Pills instead of a Beating -- MEDICA - World Forum for Medicine

Pills instead of a Beating

Photo: Young boy writes in his exercise book

Not every child does homework
with such a concentration; © SXC

Many parents and teachers do not understand the behaviour of kids with ADHD. In consequence, extra exercises at school and punishment at home are often the order of the day. ADHD stands for attention deficit hyperactivity disorder. “ADHD belongs to mental disorders”, says Manfred Döpfner from the University Hospital of Cologne, Germany. This thesis is popular among psychologists, not only in Germany. That is why ADHD appears also in the ICD-10 classification like a depression or anxiety disorder. “But the border between disorder and normality is blurred as it is in many mental disorders”, says the professor for psychotherapy.

Psychologists assume that hyperactive behaviour is particularly congenital. “If bad environment conditions are added, it is more likely that this combination results in ADHD”, says Döpfner. But researchers do not know the mechanism exactly. And the assumption that today more kids are hyperactive than in former times, is not scientifically proven. Döpfner explains the perceived accumulation of the disease with the social change. “Today, concentrated behaviour is more important than 30 years ago. Hyperactive children catch our eye even faster.”

Ritalin: Effects unclear, side effects clear

Many doctors prescribe medication to these children. Ritalin should control their behaviour. The drug provokes that kids quiet down. How the pills work in detail, researchers do not know. The treatment is based on a hypothesis. In consequence of this, the hyperactivity is related to a deficiency of dopamine in the front area of the brain. In this area, impulses are controlled normally. Ritalin should activate this function up to the normal level.

In contrast to this hypothesis, the side effects of the drugs base upon facts. Loss of appetite and disturbance of growth from three to five centimetres were observed during the therapy with Ritalin. And there are no studies which analyse if the kids’ brains may change in the long term. Döpfner advocates for an individual therapy, which should also include a behaviour therapy. And he stresses that not every child with ADHD needs Ritalin, but in some cases he thinks this is an important element of the therapy. “Because of their carelessness, children with ADHD have a higher accident risk than others. It would be irresponsible if doctors do not give Ritalin to such children”, says the psychologist.

Neurobiologist Gerald Hüther warns against the excesses of prescribing medication for children with ADHD. At first, ADHD is a sample of symptoms, which one can observe on children”, says Hüther on his website win-future.de. Further he says: “Physicians are forced to find names for certain treatments in order to get money from the health insurance. This is the same on ADHD.”

Pills do not stress the brain

He excludes a genetic defect and says that a slower development of the brain might be responsible for hyperactivity. Researchers of the USA and Canada observed this two years ago. According to their study, some children need a longer time untill they reach a certain level. Such a deficit could be balanced especially through active experience and not through looking TV or playing computer games many hours each day. Another critical point from sceptics: the drug only suppresses the symptoms, but does not introduce an active change of behaviour. If the medication is discontinued, the symptoms often come back again.

Photo: Pills
Today, hyperactive children often have to take Ritalin; © SXC

In spite of this, many children get these drugs. Hüther says, that strong interests of different sides are responsible for that. “Parents are helpless and afraid of recrimination, teachers hardly can do their work if three or more hyperactive kids are in their class, doctors believe in a genetic defect and believe in beneficial drugs, and the pharmaceutical industry earns a lot of money, if many children take their pills. It is very difficult to break up such a network of interests”, says the neurologist in an interview with Frauke Obländer-Garlichs from the German family magazine Jako-o.

Children need structures

However, in one point of view, critics and promoters are at the same opinion: the Fidgety Philip syndrome is not new. The difficulty exists for 150 years. The difference between former times and today: “In those days, these children had not attracted attention, because social structures were much harder than today. They had no other possibility than to adapt at these structures. If they ignored the right behaviour, they became beatings”, says Hüther on win-future.de.

Such circumstances nobody wants to get back. Nevertheless, both sides say that regular structures or rituals in daily routine can help children to learn discipline. And: kids must have more possibilities to develop the world with all senses again. If this is enough to control hyperactivity, is unclear. In any case, action and movement has not harmed to any child – if this applies also to Ritalin, nobody still knows.

Simone Heimann