Thursday, December 21, 2006
I don't recall if I have written about this or not... but about a year ago Zahava and I came to a decision (with the help of our pediatrician) to have Gilad try Ritalin in hopes it would help him concentrate in school. We HATED the idea of medicating him more than words can describe... but we were at our wit's end trying to figure out how to keep him from duplicating his father's abysmal academic performance.
So, we picked up a prescription for 'Vitamin R' (a low trail dosage that would only last a couple of hours) and sat Gilad down for a talk.
He certainly wasn't happy wandering around in a fog in school and having his parents and teachers tag-teaming him at regular intervals over his failure to perform, so he was willing to give just about anything a try. But at the same time, he wanted to know how the pills would make him feel.
I'm embarrassed to admit that this questions caught me completely off guard.
Zahava and I had been so focused on the potential results of the drug that we had completely glossed over its direct effects on our child; a feeling, thinking human being. As a parent, I can't tell you how sh*tty this made me feel. I promised Gilad we would look into it.
I did some research on the web (I know all you physicians out there are slapping your forehead right about now), and Zahava asked our pediatrician for his opinion. As expected, our pediatrician (an excellent diagnostician and physician) hedged a little bit and said that kids described a wide range of 'observed feelings' after taking Ritalin and that we would simply have to wait until Gilad took it to know how it would make him feel.
However, my research on the web gave me pause. It seems that not only were most of the success stories for Ritalin reported with ADHD kids (Gilad definitely did not have the 'H' (hyperactive) in whatever group of letters might be holding him back)... but in studies, Ritalin has been linked to abnormal liver function, cerebral arteritis, leukopenia, and death* (there have been at least 19 cases of sudden death in children taking methylphenidate [Ritalin's chemical name], leading to calls by the Drug Safety and Risk Management Advisory Committee to the FDA to require the most serious type of health warning on the label, but this advice was rejected**)!
Sure Gilad has serious attention issues... but he is one of the mellowest kids on the planet (just like his dad was). Parent-teacher night with him traditionally starts with "You should know that your son is such a nice boy and a pleasure to have in class, but... " which is traditionally followed by a report of non-performance (sound familiar mom & dad?).
Anyway, with heavy hearts we decided to go ahead with the little white wonder pills and Gilad gave his consent.
Long story short, almost immediately Gilad reported feeling more alert and 'there' when he was in class. But at the same time he said he didn't enjoy the 'hyper' feeling that the Ritalin was giving him. This went on for a few weeks, but we finally decided that the improvement wasn't significant enough to justify having Gilad feel out of sorts all the time.
Enter a treppenwitz reader who recently stayed with us for a few days on a trip to Israel. During one of our late evening chats she mentioned that she had decided not to go the Ritalin route with her kids and instead just let them have coffee.
Well, if you think about it, it makes a certain amount of sense. Ritalin is essentially a stimulant (amphetamine), and most, if not all or the effects mirror what people report after drinking a cup of coffee; alertness, better ability to focus... even enhanced ability to reason and make mental connections.
Coffee, on the other hand, contains the single most widely used drug on the planet; caffeine. As I pointed out before, it provides many, if not all, of the same effects of Ritalin without potentially serious health risks. In fact, new research has uncovered a host of health benefits to drinking coffee in moderation.
So, if coffee might potentially fill in for Ritalin, why not avoid something that has serious potential health risks?
We have now officially invited Ariella and Gilad into our little morning coffee ritual... Ariella because she's now old enough to make an informed decision, and Gilad because, while it might help him focus, it certainly can't hurt.
Oh, and for all you parents out there who are itching to admonish me about how coffee will stunt their growth... not only are both of the big kids (11 and 12 respectively) already, well, big (Ariella is already her mother's height and Gilad is on track to surpass his 6'2" dad)... but it turns out that the whole 'stunting your growth' scare-story our parents handed us was nothing but a myth with no scientific evidence whatsoever to support it.
Also, unlike Ritalin, there is no negative stigma attached to drinking coffee to further damage Gilad's self-esteem. If anything, our inviting him join us for a cuppa is bound to make him feel a little more grown up (and who knows... responsible?)
Look, I figure it's worth a try. Worst comes to worst, Gilad will continue plodding down the path of academic mediocrity that was blazed before him by his dad. But we will at least enjoy a few extra minutes together with the kids in the morning over a delicious cup of coffee.
I'll let you know how things work out.
