From: elg@elgamy.jpunix.com (Eric Lee Green)
Date: 29 Dec 92 22:44:23 CDT
Newsgroups: sci.psychology
Subject: Re: ADD
Distribution: world
Organization: Eric's Amiga 2000 @ Home

From article <1992Dec28.214529.25665@newstand.syr.edu>, by mdkline@rodan.acs.syr.edu (Mark D. Kline):
> In article <00725522038@elgamy.jpunix.com> elg@elgamy.jpunix.com (Eric Lee Green) writes:
> If you were in my
>>elementary school classroom I would be applying behavioral interventions
>>which have proven to be fairly effective (in my classroom) for training
>>kids to be on-task and concentrate on their classwork despite their ADHD
>>(which, however, is definitely still there!) At the college level there is
>>no such support mechanism, so you may wish to wait until you actually have
>>a degree before weaning yourself :-(.
>
> I don't think its appropriate for a classroom teacher to be giving advice
> on prescription medications on sci.psychology.

Fine. How about: human being?

I have been giving that exact same advice for the last six years. I have
been a classroom teacher for exactly four months now. 'Nuff said. As a
private citizen I will tell people flat out that they should not take
Valium unless all other approaches have failed. I see no reason why, as a
private citizen, I should not say the same about Ritalin. Drugs should be a
last resort, not a first resort. The only place where I would say "drug
first, talk later" would be for major depression or psychosis, where
there's plenty of controlled studies showing that drug therapy is the
safest and most effective treatment.

However, that's as a private citizen. As a teacher, I make no attempt to
tell the parents of my students whether they should drug their kids or not.
That's not my place, and my professional role outweighs my personal role
there. This despite the fact that I'd probably breathe a sigh of relief if
one particular hyperspeed kid was put onto Ritalin -- my job is to teach
the kid, not to make suggestions about drugs. The most I can legally and
ethically do is send home a slip asking the parent to please have the child
examined by a competent professional to see whether certain behaviors
have a medical cause (such as, e.g., squinting at the board). After
I recieve evidence that the child has seen such a professional, it's out of
my hands, unless there is clear evidence of neglect or abuse.
     Not that it really matters, anyhow. One of my students IS on Ritalin
or some other such drug. I don't know exactly because it's none of my
business so I didn't ask the parent for more information after she
mentioned "Marx's medication" in a conversation. Having that
information would make no difference in how I taught the child, because the
way I teach the child depends upon his behavior and performance in the
classroom. That's what I look at. I don't look at his IQ test scores, at
his handicapping condition label (such as ADHD), or anything of that sort.
I look at how he responds to classroom conditions, and modify my
instruction and behavior management accordingly. In fact, two of my
students have labels of "Dysthymia", and I still haven't the foggiest
notion what that label means. Doesn't matter. I know what behaviors those
students exhibit, which behaviors I desire, and which behaviors I don't
desire, and I apply behavioral techniques accordingly. Which so far has had
a 100% success ratio, in educational terms -- i.e., students are on-task
and working hard for almost every minute of instructional time.

However, that's school, and this is the net. On the net, I am posting as a
private citizen, not as a teacher. I was talking about behavioral
interventions long before I was a teacher. But that's not a popular stance.
Drugs makes huge profits for the drug companies, which means that they can
spend enormous amounts on advertising extolling the wonders of the wonder
drug of the moment. Behavioral approaches have no such advertising budget.
Thus Xanax is the world's best-selling drug for mild anxiety attacks, while
cognitive behavioral interventions with equal or better results are applied
only when a patient accidentally comes across a psychologist familiar with
such interventions.

Which isn't to say that behavioral techniques are necessarily as effective
as Ritalin for treatment of ADHD. As far as I know, there have been no
studies comparing the effects of a well-designed behavior modification
system with the effects of Ritalin where ADHD is concerned. Current state
of the art in applied behavior analysis is very tedious and time-consuming,
because you have to consider shaping behaviors which do not currently
exist, fading prompts, thinning of schedule of reinforcement after behavior
is present and under stimulus control, trained sufficient exemplars if you
wish to obtain generalization across stimulae, training across environments
if you wish to obtain generalization across environmental boundaries (such
as, e.g., the kid who behaves great in my classroom but is a holy terror at
home)... it may well be that the immediate effects of Ritalin are
preferable, at least in the short term, to all this time-consuming
rigamarole. In the long term, well... we don't know.

By the way, it's amusing to read the "psychologist's recommendations" in
the Special Education folders of the kids in the Dodson behavior center.
They all read the same, regardless of the DSM diagnosis:

"Student needs a small highly-structured class with much individual
attention and a calm, caring but consistent teacher."

> stunting of growth ... not common

From what I've read, Ritalin doesn't produce permenant stunting of growth.
I.e., it doesn't cause the growth plates to harden. Still, I'd suggest that
you read any decent recent text on adolescent psychology for a discussion
of the relationship between physical development and emotional health. It
turns out that those boys who mature physically early have a sizable
advantage through high school and the early years of college, while "late
developers" score lower on scales of happiness, socialization, etc. (The
relationship for girls is a bit more complicated... girls who mature early
in grade school or even in middle school are at a disadvantage in terms of
academic performance, emotional health, etc., but girls who mature late in
high school have some social disadvantages too).

> - Mark Kline, M.D.

Since we're pulling credentials out of the barrel here, my area of
certification is Special Education of the Severely Emotionally Disturbed
and Autistic, and applied behavior analysis is my stock in trade. However,
unlike many, I'm willing to admit that much of the improvement that my
students show (and they are showing enormous improvements both
academically and behaviorally) may be due to simple maturation rather than
to any effort on my part... i.e., "first principle of all, do no harm."

--
 Eric Lee Green  elg@elgamy.jpunix.com   Dodson Elementary
 (713) 664-6446                             Houston, TX
                "Kids are kids, no matter what"
Newsgroups: sci.psychology