Friday, November 4, 2011

The Federal Government Should Not Decide If Kids Need Mental Health Screening

by Dr. Susan Berry

On the heels of new recommendations by the American Academy of Pediatrics (AAP), that children as young as four years of age be evaluated for Attention Deficit Hyperactivity Disorder (ADHD), a new study (funded by two agencies of the Department of Health and Human Services) has concluded that the drugs used to treat ADHD do not pose risk of serious heart problems to children and young adults. Currently, ADHD is the most commonly diagnosed neurobehavioral disorder in children, with about 10% of children having been labeled with the diagnosis, as of 2007. The highest number of parent reports of ADHD has been among those covered by Medicaid.

But, why are increasing numbers of children and adults being diagnosed with ADHD? Is it just coincidence that DHHS-funded research has recently concluded that it’s safe to give stimulant medications to very young children immediately after the AAP, a major supporter of Obamacare, has announced its recommendations for earlier screening? To be sure, many physicians and mental health practitioners believe ADHD is being overdiagnosed. MedPage Today, a service for physicians that provides a clinical perspective on breaking medical news, found that 80% of its readers believed the disorder is overdiagnosed. Similarly, psychiatrist Dr. Allen Frances states that ADHD has become an “epidemic” for several reasons: (1) Changes in the wording of the diagnosis in the DSM-IV (Diagnostic and Statistical Manual), (2) heavy drug company marketing to doctors and advertising to the public, (3) extensive media coverage, (4) pressure from parents and schools to control disruptive behavior in children and (5) the use of stimulant medication (such as Ritalin) for performance enhancement.

In light of what appears to be a drive to diagnose more behaviors as “abnormal” earlier in life, Congressman and presidential candidate Ron Paul has reintroduced H.R. 2769. The Parental Consent Act 2011 prohibits mandatory mental health screening of students without the express written, voluntary, informed consent of their parents or legal guardians. The bill seeks to protect the fundamental right of parents to direct and control the upbringing and education of their children. With the passage of this bill, federal education funds cannot be used to pay any local school or government agency that charges parents, who refuse consent to permit mental health screening for their child, with child abuse or child, medical, or educational neglect.

A major concern is that daycare providers and teachers are the main referral sources for ADHD screening. The types of behaviors many of these individuals may view as “problematic,” in a classroom setting, such as fidgeting, distractibility, inattention, interrupting, and lack of organization are very much consistent with a normal four-year old’s stage of development. While some adults may view the children’s behavior as a “problem,” the real issue may be that adults are expecting young children to function, without disruption, in an institutional setting.

As more young children have been placed in daycare settings, larger groups of them must be managed by just a few adults. Dr. Paul’s bill prevents children who attend public schools, or daycare programs that receive federal funding, from being forced to submit to mental health screening without parental consent.

According to Congressman Paul, a physician:

“Many children have suffered harmful side effects from using psychotropic drugs. Some of the possible side effects include mania, violence, dependence and weight gain. Yet, parents are already being threatened with child abuse charges if they resist efforts to drug their children. Imagine how much easier it will be to drug children against their parents’ wishes if a federally-funded mental-health screener makes the recommendation.”

The bill is in response to a recommendation by the New Freedom Commission on Mental Health, established in 2002 by President George W. Bush, whose stated purpose was to bring greater awareness and service guidelines regarding mental health issues to Americans. According to Congressman Paul:

“The commission recommends that universal or mandatory mental-health screening first be implemented in public schools as a prelude to expanding it to the general public. However, neither the commission’s report nor any related mental-health screening proposal requires parental consent before a child is subjected to mental-health screening. Federally-funded universal or mandatory mental-health screening in schools without parental consent could lead to labeling more children as “ADD” or “hyperactive” and thus force more children to take psychotropic drugs, such as Ritalin, against their parents’ wishes.”

While AAP recommends that behavioral interventions be utilized first, prior to medications, for young children diagnosed with ADHD, Dr. Frances states:

“…experience suggests that these cautions will be widely ignored in busy everyday practice, especially because behavioral approaches are usually unavailable and medication is so highly promoted and readily available.”

As a practicing psychologist, this last statement is the crux of the matter. While there is a small minority of children who have neurological disorders that require medications, some parents and teachers would prefer a quick fix of medication for a child in order to make teaching and parenting easier, rather than work on an approach that requires thinking outside the box and consistent implementation by both parents and teachers. The number of young children who come to my office already tagged with ADHD, Bipolar Disorder, Asperger’s Syndrome, Pervasive Developmental Disorder, etc. is staggering. The larger educational issue is that many of the children diagnosed with ADHD are actually very bright and need to be taught in a different manner, one that our “one size fits all,” institutional public education system does not adequately address.


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