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Ritalin: A society that drugs its children

Ritalin: A society that drugs its children

By Mauricio Becerra Rebolledo

The pills are there. In the box that the director keeps in the third drawer of her desk. The children enter one by one and have to take the medicine in front of her. Open your mouth - tells the most unruly. Like a communion every morning. But in this ritual there are no prayers, parishioners, and even less a holy spirit. The host is calculated in milligrams. After communion, each one returns to his room to sit quietly in the chair to carefully follow the instructions given by the teacher.

The restless children of yesteryear, who were said to have "pissed off," would now be "carriers" of a so-called Attention Deficit Hyperactivity Disorder (ADHD). In Chile, it would affect 5% of the population between 4 and 18 years of age, most of whom are treated with Methylphenidate (MFD), a derivative of amphetamine. The teacher diagnoses, the parents (when they can) pay for the consultation, the neurologist prescribes, the psychologist confirms and the inspectors say "take the medicine." Just as the rods were yesterday, today the MFD is already a pedagogical tool and parents, educational and health agents end up putting a drug in the mouth of a child that works in the brain in a similar way to cocaine.

At the Karol Wojtyla Clinic in Puente Alto between January 2011 and August 2012, 455 children were diagnosed with ADHD. The average MFD given to each child is between 30 and 60 doses per month. A 7-year-old boy is made to take 80 doses (2 pills a day) and another 10-year-old boy takes 60 doses divided into 3 pills each day. Some children do not respond to treatment and without further analysis neurologists or psychiatrists increase the dose. This is the case of an 8-year-old girl, who has to take 4 pills from Monday to Friday, that is, 120 a month.

For 2013, Cenabast put out to tender the purchase of 5,647,200 doses of 10 MG. by MFD. If we compare with the purchase of Ibuprofen (25,652,267 doses), it is estimated that the required MFD is one fifth of the most used remedy in clinics and clinics. And that for Cenabast only passes 47% of hospital supplies.

Imports of MFD to Chile went from 24.2 kilos in 2000 to 297.4 Kl. in 2011. During 2012, 28,095 students were diagnosed with ADHD. If in 2012 133,430 boxes of 30 tablets were purchased, spending $ 196,142,100; in 2011 there were 174,536 boxes at a cost of $ 413,650,320.

The diagnosis of ADHD is made mostly by teachers only from the observation of the child's behavior. The most widespread diagnosis is the Conner Test, which many teachers apply in its abbreviated version of a page with categories as ambiguous as if the child is distracted in the room or does not pay attention for long periods. With Decree 170 ADHD can be diagnosed by a teacher or a doctor. A condition for the diagnosis of ADHD is that the symptoms occur both at school and at home. Despite this, the perception made in the school environment prevails.

WHAT IS FIRST: THE REMEDY OR THE DISEASE?

Unlike common diseases or disorders, in the case of ADHD, the drug, MFD, came first, and then the nosology of the disease was made. Inti Vega, a doctor from the Usach Medical Bioethics Program, comments that “the application of the drug produces the diagnostic criteria, thus validating the idea of ​​a disorder from the effect of MFD. The remedy works on both healthy and sick. If I take it for a month I will have a different functionality, just like children diagnosed with ADHD ”.

The neurologist Ximena Carrasco defines ADHD as “a complex neuropsychiatric condition, which manifests itself in the sphere of behavior, the conduct of the subject, and which generates a disadvantage or maladjustment in different areas (personal, family, school, work, social) . It is not a mood disorder; neither is it a deficit of general intelligence nor is it a disturbance in the judgment of reality. Behavior is affected ”[1].

Francisco Aboitiz, neurobiologist and director of the PUC's Interdisciplinary Center in Neuroscience, argues that this disorder underlies "an alteration in the cognitive and behavioral control mechanisms."

On the other hand, for Andrés Garrido, Graduate in Medicine and Usach Intern, “taking children with behavior problems and transforming them into objects for psychiatry is the product of an escalation that goes through Minimal Brain Dysfunction, and each minimal change in behavior escalates to DSM III and later. There is still no clarity on its organic origin ”.

