Confessions Of A Mum Packing Meds
By Annemarie JonsonJanuary 23, 2013
Parents are promised that drugs like Ritalin will improve their children’s grades, mood and social skills. One mother explains the choice she made when her son was diagnosed with Attention Deficit Hyperactivity Disorder — before this week, when new research pointed to the potential side effects for boys on ADHD drugs.
They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.
— Philip Larkin, ‘This Be the Verse’
LARKIN TAPS INTO a truth universally acknowledged. Even the most admirable parents know their child will not escape unscathed from the inter-generational damage of childhood. Forty years after the British poet penned that verse, though, the range of options for potentially fucking up your kid has immeasurably broadened. For one thing, we can fill our children not just with our own shortcomings but with psycho-pharmaceuticals.
There has been an explosion in diagnoses of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder in Australia and around the world — predominantly in boys — and a corresponding rise in the medication of children. These conditions, characterised by inattention, hyperactivity and impulsivity, may lead to poor performance in school. Counter-intuitively, the stimulant Ritalin is the pharmacological treatment du jour for the fidgety legions of the educationally damned.
In Australia and the US, official figures indicate between 5 to 10 per cent of children have been diagnosed, but anecdotal evidence suggests the syndrome is even more widespread. Who doesn’t know a child who wears that ubiquitous acronym?
In my son’s case, as I’m sure for most, it was a slow, fitful road to diagnosis; misgivings still plague me. My intuition, if you like, persistently told me something was not quite right; though I’m still unsure if this is wholly about him or something more systemic. There was a bewildering gap between my son’s capacity and his performance: the child I know, and the education system’s measure of the boy.
It’s another truism that most parents are blindsided by the elemental sucker-punch of maternal or paternal love. They consider their offspring to be in some way exceptional, or at least have the time and interest to see their kids as fully rounded individuals with unique repertoires of talents and skills. Count me in. If you indulge me a few excerpts from my vast archive of parental humble-bragging, they will become relevant soon.
He’s the kind of kid who can often be found hunkered down in his room, bashing out scripts like a little Barton Fink, or devising elaborately illustrated cartoon strips. He has a prodigious memory for songs, images and movie plotlines — not so much Rain Man, more hipster with a bulging mental Rolodex of cultural references. At age 11, he considers animals worthy of serious moral consideration. He renounced meat five years ago and hasn’t faltered. He’s also can be remarkably adroit in high-stakes interpersonal situations. For example, when asked in an admission interview for a private high school if we — devout heathens — go to church, he answered: “No, I don’t go to church, because I don’t believe in god. However, I do believe in peace and kindness and I generally have an open mind.” (Mother mentally punches air: that’s my boy!)
If the education system rewarded creativity, diplomacy and emotional intelligence, he might have a shot at magna cum laude.
But it doesn’t. And he doesn’t. His classroom teacher observed that he was somewhat disruptive in class — “he’d be the class clown if I let him” — chatting to his friends, twisting around in his seat, placing his feet up and generally comporting himself in a way which is verboten and interferes with class discipline. He had difficulty sustaining attention long enough to check his homework, so his assignments were riddled with errors when they needn’t have been. He would jiggle, look away, start up a comedic riff when I asked him to pay attention. An avid reader from early on, he struggled to spell. His results didn’t reflect the boy I know.
His little friends are likewise incandescent with life, energy and ideas. They pour their creativity into inventing games, drama improvisations, devising linguistic tropes and private languages, generally raising hell — and, yes, extracting the maximum screen-time they can from their beleaguered parents, especially on Minecraft (you know, the game parents worry less about, as it’s allegedly creative, even allowing junior geeks to code). They are articulate, with refined emotional capacities and an exceptional grasp of humour and irony — indicators, I always thought, of acute intelligence. And they’re good people, with social consciences. For example, he and his friends are intuitively offended at the idea that anyone could have ever been harmed or discriminated against for being gay, and baffled as to why gay couples are not allowed to marry (“Doesn’t that say that they are less than mothers and fathers?”). None of them is setting the academic world on fire. Several carry labels along the ADHD and learning disability spectrum.
But what really did it for me in terms of my son’s diagnosis was something his maths tutor said. He is a registered psychologist, and he specialises in working with boys. My son idolises him, and I greatly respect his opinion. “You know, I’m not saying E has ADHD,” the tutor told me, “but if you took him to a developmental psychologist they would say he does”.
