ADHD Medication – the good
The following anecdote illustrates the effectiveness of medication with some children.
A group of psychiatrists conducted a study that included videotaping ADHD children and their mothers in the following play situations:
a) observing play before Ritalin started
b) observing play after Ritalin
Conditions
– child and mother are in a play room with lots of toys and a 2
way mirror
– play time consisted of:
– 10 minutes free time – no limits
– 5 minutes clean up – supervised by mom
– 10 minutes structured table tasks
Christopher was by far the most impulsive, inattentive child who took part in our study. During the 10 minutes of free play the boy played with 61 different toys. (Children with a normal attention span may play with as many as five in ten minutes, but many three-year-olds will spend the whole time with only one toy.) In truth, he didn’t play with any of them; he’d just pick up a toy, throw it down, and move on to another. Christopher’s mother tried to get him to settle down, running after him and making a strenuous effort to engage him, but nothing worked. The video camera caught it all: Christopher running from toy to toy, not even pausing to look at a toy; mom following along, calling out, “Christopher! Come here! Look at the truck! Christopher! Here’s a beach ball! Don’t you want to play catch with mommy?” The faster Christopher moved, the louder and more agitated the mother became. There was complete chaos in the room.
After the time for free play had elapsed, one of my colleagues went into the playroom and told the boy and his mother that it was time for cleanup.
That’s when Christopher really went ballistic. He screamed, threw himself down on the floor and categorically refused to have anything to do with picking up the 61 toys. Again the mother tried to get her son to follow orders. “Chris, honey, come on. Let’s clean up,” she said, first in a normal voice and then, as the boy’s behaviour grew into a full-fledged tantrum, more loudly. The noise on the tape is deafening. After a minute of the tantrum we asked Christopher’s mother to handle the cleanup on her own.
The structured tasks were a total washout. Christopher would not even sit at the little table, let alone pick out triangles and blue circles. His mother put him in the chair, but he kept getting up and running around the room. Mom kept trying – “Christopher ! Come on ! Let’s sit down and play some games!” she cried, over and over again – but nothing worked. The mother became increasingly frustrated; she knew that Christopher was capable of accomplishing the tasks, but nothing she did could persuade him to sit down and do it. When 10 minutes were up, the little boy had not completed one task. The mother was exhausted !
Almost exactly a month later Christopher and his mom came back to do the test again, but by this time the boy was taking 40 milligrams of Ritalin a day. Again, the whole thing was captured on videotape. During free play Christopher chose a Fisher-Price toolbox and he and his mother sat on the floor playing with it, and only it, for the full 10 minutes. It was so quiet in the playroom that we had to adjust the microphones. “You really like this toy, don’t you, Chris?” the mother asked softly. “Yes, I love it,” the boy answered. Their conversation was lively and pleasant. Cleanup took only a few seconds; there was just the one toy to put away, and Christopher did it as soon as he was asked. Finally, during the structured-tasks portion of the test the youngster sat at the table with his mother and completed 32 of the 40 assignments. The interaction between the two of them was a pleasure to watch; there was give-and-take and lots of laughter. Voices were never raised.
A few months later I had occasion to show the two videotapes of Christopher and his mother – before and after – to a small group of medical students who were doing a rotation in child psychiatry. We asked the students, who knew nothing at all about the study, what they thought had happened in the month between sessions. All of the students came to the same conclusion: the mother was taking medication. “In the first tape she’s a mess. She’s practically driving the kid crazy, constantly yelling at him and giving him a hard time,” one med student said. “She’s so much calmer and quieter on the medication.”
It’s true: on the second tape the mother is quieter and calmer, thanks to medication, but she’s not the one taking it, of course. The medication that brought on the changes in the mother’s attitude and behaviour, not to mention the tone and the decibel level of her voice, is her son’s Ritalin. The “new” Christopher, the one who pays attention and enjoys laughing and playing and talking to his mother, is so much more pleasant to be with that his mother can’t help being more pleasant right back. And the cycle continues from there. The mother’s yelling and nagging are converted to praise and approval, and the child flourishes. The more his mother likes him, the more likable be becomes, not just to his mother but to everyone else around him as well. After a time, even the baby-sitters may have a change of heart.
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