Walter Freeman, Howard Dully, and Lessons Learned
I have so many intense feelings after listening to Howard Dully's account of what happened to him. At 12 years old, he received a transorbital lobotomy, because his step-mother convinced an eager doctor that the boy was unmanageable. Truth was, he had just lost his mom, and the adults had told him she had just "gone away." A loving Mom was replaced by this stepmother who was, at best, unkind to Howard. Of course the cause of the problems was "Howard was a difficult child." That was the story the stepmother and Freeman told themselves. It seems Howard's Dad was too disengaged to question his new wife's motives and/or judgment. The child, in this case, was labelled and treated yet was NOT the source of the problem, in my opinion. Grief. Loss. Emotional abuse. No one in his "corner." - these are the things that I believed were causing Howard's issues (if he even had any!).
Do you think that this happens today? If so, give an example -- but do not share any confidential information. If children are serving as scapegoats so to speak, what can we do as practitioners to limit the risk to kids?
Answer these questions, and then respond to at least 2 of your classmates.
Do you think that this happens today? If so, give an example -- but do not share any confidential information. If children are serving as scapegoats so to speak, what can we do as practitioners to limit the risk to kids?
Answer these questions, and then respond to at least 2 of your classmates.
I think that it is possible that a child could be labelled and treated who is not the source of the problem. Of course, I’d like to think it can’t happen in my community because I am aware of the services that are available in my local school system today. But, in larger cities where there is a larger population and school counselors or social workers can’t get to know each child, I think it might be possible.
ReplyDeletePerhaps a child is acting out at home and at school, and the parents/guardians are contacted by the school for a meeting to discuss the behaviors. What if the parents/guardians are not truthful about a disruption in the household and the behaviors the child is exhibiting are seen as hyperactive and disruptive and not being able to focus. Perhaps a suggestion is made to put the child on medication for ADHD and the parents/guardians go along with it, again without being truthful about the recent disruption in the household.
Lisa,
DeleteI often think that using medication may be more for the comfort of staff and others than it is to benefit the child. I think we need to look at benefits and side effects. In small schools it is often easier to build a relationship which often helps to reduce behavioral problems.
Nancy
Hi Lisa,
DeleteI think you make a great point. I imagine there are many families who would not want to admit that their home-life is not a positive environment for their children. Rather, blaming the child's misbehavior is easier. That way, they can keep their private lives, private.
Having a child with disabilities can be isolating. Families want to see their children be a positive reflection of themselves. When a child displays unwanted behaviors due to stress, abuse, lack of support, etc., they search for a cure. While schools and community social service agencies do a good job, I've always thought that diagnosing children so early with labels such as ADHD, Asperger's, Explosive Behavior Disorder was a mistake because it set the stage for that label remaining on the child all his/life.
DeleteI have to agree that a diagnosis and its concurrent medical treatment is not always in the best interest of children. Although parents may be assuaged by a diagnosis, they often forget that this "label" follows this child for a long time. As a matter of fact, if we are heading in the direction of weeding out those with preexisting conditions for health insurance coverage, a hasty diagnosis can have disastrous consequences.
DeleteOn the converse of that, I've seen a case where it appeared the parent was using the child's stimulant prescription. Withholding a medication the child needs can also be bordering on abusive/ neglectful.
DeleteHi Lisa,
DeleteI talked about something similar in my own post. I think there are many situations in which practitioners diagnose and prescribe medications without getting to know the child well enough to make a proper clinical judgement on what's going on. This can be reckless, especially if you are prescribing medication to a child who doesn't necessarily need it.
I am interested in this thread, as I agree that there are diagnoses that occur way too quickly, whether it is due to health insurance requirements or medical/mental health professionals needing a label to then begin treatment. I had the opportunity to read through records in a young woman's history over a few years with a psychologist. The diagnosis that came up many times was Oppositional Defiant Disorder-- not a great diagnosis to have attached; although I have not known her for long, my sense is what the psychologist was diagnosing was actually behavior that occurred as a direct reaction to the mother and her mode of intervention. I am not sure if medication was involved as well, but it seemed so off base compared to her current presentation and did not aid her in getting the services that would be most helpful.
DeleteI appreciate the word "suggestion" because some individuals are highly susceptible to the power of suggestion, which can then spiral into a diagnosis and treatment suggestions the child may not need but the parent believes they do because they were told by a doctor, teacher, or any other provider.
DeleteLisa,
DeleteYour post resonates truth and offers educational value. Behaviorist B.F. Skinner reminds us that learning begins at home. Skinner theorized verbal behavior, meaning how a child interacts with its environment is reinforced by what they learn. Yesteryears physicians did their best in treating all patients, research and thought went into all patients being treated. Today, I am not saying that is not being done, it does seem like there are short cuts being taken. When I was a teenager I used to look at the Chilton Manual (repair manual) on how to repair my 1978 Pontiac Transam vehicle. This allowed me to get the source of the problem. It appears that some clinicians, physicians are treating patients by past experiences of other patients and not by thoroughly treating each patient as each patient has their different past experiences on what brought them to be treated by a physician. What worked for one patient medication wise might not be the answer for the next patient with the same diagnosis. Although in some cases it may very will work. Physicians and clinicians need to get back to the mechanics of treating patients and giving that patient more of a one on one up front interview and research to get to the source of the problem before placing anyone to include a child on medication. When I was a child I remember being seen by a doctor for at least 45 minutes. Today have times changed, it seems you are in the doctor’s interview room for 15 to 25 minutes and you are out. It seems that today so much goes to the waste side. You brought up a good point which is why I brought up learning begins at home. Yes, perhaps a child is acting out, and from where may that child be learning that from. This is why parents should look at everything they are doing at home and perhaps make some parental changes before accepting a prescription for their child. As we know medication can change a child’s future and then we will breed another set of problems. I enjoyed reading your post.
