Can I take Ritalin after I stop taking Adderall?

Pros and cons of Ritalin as a therapeutic agent for ADD

Content:

1. Ritalin in public discussion

2. Ritalin in its current application in Germany

3. How Ritalin works

4. Risks of Using Ritalin

5. Risks of Not Using Ritalin

6. Conclusion

7. Literature

1. Ritalin in public discussion

ADS has become popular. Almost any teacher can name students who they suspect or think they know have ADD. Parents hope that ADD diagnosis will help their difficult child.

Both teachers and educators as well as the parents of ADD children are also looking for relief for themselves: an ADD child in a class / group of children may bind as much of the educator's energy as five other children. Parents are often confronted with the accusation that they have not fulfilled their educational responsibilities. The domestic and family situation is often determined by frequent conflicts in everyday life with the child / adolescent with ADD in the center. Many parents may have tried unsuccessfully in various ways to defuse the permanently tense situation. Parents in this situation also see themselves confronted with their own insecurity, with self-doubt and feelings of guilt and again and again with the fight against their own resignation. Added to this is the well-founded concern about the personal, school and later also professional development of your child (Neuhaus 2000, p. 115).

Parents have to make decisions in this regard to shape situations in which they are emotionally involved to a high degree. Time and again, hopes, fear of disappointment, uncertainty regarding one's own competence and fear of the consequences of wrong decisions are factors that, in addition to the factual weighing of objective scientific findings, shape the parents' decisions.

The prospect of a diagnosis of ADD now gives the parents and educators concerned the hope of a scientifically based concept of professional help. Very soon the parents are then confronted with the need to take a position on drug therapy. The public debate about ADD is very controversial, passionate and emotionally charged, especially in relation to Ritalin[1]. There are plenty of forums on the Internet on the subject of ADD, in which parents and teachers of ADD children, even those affected, therapists, doctors and other professionally involved, very lively debates. Again and again, the question of the rejection or acceptance of amphetamines like Ritalin is the focus. The number of experts in this field is huge, but just as huge is the range of viewpoints and, above all, the arguments that are intended to support these viewpoints.

The abundance of books that are primarily offered to parents and teachers as guides paints an equally mixed picture. In addition to a multitude of possible causes for the development of ADD, diverse therapeutic concepts are discussed. In this context, it is often stated, with reference to serious side effects of Ritalin, that this is not an alternative to the therapy presented in each case. Not infrequently, for example, from the chemical relationship between Ritalin and cocaine, the polemical conclusion is drawn that Ritalin has a comparable addictive potential.[2]

On the other hand, Ritalin is often portrayed as an inescapably necessary remedy that chemically corrects an existing physiological malfunction. This gives it a similar importance as that of the insulin syringe for the diabetic.

For those concerned who go into this jungle in search of help and support, it is made quite difficult to distinguish between serious information and information that, under the guise of scientific knowledge, represents commercial, religious or ideological interests.

The strong polarization for or against Ritalin often obstructs the view of what I believe to be an essential question:

How important is drug therapy for ADD alongside / in connection with other forms of therapy?

2. Ritalin in its current application in Germany

From 1990 to 2001 the number of Ritalin prescriptions in Germany increased 30-fold. A similar development can be seen in other European countries (Hüther / Bonney 2002). Hüther and Bonney (2002) describe this development as worrying and ask about possible reasons for this rapid increase:

- Is the active ingredient particularly good?
- Has the diagnostic practice developed in such a way that more ADD cases are recognized?
- Have the living and development conditions changed so dramatically that the severity of ADD has multiplied? or
- Is the increased willingness of doctors to prescribe Ritalin causing this increase? Do the rates of increase characterize the increasing frequency of misspellings?
- Do increased performance expectations and / or higher social and economic pressure on those affected, their parents, teachers and doctors contribute to Ritalin being prescribed more often?

(see Hüther / Bonney 2002, p. 13 ff)

Obviously, the increase in Ritalin prescriptions is also the result of a changed social reflection on the ADD phenomenon.

