If He Were Your Child, What Would You Do?

A parent asked me, "If he were your child, what would you do?"

I said I would wait. There's more that the adults could do before going that route. I said I would change the child's environment and change how the adults interact with the child before attempting to change the chemistry of the child's brain to change their behavior. We were talking about a seven year old child. Seven.

Countless meetings and conversations have occurred on the record or off line about whether to suggest the child's parents take the child to their pediatrician or attending physician and inquire about medication for presumed or suspected mental disorders.

Now, I don't fault people for doing what they believe is right and what is in the best interest of the child. I don't fault parents who work with their medical team to provide for their children the healthiest upbringing they can. In in rare circumstances, such interventions as psychotropic medicines may be necessary. May I, however, emphasize in RARE circumstances.

From my experience of working in public education systems for twelve years, I estimate that in much, much less than one percent of the population (roughly one in 500 or more) are such measures as altering the chemistry of a child's brain truly beneficial to the child and the child alone. Medicating children, in my mind, should come after steps and strategies such as manipulating the teaching environment, molding the way adults interact with the child, family therapy and ongoing consultation, counseling and social skills instruction and classes that teach parenting skills.

Some quick and perhaps not entirely accurate statistics:
• Up to as many as 5 - 10% of students may be diagnosed with Attention Deficit Hyperactivity Disorder with or without hyperactivity. The same source indicates that only half of the children who have symptoms consistent with the criteria of Attention Deficit Hyperactivity Disorder will get diagnosed.
• As many as 75% of the students who are diagnosed with Attention Deficit Hyperactivity Disorder with or without hyperactivity will in their adolescence be diagnosed with Major Depression or Bipolar Disorder.
• Stimulant medications work on 75% of the population whether or not the person actually has Attention Deficit Hyperactivity Disorder.
• Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.3
• Major depressive disorder affects approximately 6.7 percent of the U.S. population age 18 and older in a given year.
• The rate of depression among adolescents may be as high as one in eight.
• One study in 2002 found that nearly 14% reported engaging in self-mutilative behavior. That is fourteen out of 100 students reported to cut themselves without the intent to commit suicide.
• Serious emotional disturbances affect 1 in ever 10 young people at any given time.
• Studies indicate that 1 in 5 children and adolescents (20 percent) may have a diagnosable disorder. ONE IN FIVE!

ONE IN FIVE? One in five sounds like a slight and normal variation between human beings on the level of eye and hair color! It doesn't sound abnormal or atypical or out of the norm to me.

In my mind, there are two ways to look at statistics like these. First, we, as a society, are over diagnosing and, subsequently, over prescribing. (Although some report that these percentages and numbers are under estimations of the extent of mental disorders in children.) Second, if this many children are truly ill, what in God’s name are we doing to our children?

In either case, I argue we, adults, need to take two steps. First, we need to assess how we interact with our children in the micro and macro sense. How do we discipline or teach our children? How do we communicate with them day in and day out? What are our expectations for our children? What information are they given or exposed to at what age and is it appropriate given their developmental stage? In indulging in our children, have we bombarded them with too much? Too many toys, too many choices, too much pressure, too many activities, competition and too much information? Are our children overwhelmed?

Second, have we allowed our children the luxury of childhood? Or have we taken it away. How much time in the day do our children actually get to play freely? Engage in imaginary play vs. partake in structured programming in and outside of school? How much quiet and uninterrupted "down" time do our children have in their lives?

My theory. It is, perhaps, an over simplification, I admit. However, I am worried that in effort to contain our children for longer hours in structured programs, we have resorted to medical incarceration. What do I mean by that? In order to be successful in the school environment and learn to read at a rabbit’s pace, in order to stay in the after school program, child care program or day care setting (and not get kicked out) and in order to sit still, listen and cooperate, we've resorted to medication to contain our kids. I know, that's an extreme accusation and it is likely to turn heads. But the bottom line here is two fold: Should we, as a society, first change our children's environments and change how we adults interact with the child, change what we expect of the child given what we know about normal developmental needs of children before attempting to change the naturally occurring chemistry of our children's brains in order to change our children's behavior? Are we instead asking our children to conform to the needs of adults? Shouldn't adults be realizing and conforming to the needs of children?

One brief last story. I was once asked to evaluate a four year old child. The question: Does this child have an emotional disturbance? Bright child but busy, often threw his weight around by throwing marvelous tantrums. Angry tantrums-loud and very verbal. He enjoyed physical activity, playing on the play ground, running, jumping, climbing but was difficult to real in after such activities. He had great difficulty separated from his parents at drop off and often "acted out" when his parents picked him up. During the day care day, he had a hard time sitting still or sticking with one activity at a time and was difficult to redirect. He lashed out at other children and couldn't play cooperatively. He was four.

His parents were in the throws of a divorce, a peaceful one but in process of splitting up and moving to two new and smaller residences. The child had a younger infant sibling. Both parents worked full time, long days, were highly educated and successful. The children subsequently spent much of their time in a day care center. A day care center that was filled to the brim, staffed by, though licensed and well intentioned caring, young adults with little to no knowledge of the development of young children. There's more to the story but I think this will suffice....

He was four. Emotional Disturbance?

If He Were Your Child, What Would You Do?