Teachers Diagnosing Children – Legal liability implications
Last week I had the opportunity to present two keynotes and five workshops to health and education professionals in BC on the impact of technology on children. During these workshops, I profiled the increasing trend by health and education professionals to over-diagnose and medicate children, some of whom might have technology addictions. I was approached, on more than one occasion, by parents who told me an all too familiar story, one I have heard more times than I care to remember. While each parent’s story was somewhat different, the salient theme was that teachers are telling parents that their child has ADHD (or some other mental illness) and that they should be on some form of medication.
The propensity to diagnose and medicate behaviour has risen sharply over the past decade, with a total of 14.3% of Canadian, and 12% of American children receiving a mental health diagnosis, and many on some form of psychotropic medication (stimulant, antidepressant, antianxiety, sedative, or antipsychotic). When England, Australia and France have banned the use of psychotropic medication with children, one has to wonder why North America seems to have cornered the market on mentally ill children. We have truly entered the age of what Dr. Paul Kershaw terms a “diagnostic crisis”, and need to step back and take a comprehensive and careful look at what we are doing to our children, and why.
This article will profile three of this past week’s parent stories, and present to the reader some startling facts in order to gain a new and fresh perspective on how we can turn this diagnostic crisis around, and create healthy and sustainable therapeutic practices and environments for our children. Teachers should be teaching and not “disease spotting” or telling parents their child should be on medication. All facts quoted in this expose’ are referenced by research listed at the end of the article, or can be found on the Zone’in Fact Sheet available at http://www.zoneinworkshops.com/fact-sheet/zonein-fact-sheet/
Fact – 43% of all referrals to physicians for problem behaviours come from their teachers, not from their parents.
One parent was told her son had ADHD and required medication. Thinking possibly this teacher was wrong, the parent waited one year, only to be told by her son’s grade two teacher the same thing, that her child had ADHD and required medication to control his “behaviour”. This boy’s behaviour was that he was unable to sit still in his desk, pay attention and complete his school work. He was often kept inside at recess to finish his work, and punishment for “bad behaviour” was denial of playground activity.
Fact – once a school system “labels” a child as ADHD, all behaviour is interpreted as a component of the “disease”.
This parent took her son to a paediatrician, reporting the teacher’s concerns, and was told that indeed her son demonstrated behaviours that met the criteria for ADHD diagnosis, and the paediatrician recommended medication. This parent sought out yet another paediatrician for a second opinion, as she thought that maybe the paediatrician was wrong, but the second consultation also resulted in a confirmation of the original ADHD diagnosis and recommendation for stimulant medication as her son’s only therapeutic option.
Fact – stimulant medication is the ONLY option offered to parents by medical professionals in 7 out of 10 cases.
Reluctantly, the parent started her son on the prescribed stimulant medication, but stopped after only a few weeks due to worrisome side effects, and the fact that the drug didn’t appear to be working to resolve her son’s classroom behavior e.g. he still moved in his seat and had trouble completing his work. Finally, after gentle “encouragement” by the school, the mom put her son back on the medication. After a period of one year, when the medication appeared to not be working anymore, the school suggested that the parent return to the paediatrician for another consultation. The student’s stimulant medication was consequently doubled.
Fact – children taking stimulant medication are ten times less likely to do well academically, and have increased risk of cardiovascular problems.
Another parent informed me that the school had told him that he needed to put his son on stimulant medication, or his son would not be allowed to attend school. This comment has been reported to me at workshops on numerous occasions. Another parent stated that the school had told her if her son did not take medication to control his “behaviour”, they would need to put him in “special education class”, or she could choose to keep him at home. Both these parents complied with their school’s wishes, but at what cost to the health and well being of their child? Both parents were worried this medication would harm their children.
Fact – stimulant side effects often appear as if the drug is not working, when really, these are signs of medication “toxicity”, and indicate the drug should be discontinued.
All these parents are understandably distressed and worried about their children, and will do whatever they need to ensure their children do well both socially and academically. These parents had all tried as best as they knew how to not use stimulant medication, but were not given any other alternatives, by either the school or the paediatricians. Kept inside at recess, threatened with “special” programming, or even expulsion, these children and their parents accepted their “label” and complied to pressure placed on them by education and health professionals.
Fact – stimulant medication is no more effective than a placebo.
School administrations and education governments would be wise to inform their teachers that they are acting outside of their area of expertise in telling parents their child has ADHD, or any other mental disorder for that matter. At the very least, a teacher diagnosing a student with a medical condition, and recommending medication, could be interpreted by their professional associations as misconduct. In the worst case scenario, this teacher’s action could result in loss of their license to teach, and well as academic failure, long term physical harm, and potential Cardiac Sudden Death of the student.
Fact – use of stimulant medication results in a 10% reduction in weight and height due to its effect on growth hormone.
