The pervading feeling in this time of trying to find myself as a young adult was that there was something fundamentally wrong within me. A series of girlfriends confirmed this on parting, each jilting me for other men who without exception they married shortly thereafter. “Something’s wrong with you, Martin” one said as we separated, and I believed her.

Restlessness was pervasive. I could not sit still. My hands were always doing something — rubbing my nose, scratching my ear, fiddling with a strap or a buckle. I became interested in certain things to distraction. It was nothing to spend three hours learning a new 10-second guitar lick. Remembering the branches of the common carotid artery on the other hand was a gargantuan task.

I somehow made it through medical school — firmly in the middle of the class. I was okay as a new doctor in the sense that the practical hands-on stuff appealed to me, and surgery would be my career path. I did my military service, finding an opportunity to continue jumping out of aircraft this time in an operational capacity. Doing crazy stuff just felt right, while at the same time my former girlfriend’s words and the others’ relief at finding other “stable” men resonated in my head.

I did find a woman who would accommodate my restlessness and married her. I specialised late, after 10 years of exciting work and travel around the world. The surgery I chose to do, ENT surgery, was intricate, varied, and each case seldom lasted longer than two hours. I soon realised that long surgical cases were not for me — I struggled to maintain focus longer than three hours.

I spent 45 years in this state. The breakthrough came when a paediatrician we were seeing looked at my wife and I and said, “So which of you two is ADD?” He gave me a questionnaire describing adult ADD, and on reading it I saw the pattern of my whole life flashing back at me.

I do not take Ritalin. I still have adult ADD, a condition which has channelled me into a speciality that meets my own needs perfectly. I am lucky, and have no need to manage it now. I regret however that I was not diagnosed when the wheels first started falling off, when the feeling of an inherent subliminal wrongness began, and that a treatment like Ritalin was not available. I feel as if my potential to have been very good, if not exceptional, was never realised due to my undiagnosed condition.

Ritalin is not for everyone. It does have side-effects. Every child with ADD is different, and for some there are other medications that do better. But it is a safe medication that wears off quickly, and can be stopped and started intermittently. For many children and adults it makes the difference between just existing and living life to one’s full potential.

My advice to any parent starting down this road is to get the best medical advice you can, from a neurodevelopmental paediatrician or paediatric neurologist who has a special interest in ADD/ADHD. In other words, see an expert. Have your child tested and follow trustworthy expert medical advice. Review later down the line. Look at other options, but do not discount medication. Give Ritalin or other drugs like it a break — they have earned their place in the medical treatment of ADD/ADHD.

Because your child deserves to be the very best he or she can possibly be.

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14 Responses to “Give Ritalin a break”

  1. “Have your child tested and follow trustworthy expert medical advice. Review later down the line. “

    “Full marks” Dr Martin!

    February 11, 2014 at 5:40 pm
  2. Momma Cyndi #

    ADHD is a very real condition …. but, when you have 18 children in a single grade one class of 24 children who are on Ritalin (true story), you start to wonder if it is ADHD or if it is simply a fashion statement. It is like having a ‘migraine’ was a decade ago – you don’t scream at the bank teller that you have a ‘migraine’! that is not even a bad headache.

    Too much of the time, a normally active child is simply bored but seen to be attention deficient. I used to sketch all through math because hearing the teacher repeat everything that I knew was simply not something I was interested in. I used to miss a lot of new stuff that was in the middle of it all, but it wasn’t because I had an attention problem, I just didn’t have the patience to wade through a half ton of stuff that I knew for the one little kernel that I didn’t. I’m not overly intelligent but I just ‘got’ math so I found the pace of learning in math class to be excruciatingly slow. It was languages that I struggled with. Those went way too fast for me

    February 11, 2014 at 7:48 pm
  3. Yvonne #

    I support the use of Ritalin where it is gauged appropriate for the child, after due consultation. My son is mildly intellectually impaired, and attended special needs schools. He was able to concentrate for up to three hours in class , due to daily Ritalin, taken until he became a teenager. He used it only in school in the morning – we lived with him bouncing off the walls for the rest of the day! – and his teachers clearly noted the change when he didn’t take it.

    For him it made the significant difference between being able to join his class mates in school work and complete tasks, which gave his self-esteem a good boost, and being a lonely outsider. It has had a lasting effect on his life.

    But get lots of different opinions, including from educational psychologists, before launching your child on this medication, adn if he/she is on it, make sure you track their health and growth, and assess the situation regularly, as Ritalin can cause stunting of physical growth.

    February 12, 2014 at 8:39 am
  4. Ruth #

    I am so glad that this article has been published. I often hear mothers giving Ritalin and the doctors who prescribe it, a go, when in fact the drug does a very good job when prescribed for ADD/ADHD. My son is doing so well after we put him on Ritalin last year. He went from being a mediocre student to excellent in one subject and good in two others. ADD is like any other medical condition. Get a proper diagnosis and treat the issue accordingly. If your child responds to Ritalin, he most likely needs it!

