Medicating Our Children to Nowhere
“Kay” has a distinct memory of being sent to a psychiatrist when the troubles in school first started. After a momentary exchange with the doctor, Kay was left to sit in silence, while the psychiatrist addressed the adults in the room, instead, favoring “rigid conformation [and] inappropriate psychiatric medications” over listening to Kay’s actual problems.
Like many students in the United States, Kay had run afoul of a system where classroom conformity trumps individuality, and where students are being medicated into compliance rather than being properly evaluated. As Alan Schwartz recently noted in the New York Times, there’s been a troubling rise in the use of psychiatric medications in children, and not all of this use is entirely appropriate. Schwartz points to rising rates of ADD and ADHD, two common learning disabilities often treated with medication, as one reason why such drugs are more commonly used. But there are other critical issues at play: as Dr. Michael Anderson points out in Schwartz’s article, “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid [to fit the classroom]”—increasingly, through pharmacological means. And a third factor, the national crisis in school funding, has helped create a perfect storm when it comes to the over medication of young Americans.
Whether it’s low-income children being medicated into compliance to compensate for rising class sizes, limited time for individualized instruction and scant opportunities for extensive interventions, or wealthy students being encouraged to take medications to improve their performance, children across the socioeconomic spectrum are now routinely taking psychiatric medications to get ready for school. Some of these drugs come with serious long-term side effects -- especially when used inappropriately -- and the rise in their use illustrates just how profoundly the desire for conformity and performance, at any cost, has taken root in our society.
Psychiatric Medications as Performance Boosters
Welcome to the 21st-century rabbit hole of psychiatric medications. Stimulants and other drugs originally intended to help people with significant learning challenges are increasingly being abused, with prescriptions for drugs like Adderall and Ritalin markedly on the rise. Now more than ever, active children are being prescribed medications to make them less boisterous, while shy or withdrawn children may be put on medications to make them more outdoing.
The Rocafort family has their daughter on ADHD medication even though she doesn’t have a learning disability, because her personality was, as they described it, “a little blah.” What, exactly, constituted a blah personality wasn’t defined, but what is clear is that we’re living in times where if you don’t like your child’s personality there’s a quick and ready solution: just chemically modify her until she becomes the person you want her to be.
The Rocaforts aren’t the only ones seeking a chemical fix for whatever ails their children. In wealthy communities, parents may seek ADHD medications as effective attitude and academic performance boosters, as parent Bronwen Hrustka noted in a New York Times opinion piece published late this summer. In these kinds of communities, medications are sometimes used to give children an edge, accelerating their development to make them more competitive in everything from coursework to SAT scores. But the long-term societal impact of all this acceleration may be more significant that many parents are willing to acknowledge. As Hrustka notes, we’re now “juicing kids for school,” creating a generation of relatively privileged and pharmacologically enhanced “superkids” -- while leaving those with legitimate learning disabilities behind.
Crisis in School Funding
It’s not just wealthy parents contributing to the increase use of psychiatric drugs in children. On the lower-income end of the scale, other pressures are at work. It's worth noting that as ADHD and ADD diagnosis rates rise, school funding is dropping. This puts immense pressure on teachers and school districts, which find themselves faced with less disability training and funding for special programs, larger classroom sizes and more demands from parents who are growing aware of medical options. In addition, schools have become ever more factory-like, with children expected to sit still for extended periods of time, absorb information quickly and comply rapidly with orders from instructors and staff – often an impossible set of tasks for children at varying developmental stages.
Expectations like these can have a pathologizing effect on normal childhood behaviors like being active and noisy, which may be one contributing factor in the rise in diagnosis rates. Though we seem to have convinced ourselves otherwise, children are not, by nature, quiet and reserved; they’re curious, filled with life and – at their best – actively engaged with their environment. These are the traits that lead to learning for many children, especially those with tactile learning styles who need to physically interact with their surroundings to absorb information. They are not, however, the traits that make it easy to run a classroom -- especially a classroom overfilled with students who, like all children, need individual attention from their teacher.
In a conversation with AlterNet, pediatrician Vicki Soloniuk noted how difficult school environments have become for many children, not to mention for teachers and other school personnel, who can wind up frustrated by the limitations of the system. Teachers “don’t have the time,” Soloniuk says, to provide the individual instruction and mentoring some kids need to succeed, even though many have a profound desire to help their students. Consequently, some teachers end up referring children for medical workups even when those children don’t have clear signs of learning disabilities. And this, in turn, can result in the prescription of pharmaceutical fixes for issues that might be better addressed through other means.
This issue is particularly acute in low-income school districts, which have suffered a catastrophic loss of funding in recent years, particularly for disability services. Low-income children are hit particularly hard by these cuts; while wealthier districts and parents can often afford non-pharmaceutical interventions, the options for low-income students generally are far more limited. Medicaid, for example, will pay for ADHD medications, but not non-drug options, and it certainly won’t pay for aides and other options in the classroom that could help these students succeed without the use of medications.
