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Meditation or Medication for the Nation

By Dr. Cathy Moser

I have been writing for the Winnipeg Parent for many years, and have avoided writing about the topic of medicating children for all these years. It's a very touchy subject for many parents, for a number of reasons. If you are leery of medicating your child, your might instinctively be skeptical of the opinions that follow. I ask for your patience, and reassure you that my motto really is meditation for the nation' - not 'medication for the nation'. Those that are familiar with me know that I am all over meditation as a way of life that can minimize the impact of many mental health problems. I teach it as a tool for children in most all of our groups (especially the groups for children with ADHD), and it is very effective. I have personally been meditating for thirty years.

BUT, sometimes, we run up against a problem that is succinctly articulated by a comedian whose name I can't recall: 'if I could remember to take my Ritalin - I WOULDNT NEED IT!' So here goes - these are four[CM1] of the most common fears that I hear. By the way, I am speaking primarily about medication to treat Attention Deficit Hyperactivity Disorder (ADHD), not antidepressant medication aimed at treating Anxiety or Depression in children. These are more complicated issues involved and warrant a whole article in itself.

First of all - let's deal with the most significant concern about stimulant
medication. It's scary to even think of giving your children medication that affects their brain, especially when they are young and vulnerable. It doesn't help that most of us don't understand how psychotropic medication works (psychotropic meaning affecting your mental activity, behaviour or mood). My thoughts: the first intervention for many ailments should be behavioural. This applies to something as simple as a headache (take five or ten minutes to sit and relax in a quiet place - if it doesn't diminish, take a Tylenol) to something more complex like the onset of Diabetes Type 1 (if you haven't already, start a consistent program of exercise and healthy eating - if your blood sugars are still high, and your Physician advises - take medication to lower them).

Sometimes, people are unable to follow through with the behavioural treatments for a variety of reasons. If that's the case, there's no point in beating yourself up, just accept that this is the way it is for this moment in time. However, if the consequences of not treating the problem properly are significant, stop waiting for a miracle, and do something different. In the case of ADHD, some of the consequences of not adequately treating the symptoms are as follows: worst, but least frequent are motor vehicle accidents that occur as a result of impulsivity. Children who forget to look both ways before they cross the street or dash out in parking lots are at risk for accidents. It is very rare that I suggest that the parents of children under seven ask their Physician about medication. However, if this truly is a risk factor, I recommend that parents at least have that discussion with their child's doctor.

Here's another FYI - adolescents with ADHD are much more likely to be involved in motor vehicle accidents, and medication lowers that probability. Other less obvious risks include of inadequate treatment include: complications of Learning Disabilities that occur when a child needs every ounce of attention that they can muster in order to master skills that are very difficult to acquire due to their brain wiring; lowered self-esteem from having your name called out by teachers and groups leaders every five minutes, or as a result of losing friends because you are too intense; and, contributing to family chaos and dysfunction in a way that makes everyone's life miserable.

SO, the first step in this decision tree (medicate or not) is to assess the impact of using an effective treatment that may have side effects versus the complications of not treating the problem effectively.


INSANITY _ bang head

Second concern: how do I, as a parent, deal with the fear of the unknown - and the guilt of giving my child a substance whose long-term side effects may be unknown. Some parents say 'how can I make that decision for my child', and I tell them that they can - it's their job. My children all have Crohn's disease and when they were young, we had to make the decision to follow their Physician's recommendation for medications that have all sorts of nasty short- and long-term side effects - cancer, infertility, weak bones, stunted growth. It is one of the most difficult decisions we made - BUT, it became easier when I saw people losing their bowel to disease when medication could have prevented it, and years of happy life lost to months of being sick and in the hospital.

As for the guilt? Here's a funny story. Over the holidays, one of my children insisted that they wanted a higher share of their inheritance to compensate for the loss of inches - because they had taken a medication that has known side effects of stunting growth. My children have inherited my extremely warped sense of humour, so I am pretty sure that the banter that went on for many days was in jest (however - there's usually a little truth to sarcastic humour). Ten years ago, I would have felt EXTREMELY guilty and probably lost a lot of sleep over the fact that they were troubled by loss of height.

