This article applies to young and older kids in so many areas of "the system."
From the Chronicle of Evidence-based Mentoring, edited by Jean Rhodes, June 4, 2014
From the Chronicle of Evidence-based Mentoring, edited by Jean Rhodes, June 4, 2014
Nancy Rappaport, MD |
by Nancy Rappaport
In America, poverty is a disease
that comes with a host of symptoms. If you’re poor, you’re more likely to
suffer from diabetes or asthma. You’re also, apparently, more likely to be diagnosed
with Attention Deficit Hyperactivity Disorder and dosed with a stimulant,
even if you’re only 2 years old.
A recent study by the Centers for Disease
Control and Prevention found
that thousands of children between the ages of 2 and 3 are being prescribed
stimulants like Ritalin or Adderall for ADHD. This, even though the medicine’s
safety and effectiveness has barely been explored in that age group.
Even more troubling: a
disproportionate number of those children were on Medicaid, an indicator of
poverty. That is the huge red flag.
The simple fact is that
underprivileged children often grow up in home environments that lead to
troubling behavior. As a child psychiatrist who has worked with at-risk
children in schools for more than 20 years, I’ve seen firsthand what happens to
toddlers in chaotic environments.
When I’m called in to assess a child
with behavior problems, I often hear a heartbreaking story. One student I
evaluated was sexually abused by her mother’s boyfriend when she was a toddler.
Another witnessed his father hold a gun to his mother’s head. I’ve heard
countless other stories of neglect, family mental illness and substance abuse.
For these students, acting out is a way to express their terror.
This “toxic stress”
also leads the body to release increased cortisol, which impacts the
pre-frontal cortex, the area of the brain that modulates emotional arousal and
executive functioning. This can lead to later aggressive and disruptive
behavior problems.
To the untrained observer, it looks
as if these children suffer from ADHD. But they don’t need medicine. They need
stability and support.
A number of studies demonstrate the
effectiveness of teaching parents to manage difficult child behavior. This
reduces both insecure parent-child attachment, a risk factor for disruptive
child behavior, and the disruptive behavior itself.
One particularly effective approach
is a home-visiting program called the Nurse-Family Partnership. Families
who received nurse visits had 48 percent fewer reports of child abuse or
neglect than comparison families, and by the time the children turned 15 they
had 69 percent fewer court convictions.
So why aren’t we insisting that
physicians use evidence-based treatments and prescribe family-based support
services for toddlers who present with ADHD and disruptive behavior? Instead,
we’re writing prescriptions that could potentially do more harm than good.
Medication may be judiciously used
to help ADHD when a biological illness is truly present, but true ADHD cannot be
differentiated from other problems at such young ages. We owe it to our
children to give the consistent message that we will do whatever it takes to
foster their development. And that doesn’t always mean prescribing a pill.
http://chronicle.umbmentoring.org/we-are-overmedicating-americas-poorest-kids/
http://chronicle.umbmentoring.org/we-are-overmedicating-americas-poorest-kids/
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