To medicate or not

http://www.sdcitybeat.com/article.php?id=5873

To medicate or not
When it comes to ADHD, alternatives to quick-fix drugs aren't cheap


Vagan Willer has one skinny arm stuck in the metal rabbit cage stroking
"BunBun." She holds a black leather jacket in the other.

"I felt so bad when I found out about what leather was," she says, scraping
her bottom lip with her teeth, "'cause I felt bad for BunBun, you know." She
nods her head toward the white rabbit. "But then someone at school told me I
was wrong and that leather doesn't come from cute little bunnies, and I was,
like, 'Oh, well then, I don't care." She giggles and pauses. Her eyes scan
the room before stopping and staring at the cage with forced concentration.

She's trying to wrap her brain around something.

"But now I'm worried about the fur on the hoods of those big jackets that
those rappers on TV wear a lot." Her eyes remain fixated on the cage as she
closes it and empties her backpack out onto the living room floor. "That's
gotta be bunny fur," she said.

Vagan's 12 years old and in the sixth grade. It's a Friday afternoon, after
school, and she's alone until her mom, Stacey Willer, gets home at 5 p.m.
Vagan consults the chart on the fridge.

"Get self dressed," she reads. "Duh-that's morning; done with that. OK, do
homework-nope, it's Friday." Her large brown eyes dart around the room from
BunBun to her school papers and chewed-on pencils on the floor, then back to
the list. "Feed BunBun and that's it," she says. "When I'm done with all
that, I can go on online."

Vagan claps her hands together, relieved the routine is finished.

Vagan was diagnosed with attention-deficit hyperactivity disorder when she
was 6 years old. She had already struggled through kindergarten twice yet
still couldn't recognize all the letters of the alphabet or count to 20. Her
teacher suggested testing for learning disabilities and ADHD. It turned out
that Vagan had both.

"After we knew what we were up against, I wanted to help Vagan in every way
possible," Stacy Willer said, "but I didn't want to medicate her without
trying other things first."

It's tempting to boil the ADHD debate down to one hotly debated question:
Medicate or not?

A Mayo Clinic study found that roughly 8 percent of school-age kids in the
U.S. have been diagnosed with ADHD. Of those kids, a little more than half
take prescription medication, according to the National Institute of Mental
Health. Nobody, not even the drug companies, argues that pills alone are the
best treatment plan. Most experts agree that a combination of medication and
therapy is optimal, but there's no consensus on whether the risks
medications pose outweigh the benefits for kids.

Anti-drug activists, like Dr. David Velkoff of the Drake Institute and the
California Alliance Against the Psychiatric Drugging of Children, point out
that the medications commonly prescribed to kids with ADHD are in the same
Food and Drug Administration category as illicit recreational drugs such as
crystal methamphetamine and cocaine. Though conclusive research is scant,
immediate side effects include insomnia, weight loss and mood swings. Many
experts also argue that ADHD is a neurological disorder, not a disease that
can be "cured," so medications only ease the symptoms until the dose wears
off.

Proponents of the drugs, like the National Institute on Mental Health and
the American Medical Association, cite positive effects-increased focus,
calmness and the ability to finish a page of math or sit through a movie.
Prescription drugs are the most popular form of ADHD treatment, and most
people reap some substantial benefits from them almost immediately. A UC
Berkeley study reported recently that the use of prescription drugs for
treating ADHD has more than tripled worldwide since 1993. For many ADHD
child caregivers, the benefits simply outweigh the risks.

Vagan's mom wanted to try alternatives before medication. Hyperactivity,
inattentiveness and heightened impulsivity make school tough for ADHD kids,
but under federal guidelines, the disorder isn't a "qualifying handicap" for
special education. Vagan's learning disability, however, made her eligible
for a private tutor.

After a few weeks, her grades improved a little, but Vagan couldn't sit
still at her desk long enough for the tutor to make a real difference. No
one at school was equipped to handle her constant jitters, nervous chatter
or tendency to stare off into space. After a few frustrating months, it
became obvious to Stacey that Vagan couldn't function and she started her on
the medication.