Posted by David Bogner on December 21, 2006 | Permalink
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I sympathise with your dilemma. I was surprised to see Ritalin being suggested for Gilad. Is it possible to have more investigation of his underachievement and how to support his path to improving? Has the school done any serious analysis of his work to look at the reasons he's falling behind or not paying attention? Is dyslexia possibly a factor? In a good school in the UK, a boy like Gilad might be assigned a learning mentor--preferably an adult male of a type he would look up to. That person's role is to try and help him organize himself to handle the tasks he's asked to do, in co-operation with his teachers. That would include getting him to work on planning his day and his time, and reviewing what he's achieved in order to do a little bit better next time. Sometimes, with the co-operation of the teachers, it can involve pre-teaching something the class is going to do. That way, he's ahead of the class and it could motivate him.The approach is all about small step targets and rewards. Might it be possible to hire say a psychology master's or PhD student working in this field to coach him weekly in this way? Re coffee..... had you thought of looking at sports supplements if you think increasing his caffeine intake will help? Good quality ones can have appropriate and tested doses of caffeine....which is not wildly good for the heart.
Posted by: Judy | Dec 21, 2006 11:54:51 AM
David. I can almost feel the angst in your post. I , as mentioned to you some time back.. spent my entire academic career surging "towards mediocrity" as you put it ( and ihad the added bonus of people telling me that I was "LAZY AND UNFOCUSED" ). cut tot he chase, when finally diagnosed after a long battery of tests( is that like a( "parliement of owls?"),as being dyslexic-which I amsure that you know is on the same spectrum as adhd but does not necessarily mean that one mixes up letters..it answered alot of questions. At G's age it could have a profound efffect on his academic performance AND self esteem. The latter being the most important of the two. I ureg you to get a book by a Harold Levinson, M.D. entitled "smart but feeling dumb" which describes to a T what you guys are experiencing. Tnhis fellow is the chair of Neurology at Columbia and did the defining work on dyslexia in the 70-80's. Plus a mellow dude. It might change the way you guys think and ultimately benefit G very much.
Posted by: shabtai | Dec 21, 2006 12:10:54 PM
I applaud the way you include Gilad in the decision-making. that is very cool.
I have no judgments either way about the caffiene vs. Ritalin argument, since I'm neither a scientist nor a parent.
But I do have someone in my family with a caffeine addiction. Something you know something about. Worth looking into before Gilad or Ariella find that they can't live WITHOUT the coffee, particularly Ariella, since it sounds like for her, the drawbacks of coffee addiction aren't possibly mitigated by improvements in school performance and self-esteem.
Posted by: Sarah | Dec 21, 2006 12:18:46 PM
That makes sense, because Ritalin is an "upper" just like caffeine. Tea has caffeine too and is very healthy, but then so is coffee, as long as you don't overdo it.
Posted by: MamaWombat | Dec 21, 2006 12:47:04 PM
I was going to mention the 'stunting your growth' thing, but you blew that out of the water for me.
Now I'll just say, don't let him drink large amounts of coffee if he becomes pregnant.
Posted by: JoeSettler | Dec 21, 2006 2:10:39 PM
Ooh, what a thrill was that tiny moment of obscure fame. Thanks. Aryeh and I have been enjoying the comraderie of our cuppa for something better than a year. I can authoritatively report that he refrains from swinging from the chandelier for the duration of his latte. His creativity in coffee prep insures that he will have work at Starbucks; so I have fulfilled the Talmudic dictum to teach him a parnassa. School is still pretty low on his "fun" list. Well... he can always blog...
Posted by: rutimizrachi | Dec 21, 2006 2:47:10 PM
It is great you found an alternative to Ritalin. I also will be interested to learn how this turns out.
Posted by: A Simple Jew | Dec 21, 2006 2:48:28 PM
Real Israeli's give their kids "starter coffee" at a much younger age. It is 1/2 milk, 1/2 warm water, 2 T. sugar and a sprinkle of coffee.
Be honest, wouldn't you love to let Yonah in on this morning ritual? :>
Posted by: Chedva | Dec 21, 2006 2:51:57 PM
Don't forget to take the fast days into consideration. Withdrawal headaches are no fun (not that I am an expert, I stopped drinking the regular stuff years ago and just drink decaf).
Posted by: westbankmama | Dec 21, 2006 4:18:05 PM
I'm sure you know this, but you can also get caffinated water or caffinated mints (Pinguin Mints are cool) so it doesn't have to always be coffee or soda.
But the family morning coffee routin sounds neat.
Posted by: Beth | Dec 21, 2006 5:20:38 PM
I sent my daughter to high school with a thermos of chocolate-flavored coffee, which she drank on the bus. Oh, BTW, she graduated at the top of her class!
But I do agree with Judy and Shabtai that further educational and psychological testing might point you in a different direction to address the true causes of your son's attention problems.