    February 12, 2014 at 8:58 am
  5. Thank you for this article. My child has been diagnosed with ADD 3 yrs ago but we just started medication this week as it’s was getting worse. I went back to school to do a Master but i can’t focus,concentrate…. and used to be so clever at school.i also think I have adult ADD. Yes,people should give those medications a break.Until you have a child who has the condition and see her/he struggling you will know they are important .

    February 12, 2014 at 9:18 am
  6. Thabo #

    Children are not the same. The very fact that children should be group alike and those that do not behave as per our guidelines have a problem is nonsensical. Stop giving children drugs simply because they are who they are.

    February 12, 2014 at 9:24 am
  7. Martin Young #

    The critical element here is in getting ‘expert medical advice.’ I would not feel comfortable having Ritalin or any other of the drugs prescribed by just anyone. ADD is a complex condition with very fine nuances to the treatment, so advice needs to be dispensed by an expert.

    Like any other medication there are side effects, and these need to be managed in a way that they are not worse than the original condition.

    And kids’ needs change over time, so review all the parameters, again with expert advice if you can get it.

    February 12, 2014 at 10:49 am
  8. Andrew KInsella #

    We should thank Martin for writing this. Like him I am a doctor diagnosed with ADD, after the diagnosis of a family member of mine. ADD does not preclude success- about 1 in 10 of us gets very good academic results. However it makes everything harder. Keeping on top of everyday tasks and work routine becomes immensely draining. the fact that we are often restless and unsettled makes us hard to live with and makes us worse partners and parents.
    It contributes to many broken relationships and a great deal of social difficulty. It is not just a normal variant, as Thabo suggests, but a significant disruption in normal neurological development. If left untreated it can cause great harm. Stimulants are often the best option available, but by no means the only option.

    As for the current increase in prevalence- increased work hours and economic pressures, pressure to move interstate to chase jobs, and employers who will just not accept their employees working a 40 hour week have created a social environment that is toxic to normal neurological development. The sooner we realise this and reject these pressures, the sooner the situation will improve.

    February 12, 2014 at 11:05 am
  9. A Taylo #

    Is Ritalin appropriate for adults who have been weaned off Ritalin and appear to be coping, but do not do well academically? Might their attention and patience be better at tertiary level if they were still taking it? If not what would work for them.

    February 12, 2014 at 11:14 am
  10. Andrew KInsella #

    A Taylo,
    if you think that the problems created by ADHD begin and end at academic performance you make a huge mistake.
    For a start adult ADHD patients are at much higher risk of a car accident than non ADHD adults if unmedicated, then there are considerable social impacts both at home and in the workplace.
    Certainly there are other approaches that will help- especially meditation and attention to fitness and regulating sleep as well as possible (dysregulated sleep and sleep deprivation are very significant issues for many ADHD individuals), however, for many stimulants remain the best choice. Quite frankly I do not see that there is any role at all for public comment on the treatment of adults in what should be a matter between the patient and his treatment team.

    February 12, 2014 at 10:44 pm
  11. Jay #

    Thanks for a well balanced and fair article. I do feel that Ritalin/medications are being used as a first port of call, rather than a last one. There are many steps to take before medicating. Diet, structure etc all play a part. Having said that, if you haven’t had a child or family member who just cannot help not being able to concentrate despite being really bright, it is difficult to understand how damaging this can be to your self image. Ritalin has made the difference between not coping and flying academically and socially for many. I would just really like to know any personal testimonies of people who have been on long term as children as to whether their health or growth have been affected on a permanent basis.

    February 15, 2014 at 10:19 pm
  12. zella #

    Thanks for this article, it has been a God send. My son was diagnosed at age 7 and since then I have tried every diet, exercise, herbal, homeopathic, physio, occupational etc over the past 5 years. My son is top of his class and now in Gr 6, but I honestly don’t know how he does it, as when I look in his work books there is so much missing. I was always against medicating him but I don’t want to look back and know I did my son an injustice by not trying it. Ive tried for 5 years and as the Martin stated he was also top in junior school but eventually I don’t think anyone will keep up with the work load. I also don’t think its only academically, as I see it in everything my son does, whether its karate, soccer, cricket, he cant control his fidgeting, him and I are constantly fighting and it is not fair on my son as this is something he has no control over. I am now in the process of turning to Ritalin..

    March 26, 2014 at 4:36 pm
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  14. bewilderbeast #

    Solid diagnosis and advice. I get mad when people criticise ritalin when I have my son on it after expert assessments, diagnosis and passionate follow-up and critical post-assessments, spells of going off the medication to affirm the difference and a vastly improved life thanks to it. All this can be dismissed by a total ignoramus of the “I don’t believe in medicine” type!!
    Well said (unlike your religious waffling, I have to add . . ;-)

    June 20, 2014 at 7:25 pm

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