UBERTEACH
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KEITH’S STORY
ADHD, EBD AND ALLOCATION OF DRUGS WITHIN THE EDUCATION/CARE SYSTEM
INTRODUCTION
Keith is a 28-year-old student I worked with throughout a 12-week period. Early on in the Teaching
Assistant course he described his knowledge of ‘child-development’ as a subject area, as this
applied to a number of ‘transitions’ worked through in his own life and how ‘resilient’ and
independent he had become as a result. His ‘story’ was result of him relaying his thoughts with the
intention that another child/parent/teacher may benefit from his words and perhaps explore
‘alternative methods’ to being prescribed/prescribing drugs to a child who requires a greater level
of being listened to and encouragement to channel their energy in a positive direction.
THE EVENTS
NAME: Keith
AGE: I was 7 years of age when first prescribed drugs
AGE NOW: 28
AGE 7-10
I was brought up in the care system starting off in Darlington, Tyne and Wear and was there for two
weeks. I was fostered in Cleadon Village for a week and then sent to Owen Drive Homes in Boldon.
After a year I went to Lanwick Drive in Simonside and was there for six months. I then was
transferred to Henderson Road in the same town, South Shields and then back to Owen Drive. This
began at the age of 7 to the age of 10. At age 7-9 I was prescribed:
Drug: A quarter tablet of Valium
Effect: Constantly lethargic; Low motivation; In bed for 5pm
Drug: Ritalin
Effect: Nausea; Sickness; Low motivation
AGE 10-12
Stayed at Owen Drive and was in a coma for a week and a half due to alcohol consumption, Age 11.
At the time I wrote an essay called The Good, The Bad and the Drunk and Disorderly for my English
course work. At age 11 I was told that I had ADHD and EBD and was prescribed:
Drug: Tramadol
Effect: Sleep; Felt dead and particularly sick in the morning
Drug: Diazepam
Effect: Knocked me out; In bed by 5pm
AGE 13-17
Transferred to Lancaster Farms Residential Unit. Same procedure here where I was drugged up and I
was not allowed out of room. In the room was a sink and a toilet. The reason I was transferred to
Lancaster was for ‘alleged’ assault on a member of staff. I was on steroids at the time due to bone
marrow deficiency and was skinny as a rake and 4ft. 10”. The staff member I supposedly hit in the
face was 6ft. 4”. I admitted to pushing him but this was due to him badly restraining one of my
friends by twisting his arm up his back. All I did was protect my friend.
At age 17 I visited my Doctor and I asked for an assessment. He looked at his records and he told me:
“You have ADHD?”
I said, “I don’t feel that I have.” I went to visit the Mental Health Team at Monkton Village and I
attended a series of sessions. They said I had a little bit of anxiety and prescribed:
Fluoxetine:
Effect: Slowed my heart rate down, that’s what it felt like
Cilatropram
Effect: Felt as though it took the edge off
CHILD PSYCHOLOGIST INTERVENTION
From the age of eight years old, she provided me during a one hour session with a pen and a piece of
paper and asked me to draw something. She concluded: “I haven’t even scratched the surface with
him yet”. This was after four years of meetings.
AGE 17+
I was provided with a flat in Whiteleas, South Shields and went to work in a Care Home with old
people with Dementia. I worked here until the age of 19.
AND THEN WHAT?
I met a girl and moved in with her and furthered my education, a Level 1 in Mentoring and
Counselling and took a work placement at Chameleon Care Services. I have since completed
additional courses and currently seeking a College-route towards Teaching. I am skilled in computers
and feel confident I could be a positive role model to young people.
MY HOME REALITY
I first entered the care system as a result of child abuse at the hands of my step-father. He would
wake me up in the middle of the night, from age 4 and beat me up. He broke both my legs age 5 with
a bat, when I intervened to him beating my mother up. He broke her jaw, with the same bat.