Healthy and effective alternatives to teacher “disease spotting” would be to follow evidenced based interventions for improving attention and learning. Movement, access to “green space”, therapeutic touch, attachment building communication styles, and balanced technology management have all been proven to optimize attention and enhance learning in students. To choose the route of behaviour diagnosis and medication puts not only the students at risk, but also places the education profession legally responsible if they indeed were acting outside of their area of expertise. The health professions could be legally liable if they did not offer the parent and child alternatives to medication.
Fact – 45 minutes per day of cardiovascular exercise improves academic performance.
Fact – 20 minutes per day access to “green space” improves attention.
Fact – recess is the most effective behaviour management tool, yet many schools are reducing or eliminating recess.
Fact – children who use more than 1-2 hours per day of technology have a 60% increase in psychological problems.
Helpful Initiatives for Schools
1) Schools Operating Safely – Child Behavior Management Policy and Procedures
By Cris Rowan for Zone’in Child Development Series newsletter December 2009
Author offers her evidence based ten step plan to minimize student problem behaviours through using alternatives to medication, restraints and seclusion rooms.
2) Technology Screen
By Cris Rowan for Zone’in Child Development Series newsletter June 2010
Routine use of the Zone’in Technology Screen by both education and health professionals will ensure accurate assessment and intervention for problematic child behaviour.
Helpful Initiatives for Health Professionals
1) TECHSNO Rx
Cris Rowan’s alternative to psychotropic medication prescription. This Rx pad can be used by both education and health professionals, and is available at http://www.zoneinproducts.com/.
2) Unplug – Don’t Drug Policy Initiative
Cris Rowan has designed a procedure of three month technology family “unplug” trial prior to costly child behavioural diagnosis and medication. This policy initiative was published in the peer review Journal of Ethical Human Psychiatry and Psychology which can be downloaded at http://www.zonein.ca/files/Unplug-DontDrugArticle.pdf
Who First Suggests the Diagnosis of Attention-Deficit/Hyperactivity Disorder?
By Sax L and Kautz KJ for the Annuals of Family Medicine 1: 171-174, 2003
Teachers were most likely to be first to suggest the diagnosis of ADHD (46.4%), followed by parents (30.2%), primary care physicians (11.3%), school personnel other than teachers (6.0%), consultants such as child psychiatrists or psychologists (3.1%) and other specified categories (3.0%).
Medicine Goes to School: Teachers as Sickness Brokers for ADHD
By Christine Phillips for Public Library of Science Medicine on April 11, 2006
The wide acceptance of disorders of educational performance, and the penetration of the pharmaceutical industry into schools, point to similar needs for teacher training and participation in surveillance. Children have no agency in this market. To be effective advocates for children, teachers need to be supported to be objective and accurate interpreters of information for parents and healthcare workers, rather than franchisees in the sickness marketplace.
OROS-Methylphenidate, Placebo Show Equal Efficacy for Adolescents With ADHD and Substance Abuse Disorders
By Nancy A. Melville for Medscape Medical News, December 9, 2009
The researchers said they were “stunned” to find that the placebo group, receiving only cognitive behavioral therapy (CBT), showed significant improvement â€” just as much, in fact, as the medication group, which also received CBT. “What this suggests, is that we can do more for these adolescents than simply throw a psychostimulant at them” said lead author Paula Riggs, MD, professor of psychiatry at the University of Colorado School of Medicine, Aurora.
School Recess and Group Classroom Behavior
By Romina M. Barros, MD, Ellen J. Silver, PhD, Ruth E. K. Stein, MD for Pediatrics 2009; 123
This study indicates that among 8- to 9-year-old children, having 1 daily recess period of 15 minutes in length was associated with better teacher’s rating of class behavior scores. This study suggests that schoolchildren in this age group should be provided with daily recess.
Children With Attention Deficits Concentrate Better After Walk in the Park
By Andrea Faber Taylor and Frances E. Kuo for Journal of Attention Disorders 2009; 12; on August 25, 2008
Study reports inner city children have three times the ADHD as rural children due to lack of “green space”, and reports that only 20 minutes per day access to “green space” increases attention and reduces ADHD symptoms.
Raine ADHD Study: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children
By the Government of Western Australia, Department of Health, 2010
In children with ADHD, ever receiving stimulant medication was found to increase the odds of being identified as performing below age-level by a classroom teacher by a factor of 10.5 times (compared to never receiving stimulant medication). Children who had consistently received stimulant medication at all time points (including when cardiovascular health was measured) also had a significantly greater diastolic blood pressure than children who were currently receiving medication but had not in the past (7.05 mmHg higher. The results seem to indicate that there is little long-term benefit of stimulant medication in the core symptoms of ADHD. This is not unexpected, as medication is used for the temporary management of core ADHD symptoms rather than as a cure.
Nearly 1 million children potentially misdiagnosed with ADHD
By Andy Henion, University of Michigan Relations Office News on August 17, 2010
Nearly 1 million children in the United States are potentially misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest – and most immature – in their kindergarten class, according to new research by a Michigan State University economist.
Video – CBC News “Brain Gains”
Film clip of research by Dr. John Ratey, author of the book Spark: The Revolutionary New Science of Exercise and the Brain, shows how movement reduces behavior while improving attention, learning and grades.