Top: Ken, a student of political science at Chulalongkorn University, on campus recently. Photo: Taylor McAvoy
Ken had a reputation as a lazy introvert who came late to class with sleep on his face. Before the day’s lecture would begin, he would throw back a pill with a mouthful of mineral water.
Some days Ken didn’t show up at all. What his classmates didn’t know was that he was undergoing MRIs and brain scans to contend with epilepsy and a neurodevelopmental disorder. One day in 2016, he stopped coming entirely.
Sometimes, I could not remember anything or recognize people’s face, like I had a short-term memory
A year passed before the political science student returned. When he did, it was like a different personality had taken hold. The new Ken had a bright, bubbly presence and made many new friends.
The disorder he had been diagnosed with was attention deficit hyperactivity disorder, or ADHD. The pills he secreted from a hiding place in his black leather Macbook case every morning – Ritalin. Now 23, he blames the medication for stealing four years of happiness in college by hiding his true personality behind a chemical veil.
“Sometimes, I could not remember anything or recognize people’s face, like I had a short-term memory,” he said in a recent interview.
Mental health can be a taboo topic. Ken’s parents forbid him from telling anyone of his ADHD diagnosis, and he along with others interviewed for this story requested that their real names not be published.
Yet other Thai students still coping with the drug’s many adverse side effects feel a unique pressure to take it: intense pressure to perform academically and earn high test scores. Several interviewed for this story admitted to intentionally overdosing on “Vitamin R” before exams, even as early as high school, despite the alarming and dangerous side effects.
Naticha could not stop her “daydreaming” until her parents agreed with her doctor that she should take Ritalin to reduce what they deemed her absent-mindedness and hyperactivity.
With the sharpened focus the drug made possible, she stopped “distracting” other people and became a top-performing student. She landed a spot in a top university. When her doctor asked if she would like to stop the medication, she refused, citing her lack of self-control.
Her real, unspoken reason: Maintaining high scores meant secretly overdosing on Ritalin to cram overnight for exams. As with Ken, her identity was the price she paid.
“I suffer terribly when I can’t be my usual, cheerful self,” said the 22-year-old recent graduate. “When I feel less relaxed, less sociable, my friends stop complaining like, ‘Why do you talk too much?’ or ‘Can’t you just sit still?’”
Ritalin is the most commonly known brand of methylphenidate. It’s a stimulant that has been used to treat symptoms of ADHD since the mid-20th century. Doctors found it a proven means to reduce the three main symptoms: inattention, hyperactivity and impulsiveness.
Some adults have taken the drug since early childhood. The early treatment groups are children under 15, which may suffer from long-term impacts on their mental development.
Thai children seem especially susceptible to the disorder. One million children between 6 and 12 have been diagnosed with the condition, the Public Health Ministry reported earlier this year. That includes 12 percent of Thai boys, which is above the global average of 10 percent.
Suriyadeo Tripathi, a former director of the National Institute for Child and Family Development of Mahidol University, pointed out that children 3-6 are more likely to have ADHD than previous generations. He blames their early reliance on social media and loss of freedom to play outside, which affects their development.
But the Public Health Ministry does not track Ritalin prescriptions; therefore, there’s no estimate of how many students are taking it. But talk to any number of students and find many have anecdotes to share.
Dying to Get Ahead
Years of terrible pain he thought linked to the medication and the impact on his social skills were enough for Ken.
In addition to all the side effects, he developed depression and withdrew, avoiding people and social activities. Often, he suffered anxiety dreams and woke up with migraines.
The risks are even greater for those, such as Naticha, who developed a dependency and took it more than is prescribed.
Normally, Ritalin must be taken throughout the day, as its effects last three to five hours. And all indications warn against taking it before bedtime as it will cause long-term sleep deprivation.
What is wrong if I take Ritalin? It has a similar effect to caffeine
Similar to work-related stress, symptoms of such sleeping disorders include daytime fatigue and headaches, irritability, mood changes, paranoia, depression, weakened immunity and skin disorders, along with an increased heart rate and memory problems.
Though she faults anyone who takes the drug solely for an academic edge, she defends her own use for the same purpose.
“No, I didn’t cheat on the exam but cheated on sleep, just like my friends did. They drink coffee or M-150. What is wrong if I take Ritalin? It has a similar effect to caffeine,” Naticha said when asked if using such stimulants before tests amounted to cheating.