Aboitiz argues that ADHD originates from a dysfunction of the dopaminergic neurotransmitter, where norepinephrine and dopamine operate [2], which are associated with behavior and cognition, motivation, attention and learning, among several other functions. For Aboitiz “one of the primary functions of catecholamines has to do with the regulation of goal-oriented behavior, which consists of the ability to respond to stimuli that predict the appearance of an event, and the subsequent orientation of behavior in relation to to said event ”[3].

Marcela Henríquez, from the Department of Psychiatry and Medical Research Center of the PUC, maintains that evidence has only been found in the association between ADHD and 6 genes related to synaptic transmission and the metabolism of catecholamine neurotransmitters, one of them being the gene encoding for the dopamine D4 receptor (DRD4) [4].

Carrasco and Aboitiz argue that in the vast majority of ADHD cases it is a hereditary disorder (0.76 heritability, according to some studies) and they agree that “ADHD can also help us to understand the processes of controlling the behavior in the general population ”[5].

NO ORGANIC EVIDENCE

For several decades, the American psychiatrist Peter Breggin has argued that a child who has a behavioral problem cannot be related to an alteration in his brain that would be the basis of his behavior. “There is no evidence that any of the psychological or psychiatric disorders have a genetic or biological component. There is also no evidence that mental illnesses like ADHD exist ”- he maintains.

He is supported by neurologist Fred Baughman, for whom the millions of children who are medicated for hyperactivity are normal. "The country has been led to believe that every annoying emotion is a mental illness, and those who run the American Psychiatric Association know very well that they are promoting it as an illness when there is no scientific information to confirm any mental illness" [6].

Carlos Pérez, who has just published his book Antipsychiatry, says that "ADHD is part of the progressive insertion of the medical model and the clinical view in educational institutions in order to address pedagogical problems." Pérez warns that "Ritalin plays a role in therapeutic escalation, it is a precursor to more serious behavior and medication".

Garrido adds that the use of the drug “leaves aside the particularities of subjective suffering: the process of subjecting a child, the entrance to language, to be part of a family, of a community. What is expected of a child and if it meets expectations cannot be classified as being sick. When the outlets are drugs, there are no efforts to elucidate what is behind this symptom ”.

Juan Gonzáles, an academic at the University of Chile and a researcher at the Educational Policy Observatory (Opech), warns that diagnosing ADHD “damages the relationships that the child has with his environment and makes him feel disabled. That will affect their development, due to the burden of building the personality from a pathology ”.

When solving social problems with drugs, it is accepted that the problem belongs to individuals and not to society. Carlos Pérez accuses that “the discomfort is subjectivized, blaming individuals for problems that are social. Thus, an educational system in crisis is not the product of few educational resources and anachronism of pedagogical techniques, but rather of children. In this way we cast a shadow over a precarious and segregated educational school context. So it seems that the child is the only actor in the learning process ”.

Pérez goes further and maintains that “children who medicate with MFD are not calmer or have better performance, but what it causes is a placebo effect. Teachers who lose patience with a young goat relax when they give him medication and abandon their stigmatizing position. Thus the child and the teacher are relieved. It is an effect of the relationship after the use of the drug. It's not that Ritalin as a pill does anything good, but rather that it creates a context in which those involved see the world differently. "

HOW METHYLPHENIDATE WORKS

Classified in the group of psychoanaleptics (stimulant drugs), MFD has a molecular structure similar to amphetamine and acts in the brain in the same way as cocaine does, according to research by Nora Volkow, director of the National Institute on Drug Abuse (NIDA), from the USA.

Garrido explains that “the drug activates the inhibitory centers of behavior, so the boy remains calmer. It is a stimulant that raises the level of neurotransmitters, such as dopamine, with a very similar function to cocaine. There is no clarity or certainty about its long-term effects ”.