It is estimated that there are around 170,000 to 350,000 children in need of treatment in Germany. Long-term treatment with stimulants such as Ritalin was given to around 50,000 by autumn 2001 (cf. Hüther / Bonney 2002, p.12). Given these numbers, a further increase in prescriptions can even be expected. This development is worrying only under the assumption that the drug treatment of ADD by Ritalin is generally or at least frequently misindicated or that the positive effects compared to the expected side effects (medical as well as psychosocial) are not justifiable.

3. How Ritalin works

Although Ritalin and other stimulants have been shown to improve symptoms in between 50 and 95 percent of children with ADD, especially in the areas of general behavior, school performance and social integration skills (Barkley 2002), the mode of action has not been fully understood. It is considered certain that Ritalin stimulates the release of the messenger substance dopamine and inhibits its absorption. However, there are two fundamentally different lines of argument that establish the connection between this neurophysiological effect and the observable effects on ADD symptoms: The dopamine deficiency and the dopamine excess hypothesis:

Since the mid-1980s, a neurophysiological explanatory model has been established that is currently represented by many child and adolescent psychiatrists. The main symptoms of ADD (hyperkinesis, attention deficit, lack of impulse control) are traced back to a disturbed management and control of behavioral reactions, especially cognitive and motor processes. This, in turn, is seen as a consequence of reduced activity or a deficient development of the dopaminergic system in the cortex (involved in the regulation of motor activity, curiosity and the development of action strategies), in limbic brain regions (involved in the regulation of motivation and emotionality) and in the striatum (involved in the regulation of attention, willingness to react and motor skills). This disruption of the dopaminergic system is described as reduced dopamine release (receptor defects) at the synapses and / or increased dopamine reuptake (transporter defects), so that too little dopamine is available. This dopamine deficiency can be compensated by giving Ritalin. Barkley (2002) points out that there is a lot to be said for this thesis, but that the current data situation does not permit any clear conclusions. Nevertheless, this argumentation ring has firmly established itself and determines what happens in clinical practice, in research institutions, in pharmaceutical companies, in universities, at congresses and training courses. (see Hüther / Bonney 2002, p.23)

Various causes are considered for this suspected neurophysiological deviation. In addition to environmental conditions (e.g. alcohol and nicotine consumption during pregnancy, lead poisoning), which are considered to be of marginal importance (Neuhaus 1999), genetic dispositions in particular are mentioned. According to Barkley (2002), the findings available today suggest that most ADD cases are genetic. Barkley suspects that the development of the frontal cortex and the nucleus caudate is susceptible to interference as a specific factor that is inherited in ADD (cf. Barkley 2002, p.124).

Hüther and Bonney (2002) point to contradictions within this “standard model” or to contradictions to more recent neurobiological findings. Above all, the growing insight that the formation of neural connections in the developing brain does not take place almost automatically, controlled by a genetic program, but is shaped and stabilized to a large extent by the respective conditions of use and requirements, compels us to review the original Concept. By pointing out that proof of effectiveness is no proof of the validity of an effective hypothesis, they warn of skepticism towards previous ideas and develop a different line of argument based on the following fundamental considerations and findings:

- Some neurological findings in ADD, e.g. the observable increased uptake of dopamine, allow, in addition to the interpretation as a transporter defect within the dopamine deficiency hypothesis, the assumption of an increased dopaminergic innervation density, an increased expression of the neural network that is responsible for the perception of everything new and exciting , unprecedented is activated.
- The development of the dopaminergic system has a strong dynamic in the period between birth and puberty. The dopaminergic innervation increases enormously during this period, while afterwards it continuously decreases until the age limit is reached.
- The development of the dopaminergic system depends on the frequency and strength with which it is activated by the perception of new stimuli.
- The brain as a neural matrix is ​​plastic and malleable. Not only sensory impressions and motor behavior patterns, but all interactions between the person and the environment, including interpersonal experiences, are encoded in neural networks in the brain. The less mature the brain, the higher the plasticity.