Her attitude changed during the stressful time when she was 18 trying to get into a top university. This cognitive enhancer became more and more addictive, and her overdosing became a daily habit to keep ahead of the academic curve.
But she couldn’t stay there as the consequences piled up.
“Overdosing might be effective in a short time, but your body needs a rest day at last,” she said. “It is impossible to do well on an exam without sleep.”
When it all caught up with her, she thought she was dying.
At age of 18, she felt dizzy and nauseous every time she ate. She also began to get chest pains and her heart was beating alarmingly fast for no apparent reason. She went to her father’s cardiologist, thinking her mini heart attack might be hereditary. But testing found her heart was working normally. She had not realized how torturing her mind and body in exchange for an edge in high school was affecting her heart rate, blood pressure and sleep until the physician laid it out for her.
As a result, she stopped taking the drug. Her scores dipped. But today she deeply regrets having chosen the drug over sleep.
Ken, who has now been clear of Ritalin around 6 months, blamed his one-year disappearance on bad headaches and dizziness caused by long-term use of Ritalin and other neurological medication he occasionally takes as needed.
It still upsets him that his parents feel embarrassed about his disorders and pushed him to visit a psychiatrist for drugs – despite their side effects – since his childhood. Finally, he stopped Ritalin and asserts he can pay attention without it.
There are also students and others taking Ritalin or similar drugs such as Adderall to help them achieve.
Rinsook Ongarjsakulman, a child and adolescent psychiatrist at Bangkok’s Yuwaprasart Hospital, said the appeal is understandable.
“If there was a miracle drug to make people more clever, everyone in this world would take it,” she said. Even doctors, she said, who “ask their friends to prescribe ADHD meds to keep themselves working longer than 10 hours.”
Rinsook argued that all ADHD meds are proven to help certain younger children with ADHD to control behavior problems, and some people with ADHD hold professional qualifications on the basis of their abilities.
“The medicine is not needed for ADHD if their parenting and social environment understands and nurtures them,” she continued, “because family and society are major influences on the learning process and behavior development in children.”
While some children grow up to live without the drugs, it sets others on a lifetime path of dependency and addiction.
“In some cases, young adults with ADHD continue to use other drugs such as cocaine,” Rinsook said.
Songpoom Benyakorn, a child psychiatrist at Srinakharinwirot Medical School, has tried to increase awareness since 2014 on a page he maintains called ADHD Thailand. He’s also railed against the pharmaceutical industry’s marketing of drugs as miracle cures.
In a post earlier this year, he suggested that parents find activities such as sports, video games or homework to release the energy and impulses of children with ADHD, as recreation is a good alternative treatment.
Classroom Reality Check
Ritalin remains widely prescribed for “unmanageable” children who otherwise couldn’t function in school.
When it comes to managing classroom behavior, several teachers said they don’t entirely dismiss Ritalin but believe it should be used as directed when behavior is a major obstacle to the learning and well-being of students and their peers.
Chalita Viriyajatutit, a fifth-year Chulalongkorn University arts education who teaches young children, showed examples of her students’ artwork. Students with ADHD drew crude and sloppy geometric shapes when unmedicated. Under the influence of the drugs, their drawings became striking, bold and meticulous.
But the medication isn’t a cure-all and doesn’t treat behavioral issues.
Chalita described “Tee Tee,” one of her fourth-grade students with ADHD. The boy is hyper-competitive and given to acts of violence against his classmates.
“When he was told to draw a circle without using a geometric compass, he didn’t follow the instructions and tried to stop his friends from drawing by stabbing their hands with his compass. At that time, he was taking the medicine,” Chalita said.
Parajaree Korsanan, a fifth-year education major who also teaches young children, said the side effects can curb development of communication and learning skills.
A third, Pratima Ruksachon, agreed that behavioral development of ADHD students depends more on attentive teaching rather than medication.
“Teachers should understand them, help them get along well with others and make sure they’re not hated by their friends,” she said.
Nonetheless, “the medication might not help to improve these children’s mental ability. In fact, their family is the most important factor to improve their positive attitude toward life,” she said.
Today, some private schools pay special attention to students with ADHD.
Out in western Bangkok at the Plearnpattana School, parents are asked to only medicate their children if they are unable to manage their outbursts of anger in the classroom, according to Chalita Viriyajatutit, a Chula Arts Education fifth-year student.