Give Ritalin a break

Please don’t misinterpret my title. I did not say “Give kids a break from Ritalin” or “Stop using Ritalin on kids”. I meant exactly what I said. Let’s give Ritalin the respect it deserves.

I write this in response to a series of tweets I saw by a well-known HIV doctor specialist in which she bemoaned the impression that many of her friends’ young children sent to private preschools were either assessed for Attention Deficit (Hyperactivity) Disorder (ADD/ADHD) or actually put onto Ritalin. She felt it was wrong or inappropriate, and there were many responses to her tweets from parents suggesting the same. I suggested via Twitter that she, not being a neurodevelopment paediatrician, was not really qualified to comment in such a public medium where her opinion would be taken as advice. We had a good-natured, short but inconclusive interaction.

I am also not a neurodevelopmental paediatrician. I am an ENT surgeon. But the fact that I am that and not something else may have everything to do with the realisation well into my forties that I have had ADD as long as I can remember. On that basis, I feel qualified to comment and to tell my own story.

Preparatory school was an effortless experience for me. I remember coming top of my class right the way through, sharing first place with another chap who if anything was a little more odd than I was, and who I now recognise may well have had the same condition. Our parents had little to do with our success — we were both boarders, subject to the same conditions and structure, and there was nothing to suggest that our upbringings were responsible in any way.

Despite winning a scholarship to my chosen private high school, the effortless ease with which I had succeeded at prep school soon evaporated. I struggled to concentrate, to remember details and facts, doing better in methodological and analytical subjects like English and maths, never realising the promise with which I had left junior school. I started skydiving when I was 16, seeing my mother age 10 years in the year that followed. I hovered among the top 10 in class, never being first, but nevertheless getting a good enough matric to see me take my place in university as a first-year medical student.

The main reason I went to all my lectures in first year was that I had a girlfriend in the same class. We were inseparable for nearly two years, and she would have seen my bunking lectures as abandonment. She was a better student than I was, and her marks reflected this. The year we broke up I stopped going to lectures almost altogether. I saw little point in spending time writing down notes and fighting boredom when there were textbooks that could give me what I needed to know. I saved my enthusiasm for the exciting stuff, volunteering in casualties at night and over weekends to fix and mend broken bodies long before it was expected of me. I wrote important exams on some occasions learning half the annual syllabus by pulling an “all-nighter” through until the exam itself. By some magic I passed.

The pervading feeling in this time of trying to find myself as a young adult was that there was something fundamentally wrong within me. A series of girlfriends confirmed this on parting, each jilting me for other men who without exception they married shortly thereafter. “Something’s wrong with you, Martin” one said as we separated, and I believed her.

Restlessness was pervasive. I could not sit still. My hands were always doing something — rubbing my nose, scratching my ear, fiddling with a strap or a buckle. I became interested in certain things to distraction. It was nothing to spend three hours learning a new 10-second guitar lick. Remembering the branches of the common carotid artery on the other hand was a gargantuan task.

I somehow made it through medical school — firmly in the middle of the class. I was okay as a new doctor in the sense that the practical hands-on stuff appealed to me, and surgery would be my career path. I did my military service, finding an opportunity to continue jumping out of aircraft this time in an operational capacity. Doing crazy stuff just felt right, while at the same time my former girlfriend’s words and the others’ relief at finding other “stable” men resonated in my head.

I did find a woman who would accommodate my restlessness and married her. I specialised late, after 10 years of exciting work and travel around the world. The surgery I chose to do, ENT surgery, was intricate, varied, and each case seldom lasted longer than two hours. I soon realised that long surgical cases were not for me — I struggled to maintain focus longer than three hours.

I spent 45 years in this state. The breakthrough came when a paediatrician we were seeing looked at my wife and I and said, “So which of you two is ADD?” He gave me a questionnaire describing adult ADD, and on reading it I saw the pattern of my whole life flashing back at me.

I do not take Ritalin. I still have adult ADD, a condition which has channelled me into a speciality that meets my own needs perfectly. I am lucky, and have no need to manage it now. I regret however that I was not diagnosed when the wheels first started falling off, when the feeling of an inherent subliminal wrongness began, and that a treatment like Ritalin was not available. I feel as if my potential to have been very good, if not exceptional, was never realised due to my undiagnosed condition.

Ritalin is not for everyone. It does have side-effects. Every child with ADD is different, and for some there are other medications that do better. But it is a safe medication that wears off quickly, and can be stopped and started intermittently. For many children and adults it makes the difference between just existing and living life to one’s full potential.

My advice to any parent starting down this road is to get the best medical advice you can, from a neurodevelopmental paediatrician or paediatric neurologist who has a special interest in ADD/ADHD. In other words, see an expert. Have your child tested and follow trustworthy expert medical advice. Review later down the line. Look at other options, but do not discount medication. Give Ritalin or other drugs like it a break — they have earned their place in the medical treatment of ADD/ADHD.

Because your child deserves to be the very best he or she can possibly be.