There may be children whose genetic disposition is much more alert, alert, curious and easier to stimulate than others. These children are at risk of falling into a vicious circle:

Since their dopaminergic system is activated much more frequently than that of "normal" children, the outgrowth of its axonal processes is also particularly strongly stimulated. Your dopaminergic system will develop better and better and work more and more effectively, so that these children will be stimulated and stimulated more easily by all kinds of novel stimuli. If it is not possible to break this cycle early, the child will sooner or later be noticed due to its excessive drive, its enormous inner restlessness, its constant search for new stimuli (cf. Hüther / Bonney 2002, p.69f.). So nerve cell interconnections are increasingly being stimulated and thus developed over time to ever better and more effective effectiveness, which are responsible for the control of undirected motor skills, unselective perception and undirected attention. Those neural interconnections that are responsible for focusing attention and controlling impulses are correspondingly less used and thus receive fewer stimuli that stimulate their further development. The visible symptoms are noticeable distractibility and a lack of concentration

The increasing psychosocial conflicts can also contribute to the stabilization of behavioral patterns that are to be regarded as misconduct or behavioral disorders: The emotional insecurity generated by these conflicts and the associated stress reaction triggers biochemical processes that develop those neuronal connections that the child needs to regain his emotional level Uses balance. If it tries to do so by fidgeting, it will become an increasingly "better" fidget philipp. If it tries to do this through disturbance, its disturbance behavior becomes more and more effective. If it tries to listen away, it will initially become deaf in one, possibly even in both ears. (cf. Hüther / Bonney 2002, p.70) If a child has developed such a behavioral disorder in the course of his first years of life as a result of unfavorable starting conditions and / or difficult family and social circumstances, his brain is structured and organized differently than that of a " normal “child, not only with regard to the dopaminergic system, but all areas of the brain and neural networks involved in the regulation of motor activity, attention and impulsivity.

The hypothesis of an underfunction of the dopaminergic system, which is characterized by a dopamine deficit, is contrasted here with the hypothesis of an overfunction of the dopaminergic system, from which the same core symptoms of ADD can be derived. The observable effect of the Ritalin is explained completely differently in this concept:

Again, the administration of Ritalin would increase the release of dopamine. However, since the dopaminergic system is already activated at a high level and one has to assume that there is already an excess of dopamine, the child in question will not notice anything or not much of a further increase in the dopamine level. Due to the sudden massive release of dopamine, however, the dopamine reserves in the storage vesicles are used up. The empty memory can only be refilled slowly, over a period of three to five hours. A person with a normally developed dopaminergic system will “sag” during this time and will be listless and listless. During this period, ADD children would be able to experience what it is like when their overdeveloped drive system has run out of steam. (see Hüther / Bonney 2002, p.72)

This approach also leaves many questions unanswered and (in the form presented above) contradicts some empirical findings: e.g. the long-term effects of Ritalin SR ® or of staggered single doses of Ritalin within this approach.

Both hypotheses have one thing in common: They do not regard Ritalin (certainly in recognition of its effect on ADD symptoms) as a cure for the causes of ADD. However, while the dopamine deficiency hypothesis does not see a real alternative to drug compensation for the deficit, Hüther and Bonney see the importance of Ritalin & Co. differently: Treating ADD exclusively with psychostimulants does not constitute a viable strategy for the sustainable correction of such a complex one through interaction undesirable development caused by various factors (cf. Hüther / Bonney 2002, p.82)

Hoehne (2003) states that, in the course of the decades, a great number of very different explanatory models have been published, which may well apply with different weightings, but that each is by no means satisfactory in itself. In every single child one could find an emphasis on one cause or the other in the context of their life.

There is broad consensus about the observable effects of Ritalin. Hüther and Bonney (2002) have summarized the experiences of the last four decades as follows:

- In a large number of patients, the disturbed behavior under methylphenidate changed promptly, reliably and without developing tolerance,
- In particular, the symptoms of hyperactivity, restlessness, impulsiveness and aggressiveness are alleviated or disappear completely.
- School-relevant skills such as perception, concentration, attention and motor behavior. Furthermore, a higher vigilance, focused attention, reduced distractibility and a considerable increase in learning were observed.
- The improvement of the typeface suggests a stabilization of the fine motor skills.
- The treated children showed a significantly more adapted behavior with a reduced level of activity.

(see Hüther / Bonney 2002, p.74)

Neuhaus (1999) also refers to an increase in the performance of short-term memory.