I was a quiet child at school and my stepfather kept me out of school if I had marks on me.
I had no recollection of how I felt ‘at the time’, only that it hurts to look back and reflect. At the age
of 5 I thought that this was normal behaviour and I was not allowed any friends or allowed to play
out.
Social Services took me away after my step-father raped my Mother whilst his brother forced me to
watch. They then took turns to do the same.
THE DRUGS PRESECRIBED TO KEITH FROM AGE 7
1) Diazepam /daɪˈæzɨpæm/, first marketed as Valium /ˈvæliəm/ by Hoffmann-La
Roche, is a benzodiazepine drug.
It is commonly used to treat anxiety, panic attacks, insomnia, seizures (including status
epilepticus), muscle spasms (such as in tetanus cases), restless legs syndrome, alcohol
withdrawal, benzodiazepine withdrawal, opiate withdrawal syndrome and Ménière's disease.
It may also be used before certain medical procedures (such as endoscopies) to reduce tension
and anxiety, and in some surgical procedures to induce amnesia (it may be used to hasten the
onset of IV anesthesia while reducing dose requirements or as the sole agent when IV
anesthesia is not available or is contraindicated).[1][2]
It possesses anxiolytic, anticonvulsant, hypnotic, sedative, skeletal muscle relaxant, and
amnestic properties.[3] The pharmacological action of diazepam enhances the effect of the
neurotransmitter GABA by binding to the benzodiazepine site on the GABAA receptor (via
the constituent chlorine atom) leading to central nervous system depression.[4]
Adverse effects of diazepam include anterograde amnesia (especially at higher doses) and
sedation, as well as paradoxical effects such as excitement, rage or worsening of seizures in
epileptics. Benzodiazepines also can cause or worsen depression, particularly after extended
periods of use [citation needed]. Long-term effects of benzodiazepines such as diazepam
include tolerance, benzodiazepine dependence and benzodiazepine withdrawal syndrome
upon dose reduction. After cessation of benzodiazepines, cognitive deficits may persist for at
least six months and it was suggested that longer than six months may be needed for recovery
from some deficits.[4] Diazepam also has physical dependence potential and can cause serious
problems of physical dependence with long term use. Compared to other benzodiazepines,
though, physical withdrawal from diazepam following long term use is usually far more mild
due to its long elimination half-life. Diazepam is the drug of choice for treating
benzodiazepine dependence, with its low potency, long duration of action and the availability
of low-dose tablets making it ideal for gradual dose reduction and the circumvention of
withdrawal symptoms.[5]
Advantages of diazepam are a rapid onset of action[6] and high efficacy rates, which is
important for managing acute seizures, anxiety attacks and panic attacks; benzodiazepines
also have a relatively low toxicity in overdose.[4] Diazepam is a core medicine in the World
Health Organization's Essential Drugs List, which list minimum medical needs for a basic
health care system.[7] Diazepam, first synthesized by Leo Sternbach,[8] is used to treat a wide
range of conditions, and has been one of the most frequently prescribed medications in the
world since its launch in 1963.
2) Methylphenidate (trade names Concerta, Methylin, Ritalin, Equasym XL) is a
psychostimulant drug and substituted phenethylamine approved for treatment of
attention-deficit hyperactivity disorder (ADHD), postural orthostatic tachycardia
syndrome and narcolepsy. The original patent was owned by CIBA, now Novartis
Corporation. It was first licensed by the U.S. Food and Drug Administration (FDA) in
1955 for treating what was then known as hyperactivity. Prescribed to patients
beginning in 1960, the drug became heavily prescribed in the 1990s, when the
diagnosis of ADHD itself became more widely accepted.[1][2]
ADHD and other similar conditions are believed to be linked to sub-performance of the
dopamine and norepinephrine functions in the brain, primarily in the prefrontal cortex,
responsible for self-regulation functions of inhibition, motivation, memory, and the
concentration/executive functions of reasoning, organizing, solving, and planning.[3][4]
Methylphenidate's pharmacological profile involves catecholamines, similar to other
sympathomimetics of the phenethylamine class. In particular, methylphenidate is a dopamine
reuptake inhibitor and also a much weaker norepinephrine reuptake inhibitor, which increases
the levels of these neurotransmitters in the brain.