The way in which MFD intervenes at the neuronal synapse is not yet known with certainty. Aboitiz says that “the exact mechanism of action of the MFD is not known. It is known to work by blocking a molecule that is a dopamine transporter, a very powerful regulator of behavior, and on the reuptake of norepinephrine. This is called cross reactivity. This is how dopamine and norepinephrine levels are maintained inside the cell ”. Some studies indicate that a Ritalin dose of 0.5 MG./K. it is enough to block 70% of dopamine transporters.

MFD acts on the frontal lobe by increasing the dopamine load. According to Aboitiz “when the frontal lobe is activated, executive functions are facilitated and the subject improves his behavior; hence, it improves their attention focus and at the same time reduces their impulsivity and hyperactivity, improves their ability to persevere and complete tasks ”[7].

The drug does not improve the alleged disorder, causing its pharmacological action “a more self-controlled behavior on the part of the patient; and when its effect ends, the subject is the same again ”[8].

Matías took Ritalin from Kindergarten to Grade 7. Since one day a teacher told her mother that “he was a problem child”, she started taking ¼ of the pill, then ½ and then the 10 MG. From Monday to Friday. “I felt bad, my wadding hurt, I felt self-absorbed, I felt that people did not understand me. I thought I was the cuatic, the stranger. I didn't like to do the same things as other people. With pills you concentrate, but being at recess, facing social relationships, I sat and watched what the rest did, I did not feel understood. He was reluctant to love ”.

THE BUSINESS OF DIAGNOSING ADHD

When Gloria Carrillo said that she was going to withdraw her son, Matías, from the José Joaquín Prieto School, in La Pintana, administered by the Primary Instruction Society, they did everything at school so that the child was not taken. “I was a problem guardian, I distributed flyers to the guardians showing the overdiagnosis and the harmful effects of Ritalin, I interrupted the proxy meetings and they said that my child was a problem, but they did not want to let me go” - says Gloria.

When Matías was in Kindergarten, when he was only 6 years old, they began to medicate him. "He was restless, but in the garden they never complained" - Gloria details. “A few days after entering class they send me to see a neurologist after doing the abbreviated Conner Test. As he was so young, the professional asked for the support of a psychologist, who sent him back to the neurologist and they did an encephalogram. By the 2nd semester he was already taking 10 MG. of Aradix (MFD) per day. In Iº Basic it went up to 1½ pill, in the following year 2 and then 20 MG. up to date.

One day Gloria wanted to test what effect the pill had on her son and she gave it to him on a Saturday. “I wanted to know what effect it had on him and when I saw it I died of grief. He was like in limbo, stuck. I always saw him running, jumping and this time he watched TV and stayed stuck biting his nails until blood came out. He did not speak and he did not eat and he eats everything ”- he says.

Since taking the drug, Matías came home with snacks and did not participate in extracurricular activities or dance at the events. His mother says that in 3rd grade he was so sleepy that his classmates would bully him. The doubt made her participate in a workshop organized by Opech in her neighborhood, in which she was learning about the effects of Aradix. “It took me more than a year to make the decision. It's that the pressure from the school psychologist was strong. She always asked him if he took the pill. We suffer as a family, the pressure is strong. As a mother, what do you do?

“I did not speak the subject without crying and the school manipulated the situation. I brought information to the psychopedagogue about the medicine, I told them that the problem had to do with educational methods that do not adapt to the times or the advancement of children. The psychopedagogue had no idea of ​​the damage that MFD can cause and she never questioned medicating children. She told me that they teach her to treat children with the medicine ”- says Gloria.

One day he decided not to give her any more Aradix and replaced it with sweets. The boy remained the same and even became more sociable. Only at the age of 10 did he participate in some extra-curricular activity and since this year he has been going to another school. Even today Gloria wonders why so much interest from the school for Matías to stay.

Since DL 170 came into force in 2010, ADHD became a Special Educational Necessity (SEN), which meant going from a $ 51,138 grant given by a normal student to a $ 141,746. That is, almost three times more money for the supporter of the school. In Matías' course, in 2011, out of 43 students, 20 were medicated.

Today there are 2,175 establishments that benefit from the PIE program (School Integration Projects), which provides resources to hire specialized professionals to care for children diagnosed with ADHD.