4. Risks of Using Ritalin

Neuhaus (1999) points out that more research has been done on studying stimulant therapy and its effects on children with ADD than on any other form of treatment for any child psychiatric disorder. By the fall of 2001, more than half a million reports of drug treatments for ADHD children had appeared. (Hüther / Bonney 2002, p.76)

Although there are still only hypotheses about the mechanisms of action of Ritalin on ADD symptoms, well-founded statements can be made about many medical risks and side effects of Ritalin.

However, the use of Ritalin also has social and psychosocial consequences that can pose a risk.

In the following, some risks are discussed that are frequently cited and / or that are assessed very differently by different scientists:

Ritalin is a drug. It gets you high. It is addictive. It paves the way to substance abuse:

There have been reports from the United States that Ritalin is used as a drug by adolescents who do not have ADD. It is swallowed or snorted in powder form and can therefore have a slightly euphoric effect on young people and adults. Dissolved in water and injected intravenously, the effect is said to be comparable to that of cocaine. In 1995, roughly as many children and adolescents between 10 and 14 years of age in the USA were admitted to hospital emergency rooms because of an overdose of Ritalin as because of excessive cocaine use (Hüther / Bonney 2002).

This euphoric effect does not seem to occur in children, nor in adolescents and adults who take Ritalin because of their ADD symptoms, in doses such that the desired and expected effect of improving symptoms occurs (Barkley 2002, Schäfer 1998).

If the dosage is too high, ADS users report unpleasant sensations such as being overworked and restless, comparable to a “coffee intoxication”.

Many representatives from the group of amphetamines are potentially addictive (e.g. the amphetamines used in 1936 for ADD symptoms) and some are very popular in the drug scene. The chemical affiliation of methylphenidate - i.e. Ritalin - to this group made it appear advisable to the legislature to place Ritalin under the stricter regulations of the Narcotics Ordinance. Some authors incorrectly interpret this fact to the effect that Ritalin is "officially" classified as an addictive substance.

There is no study in which the development of addiction has been proven. This applies to both its use in ADD and its abuse as an intoxicant. The current package insert no longer contains any information about the risk of dependencies. A few years ago some doctors in Germany advised to gradually discontinue Ritalin in order to alleviate any possible withdrawal symptoms, but today it is a common recommendation for schoolchildren to avoid Ritalin on weekends and during the holidays.

The thesis that Ritalin is a gateway drug is dealt with under 5..

Ritalin does not change the root causes of ADD. It is a sham solution and obscures the real problem:

Here the opinions of the experts differ. Barkley (2002), who is sometimes cited as the leading ADS specialist in the USA (Neuhaus 1999), describes this statement as simply wrong and a legend. He rules out that ADD can be attributed exclusively to environmental factors, such as an overly indulgent upbringing or too little love in the parental home. He sees ADD as a largely genetic disorder, which is characterized by an underfunction in certain brain regions and thus causes the ADD symptoms. This hypofunction has to be compensated by stimulants. He compares the need for stimulant therapy and the lack of alternatives to insulin treatment for a child with diabetes. (cf. Barkley 2002, p.396f) The consequence of this view would be the necessity to be dependent on Ritalin for a long period of time and, if the symptoms do not "grow together", possibly for life.

Many authors point out that Ritalin can have a positive effect on the symptoms, but is not able to eliminate the cause of ADD.

Schäfer (1998) states that the short-term effectiveness of Ritalin cannot be doubted, but believes that long-term therapeutic success can only be expected if the drug treatment of other forms of therapy, such as behavioral therapy for children / adolescents, parenting advice, parenting training, is accompanied. (see Schäfer 1998, p.62)

Hüther and Bonney complain that this connection is not weighted accordingly in the professional world either. According to their figures, there is only one study on psychotherapeutic methods for every 170 studies dealing with drug therapy. They insistently refer to the possibilities of non-drug, especially psychotherapeutic, treatments. It has been sufficiently proven that neglect, abuse and emotional insecurity during childhood have a lasting effect on further brain development and are crucially involved in the later development of various mental disorders. Unconscious early hurts and fears determine how and what the brain is used for and how it is structured.