Posted by: Shoshana (Bershad) | Dec 21, 2006 5:53:47 PM
I was your typical Gilad/David Bogner growing up. Only recently I was diagnosed with mild ADD (at age 30!). I have not gone the drug route yet, I have been trying prescribed basic behavioural modifications to my life. But I'm very curious and interested how drugs can change my life "the easy way".
David, since you are pretty open about your mild ADD - do you have any personal experience with Ritalin and the like? Anyone else out there?
Posted by: Brutus | Dec 21, 2006 5:59:42 PM
Ummmm.... Chedva..... I'd like to see Yonah caffinated at this point sort of like I'd like to have root canal with no anesthetic.... :-(
He's a sweet kid and all, but his energy levels are mildly exhausting as it is. (understatement of the decade!)
Posted by: zahava | Dec 21, 2006 7:01:03 PM
Interesting. My theory is that Gilly and you and me too ... are normal. It's just that shool is fricking BORING.
The modern world is not normal or natural. We spent how many hundreds of thousands of years as hunter gatherers and now we need rocket scientists and statisticians.
This takes either lots of coffee or big time incentives. You could pay your kid $100 per A on thier report card but coffee is cheaper.
I'm convinced that high achievers in school are just motivated by grades and out performing thier peers. Inteligent higher thinkers are too wise to chase that BS carrot. You shaped up when you got kids to feed. I never had kids.
Posted by: Scott Fleming | Dec 21, 2006 7:06:47 PM
I love this idea.
when Ferris was in second grade they wanted us to have him tested and ultimately medicated.
We chose to simply work with him and his teachers daily. It was frustrating at times, hard at others. but in the end we are very happy with the path we chose. he is now able to function, as himself, knowing his own limits and problem areas, and without medication.
we are happy to report several A's coming out of his freshman year at college.
Posted by: weese | Dec 21, 2006 7:15:57 PM
Oy, what a loaded post.
Ok, here comes the "doctor route"
ADHD is not a chimera. It is easily diagnosed through appropriate screening tools in most cases. There are rare exceptions. Has Gilly been screened with a Conner Scale or something similar by both you and his teachers?
If not, let's get a clear diagnosis first.
O.K., next. If Ritalin caused him side effects, there are other main stream meds which might not. Adderall comes to mind. He might get all the benefits and none of the negatives from another medication. I've seen it MANY times.
Next, is there any literature supporting the use of caffeine for ADHD? If it helps, is it just a short term placebo effect? That's why lots of smart scientists run thousands of studies on medications.
Echinasia is a wonderful medication for colds. Study after study suggest it does diddly squat.
Caffeine may be a stimulant, but I don't think it influences the brain receptors involved with attention issues.
Feel free to take my musings with a grain of salt, but that's just one maggid's official opinion.
Posted by: Jersey Boy | Dec 21, 2006 7:44:26 PM
i am so glad that you posted about this topic with your typical candor. It's quite refreshing, to be honest.
i also must applaud your willingness to do what works for your child. As a person with a brain disease, i'm too often treated with stigma over what i take (like anti-psychotics and anti-depressants). Quite awhile back, in my search for what worked, i switched to all organic fruits, veggies and dairy products as well as adding some supplements (omega-3s especially, which have shown t help improve brain function). This actually helped a great deal, and though i'm back on many of those drugs, it's a lower dose than i've ever had before and with better day to day results. (Maybe the Omega-3 supplement may help too? Just a thought.) i applaud you and your wife for listening to your child and trying to make sure you find what will work for his wellness and happiness.
Posted by: mercurial scribe | Dec 21, 2006 8:45:21 PM
Are you telling me that the reason I'm short is not related to coffee? (Could it be that it's because there is no one in my family taller than 5'5" for the last six generations?)
Posted by: mochassid | Dec 21, 2006 9:49:54 PM
As a parent of a child with ADHD and a wife of a husband with ADD, I fully understand the frustration and worry that it brings on. It's just my opinion, but I would really give some thought to what Jersey Boy said.
There might be some other neurological reason for his inabilities. My hubby had told me that if you take a stimulant, like ritalin, and you are hyper, then you don't have ADD/ADHD. That just might be his theory.
In any case, I too, recommend that you find a professional who specializes in testing and a psychiatrist who would have degree in Pediatrics and specializes in ADD/ADHD, as well. Other paths to take is perhaps Occupational Therapy and Speech/Language Therapy.
Also, check out CHADD.
Posted by: jaime | Dec 21, 2006 10:49:00 PM
I totally sympathize with your dilemma and decision. I was diagnosed with ADD when I was in high school. I tried ritalin but hated how it made me feel. I would forget to eat and have a hard time going to sleep at night. Instead I learned some non medicinal coping mechanisms to help me stay focused.
