Saturday, January 06, 2007

Aspergers and Ritalin

As parents, we've had an interesting experience with Will's meds recently.

Will has taken Ritalin, and then a time-release version called Metadate, for about three years. It was not prescribed because he is hyperactive -- it was purely prescribed because he was spacing out at school and had a hard time concentrating.

Like most parents, we've been somewhat uncomfortable about giving our child these meds. I did a lot of research, and found a very mixed bag of advice. Many people just resent the idea of giving meds to their children just based on the principle of the idea -- i.e. "I LIKE my child the way he is!". Many people feel that there is some danger in giving a mind-altering drug to a child. I can sort of understand their concern. But I did read a large share of people who had positive experiences, and so we went ahead and tried it.

One of my concerns was that Ritalin has a reputation as a drug that stunts growth. I've been reassured by medical professionals and therapists that in reality, it DOES NOT stunt growth. What DOES happen is that it inhibits appetite with some children, and therefore the lack of food inhibits the growth of the child. I have a little cousin who is in this boat, and she is not eating much. I've also worked with a young boy in cub scouts, and he wasn't eating ANYTHING. But I've also seen children who have a terrific appetite, and are in high school, and they have not lacked in height. Will's current appetite is phenominal, so I've not been too worried about his height so far.

My other concern was overdosing. The first year we had small amounts of Ritalin provided twice a day. Last year we went to a time-release option given once a day. This year, we began with that same dosage, thinking that all was just fine. My pediatrician began to have conversations with me over the fact that Will is getting close to middle school, and the demands put on him are extensive, and we may want to up the dosage of his Metadate. I resisted, because I had done some research and did not want to just up the dosage for no real good reason. I told the pediatrician that we would just wait and see.

School started off well enough, and there seemed to be no problesm. But then we noticed before Christmas that, for about a month, there seemed to be problems with Will getting his homework finished, or his understanding some homework, or his ability to concentrate, and especially his ability to stay organized. These are all things that are common to kids with aspergers/high functioning autism, so I was not too surprised, but I was at a loss as to what to do. I was really thinking that life was just getting too overwhelming for him.

Then, a few days before Christmas vacation, his teacher pulled me aside and let me know that he was just having a horrible time paying attention in class. It was relatively sudden -- just in the past month or so -- and she just couldn't keep his attention to do anything -- take notes, organize his books, write down homework assignments, anything. She had huge concerns about whether he should even continue on to middle school, because she was worried that it might be too much for him. His father and I had already been thinking about homeschooling because we had witnessed this same thing at home.

I called the pediatrician, and mentioned the problems Will was having, and we upped his dosage of Metadate by 10 mg. I figured we should try this during Christmas vacation, see if there were any side effects, and that way have it ironed out before school started back up in January.

The hardest thing that I witnessed in Will before the change in dosage of his meds was his lack of self-esteem. This has been the world's most cheerful kid up until now, and suddenly he was becoming teary-eyed, and saying really kind of scary things about himself, that he was no good, that he was stupid, that he was always wrong, and worse. All I could think of was that the middle-school depression thing that we hear about when we research Aspergers and the teenage years was hitting him early.

Well, I am now a BIG proponent of meds for these kids. And I mean BIG! BIG! BIG! The change in his self-esteem is HUGE! He is so happy, so confident, so in line with what I had always hoped for him. Yes, and on top of the self-esteem improvement he is doing well in school -- so well in fact, that his teacher had been planning on having him observed to see what they should do in terms of middle school, and now she is no longer worried about him. But the most important thing is how he feels about himself. He LIKES himself! He knows that he's smart, he knows that he's clever! I quite frankly don't know how anyone could withhold Ritalin if the result is this positive.

I do have a disclaimer, though. I think that kids with aspergers/high-functioning autism react differently to Ritalin than ADD or ADHD kids do. Will never was hyper-active, and so really the thing that changes when he has the correct dosage of Metadate is his ability to concentrate and to socialize. We seem to be having absolutely NO adverse reactions to the meds. But I have witnessed the adverse reaction of appetite suppression with other kids, and that would concern me if I were a parent of an ADD or ADHD kid.


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