But it's not just negative experiences that affect the structuring of the developing brain. Everything that helps a child or adolescent with ADD to cope better than before with certain stresses, to deal with them and to find a way out of the vicious circle of fear, uncertainty and unsuccessful attempts at finding a solution, is reflected in the physiological manifestation of the Brain down. This is especially true for everything that helps him to become safer again, to develop stable emotional bonds, to gain new self-confidence and to overcome all the unconscious early injuries and fears. (cf. Hüther / Bonney 2002, p.79) On the basis of this argumentation, they raise the demand for psychotherapeutic support not only for the affected child and adolescent, but also for those around him, especially the family.

The question of the use of Ritalin no longer arises primarily under the aspect of compensating neurophysiological defects. The disappearance of ADD symptoms through stimulant therapy could hide the fact that the child and their family need substantial help. (see Hüther / Bonney 2002, p.139)

They also see causes in social processes and constellations that make healthy development difficult and increase the risk of developing ADD.

A systemic view of the ADS phenomenon is, among other things, developed by Hoehne and Resch. Resch (2003) points to the effects of globalization on the microclimate of living spaces and states in this context that the emotional dialogue between adults and children is impaired. The growing psychosocial pressure that weighs on the parents is also transferred to the children through the families' culture of upbringing and relationships. This affects the child's self-development, which in turn leads to a weakening of the ability to come to terms with postmodern maxims at all. (see Resch 2003, p.36)

Hoehne (2003) shows parallels between the increase in conspicuous behaviors and the rapid changes in living conditions for children in their environment in recent decades:

- Children have fewer and fewer rooms, especially play rooms, which they can design themselves.
- The curiosity behavior of children is restricted by ready-made game and learning content.
- Children have less and less free time.
- The general pace of life is accelerating, performance requirements are becoming more stringent.
- The number of children in our society is falling, society is increasingly shaped by adults.
- Children are increasingly dependent on contact with adults because fewer and fewer siblings or friends of children can be reached.
- Children's worlds tend to become isolated, they are increasingly determined by adults and prescribed to children.

(cf. Hoehne 2003, p.122)

It is becoming more and more difficult for children to find a corresponding free space in this world in which they can realize themselves, "in which they can develop their space and their time" (p.122).

Hoehne points out the possibility of explaining the ADD symptoms from a systemic point of view: as a form of childlike expression that is supposed to signal “I'm not fine, I would like to have changed something, please help me”. (P.122) Hoehne (2003) also emphasizes that due to a change in action or behavior, the neurotransmitters also change in their composition and accumulation. Similar to Hüther and Bonney, he thus replaces the linear-causal attempts to explain, according to which the ADD symptoms are the result of neurophysiological changes, and establishes that cause and effect are not in a clearly defined linear relationship.

This systemic interpretation of the ADD symptoms as a cry for help makes a danger clear: the unreflected "disappearance" of the symptoms by Ritalin deprives the affected children of a channel of communication. The pressure to change the environment and the interaction patterns created by the “disruptive” behavior becomes ineffective.

Hartmann (1997) describes the behavior typical of ADS within a continuum of possible human behavior and shows how the particularities in the attention structure and in the impulse control, which are now described as misconduct, were indispensable characteristics for the survival of the group in earlier stages of human culture were. In this context, he criticizes the practice of attributing “illness”, which always involves stigmatization, and asks to what extent this is a reflection of social and socio-ecological changes (e.g. “disease of left-handed people”, cf. Hartmann 2000, p. 30f ). Hartmann (1997) emphatically appeals to those affected and their environment to perceive the specific strengths of ADD people, to cultivate them (i.e. to relate them to the demands of our society) and to use them specifically for a successful lifestyle.[3]

Conclusion:

1. Ritalin should not be seen as a solution to the ADD problem.
2. The use of Ritalin harbors the danger of calming down all those involved (parents, educators, doctors, those affected and experts) where it is necessary to be concerned in an activating and motivating sense, which can create the courage and strength for change.

The medical side effects of Ritalin are serious and uncontrollable: Short- and medium-term effects and side effects are extensively described and known and are generally described as easily controllable (possibly by discontinuing the drug). They are not to be presented here any further.

Statements about the effect of Ritalin on the neural constitution and maturation of the developing brain are largely speculative.

