The ills of a generation -- of today's parents, schools and students -- are reflected in an outrageous and heartbreaking story on the front page of today's New York Times.
Alan Schwartz writes of how doctors are using medications as de facto educational reform -- giving ADHD medications to low-income students, not because they have the disorder, but because they are struggling in schools that can't teach them properly.
"I don't have a whole lot of choice," he quotes Dr. Michael Anderson, a pediatrician whose patients include many poor families in Cherokee County, north of Atlanta, as saying. "We've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid."
Modify the kid. Are you not incensed by that? How about this, then, from Dr. Ramesh Raghavan, who studies prescription drug use among low-income children at Washington University in St. Louis. Because "we as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children," he tells Schwartz, "we are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications."
Or this, from Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., whose practice is primarily with lower-income children struggling in school: "We are using a chemical straitjacket."
A chemical straitjacket. Psychotropic teaching tools.
How did we get here?
It would be easier if there were a villan in this tale. Parents who want to beat the neighbors in the race for prestigious college stickers on the back of the Audi. Doctors who will prescribe anything just to keep parents happy and move onto the next appointment. Kids who refuse to just plain buckle down and concentrate the good old-fashioned way.
But these are parents with little or nothing grasping at the only something available to get their children educated in an underfunded classroom of 42 children. And these are doctors who have pledged to help children, but can't prescribe them a better school. And the kids? They are doing what they are told and taking their medicine.
Years ago I visited my son's classroom to ask for a plan that would smooth the path for my son, who at the time was missing large chunks of time to debilitating migraines. There was a rule then that said teachers could not send homework home unless a student had been out for three days, and I was wondering if I might pick up a packet at the end of each day, instead. The teacher told me he'd like to help, then he pulled out a class list of about 30 students, and ran his finger down the notations in one column.
More than half had some sort of complication, diagnosis or accommodation -- meaning more than half could not "function" in the classroom as it was run. This one couldn't sit still and should be allowed to pace in the back of the room. That one couldn't take tests by typewriter because of fine motor deficits. There was anxiety, and attention issues, and sensory disorders. The only way my homework request could be met, the teacher told me, apologetically -- the only way he could muster the bandwidth and resources to keep track of his needs -- was if I had my son classified and put on this list.
I left the room thinking, If the ways of a classroom don't work for more than 50 percent of the students, then the problem isn't with the kids, it's with the system.
In the same way, if the ways of the school system doesn't work for a subset of children that have to turn to medications to fit in, isn't the problem with that system, not with the children?
Of course it is. And that is the easy question. Next: what are we -- as parents, as educators and as society -- going to do about it?
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It can be really tempting, especially when you know (or someone tells you) that the medication did just the trick with that somebody else. But you can't know for sure that your child has the exact same thing -- or that the dose is right, or that it isn't going to interact with something else they are taking, or cause trouble in some other way. This is a bad corner to cut. Call your doctor instead.
Giving aspirin to kids in certain situations can cause a scary and possibly deadly condition called Reye's Syndrome. Sure, it's rare and lots of us got aspirin as kids (I can still remember the chalky orange taste). But why take the chance? Use acetaminophen or ibuprofen instead.
I see this all the time. There's some leftover from last month's ear infection, Junior is pulling his ear, why not? Well, here's why not. First of all, a doctor really needs to diagnose an infection, and starting an antibiotic before we have a chance to do that can really complicate things sometimes. Second, the stuff is only good for a couple of weeks after it's mixed up at the pharmacy.
This is the stuff that makes kids vomit. We used to tell everyone to keep a bottle of it handy in case their kid ate something they shouldn't (like grownup medications or poisons). Turns out that it's not such a great idea for various reasons (like some of the stuff kids get into can do more damage if it's vomited, and if what they took makes kids really sleepy, the vomit could go into their lungs) so we changed our minds and told everyone to throw the stuff out. Keep all medications and poisons out of reach, and if your kid gets into something, call Poison Control at 1-800-222-1222 (works anywhere in the US).
While the stuff is probably good for a little while after the date on the bottle, it's hard to know when it's not good, so better safe than sorry. Get in the habit of going through your medicine cabinet on a regular basis and throwing out expired things -- it's such a drag to reach for the fever medicine in the middle of the night, only to find it's expired.
They can have dangerous side effects. They don't really work, anyway.
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