Today will be the beginning of an interesting journey. It is the first day of Ritalin for our 4yr old son.
There remains alot of controversy regarding medicating children. I personally am against medication, chemicals and similar unnatural remedies. I've been forced to adapt to the realization that sometimes you must be willing to flex your beliefs if it is the last resort. In his case, it was our last option.
Our son is very intelligent. Our son is very fun and like a ball of energy with smiles. Yet, something is just not quite right. He's very destructive and his behavior can be quite erratic. Sometimes aggressive. Very few people see anything except the hyper, happy little boy that we wish would stay forever present. His teachers have seen some of what we see. Enough for them to recommend medication to enhance his concentration during school hours.
He's got the classic signs of Aspergers or high-functioning Autism, but is lacking the official diagnosis needed to obtain the best care. Doctors wanted to first get his ADHD regulated so that he'd be better able to focus on his studies and we'd be better able to control his behavior and discipline and then be better able to determine his true diagnosis and how best to approach them. The plan was to start with a small dose and go from there.
Of course, I can see the logic in this, but at the same time I worry how a drug such as Ritalin will affect a child with current delays. My hope is that the medication will improve focus and thus contribute to increasing his cognitive abilities, yet there is a risk of an adverse affect due to his age and condition. This risk made it very hard to concede to start treatment, but his destructive behavior (sometimes to the point of harming himself) outweighs the risk. We've watched him tearing holes in his wall as if there's a ghost forcing him. Totally oblivious to anything. Then he doesn't understand why he's in trouble and is obviously upset. It's not good for his self-esteem.
This morning I gave him the first pill. It did not go well despite having water and offering a treat. He fought me, bit me and the pill was broke into half with his teeth (may make pill take effect sooner), but finally got it down. I told him the pill was to help him be a good boy and might make him feel weird. He just grinned at me really big and yelled loudy, "OK! I be good today."
He is still behind on speech and often does not understand questions and will instead repeat them or a portion of them rather than correctly answer. He doesn't do well when asked to do some tasks such as being asked to throw lima beans in the trash, but put the cup in the sink. He throws away the entire thing. Repeatedly. Despite things like this, he's intelligent enough to know when he's being tricked into something - there was no hiding the pill in a cookie and there is no way to keep anything a secret.
As for the destruction, he is like a construction worker in a tiny body. He's amazingly strong. He helped me move his train table this week. It's very heavy for me to move, but I can kinda use leverage and drag it around. He grabbed one side and lifted it like an adult moving a couch. I was stunned, impressed and a little scared. He has been an enigma and at times stressful. We had purchased our house nearly new, but he has damaged his room. It began with his toddler bed. He discovered that he was capable of throwing it. Eventually into a wall and he made his first hole. From there, additional holes until I had the idea to bolt the bed to the floor by drilling holes in the legs, running clothes hangers through, creating a loop on the ends and putting a washer and bolt through it until snug. Oh the hilarity at his facial expression when he attempted to lift his bed when we showed him what we did.
Of course, this angered him so he began finding toys and other items to use as tools and began hiding them under his carpet or inside other toys until we realized. Such simple objects quickly became forbidden. Spoons. Hot Wheels cars. Action figures. It didn't matter as long as it could become a tool. He's stolen staples, paper clips and crayons. He's chosen paint colors and removed them all in the same month. Never have I seen such destruction in a child and it scares me to feel so helpless. The hardest part is nearly all of his bad behavior is overnight while we are sleeping. For his safety and our sanity, we started to be more particular regarding his toys and lock his door at night. Nothing with a blunt object is allowed in his room. Only soft toys and those with more rounded edges. We've only recently begun returning the more typical age-appropriate toys, but only a few at a time to take away any that are used inappropriately. Thankfully his room is close enough that we can hear him if he was to need anything. If there wasn't the potential for him to get outside or begin construction on the rest of the house, we'd in no way have secured his door at night. We've dealt with misunderstandings from family, but had to do what was safest for him and all of us.
Recently, he was gifted a lego table set. When he was younger, the large legos became one of his favorite tools. Thankfully, these legos are smaller. Sofar he's actually doing really well with them and building some amazing things. We just need to obtain more legos after a longer time of ensuring he will continue the good behavior. As for discipline, we usually redirect or use time out and take away toys. He earns treats and other rewards. This lego table has provided an appropriate construction activity to focus on and he seems to really enjoy having the task to focus on.
The hardest part of this is watching this behavior control him. It's as if everything he does is on impulse. That train table mentioned earlier was new, but the legs were broken within a week. We would ask him why and he would just tell us the table was broken. Trains are his favorite things in the world, so it is very peculiar behavior. We truly don't think even he knows why or maybe even remembers why. That to us was enough to attempt the Ritalin. If he has such strong impulse to tear up favorite toys, then the impulses are definitely a concern. It wasn't just us that had a concern, but also his school. His impulse has him sometimes hard to control. When the other children are sitting still, he wants to be running around. That can be an obvious safety concern.
There's always a teacher or aide with him. Often on field trips, he's the only one being hand-held. He gets frustrated because of such restrictions that are required for his safety.
