Medication Meditation

One of the toughest decisions I anticipated us being faced with so far, is whether and when to start N on Ritalin, Concerta or something similar.  Now that he is almost 5 years old, the decision was thrust upon us 2 weeks ago at our annual appointment with the Developmental Paediatrician.  I am not a doctor.  I am not a pharmacist.  I am not even a paediatric therapist with experience working with children with ADD and ADHD.  What I do think I understand is that timing is crucial in terms of the age at which you introduce the medication and that it will ultimately come down to a cost / benefit analysis in terms of the side effects versus the gains. Some of the known side effects (costs) of the medication are insomnia, appetite suppression and growth stunting.  The benefits are well-known and well-documented, especially in school-aged children. 

Ritalin is a central nervous system stimulant (i.e. an upper) originally approved for the treatment of narcolepsy, but it has a calming effect in kids with ADD / ADHD by adjusting the neurotransmitters in the prefrontal cortex. Neurotransmitters are molecules that create a balance in the brain.   Imagine them as the valve in a toilet cistern. Topping up and waiting for the flush. If the valve is faulty the system cannot work properly.  As a therapist working in neurological rehabilitation, I have a keen interest in the brain’s wiring and its potential for neuro-plasticity.   I understand that placing a child on the correct medication(s) at the correct time and at the correct dose can enhance their neuro-development and allow their developing (plastic) brain to learn new and correct pathways, thereby facilitating the correct release and uptake of neurotransmitters across the synapses.  Our doctor, however, was unequivocal that this is new information and not something they sell as part of the benefits of the drug.

My son is spunky, cheeky, energetic and full of his own unique brand of charm and charisma (yes, I am his mother and entirely biased).  He dances freely, laughs with abandon and loves to act.  He is my sunshine.  What terrified me about the Ritalin decision, was the known possibility that the medication could squash this, could dim his light.  Even the thought of that breaks my heart.  What terrifies me more is that we are going to have to weigh up the cost to him versus the benefit to him.  We are going to have to choose what is more important and what can ‘give’.  My eyes are wide open to the fact that in a year’s time he is going to be expected to sit at a desk and participate in formal learning.  His educational future depends on his ability to contain his energy, curb his impulses and focus his attention in order to learn, perform and progress.  But do we accept that his spark may be smothered in the process?  How do we make the best decision, knowing that it might come down to a trade-off between personality and long-term educational struggles with possible co-morbid anxiety and depression.  So, it stands to reason that when we returned from our recent doctor’s appointment, I climbed into bed and pulled the duvet over my head.

So far, the trial has not raised any red flags for me in terms of N appearing “over-medicated”.  I guess in my panic about that extreme, the possibility that the prescribed dose may yield little/no change had never really occurred to me.  Until last week.  Which led me to wonder whether he just wasn’t responding yet or whether his symptoms are so strong that they require a higher dose.  Now, this week, I have gotten more feedback that it does seem to be having a positive effect within the classroom and therapy sessions.  He is more contained and less impulsive; he is sitting for longer periods of time to complete table-top activities and he is even sitting during snack-time.  To my immense relief, his therapists have not seen any personality changes and are still finding him to be the same happy and friendly child.  We have also been seeing a positive knock-on effect into the early afternoons even though the dose has worn off by then.  In a nutshell, I understand this to be because he is more contained and better regulated throughout the day.  A possible negative result of this extended ‘calm’ during the day could be an increased chance of a ‘storm’ at night or even insomnia.  We have not experienced this to date, so finger crossed!  Safe to say that, like every other decision and junction in our journey, this process will not likely follow a textbook or be without its complications.  It will not likely be a straightforward cause – effect scenario.  Because N is not a textbook, straightforward child and because (thankfully) it is clear that he will continue to march to the very strong beat of his own drum.