So I took him. And they did. The clinic — one of the longest established in Sydney, headed up by a guy who wrote a book on ADHD — pulled out some dazzling diagnostic ju ju, including administering an electroencephalogram, which revealed “an excess of slow brain wave activity, which is a marker for ADHD”. The closer was the medication challenge. They had him do an IQ test, take a dose of Ritalin, and then re-sit the test. We were told that kids with ADHD would expect to see an improvement of over 15 per cent after medication. E’s result shot up a startling 67 per cent.
This apparently made him the model candidate for pharmacotherapy. Despite my deep scepticism of psychometric testing, of reducing intelligence to empirical results, of the ADHD industry, of the troubling cosiness of big pharma and the medical establishment — of pretty much everything about this — I caved. I came out clutching a script for a small dose of Ritalin, to be taken on school days, and a handwritten page of notes from the consultant, who, to his credit, had accommodated my questions and doubts. In his flamboyant hand, underlined, were the words “Ritalin. No long-term side effects.”
I told E’s class teacher about the diagnosis. He’s an energetic and highly capable up-and-comer, but hampered by an underfunded public system in obvious decline and an over-subscribed classroom. He could barely contain his relief at the prospect that E might be drugged into compliance.
We had tried all the usual behavioural therapies as a matter of course. I had some thinking to do.
It’s a mercurial and complicated beast to wrangle, ADHD. Theories abound on its social, medical or psychological origin, some more or less pernicious than others. As one might expect, ‘‘blame the parent’’ is a recurring motif. A particularly virulent intervention was made recently by psychology professor L. Alan Sroufe, who wrote in The New York Times last January that ADHD was the product of bad parenting, “including patterns of parental intrusiveness that involve stimulation for which the baby is not prepared”. His example? “A six-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath,” thereby “excessively stimulating and also compromising the child’s developing capacity for self-regulation”.
Guilty as charged. But who knew that when I picked up my infant son to bathe him I was condemning him to a chronic neuropathology with its own entry in the infamous Diagnostic and Statistical Manual of Mental Disorders?
Needless to say, in the view of this particular expert, “putting children on drugs does nothing to change the conditions that derail their development in the first place”.
I do share, and strongly, the reservations of those who question the medicalisation — and medication — of children’s behaviour. But that’s not because I think my bathing technique caused my son’s condition, though I know I’ve failed him in countless other quotidian ways. Rather, I wonder if ADHD’s not so much, or not only, about a boy and his individual “mental disorder”, but in more subtle ways systemic, sociological, and somehow structurally endemic in our times.
The past decade or so has produced a sub-industry of pop-psychology calling time on traditional models of masculinity, the “boy crisis”. They have titles like The End of Men, The Demise of Guys, Why Boys Fail, What’s Happening to our Boys?, and Raising Cain. They marshal voluminous evidence to show that the double-X is everywhere in the ascendant, while men and boys languish socially, educationally, in their emotional development and in their employment and career success. They blame, variously, the decline in traditionally male industries and sectors as the West changes to service-based economies; the ubiquity of online porn and computer games; the absence of strong male role models with the rise in single-parent families; the predominance of female teachers; and the entrenched, negative view of masculinity that prevails in contemporary Western culture.
Pop culture is in on the act. Mainstream TV and film are a fools’ parade of village idiots, slackers and dupes — almost without exception male. I’m talking about you, men-boys of Apatow, almost every character Adam Sandler has gifted to film, that delusional Office narcissist David Brent and his sorry, cubicle-dwelling drones, and the daddy of ’em all — Homer Simpson and his famously academically underachieving son, outshone by his intellectual prodigy of a sister.
While Bart and Lisa Simpson are outliers at their respective ends of the academic spectrum, their relative performance is reflective of a deep and growing trend. Consistently in Australia, as elsewhere, girls are trouncing boys in final school exams, even in traditionally male-oriented subjects such as engineering , as boys fall farther and farther behind on all the key indicators of academic success. Here, for example, boys complete high school at much lower rates than girls, and the education gap continues into adult life, so that young men between 25 and 29 are significantly less likely than their female counterparts to have a degree.
What is going on?
There seems to be compelling evidence of a fundamental disconnect between education — at least as it’s conducted in mainstream schools in economies such as Australia and the US — and boys. According to some psychologists, brain science has elucidated deep physiological differences that orient the sexes to different learning styles. In short, boys are oriented to learning experientially, through physical interactions with the world — an evolutionary hangover from hundreds of thousands of years of hunter-gatherer life where the educational milieu for young males was the natural environment. The square classroom, which confines boys indoors behind desks for hours on end completing repetitive, rote tasks, is the antithesis of this. (It does seem to me to be a miracle of modern pedagogy that kindergarten boys forced to sit still all day do not self-combust.)