3) Tramadol (marketed as the hydrochloride salt by Janssen Pharmaceutica as Ultram
in the United States, Ralivia by Biovail in Canada and many other companies
throughout the world) is a centrally-acting atypical opioid analgesic with additional
serotonin-norepinephrine reuptake-inhibiting effects used to treat moderate to
moderately severe pain.[4] It was launched and marketed as Tramal by the German
pharmaceutical company Grünenthal GmbH in 1977 in West Germany, even though it
would take another 20 years for it to be launched in English-speaking countries such
as the UK, US and Australia.[4]
Tramadol is marketed as a racemic mixture of both R and S stereoisomers.[1] This is because
the two isomers complement each other's analgesic activity.[1] It is often combined with
paracetamol as this is known to improve the efficacy of tramadol in relieving pain.[1]
Tramadol is an atypical opioid because it is a serotonin-norepinephrine reuptake inhibitor of
and, by itself, a fairly weak μ-opioid receptor agonist.[5][6] Tramadol is metabolised to Odesmethyltramadol, which is a significantly more potent opioid with additional
norepinephrine reuptake-inhibiting properties,[1] making it analogous to tapentadol.[7] When
taken as an immediate-release oral formulation, the onset of pain relief usually occurs within
about an hour.[8]
Despite the original belief that tramadol was a purely synthetic opioid it has been recently
found in a South African tree.[9]
4) Citalopram (/sɪˈtælɵpræm/ or /saɪˈtælɵpræm/; brand names: Celexa, Cipramil) is an
antidepressant drug of the selective serotonin reuptake inhibitor (SSRI) class. It has U.S.
Food and Drug Administration (FDA) approval to treat major depression,[1] which it received
in 1998[2] and is prescribed off-label for other conditions. In Australia, the UK, Germany,
Portugal, Poland, and most European countries it is licenced for depressive episodes and
panic disorder with or without agoraphobia. In Spain it is also used for obsessive-compulsive
disorder.
5) Fluoxetine (also known by the tradenames Prozac, Sarafem, Ladose and Fontex,
among others) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI)
class. Fluoxetine was first documented in 1974 by scientists from Eli Lilly and
Company.[6] It was approved by the U.S. Food and Drug Administration for the
treatment of major depressive disorder in December 1987.[7] The fluoxetine patent
expired in August 2001.[8]
Fluoxetine is used for the treatment of major depressive disorder (including pediatric
depression), obsessive-compulsive disorder (in both adults and children), bulimia nervosa,
panic disorder and premenstrual dysphoric disorder.[9] In addition, fluoxetine is used to treat
trichotillomania if cognitive behaviour therapy has been unsuccessful.[10] In combination with
the atypical antipsychotic olanzapine it is known by a few brand names,[note 1] including its
US brand name Symbyax, which is approved for the treatment of depressive episodes as part
of bipolar I disorder and in the treatment of treatment-resistant depression.
In 2010, over 24.4 million prescriptions for generic formulations of fluoxetine were filled
in the United States,[11] making it the third most prescribed antidepressant after sertraline
and citalopram.[11] In 2011, 6 million prescriptions for fluoxetine were filled in the United
Kingdom.[12] It is on the World Health Organization's List of Essential Medicines, a list of
the most important medication needed in a basic health system.[13]
INTERNET ARTICLE
http://www.boston.com/lifestyle/health/mdmama/2012/06/do_you_know_what_the.
html
Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children’s
Hospital. An Assistant Professor of Pediatrics at Harvard Medical School and a senior editor for
Harvard Health Publications, she has been writing about health and parenting for magazines,
newspapers, and the internet for more than 20 years. She and her husband are raising five children
ranging in age from 21 to 7. She blogs for Thriving, the health and parenting blog of Children's
Hospital Boston, and for Boston.com as MD Mama; you can follow her on Twitter at @drClaire.
