Ritalin

This study investigated the effect of methylphenidate (Ritalin) on the selective attention of hyperactive children designated as favorable or adverse responders to stimulant medication. Using a type II incidental learning paradigm, it was found that children in the drug condition recalled more central and less incidental stimuli than those children in the placebo condition. While no differential effects on recall were found for responder type, methylphenidate did affect the
spontaneous overt labeling of central stimuli by the favorable responder group. Results were interpreted in terms of the role of methylphenidate in narrowing the focus of attention. Implications for the classification of hyperactive children
as favorable and adverse responders were also discussed.

Much of what has ever been written about attention affecting syndromes is subject of debate. Attempts at an explanation have varied within scientific disciplines from the very beginning. After almost three decades of a principally drug-driven practice of treatment, in recent years, ethical, social, pedagogical, and—obviously—medical concerns, regarding such an alignment’s adverse aspects, sharply regained in public as well as academic relevancy. In this paper, I am giving credit to the findings of Hüther et al., who, since 2009, investigated potential alternative ways of giving therapy to attention affecting syndromes by taking ADHD diagnosed children out into nature, discontinuing their medication for several months—and returned with results that were astonishing, showing that alternative ways of dealing with attention affecting syndromes generally existed. These findings altogether resonate with my own observations and long-standing experiences in working with adolescents in an experiential educational and Steiner/Waldorf pedagogical context, which I exemplify in order to endorse and make a reinforcing case for Hüther’s preliminary findings and hypothesis.

Je dois d’abord avouer que je ne me suis jamais intéressé de près à la maladie que l’on nomme Trouble du déficit de l’attention avec hyperactivité (TDAH) et que j’avais sur elle un avis assez critique, avis que partage la plupart de mes collègues enseignants,  avis que j’ai retrouvé dans un article, lu totalement par hasard, à la fin d’un Charlie Hebdo paru en mars 2015. 
Dans celui-ci, le psychanalyste Yann Diener remettait en cause les fondements « scientifiques » de cette « maladie » en critiquant la prise en charge de celle-ci par le biais du méthylphénidate que l’on connaît plus sous le nom de Ritaline. Dans ce court mais roboratif article, il critiquait l'utilisation de sigles pour nommer les troubles, voire confondre ceux-ci avec l’enfant. Il notait aussi la piteuse tolérance de notre société vis-à-vis des comportements, selon elle, problématiques ; comportements que l’on  « soignait » par le biais d’un arsenal pharmacologique vendu par « Big Pharma2 » dans une logique à court terme, toujours selon lui,  strictement mercantile.
Or, cette représentation que je me faisais du TDAH a violement été remise en question par Frank Devière qui, le 8 juillet 2015, nous dispensait un cours de Neuro-éthique. C’est, je crois, à la fin du cours, en réponse à la question d’un collègue au sujet de la prescription de Ritaline pour traiter le TDAH, que ce médecin neurologue répondit lapidairement par l’affirmative en soulignant que : « ça marchait » et qu’il avait pu en voir directement les bénéfices. Silence dans la salle… Sentant que ce problème le touchait dans sa vie personnelle, je me gardais bien de vouloir lui apporter un début de contradiction. En effet, je n’avais ni sa connaissance ni son expertise pour lui opposer quelques arguments et je dois bien avouer qu’au regard de son cours particulièrement passionnant, il aurait été inconvenant de rentrer dans une polémique assez vaine vu le corpus impressionnant de concepts et de pistes de réflexions abordé lors de cette journée. 
Néanmoins, en y repensant le soir, je n’arrivais pas à me résoudre à concevoir que le TDAH et son traitement médicamenteux pouvait faire l’économie d’une réflexion éthique sous prétexte que celui-ci était efficace aux yeux d’une expérience singulière.
C’est cette réflexion que je vais tenter, en quelques pages, de commencer modestement à élaborer. Il n’est pas ici question de vouloir réfuter ou d’attaquer la pertinence de l’opinion de ce médecin au sujet de la ritaline mais bien plutôt de voir, en quoi cette position tranchée a été la source d’une réflexion « éthique » et la prise de conscience de la nécessité que nous avons tous d’aborder l’apport des neurosciences avec une certaine prudence voire un regard critique. Cette opinion lancée en fin de cours a été pour moi le début d’une réflexion « neuro éthique » qui va bien au-delà du TDAH et je me propose de la partager à travers ce dossier. Néanmoins, je me dois de commencer par expliciter un peu mieux, les problématiques liées au TDAH (élément déclencheur de ce dossier) afin de les élargir dans une perspective neuro-éthique.
J’exposerai donc, dans une première partie, ce que j’ai pu découvrir, lire, apprendre au sujet du TDAH et de sa prise en charge médicamenteuse par le méthylphénidate. Dans une seconde partie, j’exposerai les arguments de ceux qui s’opposent à cette vision et qui considère que le TDAH est une maladie totalement inventée ne relevant d’aucunes preuves médicales ou scientifiques. J’essaierai, dans une troisième partie, d’expliquer en quoi cette recherche sur le TDAH a nourri, dans un cadre plus large, une réflexion neuro-éthique. Je conclurai en affirmant que la neuro éthique est un cadre réflexif  nécessaire à tout projet relevant des neurosciences.

