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To Be or Not to Be…Medicated Part 2

Continued from Part 1

I’m not 100% comfortable with medication as a solution for attention problems.

I can’t deny the efficacy of certain prescriptions—last week, our son had his FIRST PERFECT WEEK at school.

Granted, we only had two days in class due to snow but this is still a first. Two days, back-to-back, with only green marks (given for helping, staying on task, getting behavioral compliments from teachers in supplementary classes, etc.)? Never happened before.

The potential for success is incredible.

Possibility of side effects, now or in the future, concerns me.

I can say, in good conscience, that we tried EVERYthing before turning to medication. Still, nagging guilt plagues me, an oppressive feeling we “gave in” to the road more traveled.

Some of my friends say things like

Drug companies are the devil

and

Pharmaceutical conglomerates care about making money, not about making kids healthy

and although I’m not sure they’re correct on the first count, I acquiesce on the second. Companies are formed and sustained for one purpose: to make money for someone.

Knowing this, why do we—as a nation—fall in line for the daily dose?

The unfortunate truth is this: other alternatives require more time and sometimes bring less direct results. In the world of mental health—mental health of children, in particular—we search for expedient outcomes.  Medication is fast, and in some cases, immediate.

Research for alternatives led me to an option so easy it’s laughable. MOVEMENT. Activity requiring physical effort, carried out especially to sustain or improve health and fitness. In other words, exercise.

One of the article links cracked me up: “exercise-seems-to-be-beneficial-to-children.” No. Really?

According to several studies (see the links throughout this post), exercise can be just as beneficial as medication. Some claim prescriptions may be eliminated by implementing a consistent workout routine.

Why don’t we hear more about exercise as an alternative to drugs? 

This article by Yasmin Tayag is blatant in accusation. There’s no money to be made; physical activity is, well, free.

To be fair, our doctor did recommend exercise—not to replace, but to supplement the medication. After I explained our involvement in Karate twice a week, Scouts, family chores (yes, cleaning up counts as exercise) and treks through the woods, she agreed that no one could call our family sedentary.

CalorieLab even has a cool page for learning how many calories you burned vacuuming or doing other chores, if you’re interested. 

She also recommended limiting screen time. Our kids watch about four hours of TV. Not per day. PER WEEK. Much lower than the national average, according to an American Academy of Pediatrics article. Where these kids find time to spend 7 hours a day (A DAY!?) entertained by screens is beyond me.

I have to agree with Yasmin; money seems the root of the problem; drug companies court pediatricians and other doctors constantly. I saw three reps during our 30-minute stay in the waiting area.

Why exercise?

If you don’t know the answer to this question after years of watching Richard Simmons Sweat to the Oldies, I can’t offer you help. I mean, really.

Stop pretending you’re not overcome by memories. You know you loved it.

Okay, let’s get serious. Shake off your nostalgia.

This article in The Atlantic shows pictures of brain function with and without exercise. Due to the wording, I can’t determine whether the pictures are a representation of the study or genuine, actual slides. Either way, the visual difference is staggering. The article references children sitting in class with “blue heads” for nine months. Lost learning potential could be significant. An excerpt:

John Ratey, an associate professor of psychiatry at Harvard, suggests that people think of exercise as medication for ADHD. Even very light physical activity improves mood and cognitive performance by triggering the brain to release dopamine and serotonin, similar to the way that stimulant medications like Adderall do.

Nutshell:

Exercise makes you feel good.

No small accomplishment for a child who tends toward a negative self-image. Many kids with ADHD feel “less.” Less able to do the work, less likely to succeed, less likable (due to their sporadic behavior) than their more focused classmates. Exercise can improve self-image in many ways—not just physical.

Exercise reduces “learned helplessness.”

ADHD kids are likely to quit before they start because they feel they won’t succeed regardless of what they do. ADDitude mag editors also quote John Ratey as a resident expert, but are more conservative. This article describes exercise as a supplement rather than replacement for medication.