Studies on young rats (Moll et al. 2001, according to Hüther / Bonney 2002) have shown that the dopaminergic system develops less strongly and remains less intense throughout life with chronic administration of Ritalin. Provided that these results can be transferred to the development of the human brain[4], would lead to the following conclusions:

If, as Hüther and Bonney (2002) consider, the dopaminergic system of children with ADD should actually be too strongly developed, this treatment might prevent it from developing further, that is to say “cut it back”. In this case, Ritalin could actually have a long-term balancing effect on the development of the neural matrix.

However, if the dopaminergic system is actually underdeveloped and insufficiently active, as assumed in the classical thesis, early and intensive Ritalin treatment would intensify this deficit even further and thus lead it further into the disease.

Incorrect indications or use in children whose dopaminergic system is not overdeveloped would also result in a deficient development of the dopaminergic innervation. Then there would be the risk that the prerequisites for the later development of Parkinson's syndrome, which is precisely characterized by insufficient activity of the dopaminergic system, improve. (Hüther / Bonney 2002, p. 73)

5. Risks of Not Using Ritalin

In view of the currently existing uncertainties about the mechanisms of action of Ritalin and about the serious long-term consequences of long-term Ritalin treatment in children and adolescents that cannot be ruled out, the vehemence with which Ritalin -critical positions are represented in public is somewhat understandable. Ritalin should only be viewed as a “stopgap solution”. The demand to look for alternative ways of dealing with ADS is justified.

From my point of view, an unacceptable way of confronting the ADS phenomenon is to view ADS as a “fashion phenomenon”, as a theoretical construct without a real existing equivalent. The following reference seems important to me in this context:

Viewed in and of itself, ADD does not impair the person affected, such as a runny nose or a broken leg. ADD only becomes an impairment in the context of the social environment, in the arc of tension between requirements and norms of society and the possibilities of those affected to meet them. Hartmann (1997) describes how the specific life situation of the person affected decides whether an impairment actually arises from the ADD symptoms and supports his thesis, among other things. with the following quote:

“I have worked as a doctor in indigenous hunting societies all over the world, from Asia to North and South America. Over and over again I have seen the constellation of behavior patterns in adults and children that we ADD [Attention Deficit Disorder; d.V.].

In tribes in North America, such as the caribou hunters of the McKenzie Basin, these adaptive traits - constant control of the environment, quick decision-making (impulsiveness) and willingness to take risks - contribute to the tribe's survival year after year.

The same behavior, however, makes it difficult for the children of these tribes to succeed in our western schools when we try to force our western timetable on them. ”(Krymen quoted in Hartmann 1997, p.42)

ADD should not only be understood as a medical problem. Lack of focus of attention and high impulsiveness only become disorders when they become the cause of constant and serious conflict. Then, however, vicious circles can be induced in the way that Neuhaus (1999) describes as a "learning history":

Figure not included in this excerpt

Such downward spirals can form, stabilize and generalize in various areas of life and, as Hüther and Bonney (2002) have shown, materialize in the formation of neural networks.

School failure, unsuccessful social and professional careers, an increased risk of slipping into crime and an increased risk of mental illness (e.g. from depression) are common consequences.

When parents or teachers turn to experts for help, it is not primarily because of the specifics of the focus of attention, but because of the already existing enormous suffering that results from the effects of such downward spirals.

When looking for help, children with ADD and their parents are generally in chronic conflict situations and need help that will lead them out of the crisis as quickly and effectively as possible.

There are various educational and psychological therapeutic programs that aim to reshape the communication and interaction patterns between the child with ADD and their environment and to establish and train internal control and management bodies. All of these programs have in common

- that they should enable experiences that are not feasible within the negative spiral
- that they should "overwrite" existing behavior patterns and replace them with new ones
- that they Not promise a short-term solution to existing conflicts.

They also assume

- that generally a relatively large group of people, especially from the family and educational institutions, have the will and the ability to participate and
- that they are professionally instructed / supported.

It is simply a fact that for many of those affected a corresponding educational / therapeutic offer is not available. In many places, pediatricians and teachers, but also psychologists, do not feel competent. Contact with “specialists” often means long waiting times and long journeys, so that continuous and timely cooperation is hardly possible. For many families, this effort is not manageable.