Psychostimulants are highly effective in the treatment of attention-deficit/hyperactivity disorder. The clinical efficacy of these drugs is strongly linked to their ability to improve cognition dependent on the prefrontal cortex (PFC) and extended frontostriatal circuit. The procognitive actions of psychostimulants are only associated with low doses. Surprisingly, despite nearly 80 years of clinical use, the neurobiology of the procognitive actions of psychostimulants has only recently been systematically investigated. Findings from this research unambiguously demonstrate that the cognition-enhancing effects of psychostimulants involve the preferential elevation of catecholamines in the PFC and the subsequent activation of norepinephrine α2 and dopamine D1 receptors. In contrast, while the striatum is a critical participant in PFC-dependent cognition, where examined, psychostimulant action within the striatum is not sufficient to enhance cognition. At doses that moderately exceed the clinical range, psychostimulants appear to improve PFC-dependent attentional processes at the expense of other PFC-dependent processes (e.g., working memory, response inhibition). This differential modulation of PFC-dependent processes across dose appears to be associated with the differential involvement of noradrenergic α2 versus α1 receptors. Collectively, this evidence indicates that at low, clinically relevant doses, psychostimulants are devoid of the behavioral and neurochemical actions that define this class of drugs and instead act largely as cognitive enhancers (improving PFC-dependent function). This information has potentially important clinical implications as well as relevance for public health policy regarding the widespread clinical use of psychostimulants and for the development of novel pharmacologic treatments for attention-deficit/hyperactivity disorder and other conditions associated with PFC dysregulation.

The association between Attention Deficit Hyperactivity Disorder (ADHD) and Offending behaviour is well documented in Literature. The DSM IV and the NICE Clinical guidelines state that Hyperactivity, Impulsiveness and poor concentration are the core features of this condition. Attention Deficit Hyperactivity Disorder can be seen as a Neurodevelopmental disorder and a spectrum disorder. In this case report the discontinuation of pharmacological treatment with Modified release preparation of Methyl phenidate Hydrochloride led to an escalation of offending behaviour within a few weeks which resulted in an admission into a Secure Children's facility in Leeds West Yorkshire and Subsequent 'Electronic tagging' in a 15 year old. Some young persons with ADHD can present with 'complex needs' and Health care professionals, Drug workers and other staff as well as Forensic Physicians working within the Custodial and Forensic settings would need to be sensitive and responsive to their needs in order to ensure the continuity of treatment for as long as is practicable and achievable even whilst in custody. The importance of multidisciplinary and multiagency working with a 'joined up' approach so as to maximise out come is highlighted.

This paper endeavours to analyze the available empirical research on the treatment of ADHD in children, looking at pharmacotherapy, neurofeedback, diet and psychotherapy. These catagories will be closely reviewed and  assessed with the help of the ADHD Treatment Effectiveness, Safety and Efficiency Index (TENSE) in order to arise to an advice  on the most adequate techniques for this subgroup of patients.

The intention of this blog is to define human enhancement drugs (HEDs) and its subcategories, and to invite readers to add to this definition, or any of the drug profiles described on the HED website for that matter. This blog is a ‘living document’, meaning that it hopes to evolve and change over time as we work towards a greater understanding of HEDs. The blog is available on the Human Enhancement Drug website: http://humanenhancementdrugs.com/2016/01/.

