up?
Aaron Nicodemus
Parents of children at schools in Cape Town’s affluent suburbs say their children are forced to take the drug Ritalin – a stimulant which inhibits impulsive behaviour.
Some children have been threatened with expulsion if they do not take the drug, while at other schools taking it has been made a prerequisite for admission.
Ritalin is a powerful schedule seven drug that has been shown to be effective in calming hyperactive children, focusing their attention on their schoolwork and limiting aggressive outbursts.
But it also has serious side effects in about 20% of children, most notably trouble sleeping, loss of appetite, moodiness and a change in personality. Some children suffer depression, nausea and, in rare cases, permanent facial tics.
It should not be dispensed like aspirin, as a panacea for a teacher who cannot control a class of 35 children.
Denise Ridge’s seven-year-old son was labeled “the Ritalin Case Kid” by teachers at two Cape Town primary schools because she refused to place him on the drug.
Ridge says the schools pushed to have her son assessed, and then pushed to put him on Ritalin. He has been diagnosed with attention deficit hyperactivity disorder, but she believes there are other ways to help him learn.
“It’s not fair to a child to get him doped up to shut him up. It’s wrong,” she says. “It’s too easy now to put a child on Ritalin and keep him quiet. Every child should have the chance to reach his full potential without being drugged up.”
Michelle Tonks placed her hearing-impaired daughter on Ritalin seven years ago. It made her irritable, suppressed her into a “zombie- like” state and curtailed her appetite. At one point the family paediatrician recommended placing her on other drugs like Prozac and Convalex.
Tonks found alternative medicine for her daughter, gave her vitamins and decreased her sugar intake. And now, seven years later, her daughter is performing well at school. But she has developed an involuntary tic, which makes her eyes big and pulls her mouth to one side, which Tonks blames on Ritalin.
“In my opinion it is very `in’ to put children on Ritalin if they show the slightest tendency to be noisy, active or disruptive,” says Tonks. “It is frightening to me how many children are on this drug.”
Other parents have been happy with their child’s reaction to Ritalin. Anne Doyle says her son “couldn’t do without it”. In the past three years he’s been on Ritalin, Doyle says her son’s concentration and behaviour have improved. But his daily dosage of Ritalin is small, and she is combining “natural alternatives” and a strict diet as part of the overall strategy to control his hyperactivity. A neurologist re-evaluates her son’s Ritalin intake during regular check- ups.
The issue that some parents have with the drug is the way it’s being forced upon them. They say the drug has become a first resort for some schools, where large class sizes make it difficult for teachers to handle poorly behaved children.
Many parents whose children are on Ritalin are embarrassed to talk about it, either to other parents or to doctors. Once a child’s teacher, principal, paediatrician and psychiatrist agree that Ritalin is the answer, parents are left with a troubling choice: sign the forms the experts have placed in front of them, or buck an entire system and search for alternatives. Many parents, emotionally drained by their hyperactive child, sign the documents.
School officials say they do not force parents to place their children on Ritalin. Suzette Swart, a psychiatrist at Tafelberg School in Sea Point, says: “There are a lot of children who cannot function without Ritalin. It’s like a diabetic without insulin. We use Ritalin as a means to help children concentrate better, not to change their behaviour.”
Swart says the drug is strictly controlled at Tafelberg, that regular consultations are made to monitor a child’s progress and that medication is only dispensed at school with a written parental consent.
Swart estimates that about a third of Tafelberg’s pupils are on Ritalin, but that since the school is specifically geared to children with special needs, many of them have behavioural and learning problems. “Not all children with concentration problems need Ritalin,” she said. “Not all children will respond well. But for some children it is very effective.”
Wendy Crondie, deputy principal at the private Sweet Valley Primary School, says about 30 of the school’s 960 pupils are on Ritalin. She says school officials might suggest that a parent have their child assessed for Ritalin use, but that they would never force a child on to the drug.
Officials at Wynberg Boys’ Junior School, a public school, say that less than 3% of pupils take Ritalin on a regular basis.
Department of Health officials who work with Cape Town schools say Ritalin is not over- prescribed. Attention deficit disorder and hyperactivity are under diagnosed, they say, and some children with concentration problems are falling behind in their schoolwork as a result.
“I don’t see Ritalin as a dangerous drug,” says Dr Jennifer Fairborn, who works with schools in Cape Town’s southern suburbs. “What’s bad about it is that it’s not being properly monitored. If they’re just given the drug and not monitored, that’s quite heavy.”
Dr Karina Hart, a health official, also believes Ritalin use is low. “It is increasing, but I don’t think that much,” she says. “The size of classes is becoming a problem, and some teachers cannot cope with children who cannot concentrate on the lesson. There are children who are being passed who aren’t learning what they should because they cannot concentrate.”
According to the drug’s local manufacturer, Novartis of South Africa, about 12 000 packs of Ritalin are sold in South Africa every month. Novartis estimates that the average patient takes two tablets per day, so about 6 000 children a month take Ritalin.
There is a movement against Ritalin and for alternative treatments. Dr Carel Bredell, a general practitioner in Somerset West, calls Ritalin “an evil drug”. He says it damages children, and that not enough time and effort are spent exploring other options.
Bredell says the drug “makes a child less of a person” by diminishing their personality. A child once described Ritalin’s effect to Bredell as “squashing me in a little box”, and he says children on the drug often are depressed, don’t eat and lose interest in toys and friends.
“It can have some really scary side effects, and some of them don’t come out until years later,” Bredell says. “Life is higher than scoring a little bit higher in math. I go out of my way to take kids off it.”