Willer describes her daughter's life as like trying to watch 100 TV screens
at once, only able to catch glimpses of scenes and bits of noise from each.

"But with the medication, it was like all those screens fed into one big
screen that she could focus on without being distracted by the other ones,"
she said. "We gave her the smallest possible dose, and within one week Vagan
was reading fluently. She knew how to read the whole time; she just couldn't
focus long enough to say it or something."

These days, Vagan takes Focalin, one of the stimulant drugs critics worry
about, and attends a full-day special-education class st Sunnyside
Elementary in Bonita.

The drugs have such an impact on Vagan that some people prefer her company
only when she's on them.

"My dad uses figures of speech all the time, like 'Stop bouncing off the
walls,'" Vagan says. "And whenever my mom drops me off with him, he always
asks her if I've had my meds today. A lot of times I get hyper and my
friends don't like it and they tell me I'm annoying when I get hyper. I talk
a lot so I won't just start getting all crazy when I'm hyper-I'll talk on
and on and-but if I can't talk, like at school or something, then I'll just
smile a lot." Her eyes widen and she smiles a huge, almost frantic smile. "I
smile to get the energy out, but it's better than acting up," she says.

The grin, for Vagan, is a self-taught, non-drug, coping mechanism for
dealing with her ADHD.


Six-year old Sam will spend the next six minutes crouching in the corner of
his principal's office at Balboa City School, hugging his legs just below
his knees, rocking back and forth and missing a chunk of hair. Sam had told
his teacher he needed to use the bathroom. Moments later, he returned to
class with his bangs chopped off into a 'do that only dull school scissors
can create.

Sam's a student with ADHD at this private school for kids with learning
disabilities and ADHD. Situated across the street from Balboa Park, the
school exudes a certain urban serenity. There's lots of lush shrubbery,
plenty of potted plants and even a small rock-climbing wall in the quad
area. Inside, the classrooms are small.

Dr. Stephen Parker, the school principal, argues that kids with ADHD can
learn how to stay in control of their symptoms and be successful without
high doses of medications.

"For example, Sam's learned that he can bend over and grab his knees like
that when he needs to calm himself down and regain focus," Parker says,
nodding toward Sam in the corner.

He keeps talking but sneaks frequent peeks at his wris****ch while Sam
serves his sentence. Time's up.

"Sam, come here and sit down in this chair here and relax. You know what,
Sam's a good boy." Parker says, looking at but never locking his eyes on the
small boy balled up on the large chair. That would be too threatening.

Instead, Parker's voice is light and soothing and offers Sam a clean
slate-no lectures, no ominous phone call home and no critiques of the
haircut.

"You just have to understand what kids with ADHD need and help them
understand how to meet their own needs," Parker says as Sam returns to
class.

It sounds complicated, but the techniques Parker and his colleagues use to
help the kids are simple, if pricey.

For example, every classroom at the school is equipped with surround sound
and teachers wear wireless microphones. Kids who can hear clearly, Parker
said, can pay attention better. Students are encouraged to stop and hug
themselves, roll their neck around or breathe deeply whenever and wherever
they realize they need to regain control. The classrooms have charts on the
walls that illustrate ways to calm down and participate appropriately in
class. They get "sensory buckets" filled with trinkets and cheap plastic
toys to "fidget with" while they work.

Every case is unique, but Parker says most of his ADHD students quit taking
their medications after several months at the school. Others cut their dose
in half.

"Look, it's that simple," Parker says. "But people would rather pay $5 a
pill than 29 cents for a plastic toy because no one's pushing 29 cent toys."

Parker contends that huge revenues for drug companies discourage some people
from exploring alternative treatments like the ones he uses at his school. A
UC Berkeley study put American ADHD drug spending at $2.4 billion, the most
in the world.

The toys Parker uses with his students may be cheap, but the school isn't.
Attending Balboa City School costs $13,000 a year, far more than Vagan's
prescription costs Stacey Willer.

"My insurance covers her meds," Stacey said. "I'd love for Vagan to have a
chance to go to a private school, but I'm doing the best I can."