Carolina Correa Braun, director of the José Joaquín Prieto de La Pintana School, maintains that there is no child of the 1,582 that the school educates that receives a subsidy for Special Educational Needs (SEN) and that they solve by themselves the cases of Attention Deficit Disorder and Hyperactivity (ADHD).

If in 2011 in the Metropolitan Region there were 2,723 students from public and subsidized schools diagnosed with ADHD, in 2012 they rose to 8,339. In Region VIII they went from 1,492 to 6,001. The national total went from 7,940 to 28,095.

Gonzáles believes that “due to the funding system for vouchers and the increase in subsidies for SEN, diagnosing children with ADHD has become a business. The schools in order to raise the subsidy are making the diagnosis to the tun tun ”.

Gloria says that “they convince you that your child is a problem child, that he is a chunk. And being told that is super strong, so for many parents it is a taboo. The proxies create the medical model. They believe that their son is sick and must be medicated, when in that school the teachers still do a whole class writing everything on the blackboard and they made me have problems because my goat did not write. One day I told the teachers ‘you are the one who does not innovate in pedagogical methods. You use a blackboard and a notebook at the time of the play station '”.

When María Pucheu, a child and adolescent psychologist at a Cesfam in Puente Alto, tried to convince the teachers of the risks that excessive medicalization entails, they told her that “they have 40 more in the class and they sit him up and repeat the instruction, but you can't let him interrupt the other kids. Teachers are the cornerstone of this system, they are required to have statistics like the Simce or the PSU, which measure very little ”.

Opech has received complaints that the parents are pressured by the schools to medicate their children, even conditioning their permanence in the schools. Gisett, a teacher at the Australia School in La Pintana, says that it is common for parents to be told in schools: “Your child is not controlled in the room, take him to the doctor. In the office they will give you the pills ”.


Family-oriented Ritalin advertising. Says: Much easier for raising children

Pucheu has also confirmed this: “Parents are told that if they do not medicalize their children, they will be future criminals or they will have mental disorders. A father who has no training in health like this accepts medicalization ”.

For many teachers and educational communities, medicalizing children with drugs has become trivial. Gisett is used to hearing from his colleagues words like "such a boy is unbearable because he did not take the pills"; or to students say "Auntie: give the pill later"; or that one child says to another: "You haven't taken the pill."

On one occasion, a 2nd grade boy went to ask him for pills and another 11-year-old takes 3 a day in a school where there are an average of 40 children per room and they have 2 data with the bad cable and 2 notebooks without a charger to do classes . “With fewer students and more pedagogical resources you can handle the situation. In a class of 40, a student can speak only once in class ”- he highlights. The regulations allow up to 45 students per classroom, and more can fit if permission is requested.

DEMEDICALIZING

Matías one day decided not to take any more pills and told his mother. He was already in 7th grade and had been taking Ritalin for 8 years. "When you grow up you start to think for yourself and I realized that I did not want to take pills" - he says. His process started when he assumed that he really felt bad taking Ritalin, then questioning why he had to take them?

Matías says that when he stopped taking the drug “it started to go well for me. I went back to painting and drawing, which is what I did when I was a kid ”. Today he is studying Pedagogy and “I would not recommend giving pills to children. A pill that affects the brain on a cognitive level does not go with pedagogical ethics. Getting educated is not just about concentrating and getting good grades ”- he highlights.

Gonzáles emphasizes that learning problems “are educational, not psychological. Today the focus is towards finding some individual harm in people who do not learn. Education for more than a century is understood as a collective process, the educational sciences are much broader than the psychological sciences, of learning. It is essential to resignify the problem of SEN as an educational, social and political problem and not as a psychological or neurological problem ”.

Like all drugs that act on the nervous system with MFD, its use cannot be stopped abruptly. The interruption must be progressive and with the agreement of the treating physician. In the event that a child is indeed restless and cannot carry out his tasks, it is recommended to choose a therapy in which medication is the last resort (and not the first) and in which various health agents participate and that is taken in it takes into account the affective and social context of the child.