I see “learned helplessness” in our children, both of whom struggle with attention (although our guy has a much more difficult time). Our daughter, in particular, would rather not try if she sees potential for failure.

Simple math problems take FOR-EVVVV-ERRRR because, instead of relying on her bank of memorized facts, she counts on her fingers before answering. This backfires, as she is often distracted while counting and ends up with an incorrect answer. This reinforces her idea that she won’t get it right. We’ve worked very hard with her, encouraging her to use the first answer that “pops into” her mind.

Exercise jump-starts your brain

Exercise turns on the attention system, the so-called executive functions — sequencing, working memory, prioritizing, inhibiting, and sustaining attention.

-John Ratey, M.D.

Working memory is the key for many ADHD individuals. Our son scored very high on psych evaluations in almost every area except this. Without working memory, we can’t perform two tasks at once—at least, not easily.

How much, how often?

  • WebMD suggests 150 minutes of exercise per week in an article about adult ADHD
  • According to an article in Inverse, some schools have implemented three 20-minute exercise sessions or use “time-in” instead of time-out: if a child acts out, he or she spends the “time-in” on an exercise/ machine

Exercises to try

  • Aerobics/Cardio
  • Running/Jogging/Walking
  • Push-ups, squats
  • Yoga
  • Sports/Martial Arts

Not all exercise must be physical, although aerobic exercise is an excellent strategy to focus that brain. You can also try the following:

  • Try focus exercises geared toward ADHD.
  • Train your Brain. The jury is still out regarding brain-training games, but it seems logical. If your brain is a muscle, and you engage in consistent brain workout, I conclude that it will be stronger and better.  NeuroRacer sounds pretty cool, although they now focus on aging adults. I contacted the company to ask if the game is available to the general public. 
  • Learn something new. Khan Academy offers free classes; the site is amazing. Learning a new skill stretches your brain. Remember when you learned to read? C-A-T. Struggling to decode words. Look at ya now—reading is as easy as breathing. Always wanted to learn Chinese? Greek? Spanish? Learn to play an instrument, to cook authentic Italian food, to swim. Now you have a reason.
  • Do math. I’ve seen exponential (see what I did there?) improvement in the kids’ focus as we’ve dedicated time to learning long division and double-digit multiplication.
  • Write. (YAY!) The creative process, research, putting words to a page whether written or typed, editing—all of these contribute to better focus. I’ve never been diagnosed ADHD (except by all my best friends and Hubby), but I do have my suspicions. When I practice faithful writing, everyone can tell.

Now what?

Our new routine started today. 30 minutes of sustained activity each day—that’s the goal. Hubby and I don’t often sit (we like to DIY, and we’ve been remodeling the kitchen for several weeks). The kids, however, would prefer to meld with the carpet, or couch, or whatever.

As I mentioned above, we all take responsibility for chores at home. Daily chores take a legitimate 15 minutes (for the 9 year old) and 25 minutes (for the 11 year old).

I’ve stopped counting their chores toward daily fitness because she, in particular, moves at a very slow pace. She’s admitted a hope that we will give up if she takes forever. So far, no dice. Sorry, honey.

During research for this post, I realized that our kids don’t participate in sustained physical activity every day.  So, today, I instituted the first daily “30 Get Up and Move Minutes” session. 30GUMM for short, because I’m a nerd. If the weather is nice, out they go. If I look out a window,they should be walking, running, playing with the dogs, swinging, etc.

Our first day of bad weather, I plan to break out the Wii. Yes, it’s screen time, but at least they’ll be moving, so I think it counts. Sort of like tricking them into exercise. Bwah ha ha ha.

Do I have to forgo meds?

This post (including Part 1) is not intended to denounce medication as originating in brimstone.

Although I don’t like the thought of possible side effects, school and self-image are my main concerns for the moment. As long as the side effects remain only on the pharmacy document regarding “all the horrible things that will probably happen because now you are looking for signs of them,” they’ll keep popping pills. Responsibly and at the lowest possible dose. If side effects occur, we’ll re-think the plan.