In recent decades pharmaceutical consumption has skyrocketed, growing from $43 US billion in 1985 to over $1,143 billion in 2017. In trying to understand the source of this growth, social scientists have identified the key actors driving medication use and the processes through which they are driving it. However, much less attention has been devoted to understanding the forces that constrain medication consumption. This information is crucial for developing a deeper understanding of medication consumption, one that explains how context mediates the ability of key actors to shape medication consumption. To address this gap, I examine France’s low consumption of psychostimulants to treat ADHD symptoms. France is a strategic case to analyze because it diverges dramatically from comparative cases: while 7% of U.S. children are medicated with psychostimulants, the same is true for only 0.2% of French children. To explain the French case I use the theory of countervailing powers. Informed by interviews with key informants, the French medical literature on psychostimulants and secondary sources, I explain how the state, medical experts and consumers have acted as countervailing forces against pharmaceutical interests. In doing so, I provide deeper insight about how context can limit the pharmaceutical industry’s power.

Vieles von dem, was jemals über Aufmerksamkeitsstörungen und deren Hintergründe geschrieben worden ist, ist nach wie vor Gegenstand ausgiebiger akademischer Debatte. Von Anfang an wichen Erklärungsversuche innerhalb wissenschaftlicher Disziplinen voneinander ab. Nach fast drei Jahrzehnten einer vornehmlich Medikamenten-orientierten Behandlungspraxis, haben ethische, soziale, pädagogische und –offensichtlich– medizinische Bedenken, in Bezug auf die negativen Auswirkungen einer derartigen Ausrichtung, in den letzten Jahren stark an öffentlicher, als auch akademischer Relevanz gewonnen. Der Artikel nimmt Bezug auf die von Hüther et al. seit dem Jahre 2009 gewonnenen empirischen Erkenntnisse in Sachen alternativer Therapiemöglichkeiten in der Behandlung von Syndromen des so genannten ADHS. In einem Feldversuch zog Hüther et al. mit einer Gruppe ADHS-diagnostizierter Kinder, unter Absetzung jeglicher Medikation, für mehrere Monate hinaus auf eine Berghütte in den Südtiroler Alpen und kehrte mit Ergebnissen zurück, die
bemerkenswert sind: Sie zeigen, dass alternative Wege im Umgang mit Aufmerksamkeitsstörungen generell und faktisch existieren. Diese Befunde resonnieren insgesamt mit meinen eigenen, langjährigen Erfahrungen und Beobachtungen in der Arbeit mit Jugendlichen in einem erlebnis-, und waldorfpädagogischen Kontext, welche ich Hüthers Erkenntnissen in einer konstruktiv-bereichernden Weise gegenüberstelle und diskutiere.

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements are permissible for individuals with no particular ‘medical’ disadvantage along any of the dimensions of interest. Rarely addressed in the literature, however, is the fact that sometimes the diminishment of a capacity or function, under the right set of circumstances, could plausibly contribute to an individual’s overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a welfarist conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing.