In these cases, if indicated, Ritalin can quickly and significantly relieve the situation:

- School “slipping” can be stopped, the field of experience “learning / school / school performance” can be given a positive value again.
- Relaxation in the family area, less traumatic situations are experienced (e.g. "drama homework" or "drama tidying up the room").
- The initiation, maintenance and creation of satisfactory social relationships is more successful. It is possible to behave in a more socially appropriate manner. Negative feedback is becoming rarer.

Like therapeutic methods, Ritalin can help break down "downward spirals" and create space for the emergence of new behavioral structures, but with two main differences:

1. Ritalin works immediately, but only for a short time.
2. Ritalin does not cause any lasting changes in the person's environment.

Hüther and Bonney (2002) point out that the new conditions of use of the brain achieved by drug treatment also lead to the fact that the neuronal interconnections, which are now used more intensively and successfully, lead to a corresponding structural anchoring in the brain.

In the Scandinavian countries, the prescribing and use of Ritalin et al. linked to the condition of an accompanying therapeutic treatment. This means that the legislation already recognizes the thesis that the treatment of ADD with Ritalin is not a viable strategy for the sustainable correction of such a complex undesirable development.

However, the initiation and course of a therapy can possibly be positively influenced by Ritalin. The combination of low-dose stimulant and behavioral therapy is likely to be more effective than either treatment on its own. (Schäfer 1998) The prompt effects of Ritalin can be used therapeutically in a targeted manner to create and explore new spaces of experience. They can create free spaces in the behavioral repertoire in which new structures can grow with therapeutic support.

But even if Ritalin is given to children and adolescents as a long-term drug without accompanying therapy, it has positive effects on successful socialization. Barkley (2002) cites study results that show that adolescents with ADD who were treated with medication used drugs significantly less than adolescents with ADD who did not take any medication. This result can be interpreted in different ways: on the one hand, that the long-term medication prevented or reduced the development of downward spirals; on the other hand, one could view the relative frequency of drug use among adolescents with ADD as attempts at self-medication that becomes superfluous when stimulants are used . For example, nicotine increases the effectiveness of dopamine, which is probably one of the reasons why people with ADD are smokers more than average.

“When I was seventeen, I finally found something that turned off the constantly buzzing cogs in my brain: alcohol. When I was twenty-three I was a completely seedy drunkard. I was really exhausted. With God's help and the support of Alcoholics Anonymous, I did it again.

But it wasn't until I was thirty and started taking Ritalin that the constant rattling in my head finally stopped, the constant distractions from all directions. That was the first time I could smell flowers and experience life. I could listen to others and understand what they were saying.

And since then I have changed: I used to have to fight the hot cravings for a drink. Today I no longer have this urge. ”(Anonymous, quoted by Hartmann1997)

6. Conclusion

Are the children with ADD sick or is it our society? The causes of ADD are not to be found in the brains first. Genetic predisposition cannot be accepted as a sufficient explanation for the growing number of children suffering from ADD. The society in which and by which they are brought up has played a major role in the worrying undesirable developments in our children. Hüther and Bonney raise critical questions:

- Why do children keep being born that nobody looks forward to?
- Why are we actually unable to shield our pregnant women sufficiently effectively against all external influences that impair the undisturbed development and maturation of their unborn child?
- Why are many parents insecure in their upbringing and easily influenced by other people's ideas?
- Why do so many partnerships fall apart when the children urgently need both parents?
- Are the educational facilities for our children really designed to meet the needs and development opportunities of these children?
- Is there still enough space and time for children in today's excited, hectic, performance and competition-oriented world of adults?
- Why do many parents find it difficult to set and adhere to clear boundaries for their children?

(see Hüther / Bonney 2002, pp.81f.)

The often striking effectiveness of Ritalin against the symptoms of ADD and its immediate social consequences increases the temptation to hide social responsibility under the guise of medical conditions. This applies to parents and grandparents, to their neighbors and friends as well as to educators, doctors and politicians.

Nevertheless, under the conditions that have prevailed up to now and probably also in the near future, it will often not be justifiable to consistently forego Ritalin.

The use of Ritalin as a long-term drug in children and adolescents involves risks that cannot be calculated based on current knowledge.

Absolutely not using Ritalin in a society that does not offer sufficient alternatives would mean accepting considerable risks, which can very well be assessed.