The school will be monitoring his reaction today. Sofar, he's been started on only a small dose with it doubling after a trial period if the medication seems to be helping. I still question whether or not we've done the right thing, but all I can do is have faith. The school has seen countless children and if they have issues with his behavior too, obviously we're not crazy. Hopefully, the medication will make him feel better too from not being so controlled by his impulses. If so, maybe he'll take his medicine without issues and just maybe, our happy child will stay happy while finally being calm enough to have the patience to sit still for a family moment.
Updated to add answers to questions I've received since posting:
Why Ritalin and not Adderall?
Did they discuss medications or just prescribe?
There is another child in his school on Adderall and the difference in her is amazing. Adderall is also known to be safer, except more addictive. I requested Adderall instead of Ritalin, but was told that they can't until first trying Ritalin. I was never told why, but assume it's due to the government or seeing effectiveness. They didn't discuss any other treatment options, but at the end of this 30 day prescription said they would evaluate the results and options. This feels like our child is being a guinea pig so believe me, we are monitoring him closely. IF he begins showings signs of any negative effects, we're going back to the pediatrician for another solution.
Are you sure that medication is needed?
No. I'm not a doctor. I am a parent and we know something is not right regarding our son's impulsiveness. When the ADHD doesn't respond well to redirection or the child is unable to focus at school, home or even to learn better self-control and discipline, then sometimes you have to try something else. We've tried natural remedies, avoiding dyes and sugar. This helped, but it was impossible to restrict his diet consistently between school and well-meaning family. We've also lost alot of friends due to this. Many don't understand his behavior and begin to prefer activities where he is at a babysitter. We're not remaining 'friends' with anyone that can't accept our entire family. We worry this will affect his future social development due to our lack of interactions because of this.
Have you read the prescription information? Did you not notice where it was recommend to not be given to children under 6yrs old?
Of course. It was provided by our pharmacist. Yes and I was just as concerned as you. I contacted the pharmacist and doctor who both said it was a guideline, but in his case the benefits outweighed the risk and his low dose would have minimal risk.
How much is he on and for how long?
One small 0.5mg pill each morning for 7 days. If there are no negative reactions, then one before and after school for a month. Then re-evaluation.
At the end of 2013, he was raised to two pills a day.
He became aggressive, demanding, controlling and unable to control his emotions and frequently vomited. So I stopped the double dose and am looking into another option since the single pill seems to have little effect beyond a couple hours at school once prolonged in the system. However, teachers notice he can better focus while on than off the meds.
What is your opinion regarding this issue?
As children, my Husband and I were both on Ritalin. I'm not sure why he was not continued, but mine was stopped because I became aggressive. For us, his behavior out weighs the risk. He's so impulsive that it has risked his safety. He can not be trusted near a road or parking lot or at school getting on the bus. We aren't even able to trust babysitters with him. The school has adapted, but he needs to be more independent in order to progress to kindergarten. We love our son, but it's gotten to the point to where we have explored many options from herbal, natural, therapy etc. The school and doctors recommended it. Since we were also on it at one time, it was easier to consider it. I would rather never use medication. I don't even trust these shots that are forced upon parents. I rarely visit a doctor when I'm ill. I always treat illness via home remedies unless absolutely necessary because many times our bodies become immune to the effects of antibiotics for instance. Yet, this was a time where the hopeful outcome will outweigh the risk. We wait daily for a call from school that he's gotten hurt or exhibited bad behavior. We're not talking about typical disobedience either. I've never known a child like him. Neither have the doctors or school. Everyone loves his intelligence and happy nature. If he can retain that, but better focus at school and home he'll be safer and better able to learn and progress. Without help, we fear what will happen.
What about your Daughter?
Currently, our Daughter is not on any medication and never has been. They are total opposites regarding behavior. Both have the Aspergers/Autism dynamic, but she is calmer without such impulses and has better control and focus at school and home despite being hyper. She had issues focusing and still does, but they can usually be managed by taking breaks, using positive reinforcement or treats. These things didn't work well with Tristan.
Many of you may not agree with this or consider us poor parents, blame us etc. Know that we have attempted every known resolution. School and his doctors have both pushed and we are only attempting this for his safety and primarily for him to be better able to focus and function. There is no plan for long-term usage and we will fight back against the school and doctors to do what is best for our child if we don't feel the medicine is beneficial. By not trying, we would be poor parents. You can not judge when you don't know our child or the attempts to help him adapt to school and home.
2015 Update: After a few months on Ritalin, he became aggressive. Tried to choke one of our cats, pulled sister's hair and was shaky and just not acting right. I removed him from the meds after verifying with pharmacist that it wouldn't harm him. Since this time, his behavior has remained an issue at school. It's gotten to the point of regular school harassment and insistence that he is ADHD and needs medication. He is at and above grade level. They have been disrespectfully questioning my parenting and pushing the medication despite knowing it's against my wishes. He's been diagnosed with Sleep Apnea and the local psychologist is in the process of evaluating him for what she feels is Aspergers. Despite me following instinct and what is right by first pursuing medical diagnosis for behavior, the school still argues meds are the solution. It's a serious mess, but a much longer story than I can type tonight. Stay tuned to this blog, for a more recent post will have all the details.