This morning, I visited the child care program where one of my summer semester students has been placed for her practicum. It’s a room of twelve four-year-olds. I have known the supervising teacher for a number of years and we often exchange ideas and concerns.
Today, she asked me to step outside the classroom to chat for a minute. “I just need to run something by you that is troubling me,” she said. “I can usually expect about one or two children to be on meds in my class each summer. But, this summer, seven of the twelve are medicated. It’s unbelievable. And, none of them are well medicated.” I asked her what she meant by that.
She proceeded to explain that their medication was never administered correctly or consistently by the families. Sometimes it was skipped and then double dosed. On some days, many of those children might be active and participating and then lethargic and almost non-functional the next.
This teacher has known most of these children since toddlerhood and watched them grow up. One by one, they were prescribed medication, although she saw no real indication they needed it.
Health statistics data indicates a five-fold increase in the number of children under 18 taking medication for behavioral or emotional issues in the past 10 years. This is despite the advice of the CDC to utilize behavioral therapy rather than drugs with young children. They report that less than half of children receiving meds are also participating in psychiatric services, which would include behavioral therapy.
It is also disturbing to note that physicians are prescribing psychiatric drugs typically reserved for use by teens and adults to young children. This is known as “off-label use.” The long-term effects of these medications are largely unknown at this point. The short-term effects can include muscle twitching, violent behavior, and even seizures.
Psychotropic agents in the medications that are typically prescribed can influence a child’s brain development… producing alterations in the nervous system, especially when administered repeatedly during sensitive periods. One of the issues is that parents often have trouble finding (or taking the time to seek out) pediatric psychiatrists with experience to properly diagnose young children and prescribe these medications.
All of this is scary stuff, indeed. As a mother of a child with a psychiatric illness, I certainly do not want to minimalize in any way, the use of medications for a child who needs them. I know that properly prescribed medication can make the difference in being functional, being able to learn, and to participate in life. And finally, finding the correct combination of medications can take time, frustration, and heartbreak. That being said, I also know that there are instances where there are prescriptions being written for very young children without justification.
I believe there are three things we can look at here:
- Society seems to have taken on a “quick fix” mentality. A child’s developmentally appropriate, toddler or preschooler behavior can be annoying and difficult for some parents and they’ll ask the family doctor for something to help with that.
- There really does seem to be a wider acceptance by society of medication use than a few decades ago. There isn’t as much stigma attached and the fact that children are on this or that drug is freely exchanged in parental conversations. I hear this discussed on blogs and around the swings on the park playground. Several years ago, I was teaching an Early Childhood Education class in a large, metropolitan high school here in Indianapolis. The group consisted of mostly junior and senior girls. During a free period, I was amazed to hear their conversation about medication use. Most of them had been on prescription drugs since preschool or early elementary for depression, bipolar disorder or ADD. They bantered back and forth about which drugs they’d taken, which ones worked best, which ones had side effects, and what they were taking now. Wow.
- Parents are often pressured to have their children conform to behavioral standards set by the child care program, although the standards are not always reasonable or appropriate. Preschoolers and toddlers are always going to be preschoolers and toddlers. Of course, there is going to be fidgeting, restlessness, and even aggression when unhealthy expectations are enforced… like sitting for long periods of time, completing worksheets, or having to stand in lines.
As Early Childhood educators, I believe we need to take our roles as advocates for young children seriously. Give them the chance to be children, which includes acting like children. If a child is having issues, look deeper than the behavior. The problem just might be the environment we have provided for her. Or, perhaps our expectations are unrealistic or aren’t meeting her specific needs.
We first need to consider what WE can change, without changing the child. Uniformity never works, because there is nothing uniform about young children. Every single one that comes into our care is unique and special. Who said this work was easy?
There is no ethical way I can ask a parent to change their child so my day goes easier. Because if, as a result, this child is medicated and it was not specifically required, I would have to live with these questions…
What passions might this child have had?
What exuberance for life and learning could she have missed?
What might this child have become, if it wasn't for me?
Center for Disease Control and Prevention
National Institute of Mental Health
American Psychological Association