If Gilad felt hyper on Ritalin then he may not have ADD or he may not have had the right dosage. Ritalin didn't make me feel hyper, and from what I understand, it's not supposed to. ADD is caused by the frontal lobe of the brain performing sluggishly. Ritalin is supposed to stimulate that part of the brain so that it functions "normally." That is why giving a drug to someone with ADD allows them to focus but giving the same drug to someone with a normal functioning brain gives them a high.
Posted by: Fern R | Dec 21, 2006 11:32:10 PM
I have children with ADHD...6 of them as a matter of fact. I have it myself as well.
I did the medication route with my kids. Why? Because I wanted them to understand what a normal brain felt like...
Ritalin sucks. Only one of my kids was on ritalin..and it sucked. Dexedrine worked much better and at lower doses. It also lasted longer. As well, it didn't have the horrible appetite suppression that Ritalin has, nor the rebound effect.
Adderall is another one that is good, but it does have the appetite suppression and that can be an issue.
That being said, they are also no longer on medication because having learned what a normal brain felt like, when they got old enough to make an informed decision, they decided that the organizational systems that I had put in place for them were good enough.
Besides medication, there are a multitude of other things that can be done and should be done regardless to help a child focus and pay attention.
Some of those include a rigid schedule for certain things..like homework time..etc. And, rigid organization for those things they need on a daily basis.
Plenty of exercise is another one that helps alot. Fresh air and exercise can do a lot to clear your head.
Letting the kid drink coffee actually isn't a bad idea and if it works..YAY!
Good luck with that and if you'd like some recommended reading material, let me know.
Posted by: Kelly | Dec 21, 2006 11:57:33 PM
Kelly - six kids with ADHD? You are a saint! I just have one (well two, including hubby) and thank god my daughter has her medicine - Focalin - cuz otherwise, I would be in Jail for a long long time!
You are absolutely right about the behavior modifications and organization and time management skills. It's something my husband and I both lack which makes its all the harder for us to teach and to carry out with our children. Again, it's an amazing thing that you have accomplish for yourself and your family.
Posted by: jaime | Dec 22, 2006 12:10:23 AM
OK, I have no medical advice whatsoever... although, coming from a background where the idea of ADD and ADHD was virtually non-existent, I do tend to be a little suspicious about the proliferation of this diagnosis and the states, and the readiness with which doctors recommend medicinal routes, rather than other alternatives... But that's just me, so you can ignore it. Like others, I admire the way you included Gilad in the decision-making and for the creative alternative! And, by the way, regarding your point about path to academic mediocrity - you turned out to be all right! : )
Posted by: Irina | Dec 22, 2006 4:19:07 AM
Todays New York Times has an article on another approach, aimed mainly at the hyperactive kids, but still:
Parenting as Therapy. Apparently some parents can be trained to train their kids in a particular way that helps. It doesn't sound easy but I'm sure it's worth learning about.
Posted by: Warren | Dec 22, 2006 10:26:18 AM
shabbat shalom trepp...i have been teaching and working with learning disabled kids in jerusalem for close to twenty years...dyslexia/dysgraphia/
dyscalculia/add/adhd...(oh btw the low estimate is that at least 20% of all classroom kids are l.d. kids...makes you think, no?)be happy to talk to you any time...i understand everything you have written and in your place would have probaly done the same thing...but on the other hand i have seen ritalin work miracles for kids...absolute miracles...so gey veiss what is right...maybe it's what feels correct inside your heart and belly...a sweet shabbat shalom to you all...stay safe
Posted by: marallyn | Dec 22, 2006 1:43:00 PM
ps i forgot to mention that i have an l.d. kid...math/dyscalculia and short term memory...who often has said...oh if only ritalin could help me...today she is a brilliant teacher and works with some of the most difficult children in the city...so when i say 'i understand'i do both as a parent and as an educator...good luck...ps the kid will be great
Posted by: marallyn | Dec 22, 2006 1:46:36 PM
Warren - from my own experiences talking to different therapists they all said that most of the time, when you sign your child up for therapy, it's really for the parents. It's the parents that go for therapy not the child, because they are the ones that need to learn how to deal with their children and to learn various behavior modification techniques to use with their children. And yes, it's very hard work, but something I would recommend any parent to look into, not neccessary those with children of labels.
Posted by: jaime | Dec 23, 2006 7:10:55 AM
look out hideously stained teeth
Posted by: Seth | Dec 23, 2006 9:27:16 AM
Hi David and Zahava, from California. There are some great, reliable resources on the web.
