Pretend you are having a group discussion with four hyperactive children, Karen, Ray, Larry, and Ben, on how they feel about taking medication. You ask them, “How do you think medication helps you?”
Karen answers, “it lets me make friends.”
“Didn’t you have any friends before?” you ask her.
“Yeah, but since I’ve started taking medication I have way more.” Karen demonstrates a psychological side effect common to many hyperactive children: she shifts responsibility for her actions from herself to her pills. When children do this they give up control over their behavior, and let their pills behave for them. They may no longer feel deserving of credit for what they do right, nor responsible for what they do wrong when they are taken off their medication. This may make children feel less confident in their abilities, and discourage them from taking on new challenges.
Ray’s response is, “I’d go nuts without it.”
You ask Ray, “What do you mean, you’d go nuts?”
He replies, “I’d have a lot of fights at school, and my marks would go way down; then they wouldn’t let me come back.” Ray believes that taking pills is the key to him staying in school. Children’s reliance on pills stems from other people’s reliance on them taking pills. For instance, a child may notice his mother hovering around the breakfast table until she sees him take his pill, or his teacher may ask him if he remembered to take his pill before coming to school. Children pick up on these cues and may conclude they need pills to get through the day.
Next Larry answers, “So I can be the best in my class, and not have to try so hard.” Sometimes parents, teachers, and doctors entice children into believing that “you’re on easy street when you take medication.” It is desirable for children to feel good about taking their medication; however, it is not healthy for them to expect more than what they’re going to get. Eventually children find out the truth: school is still hard; they’re still playing second string in basketball; other kids still don’t want to play with them.
It is important you help children understand the difference between a pill helping them do things, and a pill making them do things. When children believe that pills make them be somebody or do something, they have given up on their own abilities and pinned their hopes for change on their pills. In the long run, this way of thinking shortcuts their own efforts to control their behavior, makes them dependent, and undermines their self-respect.
Ben is the last to answer. He says, “I don’t really know why I take pills. I suppose to calm myself down, but that’s what my mom says.” Ben’s comments indicate that some hyperactive children may not know what they think about medication; they merely parrot what everybody else tells them. They may hear comments like, “You’re doing much better in class now,” or, “You’re so much nicer to have around the house,” at the same time not noticing any changes themselves in their behavior. This may confuse their understanding of how medication can help them, as well as make them doubt whether they should be taking pills in the first place.
Psychological implications such as these can be more harmful than any physiological side effects, because they influence what children think about themselves, how they attribute their successes and failures, and what they think they’re capable of doing in the future.
Many of these side effects arise from children not having enough information, or being told the wrong information. Children need to make sense of their world. If they don’t, they may create explanations by piecing things together, or making things up in their heads, which inevitably ends in distorted fears and misperceptions. The best way of preventing this is by making sure children know ahead of time, in their own terms, what their problems are, and how medication can and cannot help them. I have given some practical examples in the section entitled “Your Role in Medication.”
If you have an interest in the psychological effects of medication, I suggest reading Carol Whalen and Barbara Henker’s book Hyperactive Children: The Social Ecology of Identification and Treatment, 1980.