And for the moment, we’ve had no issues.

On the other hand, I plan be more intentional about integrating physical and brain exercise. Getting them in shape, body and mind, can only benefit. If we’re able to phase out the medication, that will be a lovely added bonus.  I’ll let you know how it goes.

How about you?

Are you a medical teetotaler or pill pusher? Is BigPharm the evil villain, or do you think alternative medicine is for hippies? Have you found ways to focus? What’s your strategy?

Of course, if you think freebasing Vicodin is a panacea, I recommend keeping that to yourself…

We’re all interested in what you have to say. Share below!

 

 

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To Be or Not to Be…Medicated Part 1

To medicate or not…that is the question.

Hamlet’s angst is nothing compared with the stress parents face in the decision of whether to alleviate ADHD symptoms with medication.

Everyone has an opinion to voice, including 95-year-young great-aunt Judith.

In myyyyy day, we just sent the kids outside to run around until they fell over. Worked like a charm.

Right. That’s helpful. The kid is in school all day, expected to be motionless and butt-in-seat for almost seven hours. A colossal task for a child whose small body vibrates with energy. There’s little time built into the school schedule for “running around.”

I agree that the issue of exercise must be addressed (another post) but changes in a public school drag out as only bureaucracy can.

While school officials and teachers are not allowed to recommend medication, parents of kids who fall under the “ADHD” banner can read between the wide-rule notebook paper lines.

We have tried all the strategies available to us but she’s still having significant trouble keeping up with the class. Have you talked with your pediatrician about sleep, diet changes…other…possible solutions?

And then there are the meddlesome individuals concerned friends with opinions. 

Have you read about the side effects? My friend’s brother’s girlfriend has a facial tic and hallucinates. She was on that Concertadderalin drug for fifteen years. I bet that caused it.

What is a parent to do?

When the kids first came to live with us, our girl was the picture of perfection in public. This byproduct of Reactive Attachment Disorder was a boon, because…the same could not be said for our little guy.

At age five, he unleashed mayhem and havoc with a talent Spiderman’s supervillain Electro would envy. Especially at school.

3893839842_2547318233_zElectro, as photographed by Compulsive Collector

Finding the social worker to be less than helpful, I appealed to a local government agency and procured a behavioral mentor. Three quit, without ceremony, in quick succession.

The last one, a no-nonsense black Mary Poppins, worked magic. As they say in the South, she yanked a knot in his tail. While she was present, he managed to keep his behavior to a notch below “expel that kid.”

The bus ride home…that was a different story. I found myself in the principal’s office, “volunteering” to drive the kids to and from school (because bus behavior was a notch above “expel that kid”). The chaos on the bus was just too stimulating for his hyper little brain.

His behavior was not unlike a puppy with separation anxiety (freaking out, destruction, snapping and biting). And like said pup, once he could see us, he calmed.

By the end of Kindergarten, we thought we’d turned a corner. Maybe the pup was maturing. The behavioral aide told us she didn’t feel he needed her any longer.

What we didn’t realize at the time: he transferred his need for a parental figure temporarily to her during school hours. His ability to self-manage appeared to grow, but in reality, he simply allowed himself to relax when she was present.

Because he seemed to have made such progress, the agency deemed a behavioral aide unnecessary for first grade. Then he escaped school. And then the Assistant Principal tackled him to prevent a second escape. The behavioral aide was reinstated, but Mary Poppins was no longer available.

By this time, we had him in occupational therapy, were using ABA techniques at home and had an in-home counselor visiting several times a week in addition to the”office” counselor. I averaged three hours of sleep, because he woke up between 3 and 4 each morning, screaming. (The girl didn’t fall asleep until after midnight most of the time.) We tried natural remedies like melatonin and installed blackout curtains. I read every book and article available. Tried every behavioral modification. Rewards. Negative consequences. Bribes. Nothing worked.

