Ritalin

By Julie A. Miller
Catholic Herald

Ritalin: Is medication overused?

SUPERIOR -- There is a growing concern about the number of children taking prescription medication for Attention Deficit Disorder (ADD) or Attention Deficit/Hyperactivity Disorder (ADHA). Several states are considering or have already adopted rules or recommendations on the role schools play in suggesting that parents seek these drugs for their children.

How large is the problem? According to John F. Taylor, Ph.D., about 6 to 8 percent of all children in the United States have some form of ADD or ADHD. He added that three-quarters of those children will be on Ritalin or other medication at some time, and at any given time about one-third are taking a prescribed medication.

Taylor, a consulting clinical psychologist and president of A.D.D. Plus, an information and resource provider, is also the author of the book, "Helping Your ADD Child."

Requires medical diagnosis

Dr, Daniel Shreeve explained that ADD is a learning problem, a social-behavioral problem, and a medical problem that requires a medical diagnosis. Proper diagnosis requires information from the teacher, the parent and the child, he said.

Shreeve is in the department of behavioral health at St. MaryÕs/Duluth Clinic, in Duluth, Minn., which serves many communities in northern Wisconsin.

Asked if the drugs were over prescribed, Shreeve said there are two answers. First, only a small number of children with ADD or ADHD have been diagnosed. From that perspective the prescription drugs are under-prescribed.

On the other hand, if just children who have been diagnosed with ADD or ADHD are considered, some of the prescriptions may be unnecessary. Shreeve said sometimes ÒRitalin is used too quickly without consideration of the full dimension of the problems that the child has. ... It is a mistake to prescribe Ritalin capriciously in primary care appointments without a full investigation.Ó

Effective treatment requires psychological, behavior, academic and sometimes medical treatment, Shreeve said. He added that it takes a team made up of psychiatrists and psychologists who are childhood specialists, parents, teachers, and the child.

Catholic schools have no policy

The diocesan schools have no specific policy addressing ADD or ADHD, but Phyllis Schlagel, superintendent of schools, said that small class size, the faith-based background of the schools and a strong focus on the family all help Catholic schools address the problems. "In a larger system they could fall through the cracks," she said.

The first step in addressing the problem is for school personnel is to educate themselves about ADD and ADHD, rather than just jumping on the bandwagon of prescription drugs when a student is having trouble, said Ann Mitchell, principal at St. Anne School in Somerset. The second step, Mitchell said, is for the teacher to involve other adults who can help -- school administrators, counselors and the parents.

In discussing the problems with parents, David Eaton, principal of Our Lady of the Lake School in Ashland, said it is important to stick to a factual description of what is happening in the classroom and then try to determine the root cause of the problem and discuss alternatives. "Ultimately even if they are referred to the public school district for testing, itÕs still up to the parent to decide. ... We aren't really in the position of saying to the parent. 'You have to get your child medicated,'" Eaton said.

Barbara Bugar, principal at Holy Rosary School in Medford, has attended workshops put on by A.D.D. Plus. Before coming to Medford, Bugar was a teacher and principal in the La Crosse diocese for 20 years. She said in that diocese, "we were instructed that we were not to suggest that the parents take the child in and have the child tested for ADD, ADHD or any of these disorders.

"If the child was having problems we were to have a conference with the parents and talk about the problems," added Bugar. "Then you let the parents know what options they have. One might be physical examination."

Strategies schools can use

Besides medication, there are other strategies that schools can use to help children with these conditions. Bugar said teachers may need be more patient and spend more time working one-on-one with students. They many also need to remove some distracting items from the classroom.

Mitchell added that it is important to get to know the child as a person first and put their faith, their spirituality and their whole being before their academic progress. Rather than a guidance counselor, a spiritual counselor is what is called for -- someone to console, counsel. She advocates a team approach, if possible, including all school personnel who interact with the student -- the recess teacher, the bus driver too."Kids don't have enough adults to listen to them," Mitchell said.

Daily communication between the teacher, the parents and the student helps with difficulties children have with their school work and with other problems, such as not completing assignments, according to Ira Rebella.

Rebella taught in public schools for 38 years before becoming principal at St. Francis Xavier School in Merrill last year. He said each student at his school has a student planner that lists their assignments and a daily note from the teacher. The parents are asked to review the assignments and sign the planner. They can also write a note to the teacher if they have comments, questions or concerns.

One important role Taylor sees for teachers is to give the physicians feedback on whether or not the Ritalin or other medication is working. He has developed a form and a rating scale teachers can use to rate effects they observe after a student has taken the drug. This includes desired effects, such as the amount of activity control the child exhibits and undesired effects.

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