Systemic Healthcare Issues
Tell us about your research into the effectiveness of Ritalin on kids with attention deficit hyperactivity disorder (ADHD). How does this issue illustrate the complexities of ‘wicked’ healthcare problems?
ADHD is the most common childhood ‘disability’ in the U.S., the most common mental health problem in the UK, and it is becoming a big problem here in Canada, too. Clinical trials show that Ritalin helps kids concentrate and controls outbursts of hyperactive behaviour. The problem is, the environment of a clinical trial is very different from the real world, where you are no longer in control of how children take the medication, the dosage they take, who prescribes it, or whether the child actually has ADHD in the first place.
Going into this research, my colleagues and I thought we’d find mainly positive effects of Ritalin; instead, we found a picture of deeper, systemic problems. Ritalin itself is probably not hurting kids, but I would say that doctors are very quick to prescribe it (or similar stimulants), and that parents and teachers tend to think that solves the problem. From the perspective of a teacher, if Ritalin stops a child from running around and misbehaving, the problem might seem solved; but it doesn’t mean that the child is actually learning and he or she is probably now getting much less attention. So these drugs can mask other problems.
This is an interesting wicked problem because we are continuing to learn about how the brain functions, and there is still a stigma surrounding mental health. Whenever I talk about our findings, someone says, “Isn’t ADHD just what we used to call bad behaviour? Just be stricter, and this problem won’t happen anymore.” There is still a disbelief among some people that mental health problems can be partially corrected through medications that change the balance of the brain’s chemistry. On top of that, a lot of people who probably don’t have ADHD are taking these drugs. So, there is this curious combination of some people not taking the problem seriously enough, and others over-treating it. Overprescription is problematic because these drugs can have serious side effects — everything from nausea to suicidal thoughts.
Complicating matters, most people seek help from their family doctor, many of whom don’t specialize in mental health, so you end up with a parent who’s desperate, a kid who’s not doing well, and a doctor who doesn’t have a lot of experience with the problem. If all these kids required diagnosis and treatment from doctors who specialize in ADHD — which is required in France, for example — I think the rates of over-prescription would be much lower.
There is also a willingness among the general public to believe that we can solve everything with medication. Pills can help, but they are not the whole answer — it also requires time and hard work. There is evidence suggesting that intensive training for parents is a helpful way to combat ADHD, but this treatment is expensive, and it requires a large commitment of time and effort from the parents and educators.