Do you know what the most prescribed drug is for kids ages 12-17?
It's methylphenidate. And that's scary.
Methylphenidate is a stimulant medication used to treat Attention Deficit Hyperactivity
Disorder (ADHD). It goes by the brand names Ritalin, Concerta, Metadate and Methylin.
According to a study just released in the journal Pediatrics, it's the top-prescribed drug
for teens. More than asthma medications, more than antibiotics, more than anything.
This should worry you. It worries me. There are three likely reasons why
methylphenidate is #1, and each one of them needs our attention.
There are more kids with ADHD. In 2002, there were four and a half million kids with
ADHD; in 2010, that number was five million. That's an increase of 11 percent in only
eight years. I know that in my own practice, I am seeing more and more kids with
ADHD. We need to understand why this is happening, because ADHD can be very
disabling. There have been links between TV and video games and ADHD--we need to
understand this and any other contributors and we need to do it fast. The future of our
children is at stake.
We are using medications as a quick fix. Yes, medications help ADHD. But so does a
really good school program--and so does behavioral therapy. But individualized school
programs and behavioral therapy require resources and personnel that aren't always
easy to find or pay for. So we turn to medication, which is covered by insurance--all you
need is someone to do the prescribing. I can't tell you how many parents have come to
me saying that the teacher wants their child on medication. I don't blame the teachers-they are just trying to help kids behave and learn. But we need to do more than medicate
kids. Not only do these medications have side effects that can be dangerous, if all we do
is medicate we don't give them the skills and strategies that they need to cope with
ADHD, skills and strategies they will need as adults.
Some kids are taking stimulants when they shouldn't. Recently, I've read a bunch of
media reports about kids taking stimulants not because they have ADHD but to do
better in school or the SAT's or whatever. As the latest mainifestation of our achievement
culture, kids are turning to these medications for that extra bit of concentration, that
extra boost, that extra edge. It's not fully clear to me where these meds are coming from-kids apparently find friends that have them, or doctors who will prescribe them. But this
is not Red Bull we are talking about here. Used carefully under a doctor's supervision
these drugs can be safe, but they can cause heart problems, interfere with sleep and
appetite, be habit-forming and cause all sorts of other problems. This is not a pill to pop
before a geometry test.
When I evaluate kids for ADHD, I give the parents and teacher a questionnaire to fill out.
The first part goes through various symptoms of ADHD and other problems that can
look like ADHD. The second part asks about how the kid is doing at school and at home.
You can be distracted and hyperactive all you want, but if you are actually doing well at
home and at school, you don't need medication.
We need to take this study really seriously. It says something about us as a society that
methylphenidate is the most prescribed drug for our teens--and what it's saying
isn't good.
KEITH’S CLOSING REMARK
“I recall Diazepam being the worst drug as all I would recall after swallowing the tablet was waking
up in the morning feeling sluggish and it felt as though I had not been asleep. I am aware now
through working in education how many young people are labelled ADHD, disruptive, bad
behaviour, nuisance, aggressive or a hindrance in some way and are prescribed medication rather
than ‘alternative therapies’, where in actual fact there could be a high number of reasons why this is
the case.
“On reflection I would not change anything as the events led me to the individual I am now, though I
feel that an acknowledgement of my situation and an appreciation of the fact that I was simply a
seven-year-old child with quite severe and intense family disruption might have led to an emphatic
understanding of the root cause. It sickens me to consider a society/reality who continue to explore
what I feel are the mainstream ‘easy-options’ when such a variety of alternatives could be made
available. Listening to a child, really listening to them and asking critical question, would be a start.”