Francisca Espinoza, a psychologist at Psicoymed, recommends a psychotherapeutic treatment that considers the various dimensions of the child's life. Those carried out in Psicoymed last at least 3 months and are complemented with art workshops, Bach flowers and children's Reiki. "The family joins the treatment to develop parental skills, so that they know how to intervene from home and we provide tools for the child to work on his hyperactivity, so that he can control impulsivity" - he highlights.

In addition to the Opech workshops, various other groups have focused on contesting the area of ​​excessive childhood medication. The Center for Counterpsychology Studies has already designed an approach manual and other groups have developed local works. In one of these experiences, Pablo Soto, a 4th year Sociology student at the UAH in 2011, participated. It was the Exequiel Gonzáles Cortés Population Workshop, in which 15 parents participated together with their children, of which 10 were diagnosed with ADHD . "After informing them of the risks of MFD, we looked for alternatives such as Bach flowers, involving parents in the studies of their children, who paid more attention to them and accompanied them" - he highlights.

Gonzálesaffirms that “learning problems in school must be addressed first of the meaning that children have for them, of time management, the number of students per room and the teaching of learning. None of these areas is being addressed today and it ends up only seeing the problem from the child. More actors must be involved in learning problems, beyond the psychologist, teachers and the family ”.

In its educational proposal presented in December 2011, the Coordinating Assembly of Secondary Students (Aces) integrates the demand for the end of childhood medication.

Gloria Carrillo recommends to other parents that “when a teacher or doctor gives you a diagnosis, it is not only important to contrast with the opinion of another professional, but you should also look for the information yourself. His son, Matías, is now in a school in La Pintana with 27 classmates in his class, he wears school clothes only 2 days a week and does not take drugs. “At school Matte did not like going to classes, now he is delighted to go every day. The school is the one that has to adapt. A child who is not delighted in the room will not learn anything. And the technology is there ”- he maintains.

Just as large amounts of Anxiolytics are prescribed to adults, hundreds of pills intended for minors are kept in the drawers of the principals of many schools. By accustoming children to taking drugs to perform according to standards imposed by a society obsessed with measurement mechanisms, subjects are trained in how to adapt to competition regimes. The promoted drugs do not promote autonomy and less creativity, but rather accepting authority and knowing how to solve tasks assigned in a classroom whose structure has not changed in depth in the last three centuries.

The objective of some scientists is to extend the diagnosis of ADHD to adults, to apply MFD to lawbreakers and to child inattention, especially women. Vega highlights that the MFD is now coming as an enhancer and the laboratories promote it to study ”.

Today the most bizarre piece of the Museum of Pedagogy is a rod that reminds us of the educational mantra of other times: The letter with blood enters. The pharmaceutical industry has made more infinitesimal the control of the swings of consciousness and the attention of many restless students: now it occurs in that atomic space where neurotransmitters act by retaining catecholamines. As subtle as it is effective, the memory of the pedagogy of our time will show in the future next to the rod an innocent little white pill.

Notes

[1] In ‘Attention Deficit and Hyperactivity: borders and challenges’, compilation by Francisco Aboitiz and Ximena Carrasco. PUC Editions, 2009.
[2] Dopamine and norepinephrine, along with epinephrine (formerly called adrenaline) are catecholamines, that is, hormones produced by the adrenal glands and released into the blood during times of physical or emotional stress.
[3] Francisco Aboitiz; Tomás Ossandón; Francisco Zamorano and Pablo Billeke: Tightrope balance: the neurobiology of attention deficit and hyperactivity disorder. Medical Journal of Clínica Las Condes, 2012.
[4] In ‘Attention Deficit and Hyperactivity: borders and challenges’, compilation by Francisco Aboitiz and Ximena Carrasco. PUC Editions, 2009.
[5] Ibid.
[6] In Insight magazine, June, 1999.
[7] Francisco Aboitiz; Tomás Ossandón; Francisco Zamorano and Pablo Billeke: Tightrope balance: the neurobiology of attention deficit and hyperactivity disorder. Medical Journal of Clínica Las Condes, 2012.
[8] Ibid.

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Video: What does Ritalin do? (June 2021).