As Jen, who spent 14 years working in special education, recalls:
It really was heartbreaking to see kids who struggled so hard to fit into the mold the majority of their peers fit into, and then were made to feel as though there was something wrong with them when they didn't succeed. Our school system is set up for kids who fit into that mold and, ideally, anyone whose learning style or ability fell outside that window of ‘normal’ would simply be taught in the way that best matches whatever their unique needs were.
It’s a more humane approach to learning, without a doubt. But assessing such students and meeting their needs is both costly and time-consuming, and as school budgets are continually slashed, it is rare indeed to find small or overburdened school districts that have the capacity to put such an ideal into practice. Instead, medication becomes the answer, with doctors giving their tacit approval by signing on the dotted line.
The Push to Prescribe
As many doctors will tell you, ADHD and ADD can be significant learning disorders, with diagnostic criteria that require careful evaluation for a successful diagnosis and equally careful treatment planning to achieve the best outcome for the child. For her ADHD and ADD patients, Soloniuk often recommends numerous non-pharmaceutical treatment measures -- like notebooks to track homework and tasks, and sticking to strict schedules to help children who need routine stay focused. She also works closely with parents to create a productive home environment, pointing out that ADHD is familial, and often one or both parents have it as well. In these cases, treating the family as a whole often helps to create a more stable environment to support the child.
Ultimately, however, Soloniuk says she does often prescribe medication for her patients, both because she finds it effective and because it helps alleviate the pressures (busy work schedules, limited resources and complaints from teachers) that her patients and their families are under. Working at a rural health clinic focusing on treatment for low-income patients, she’s well aware of the financial and staffing limitations faced by the local school district and the families she treats, and believes that sometimes medication is simply the best available option to help a kid get through school.
“For me,” she says, “the medication might not always be appropriate, but getting the kid through school is the most important thing. If you can’t concentrate, have impulse control problems, and live in a chaotic household, you’re not going to do well in school. What does that mean long-term for these kids?”
For Soloniuk, medications like Adderall are an important part of the medical toolbox. She points out that while the classroom environment isn’t generally friendly to children, particularly those with learning disabilities, she can’t fix that; what she can do is help children adjust, with the goal of helping them establish coping tools and routines that will allow them to get off medication eventually. If a student has trouble in school, that can lead to depression and behavioral outbursts that might be headed off with the judicious use of medication.
Soloniuk also notes two other factors that may play into the willingness of doctors to prescribe these medications: lack of time and lack of training. Learning disabilities are complex and require lengthy evaluation, something not all physicians have time to do in the pressure of a fast-moving practice. Soloniuk, for example, tries to see approximately 22 patients a day, but like many physicians she’s often compelled to see many more, and that leaves limited time for careful evaluation.
Furthermore, Soloniuk notes, many pediatricians have limited psychiatric training, and may have scarce resources when it comes to referral options for their patients, especially low-income kids. Consequently, they conduct evaluations with the best tools they have available, and may miss important signs of other underlying problems. “Childhood bipolar, ADHD, and even Asperger’s for that matter can look the same,” she says, but these conditions need to be addressed in radically different ways. Hasty diagnoses can lead to troubling experiences like Kay’s, who is clear that “the learning disabilities and difficulties I was facing did not get accurately diagnosed or treated or addressed.”
Instead, Kay was put on a wide array of psychiatric medications (antipsychotics, among others) that “had a generally zombifying and sedative effect.” Heavily drugged but essentially untreated, Kay continued to struggle in school until making the decision to stop taking the medications altogether -- at which point the very real learning disabilities that had been masked by the medications led to expulsion from school.
What’s In the Best Interests of Children?
Psychiatric medications can be profoundly valuable for learning disabled students; they can transform a struggling, frustrated, and behaviorally-troubled child into one who can develop a love of learning. Many adults whose ADD or ADHD was never diagnosed during childhood report years of frustration and misery, not fitting in and difficulty completing schoolwork. For some, lack of medical intervention led to missed opportunities; grades too low for good colleges, difficulty finding and keeping jobs, and trouble building families. When used appropriately, after thorough medical evaluations and under careful supervision, such medications no doubt offer numerous benefits. But it’s also clear that in an educational landscape where conformity is king and quick fixes are the coin of the realm, the growing medication of children and teens must be cause for concern.
The rise in the use of these medications is an indicator that several cultural issues need to be addressed, including the pathologization of normal childhood behaviors, hypercompetitiveness among the wealthy and the slashes to school funding we see occurring nationwide. In an educational system where children are recognized as individuals and met where they are, students with real learning differences would have a better chance at fitting in and receiving the treatment they need (which may include medication), while those who are just a bit different wouldn’t need to be drugged into submission.
A growing awareness of these issues among parents could be one prong in seeding a movement for change. But what will it take to overcome the factors currently lined up to treat children as automatons and classrooms as their assembly plants? When will we be prepared to say enough is enough when it comes to medicating our kids?