1. Schwab Learning,
2. Schwab's parent-to-parent board
3. Children and Adults With Attention Deficit Disorder (CHADD)
4. CHADD's National Resource on AD/HD
Posted by: Liz | Dec 24, 2006 4:40:59 AM
For those still with family members diagnosed with ADD either on Ritalin, or not, you may like to visit
Posted by: Robert | Dec 24, 2006 12:11:44 PM
Your post brought back fond memories of my coffee time with my Bubbie. She and I sat down and had a cup of coffee everyday from before I remember. Mine was coffee milk with lots of sugar. I don't know if the caffeine will have the desired pharmacological effect, but I think its a great idea. BTW, I drink coffee today and my kids do not. Also, my Bubbie had tea with my younger brother. The coffee was only for me.
Posted by: lrg | Dec 24, 2006 5:59:58 PM
why take Ritalin for ADD? Here in the U.S., most physicians prescribe Ritalin for ADHD. ADD kids get Adderall or just a 10mg dose of Dexedrine (the last for mild cases of ADD). If the coffee doesn't do the trick, Ritalin is definitely NOT the only remaining answer.
I've been there with one of my kids ... and it was Dexedrine. She never even knew it was for ADD, we didn't want her school to typecast her. Since she also took allergy shots for a multitude of allergies, we simply called it the "allergy pill". She took it from age 12 to 18, and stopped then. All the while being a basically straight A student.
Posted by: Sal | Dec 24, 2006 11:43:16 PM
Hi David -
Don't have time to write much but got to your blog from your ou article and wanted to point you toward www.feingold.org If followed to the letter it can produce amazing results in the behavior of a child. We did it for Ben for 5 years and it was a life saver!
Regards to Zahava!
Posted by: Stacy Kennedy | Dec 25, 2006 5:14:26 AM
"Ritalin is essentially a stimulant (amphetamine)"
just to clarify (i had a unit on adhd this semester in my clinical therapeutics class), methylphenidate drugs (including ritalin) are actually non-amphetamine stimulants (as was the the now discontunued pemoline). the stimulant amphetamines are adderall and dexedra.
Posted by: Ari Kinsberg | Dec 25, 2006 11:20:05 AM
Neuropsychologist here, with ADHD and who diagnoses adult ADD/ADHD. Ritalin and other stimulants affect a different part of the brain, the nucleus accumbens, than caffeine does, which is why past research has not shown Caffeine to have much benefit. Caffeine is like throwing sand at a target rather than a dart.
Ritalin and stimulant drugs work best where there are problems with sustained goal-directed behavior and hyperactivity, not just attentional impotence (can't get it up when you want to). They alter and may normalize subjective time perception as well. NON stimulant drugs may help when the primary issue is just paying attention. Since ADD/ADHD kids often have poor sleep, caffeine may help if the issue is partly fatigue, but that's not fixing the underlying issue. That's why really careful diagnosis is so vital -- not just IS it ADHD or ADD, but what subtype? There are more than two. No oppositional behavior, No restlessness, No leaving a trail of incomplete tasks in your wake? Then maybe not ADD. (Consider boredom in a really gifted child. Eyesight... Hearing. Anxiety.)
The most promising non-drug stuff I've seen is moderately high doses of high-grade fish oil, and some research supports this. Ritalin has been in use for 75 years, and given the level of prescribing, is a pretty safe drug -- I'd rather have a kid on it than any of the antidepressants, for example. But its not right, or needed, for everyone.
Posted by: Pam | Dec 26, 2006 6:57:06 AM
I can't believe the level of interest in this topic as well as the helpful suggestions/advice I've gotten. You guys rock! Just because the kids and I will be enjoying our morning coffee together doesn't mean I'm not looking into many of the options you guys have been so kind as to suggest. Thanks again!
Posted by: treppenwitz | Dec 26, 2006 9:56:16 AM
Hmmm...surprising that no one has yet written in talking about their OWN experiences having ADD/ADHD - only parents and spouses. Well, let me be the first. From personal experience, having been diaanosed with ADD about 14 years ago, I can tell all of you skeptics out there that ADD is very much a real phenomenon.
I've gone the medication route before, but never tried coffee consistently. However, if I had to guess, I'd say that the coffee pretty much just helps with alertness. You see, ADD (like many congitive issues, I imagine) worsens with greater fatigue. When I'm too tired, I have a lot of trouble concentrating, medication or not.
Posted by: ilan | Dec 26, 2006 9:59:52 PM
The U.S.-Mexican border fence works, doesn't work
Posted by: Steve | Oct 2, 2007 9:24:28 PM