“Ritalin and other forms of enforcement and psychological policing are the contemporary equivalent of the old practice of tying up children’s hands in bed, so they won’t touch their genitals. The parent stupefies the child for the parent’s good.”
This was how Hanif Kureishi, a well-respected author, described the treatments for attention deficit hyperactivity disorder (ADHD) in the New York Times earlier this year. It’s not an uncommon view.
Ask an adult what it’s like to be a child with ADHD or a child on Ritalin, the most common drug to treat the condition, and you’ll get the same standard answers: Kids with ADHD are just naughty. Kids with ADHD have bad parents. Kids with ADHD have something wrong with their brains. Ritalin turns kids into robots. We’re using Ritalin to control children. Ritalin is a biological tool to treat a biological problem.
The debate over Ritalin-type drugs is over half a century old, and yet the shape of this debate really hasn’t changed much over that period of time.
But while adults argue over the rights and wrongs of ADHD diagnosis and stimulant drug treatments such as Ritalin, did anyone think to ask the children what they thought? This is what my colleagues and I have spent the past five years doing. We sat down and talked to the children, asking them to verbally describe and to draw their experiences. Most importantly, we listened to them.
It might be surprising to hear that when you ask young people about their experiences with ADHD, most of them say they value the medication. They don’t say that Ritalin turns them into robots. In fact, they say the opposite: Ritalin helps them gain control over impulsive, thoughtless behaviour so that they can think about what to do next. In other words, Ritalin helps their moral reasoning ability.
Glenn, aged 10, one of the children we spoke to, put it like this: “If you’re driving in a car, and there’s two different ways, and you usually always go this way… and then one day you want to go the other way, but… the ADHD acts as like a blocker, so you can’t… It [the medicine] opens the blocker so that you can go [the right] way. But you still have the choice of going the wrong way.”
I’m not arguing – and Glenn makes this point quite clearly – that medication suddenly makes children with ADHD into angelic model children, but crucially, it gives them control over their decisions.
So why are so many adults so convinced that Ritalin does children harm? I believe the answer is simply that we adults have never asked the children about their experiences. While we have been cycling through the endless debate about medication, young people may have been quietly feeling some real benefits. Their experiences don’t fit the polarised debate. They don’t blame their brain for their behaviour, neither do they blame their parents or anyone else. Like most children, they would like more friends. They would also like to learn strategies to help them control their behavior. They would like more access to their doctors – and for their doctors to tell them what is going on, what ADHD means, why they are being offered medication. They would like more time outdoors, and less shouting in the classroom. Few are lucky enough to be offered these in any sustained way.
It’s little wonder, then, that these young people are often being held back and prevented from flourishing – but it’s not Ritalin that’s constraining them: it’s stigma. On school playgrounds, a bullying culture identifies them as targets. Other kids think it’s fun to wind them up to see them lose control. Even well intentioned teachers don’t know what to do. A child with ADHD will use his diagnosis as an excuse for bad behaviour because he knows he can. “I get away with everything,” says Carl, a 12 year old who frequently gets into fights at school. He’s taking Ritalin and he says it helps reduce his impulsivity and feelings of explosive anger. But he has little incentive to stop fighting, when adults believe he is incapable of good behaviour and other kids keep taunting him. We blame the drug for doing harm, but we do little to change the social environments that exacerbate a young person’s difficulties with behavioral self-control. Does that make sense?
Listening to young people talk about ADHD and their treatments is a revelation, and not just because their experiences contradict so much about what we assume are the harms of stimulant drug treatments. Children are aware of the impact of their behaviour, irrespective of how well they are able to control it. They have a moral sensibility. They are willing to change, but they need help. We have focused on the drug in the interest of protecting kids. In the process we forgot the kids themselves.