Professionals and those affected are not living up to their responsibilities if they use Ritalin as the sole means of dealing with ADD. Both demonizing and stylizing Ritalin as a "savior" are not appropriate. Those affected are faced with the task of weighing the risks of using Ritalin and those of not using it.

ADD should no longer be perceived as an isolated medical problem, but also as a social phenomenon.

“Wherever adults begin to make the accumulation of material goods, their own well-being and the satisfaction of individual needs the most important guideline for shaping their lives, at some point only that which is brought about by competition, pressure to succeed, envy and greed can develop. Everything else withers away. Children also wither. "(Hüther / Bonney 2002, p.143)

The perception of what we now call ADD has shifted since Hoffmann's “Struwwelpeter”: away from a behavioral disorder (as a mirror of concrete living conditions and socialization processes) towards a physiologically explainable medical fact. Does this (among other things) perhaps also reflect to a certain extent the collective attempt to delegate responsibility to specialists and thus to buy oneself off?

The growing public discussion about ADD not only reflects the increasing individual suffering of those affected, but is also an indicator of a crisis in our society in a systemic sense. It shows that our coexistence is “upset”.

The responsibility for dealing with the ADD phenomenon is not limited to professionals and those affected. Due to its increasing presence in our consciousness, ADS demands a change in our collective self-image, our material and, above all, our cultural and social values ​​and norms.

7. Literature:

- Aust-Claus, E., Hammer, P.-M .: The ADS book. New concentration aids for fidgety philippines and dreamers. Ratingen 1999
- Barkley, R. A .: The Great Parenting Guide to ADHD. Taking responsibility for children with attention deficit and hyperactivity. Bern, Göttingen, Toronto, Seattle 2002
- Bolvansky, R., Czerwenka, K., Kinze, W .: Hyperactive children. Weinheim and Basel 1997
- Franke, U. (Ed.): Therapy of aggressive and hyperactive children. 2nd ext. Stuttgart, Jena, New York 1995
- Hartmann, T .: Another way of seeing the world. The attention deficit disorder ADD. A practical help in life for children and adolescents with disturbed attention. 2nd edition, Lübeck, Berlin, Essen, Wiesbaden 1997
- Hartmann. T .: ADD: bring about changes yourself. Lübeck, Berlin, Essen, Wiesbaden 2000
- Hüther, G., Bonney, H .: News from the Zappelphillipp. ADS: understand, prevent, act. Düsseldorf, Zurich 2002
- Hoehne, R .: ADS / ADHD - Appearances, positions, perspectives. in: Klein, M., Klein, J. (Eds.): Attachment, self-regulation and ADS. Accompany parents and children in a crisis with confidence. Dortmund 2003
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- Schäfer, U .: Do you have to fidget all the time? The Hyperkinetic Disorder: A Guide. Bern 1998
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[1] In the public discussion of the use of amphetamines for the treatment of ADD, the drug Ritalin is mentioned above all in Germany. Ritalin has been on the market since 1956. It is the most effective drug and by far the most widely used drug worldwide since the 1970s. Like the drugs CONCERTA, Equasym, Medikinet and Ritalin SR, it is based on the active ingredient methylphenidate hydrochloride. In the following, Ritalin is named as a representative of this group. Further stimulants from the group of amphetamines are Tradon, Pemolin, D-Amphetamine and Adderall. No reference is made here to antidepressants and the high blood pressure drug clonidine, which are occasionally discussed in connection with ADD.

[2] There are a number of thick books on the German-speaking book market whose aim is to warn against Ritalin. Often the representations are distorting, taken out of context and deliberately dramatizing. The list of the dangers and risks listed is almost impossible to keep track of. Simonsohn (2001, p.89ff) mentions on 9 pages i.a.

[3] Children and adolescents sometimes reject Ritalin because they experience themselves “not as themselves”, “as strangers” under the drug and find this difference between their self-image and their current experience uncomfortable and unsettling.

[4] Some physicians reject the transferability of these results to humans, pointing out that the development of the rat brain basically follows different mechanisms, e.g. a pronounced prevalence of genetic dispositions. Hüther and Bonney, on the other hand, refer to other rat experiments in which altered interaction patterns caused corresponding changes in the neuronal matrix. At least to that extent, mechanisms analogous to those in humans would work.