While cycling through a parade of aides, I began discussing medication with his counselor, who referred me to a psychiatrist. Because the children were still in legal custody of social services, I had to fight with the Bat from Hell to get approval to try meds. Her level of hostile resistance reminded me yet again that she must have spent almost no time learning about these children. Even the school was (unofficially) on my side by this time.

We received grudging approval for a low dose of Concerta. His improvement was almost immediate but the effect was brief; the pill was too small to last through the day. Applying for permission to increase the dose margin, I could almost hear the social worker’s clogs dragging. She ignored most of my requests, but by the middle of second semester, we’d tweaked the prescription to a still low but more effective level.

In late Spring, for reasons unknown, he relapsed into mania. Glue poured over his desk. Crayons broken and thrown. Another child’s head slammed into the wall. Attempts to escape. The social worker suggested an increase in meds; we agreed while graciously gritting our teeth in a slightly we-told-you-so manner.

The higher medicine adjustment allowed him to stay in school, but he stopped eating and began a yawning tic. Dark circles appeared under his eyes. He looked like a patient of chronic illness. The school year ended and I worked with the doctor to remove medication for the summer. The side effects concerned us more than his erratic behavior.

At this point, we discussed home schooling. After that first touch-me-not year, he has always been most settled at my side. I understood the commitment, having home-schooled ten of my own school years. If we homeschooled, he’d have one-on-one attention and infinitely fewer distractions.

Hubby and the counselors and doctors all agreed—against me. He needed the social interaction; many of his issues began (and sometimes still stem) from his inability to handle interaction with others. Keeping him in constant contact with others is key.

When the school year started again, his psychiatrist suggested guanfacine. As I understand it, the drug was initially meant for blood pressure. Soldiers in a military hospital took it for heart health, but their PTSD symptoms were suddenly ameliorated. ADHD and PTSD can be related (and our son does, in fact, have a PTSD diagnosis). We’ve experienced a shift from insanity to relative composure, with no side effects.

The medication also helps him stay asleep. Lack of sleep exacerbates ADHD symptoms (in EVERYONE, right?) so the sleep aid is very beneficial.

For a short time she also prescribed Strattera, but I saw no improvement and didn’t like the possible side effects, so we discontinued the prescription.

Now in fourth grade, he communicates frustration brought on by his impulsivity.

I want to be good. But I do the wrong thing! It’s like I just can’t help it!

The psychiatrist asked our guy if he’d like some help being focused. With a pleading look on his face, he nodded. She described a dose of Vyvanse, so low that our pharmacist had to order it. He’s taken it for two days. Because it wears off throughout the day, I see very little change by the time he’s home. However, his teacher is enthusiastic in her praise for his new attitude. (She’s worked incredibly hard with us to help him self-regulate; we text throughout the day. I am so thankful for her.)

I tell you our story, not to support medication, but to give you my perspective. I am overjoyed that we may have found his perfect match. I am thrilled to see him so happy; it’s evident in both what he says and how he carries himself (he has had two days with no “bad marks” since starting the med, and he’s proud of himself).

I am weighed down by unbelievable, maybe-irrational, massive amounts of guilt for “giving in” and medicating. I am terrified that long term side effects, yet unknown, may plague him in his teen or adult years. I pray the list of already recognized side effects will not visit him. I feel like a failure. Maybe if I’d changed our diet, gotten up an hour early to take him for a run each morning, found an alternative, we could skip the meds altogether.

But at the end of the day, it’s about my boy. And at the moment, he’s moved from feeling that he’s the “bad” kid in class to knowing that he CAN succeed. He has a taste of what it is to enjoy school. To ignore the barbed words from his arch-nemesis. To refrain from throwing the lunchtime green bean back at its sender. To have control. To focus. 

He no longer drags himself to the pickup line, weighed by the knowledge that we need to have yet another discussion about his behavior. He actually trotted to meet me today, a grin on his face.

I got EIGHT green marks today. Eight. And no red ones. Pretty great, huh?

Pretty great, indeed.

 

 

 

 

 

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