ADHD traits are seen as “maladaptive” because we are not wired to learn by sitting all day in a classroom. The restless energy and expansive, exploratory impulses characteristic of ADHD may have been essential traits in communities that needed to adapt continually to changing circumstances, and explore to survive. Translated into the modern classroom context, though, where the goal is not to innovate but to passively absorb and reproduce existing knowledge, these tendencies are viewed as problematic.
An appealingly straight-shooting insight into the epidemic comes from psychologist Phillip Zimbardo. As he calls it, excessive internet use and video gaming, and in older boys, high levels of exposure to online porn, mean that boys’ brains are quite literally being digitally rewired for change, novelty, excitement and constant arousal. As a result, he says, boys are completely out of sync in traditional school classes, which are analogue, static, interactively passive.
WHILE WRITING THIS, I came across a blurb for the recently Booker-shortlisted Will Self novel Umbrella, set in the 1970s. It features a protagonist who has been immured in in a mental institution for many decades. The blurb asks: Is the character’s “diseased brain … a microcosm of the technological advances of the 20th century”? It continues, most intriguingly, if the character “is ill at all — perhaps her illness is only modernity itself”. It struck a mighty chord. Might ADHD, likewise, be less a disease and more a sign of the times?
We know that epidemics of psychopathology erupt at certain historical moments only to eventually disappear — hysteria, for example, a uniquely “female” disease that emerged in the late 19th century, shaped by now-discredited assumptions about women and the neurophysiological dogma of the day. There is an argument put by writers like Ethan Watters, one which to me at least seems highly credible, that the “neuropathology” of ADHD is, similarly, an expression of deeper cultural currents now confluent in the West, such as those sketched above: masculinity in transition, reconfigured by sweeping social and gender-role transformations, and by the pervasive exposure to digital media that distinguishes our era from every other period in human history. Throw in the underpinning predisposition of boys to experiential learning, slap them in a 19th century pedagogical straitjacket, and you have a sure-fire formula for behavioural disorder.
How history will view ADHD, and the chemical behavioural modification of children, will by definition become apparent only in retrospect, when it is too late. I imagine that, as is the case when we appraise antiquated medical treatments from the distance of time, our own crude pharmacotherapeutic interventions will be the object of horrified fascination. So, I suspect, will be our schooling methods.
I do know this for sure: schooling is not expansive, in the sense of accommodating and nurturing the mix of predilections and abilities my boy and others like him bring, but reductive, confining. It requires a very particular kind of performance, and its instruments of measurement are blunt. They lack the sensitivity and nuance to identify and illuminate, let alone develop, capacities outside of a bell curve or a bandwidth of capabilities that are deemed academically legitimate or curriculum-relevant. My kid, like many of his friends with various attention and learning “disorders” — freaks and geeks, quirky clowns, dreamers, nerds and oddballs — does not easily fit the achievement-shaped boxes churned off the educational production line.
Trouble is, if the kid doesn’t conform, over time he is systematically winnowed out of important pathways of opportunity. The process establishes its own momentum, building on itself and becoming chronic and inexorable. Idiosyncrasies are repeatedly red-carded, and proclivities fall on fallow ground. Educational and life choices are limited as the child’s behaviour — let’s say his way of being in the world — is pathologised and punished with poor grades, which amounts to the same thing. The open stream of near-boundless potential available to the child is narrowed to a few rocky trickles.
A parent is left with a choice. What to do? With all due respect to Larkin, when it comes to the administration of pharmacotherapy to your child, it is hard to tell if fucking him up is a matter of omission or commission. I do not know how the future man will judge me, especially as our cultural fix on ADHD is modified by the crystalline clarity of retrospect. I hope he will understand that my decision was born out of love, however flawed and complicated, however inflected — infected, might Larkin say? — by my vicarious ambition for his to be a good, fulfilling life, lived authentically and to the extent of his potential.
Reader, I medicated him.
After a slightly rocky start — “Mum, what’s wrong with me that you are trying to fix?” (that damn insight again) — my son says Ritalin is fine, and he feels it helps him “a lot”. Three weeks after beginning the medication, he arrives home with a gold-embossed certificate of achievement that had been presented to him that day at school assembly: “To EL, for an outstanding improvement in classroom focus.” Bittersweet doesn’t quite capture it.
Around the same time, another friend texts wanting the number of E’s specialist. Her school counsellor has reported that there is a greater than 90 per cent likelihood that her son has ADD or ADHD, and has recommended she get him professionally assessed.