Not now - I know that it was the right decision - even if my estate does have to deal with a lawsuit. But by then, I won't have to worry about it! So shed the guilt, read literature from reputable sources (not ads or blogs that are funded by the In terms of stimulant medication - much fewer worries there. Not all children have side effects, and often, the side effects diminish over time. If minor side effects such as sleep disturbance or appetite loss seriously impact your child, weigh the pros and cons. It's not worth it if your child can only sleep six hours, because sleep deprivation causes symptoms that are similar to those of ADHD. If your child is not gaining enough weight, and a medication holiday doesn't let them catch up, then it may not be the right choice. Weighing pros and cons and doing due diligence in trying the different medications that have different side effects is an important step to take before long term decisions are made. Speaking of the long term - Ritalin has been around since World War II, when it was given to soldiers to enhance their ability to perform under conditions of exhaustion. Because of that fact, it is one of the most researched drugs around. The only side effect that tips the scale weigh and way over on the downside is an adverse cardiac event. Control what you can - if there is a history of heart problems in your family, talk to your Physician about that, and there are precautions that can be taken.

I trust their Physician more than I trust myself. Who should you trust to help you decide whether a trial of medication is needed? Unfortunately, most parents have heard stories of professionals (like teachers, Psychologists, Physicians) that have diagnosed children who present with significant behavioural or academic problems as having ADHD and have recommended medication. Sometimes this is indeed the scenario, and the professional may have had enough experience and medical knowledge to make an informed diagnosis and treatment recommendation. But if parents have not been satisfied that all other avenues have been exhausted, that is often NOT the solution they want to hear.

Third - every medication has side effects; these can sometimes create more problems than the ones they are targeting to improve. Worse yet, is the fact that many parents don't know what the long-term effects of the medication might be. And that is very scary for some. Fourth - medication is sometimes looked upon as a huge white flag of surrender and defeat. Sometimes parents feel as though if only they or their child tried a little harder, they wouldn't need medication.

If I was asked to succinctly summarize all of the training and experience that I have had throughout my life into a few suggestions on becoming the best parent that you can, it would be this. First, ofcourse, is to continually work at reconnecting with that unconditional love that you felt for your child the day they were born. Second - use your common sense (although common sense is not that common - so you may have to develop that talent through observation, questioning, trial and error).

Third - though shalt not expect your child to perform a skill or engage in behaviour that you yourself have not yet mastered.... i.e., you gotta walk the walk before you talk the talk. Fourth - make the serenity prayer your daily mantra: give up on the things that you cannot control; have the courage to take control over the things that you can; and, develop the wisdom to know the difference.

Let's start off with common sense. If you bang your head against a wall 100 times and it hurts... and expect that it will not hurt the next time you hit your head - you have lost common sense during one of those bangs. Here's a scenario - your child is extremely impulsive, and you fear for their life because at the age of ten, they still forget to look both ways when they run to catch the ice cream truck on the other side of the road. If you are old enough to have seen Dennis the Menace - it's not that your child has one ounce of bad intention within them. It's just like Dennis says 'by the time I realize that I shouldn't do it I already did it'. You have screamed at them, disciplined them, grounded them for the rest of their lives - and they are still a danger to themselves and others. This is one of those scenarios where an evaluation for ADHD is in order. And, if all behavioural interventions are non-effective, the question of whether medication is a good option should be asked. There is good evidence showing that young children with ADHD are more likely to be accident victims (including on the road) and that un-medicated drivers with ADHD are more likely to be involved in automobile accidents. This does not mean that children with ADHD should all be medicated because they are at risk for accidents. It mean that if your child is accident prone or impulsive, and is at risk for harming themselves - the potential effect of not using medication may be much more severe than the potential side effects of medication. By the way, the use of medication in childhood is not the answer - but it may be something that is needed in order for behavioural treatment strategies to be effective. Often, the few degrees of calm that medication gives to children allows them to take a moment to think before they act. You still have to help your child learn good decision making strategies - it's just that the medication will enable them to access those strategies when they need them. I look at it like training wheels - they can often be removed once the skill is well learned and executed.

The common sense argument overlaps with the serenity prayer.

Often, we spend so much time worrying about something we don't really understand or have control over (like the long term effects of medication), that we completely miss out on the things that we can control.

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