Monday 6 February 2017

ADHD easy lazy

Ritalin is doing very well . . . for share-holders. It is a long time off-patent, so methylphenidate [formula L] exists in a blizzard of brand names: Ritalin, Concerta, Aptensio, Biphentin, Daytrana, Equasym, Medikinet, Metadate, Methylin, and Quillivant. And as generics: Ritalina, Rilatine, Attenta, Medikinet, Metadate, Methylin, Penid, Tranquilyn, and Rubifen. My students have difficulty spelling but even they would be as skeptical about buying Rilatine as purchasing a Ralex watch, especially if they were going to pop the pills into their slightly off-centre teenager. Ritalin has been around for 60 years, and is so widely prescribed [2.4 billion doses in 2013 and rising each year] that we know quite a bit about how it works.  It is a catecholamine re-uptake inhibitor. Catacholamines include neurotransmitters NTs noradrenalin and dopamine which stimulate certain nerves in the brain, after stimulation across the synapse these chemicals are subsequently "re-uptaken" by the delivering neuron and re-cycled. If the NTs are not processed in this way they continue to stimulate the down-stream neuron. If this happens in your pre-frontal cortex, you can achieve more sustained concentration, planning, problem solving. IF your teenager is not-so-good at these executive functions BECAUSE his dopamine receptors are a little lazy or insensitive THEN he might benefit from a course of Ritalin, because he may have attention deficit hyperactivity disorder ADHD.

Jerome Kagan, renowned Harvard child-psychologist, popped up in the blogosphere last autumn being highly critical about over-prescription of Ritalin etc. It wasn't hot news because the original interview with Der Spiegel was from 2012. But it's worth reading nevertheless because, particularly in America, there is an epidemic of ADHD - 5.5 million children diagnosed! . . . and a separate but equal epidemic of depression. You will not be surprised to hear that there are a range of drugs available to treat depression.

I was 'clinically depressed' between the ages of ~16 and ~18. I was going through my very expensive education: nailing the cranial nerves of a dogfish; parsing the bejaysus out of The Ancient Mariner and The Old Man and The Sea; knowing all the capital cities of South and Central America; being intimately familiar with the politics of Gladstone and Disraeli. But at the same time, I was sleeping 16 hours a day; eating cauliflower cheese and toast alone rather than regular food in the school dining hall; writing a lot of "now more than ever seems it rich to die" poetry; and being snarky and stand-offish with my peers. Thank godde it was the 1970s, a generation later I would probably have been drugged - MAOIs, TCAs, SSRIs, SNRIs, Lithium - out of my mind but probably not out of my condition. Actually, although it took a couple of years to work through it, I was made by my maundering. I realised that I was crap at poetry, I got the chance to switch from 19thC politics to science whence I've earned every honest crust since.

Kagan was born in 1929, he went into child psychology because he wanted to make a difference, his liberal ideology was convinced that children were made not born and his liberal conscience felt that by empowering the families of the dispossessed, the fate of poor children could be made brighter. If he/we could only understand how children developed their personality, then parents, teachers and carers might be able to tilt the process to give kids more equanimity and stability. It took him a few decades to realise that none of us are Blank Slates - we are genetically predisposed to being skittish at or curious about The New. About 20% of small children are anxious about change and 40% are eager for it and there's a chunk in the middle who are on-again off-again about it.  In the 1970s he was part of a mammoth study comparing day-care to home-care which found no differences in any measurable outcome between the two groups. That meant that more women could join the work-force and get a life beyond child-care and aprons. That was good for the economy and generated disposable income. If you want to view everything as connected you might say that MegaPharm said "We'll have some of that" and started to develop drugs for the 'motherless' kids, who were either over-bouncy at the back of the class or too quiet in the front desks.

If a child is being a pain-in-the-ass you could refer him to his doctor and sign him up for a decade of ritalin . . . OR you could do a little digging to discover why he is acting up all the time and sort that out, so the the poor chap has the super competitive playing field levelled to account for what's going down at home or in his head.

Neither Prof Kagan, nor me, nor you will deny that some folks are unwell in the head. If they hear The Lord calling them or are profoundly unhappy without any discernible external cause but having a quarter of the population labelled as certifiable - that is not credible.

On the hearing voices front, I heard a nice story about the father of a friend of a friend of mine. The old chap suffered a stroke and was hospitalised. He was smart and well educated and was briefed by his care team that he might suffer weird hallucinations as his brain rewired itself after the insult.  Don't worry, they said, you're not going mad, you're going to make a good recovery. After a couple of nights on the ward, he woke up to see Seamus Heaney [prev], the poet, in the bed next to his. That's not right, he said to himself, it's the stroke talking, if I turn over it will go away. So that's what he did. A couple of hours later, there was a slight commotion, and he woke to see President Bill Clinton pass by the end of his bed. This is getting tiresome, he thought, I hope this madness passes quickly, and went back to sleep. When breakfast came round in the morning everyone was all in a lather because the great poet had been admitted the previous night and his old friend President Clinton had made time to visit him in his time of trouble.

1 comment:

  1. Dear Bob, I was going to post something long and adulatory. Instead here's something short and adulatory: your diligence, humour and conscientiousness, and recognition that Spelling Is All, are duly noted. Lang may yer lum reek, as my parents might have put it. Pip pip!