Bu çalışma ‘güncel hakikat rejimi’ olarak neoliberalizm ve onun birey kurgusu ‘homo-economicus’a odaklanmaktadır. Çalışmanın amacı, Bir Web 2.0 platformu olan Ekşi Sözlük’te DEHB’nin tedavisinde kullanılan Ritalin isimli ilaca ilişkin yürütülen tartışmayı neoliberal yönetimsellik nosyonu üzerinden değerlendirmektir. Bu kapsamda Ritalin başlığı altında bulunan, 2002-2019 yılları arasında oluşturulmuş 540 giri, MAXQDA 20 nitel veri analiz programı kullanılarak analiz edilmiştir. Analiz sonucunda, Ritalin başlığı altında yer alan giri sayısının yıllar içinde artış gösterdiği, en fazla girinin 2019 yılında oluşturulmuş olduğu belirlenmiştir. 2002’ye kıyasla 2019 yılında Ritalin başlığı altındaki giri sayısı 38,3 kat artarken sözlükte bulunan yazar sayısının 17,9 kat artış gösterdiği görülmüştür. Ritalin tartışmasında en çok tekrarlanan ana konuların %47,49 ile Ritalin’in etkileri, %38,51 ile Ritalin’e ilişkin bilgiler, %14 ile Ritalin’e ilişkin bu bilgilere hangi yollardan ulaşıldığı üzerine olduğu görülmüştür. Ekşi Sözlük yazarlarının, neoliberal yönetimsellik anlayışına uygun bir şekilde Ritalin’e ilişkin fayda/zarar analizi, risk değerlendirmesi gerçekleştirdiği belirlenmiştir. Ritalin tartışmasında en sık tekrarlanan alt kategori çoğunlukla akademik başarı temelinde ele alınan, ilacın olumlu etkileridir. Yazarlar Ritalin’in rekreasyonel amaçlarla kullanılabildiğini, reçetesiz tanıdık vasıtasıyla ilaca ulaşımın sağlanabildiğini dile getirmiştir. Ritalin tartışmasında ilaç, farklı etkileri üzerinden değerlendirmeye alınırken özellikle 2017 yılı sonrasında ilaca erişme yollarının tartışmanın önemli bir bölümünü oluşturduğu görülmüştür. Çalışma kapsamında Ritalin, performans odaklı neoliberal toplumda bir kendini biçimlendirme teknolojisi olarak ele alınmıştır. Ritalin’in bu bağlamda Ekşi Sözlük’te performans gösterebilirliğin bir aracı olarak değerlendirildiği saptanmıştır.

This is an excerpt from Chapter One "Smart Drugs: Corporate Profit and Corporeal Control" from Kenneth J. Saltman, Scripted Bodies: Corporate Power, Smart Technologies, and the Undoing of Public Education (Routledge 2016).  The excerpt discusses how the over-prescription of ADHD medication coincides with the advent of high stakes standardized testing.  It contends that the expansion of drugging children for educational competition is part of a broader set of assumptions about knowledge, learning, and intelligence that can be found in dominant educational policies and reforms.  The excerpt explains how drugging children for educational competition is an example of repressive pedagogy that is at odds with the aspirations of the tradition and values of critical pedagogy and democratic education.

This chapter examines the way government funding activities influence the pharmaceuticalization of ADHD. To shed light on this issue I focus on the New Zealand case, whose consumption of ADHD medications grew significantly during the 1990s. This paper explores how consumption was shaped by government funding policies, including those affecting medication cost and those affecting access to healthcare professionals. Additionally, it examines how government decisions have sought to steer consumption towards lower-cost medications. The paper also considers how the influence of funding activities is itself shaped by the surrounding economic context, and the activities of regulatory agencies. Beyond elucidating the New Zealand case, this analysis provides a better understanding of how governments can mediate the pharmaceuticalization process more generally.

Methylphenidate improves cognitive deficits produced by infantile iron deficiency in rats.

Mohamed WM, Unger EL, Kambhampati SK, Jones BC.

Neuroscience Institute, Penn State University, USA.
Abstract

In humans, iron deficiency early in life produces persistent, impaired cognition. Dietary iron replacement does not ameliorate these problems and to date, no attempt to treat these individuals pharmacologically has been reported. The aim of this work was to test the hypothesis that rats made iron deficient in early infancy exhibit cognitive deficits similar to those seen in humans at adolescence. A second aim was to investigate whether the deficit could be treated pharmacologically. Sprague-Dawley rats were made iron deficient (ID) starting at postnatal day 4 by being placed with iron-deficient dams (vs. control). At weaning, all pups were placed on an iron-sufficient diet for the remainder of the study. At 45 days of age, the animals were tested for attention set shifting. After testing, the animals were assigned to one of three methylphenidate (MePh) dose groups, 1, 5 or 10mg/kg, p.o., vs. vehicle control and treated daily for 15 days prior to a second round of attention set shift testing and continued throughout testing. The results showed that ID rats performed more poorly than controls overall on attentional set-shift testing. MePh improved ID rats' performance and lower doses were more effective than higher doses. This is the first demonstration that MePh can improve cognitive deficits produced by early ID in animals. These findings may open the possibility of pharmacotherapy to treat the persistent cognitive difficulties in children who were severely iron deficient in early infancy. Copyright © 2010. Published by Elsevier B.V