Where is the Middle of the Road?

When stimulant medication first became available for commercial use, it enjoyed a short period of unbridled popularity. This was followed by an emerging trend of skepticism as parents and teachers saw the side effects it was producing in children, and realized it was not the magical cure they initially thought.

In 1970, this trend gathered momentum when an Omaha newspaper claimed that five to 10 per cent of the students in Omaha public schools were receiving drugs for hyperactivity. This contention turned out to be false; however, it started a wave of articles alleging that drugs were being misused with large numbers of schoolchildren, as substitutes for improved teaching methods. Media releases like, Chaining Children With Chemicals, The Educator as Pusher–Drug Control in the Classroom, and Study-Aid in Pill Form: The Problem of Over-Use of Ritalin in the U.S. fuelled the public’s belief that stimulant medication was being misused.

An added concern now is the illicit dealing of stimulant drugs on the streets. Newspapers are running full-page stories on teenagers pushing and becoming hooked on stimulants such as Ritalin and Talwin. These matters have resulted in both physicians and educators tightening their policies regarding the prescription and administration of stimulant drugs. They have also deepened the public’s conviction that stimulant drugs should not be given to children under any circumstances–the opposite extreme of 20 years ago.

At one point I felt the same way. I believed stimulants were being used as an easy way out for parents and teachers, and children were facing the harmful side effects because of it. Then I met some children who started their day off by trampolining on their beds, who walked around with only two buttons done up on their shirt because it was too hard to do up the rest, who started squirming in their chairs as soon as they sat down at the breakfast table. However, by the time they left for school, they were able to sit in a chair and read through a comic book without getting distracted. Their medication helped them control their behavior, so they could learn and function within the structure of their classrooms.

I still don’t like the idea of children taking medication. Nobody likes taking medication unless they have to, and children seem more vulnerable because they have less power to say, “No.” And I realize that some children are taking medication that don’t need to, or are taking more medication than they need to. At the same time, however, there is a group of hyperactive children who, I feel, wouldn’t get the most out of their school experiences if they didn’t take stimulant medication.

For which children is stimulant medication a reasonable alternative?

Ask yourself these questions:

–Have we tried everything? Stimulant medication should only be used as a last resort, after other options have proven ineffective. It should be regarded as a temporary measure, used in conjunction with other techniques, which will supersede it as soon as possible.

–Does the child have a problem, or do I have a problem with the child? This is a hard question for you to answer fairly–you’re too close to the problem. A good way of getting an objective viewpoint is to ask other teachers to come in for an hour and observe you and the child. They can give you their opinions on how serious the child’s problems are, how effective you are, and what strategies they would use in managing the child.

–Do the child’s problems warrant medication? This depends not so much on what the problems are, as how the child and other people in his life are coping with his problems. For instance, Michael and David both have nonstop energy. Michael, however, is able to channel his energy into goal-directed activities, and gets more done in a day than most children his age. David, on the other hand, squanders his energy and gets little done. Michael feels good about himself, whereas David thinks of himself as a loser and feels like giving up at school. Michael does not need medication. David may, if it seems medication will help him get onto a positive track, and build up his self-confidence.

Another case where medication may be considered is the hyperactive child whose symptoms are creating a major disturbance in his life, coming between him and his family, friends, and ability to learn at school.