Young Children Are Diagnosed With ADHD-type Symptoms, When Behaviors Are Actually Typical

KJ Dell’Antonia’s May 16 post for Motherlode, the NY Times parenting blog, revealed the fact that “about 15,000 American toddlers 2 or 3 years old, many on Medicaid, are being medicated for attention deficit disorder, according to data presented by an official at the federal Centers for Disease Control and Prevention.”  She told us that Alan Schwarz reported that “toddlers from low-income families are disproportionately represented among those medicated.”  Dell’Antonio goes on to draw the following “inescapable” conclusion:  Families that can afford alternatives to medicating toddlers (such as evidence-based therapeutic alternatives) have access to those alternatives in far greater numbers than families that cannot.  

Two- to Three-year olds are talkative, impulsive, loud, extremely active children who are poor listeners when it comes to instructions and prompts to sit still or “listen.”  They are just about the busiest crew you will ever find in terms of shining their lanterns of consciousness on everything they see, hear, touch, taste and smell.  They soak up the world with reckless abandon, as they should.  These behaviors are 100% developmentally appropriate and are necessary for toddlers to learn what they need to learn in a short amount of time in order to be ready for school at age 3, 4 or 5.  They seem almost unconsciously aware of the fact that preschool, Pre-K or kindergarten is around their developmental corner, which causes them to want to gather the language, social, emotional and sensory experiences they will need to succeed in school.  To be sure, these behaviors are not symptoms of ADHD in toddlers.

Both Dell-Antonio and Schwarz, who wrote the NY Times article titled Thousands of Toddlers Are Medicated for ADHD, Report Finds, Raising Worries on May 16, point out that there can be, of course, legitimate diagnoses of ADHD in toddlers who are having significant problems managing their behavior and impulsivity in order to learn successfully.  However, what was found to be most concerning by them as well as other professionals was that toddlers covered by Medicaid were medicated for the disorder far more often than those covered by private insurance.  Schwarz wrote in his article, “Dr. Nancy Rappaport, a child psychiatrist and director of school-based programs at Cambridge Health Alliance outside Boston who specializes in underprivileged youth, said that some home environments can lead to behavior often mistaken for A.D.H.D., particularly in the youngest children.”  Rappaport also said:

“In acting out and being hard to control, they’re signaling the chaos in their environment. Of course only some homes are like this — but if you have a family with domestic violence, drug or alcohol abuse, or a parent neglecting a 2-year-old, the kid might look impulsive or aggressive. And the parent might just want a quick fix, and the easiest thing to do is medicate. It’s a travesty.”

In my opinion, Dell’Antonio summed up my experiences with the inner-city middle- and high-school students with whom I work when she ended her blog post saying:

It’s not hard to see what may lead a parent and a doctor to choose to medicate a toddler’s ADHD-like behaviors under those circumstances. What is difficult is addressing the vast set of inequalities that underlies this particular example of the increasingly large gap between the childhoods of low-income children and those of children whose circumstances are more fortunate. For now, we’re left with one of the ironies of income inequality: a rare instance of poor children getting more of something than they need.

Amazing, positive early language, social, emotional and sensory experiences, not medication, is the answer for closing the achievement gap between poor and low-income children and the rest of the children in our country.  Parent and caregiver training should be of the highest priority in the United States since they are the ones who are around infants and toddlers most and who will have the greatest longterm impact on the development of a child.  Every parent and caregiver of poor and low-income children need to know the basics of giving babies and toddlers the language, social, emotional and sensory experiences they need, and then we need to check in on these parents and caregivers weekly to be sure that the right “stuff” is being given to children.

But, how do we know just what these parents need in order to help their children develop as well as children from middle- and high-income families?  Policies, educational or care standards, mountains of data, academic research, newspaper articles and blog posts, and laws are important to have in place in order to fix a problem, but these don’t really offer deep understanding of the problems that poor babies and toddlers and their families encounter daily.  For deep understanding and true problem solving, we need to ask parents, caregivers and families what they actually need to improve their young children’s lives.  

David Brooks, in his May 15 op-ed column in the NY Times titled “Stairway to Wisdom,” explained that in order to truly understand a social problem in depth (and, I say, to then find solutions to the problem), we must go beyond data, academic research and journalism.  He stated that in order to achieve a “rich, humane” understanding of a problem, we need intimacy.  Brooks informed us that as Augustine, an early Christian theologian and philosopher, aged, he “came to reject those who thought they could understand others from a detached objective stance.”  Brooks told us that Augustine:

“came to believe that it take selfless love to truly know another person. Love is a form of knowing and being known. Affection motivates you to want to see everything about another. Empathy opens you up to absorb the good and the bad. Love impels you not just to observe, but to seek union — to think as another thinks and feel as another feels.”

Brooks so beautifully ended his article saying:

There is a tendency now, especially for those of us in the more affluent classes, to want to use education to make life more predictable, to seek control as the essential good, to emphasize data that masks the remorseless unpredictability of individual lives. But people engaged in direct contact with problems like teenage pregnancy are cured of those linear illusions. Those of us who work with data and for newspapers probably should be continually reminding ourselves to bow down before the knowledge of participation, to defer to the highest form of understanding, which is held by those who walk alongside others every day, who know the first names, who know the smells and fears.

I say we shoot for all families having alternatives to medication in their parenting “pockets.”  Babies and toddlers needs are simple, but their needs simply cannot be met by those who do not understand what is needed.  Until all who are involved with babies and toddlers have a deep and intimate understanding of what early childhood development should look like, there will forever be an achievement gap between the rich and poor.