Saturday, March 22, 2008

(Hyper?) Active kids

Children are a delight and a worry. The only time I am completely happy is when they are asleep in bed. And even then I wonder whether the blankets are occluding their breathing and the CO2 giving them brain damage. When my youngest was a baby, I was convinced he was growing asymmetrically. It didn't help that our pediatrician was new to the job and tended to validate all my concerns before referring him to other more experienced doctors who reassured me that he was quite normal every time.

Now they are older (soon-to-be 15, and 12) and they worry me no less. The older one for obvious reasons, but both of them because this is the time in their life when they are developing a sense for what they might want to be when they grow up. It was with great surprise then, when my 12 year old asked me to talk to his teachers about him intending to be a musician when he grows up, and asking for their help in getting his grades up so he could get to college. The music bit was not a surprise-the boy creates new songs every day- but the link to good grades and college was.

I did meet with his teachers to talk about his academic progress (or lack of it in some areas) after his home room teacher suggested I needed to come in. I was nervous, because earlier in the year, the school counselor had called and asked if they could assess my son for attention problems. I said yes, feeling like I would have been a bad mom if I said no. But then when my part of the paperwork came home, I did not fill it out, instead opting to get advice from a friend who is a child psychologist. He suggested that if an investigation was warranted that I go to a professional outside of the school system as they tend to look at all potential issues rather than just ADHD. Good advice and I chose not to follow up with the school assessment at that time.

My son is not unable to focus, or to hold concentration. He is just easily distracted by one or two things; Friends, and the opportunity for an audience. Given his aspirations to be a musician perhaps at least the latter is not such a bad thing.
So, when I entered the room and saw his teachers sitting in waiting I felt some trepidation. I felt for sure, this was it. Time to confront the ADHD issue. But, it didn't go that way. All of his teachers appeared to recognize that they had a talent on their hands. They understood the tragedy of suppressing the spirit in artistic kids, and they offered suggestions to help my son improve his grades without compromising his dreams or his social life. Small organizational tips, and gentle reminders that there us a time and a place for everything now seem to be keeping him on track. How many other kids are so lucky to have teachers like that? How many others would have been pushed into medications rather than viewed as unique spirits on their way to their own special destiny? A 2007 review in the American Journal of Psychiatry found that there is a worldwide prevalence of ADHD/HD of 5.29% and the US is similar. The use of stimulant drugs to treat ADHD is necessary in severe cases but the risk of over-prescribing and mis-use of medications is a concern for parents, teachers and doctors alike. It is estimated that about 1 in 8 children in the US take a stimulant such as Ritalin, or Dexidrine, in order to control their ADD or ADHD.
A Time Magazine article way back in '03 (http://www.time.com/time/magazine/article/0,9171,1101031103-526331,00.html) highlighted the dilemma of having pills that work to focus and calm anxious middle schoolers, versus the unknowns associated with such medical practices, mainly regarding effects of artificially modifying the emotional and behavioral control mechanisms that are still underdeveloped in kids of that age. We don't know much more now about the use of stimulants in kids than we did in 2003. If you learn to cope chemically in those formative years, does it compromise your ability to cope without the chemicals later on? It's a balance between doing well enough to stay in the game (with or without medication) and developing the life skills for a successful adulthood without reliance on those same medications. In 2008, it is emerging that teenagers are abusing stimulants to stay awake longer during crunch time for exams. The pill takers are raising the game. Reminds me of the steroid problems that athletes face. If one does it, the baseline is elevated and if you snooze you lose.
The pharmaceutical trade group PhRMA have suggested that up to 10% of American children suffer from some mental illness. I offer the notion that perhaps we are too eager to classify the considerable angst of teenager-hood as bipolar, ADHD, depression or any number of other maladies that can now be ameliorated with non-street versions of uppers and downers. The FDA also worries. But don't misunderstand me. I am not for or against these therapies, just very strongly in favor of a thoughtful process on a child by child basis before jumping to a label and a drug to fix it.

In the case of my son, I am still open minded regarding a diagnosis for his oddball characteristics. If is has troubles with his peers, or with authority figures, or with himself, that he can't deal with, I will take him in. At the moment, we (his teachers, myself and my son) accept that he has an unusually creative and sociable side that he must reign in at certain times, such as the classroom. They tell me he thinks beyond his years. He is not weird, doesn't need medications, nor therapy, and is doing quite well at school with the gentle nudges and organizational tools we are helping him develop. I am proud of his creativeness and his ambitions to become a professional musician. Luckily, his teachers are too.
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