Fletcher, A., Siliezar, A., (2010), Behaviorism, http://behaviorismskinner.blogspot.com/
Walter Feeman, Howard Dully, and Lessons Learned- Nancy Ackley
ReplyDeleteI think that the story of Howard Dully as one of the youngest people to have a transorbital lobotomy as a 12 year old is a good example of a failed system. In his case, his mother died of cancer and his father remarried quickly. A family in crisis made some poor decisions which had life-long consequences for a 12 year old boy. I think that the specifics of having a lobotomy would not happen today. I do think that the 2018 version might look a bit different. I think that kids can be diagnosed with ADD, ADHD, depression, DMDD, or perhaps bipolar disorder without enough safety checks and be given powerful medication which may not be specifically tested for that population. I think there may be pressures from schools to improve behavior and result in medications that may have long-term impact on developing brains. Friends of ours have a child who was given a number of diagnoses before DMDD was an option. This child has been given a wide range of meds from age 7 to age 13. Currrently this child is doing much better at home and at school. The child's parents also have pushed back in terms of medications and found provders who are good advocates. In the case of Howard Dully, he did not have anyone in his corner. I would guess that perhaps kids who are in foster care may be at higher risk of some of these current abuses in that they may or may not have people who are advocating for them.
If students are scapegoats, what can we as practitioners do to limit the risks? I think we can be advocates as well as be present at meetings in which decisons are made. I also think we can encourage using second opinions in terms of medicating developing brains. I also think we can encourage the use of other strategies that are not medcation based.
Hi Nancy,
DeleteThank you for sharing that story. I think our society is used to doctors being the experts, and yet we really have to trust our own gut these days when our child is being prescribed a medication or treatment (Is it necessary? What are the side effects?). As you mention, it is important as practitioners to be present at meetings for the patient/client, and to advocate for them accordingly.
Hi Nancy and Heather,
DeleteIt does appear that medical experts are seen as the defining "deciders" on how a child is treated. Of course, there are wonderful special education programs as well as counseling and Early Essential Education which can help identify symptoms and provide services and early preschool experiences in a more holistic fashion.
When children are given diagnoses and medications, especially in preschool age, when the brain is still developing, I worry about the long term effects on the brain, how the brain copes in adulthood, and the longer term impact on the individual.
Sue,
DeleteI too wonder about the long-term mpact. I think the scary thing for me is that my experience is that schools support the use of medication as t makes life easier for adults.
Nancy
History clearly demonstrates that, often prior to approval, the long-term ramifications of medications are not always vetted. Although I understand the urgency in getting potentially beneficial medications approved, medications prescribed to still-developing children should be more thoroughly vetted for long-term consequences.
DeleteI used to be a BHP for kiddos that were involved in DHHS reports. I had a young kid. He was getting special accommodations in school for behavioral outbursts. He did well in math, but wouldn't sit still, didn't follow directions. He had the in home supports. I had gone to meetings at his school with his parent. I went to the intake appointment for the medications with mom and the HCT clinician. Everybody wanted him on medications. He had so many people following his case wanting him to succeed and they were ushering him towards the medications, the extra supports, anything they could throw at him. Do you know what I think he really needed? Structure. He had no rules at home. None. No bedtime. No brush your teeth. No clean your room. No nothing. We tried a reward system and assigned chores with no success. Little sister loved the system. But he didn't take to it. When he got angry he kicked, bit, spit, and hit. He was small, but if those behaviors continue into his teen years, I'm fearful for family's safety.
DeleteThe psychiatrist diagnosed him with ADHD & anxiety. Believed his behaviors were likely due to anxiety. This kid had found one parent passed out on the floor of their home in an overdose a year or two prior. And the other parent had been taken away in an ambulance from an overdose that same summer. Parents fought a lot. etc. etc. No wonder he's anxious. His life is unstable.
I use that story to demonstrate why I agree with you, Nancy. I don't think there is enough emphasis on non-medication strategies. Perhaps the medications will help him, despite side effects. But having the in home supports for such a brief time I think was almost a disservice. It took months to gain any rapport with this kid. And when he's finally used to having me around then the assignment is up and whatever changes I put into place may be dropped. It's just more change for him, instead of more of a reliable structure he can depend on. However, the only reason this family accepted the in home supports was because a DHHS report had been made on them and they had to.
Nancy,
DeleteI can sense that Mr. Dully had many sleepless nights on why his stepmom submitted him to Walter Freeman for a lobotomy. Looking at the pictures of Mr. Dully with dual icepicks protruding from both eye sockets must have been very painful. Mr. Dully was one of the lucky ones as Dr. Freeman’s lobotomy technique resulted in 490 deaths. Howard Dully seemed to have found some peace in talking it over with his father. He let his father know he held no grudges against him for what his stepmother did. One of the things I found interesting is that Dr. Freeman was hired by Veterans Administration to perform his lobotomy technique to veterans who had endured combat of World War II. Dr. Freeman was on a crusade to heal the mentally ill. Dr. Freeman believed he was doing more good than harm with his lobotomy techniques and he would not let anything stand on his way as he traveled the US giving lobotomies to many across our nation. What we as practitioners can do to stop children being scapegoats is to stick to natural supports and natural mechanics of the medical field before resorting to medical prescriptions. As we continue to read that often medication can be a life sentence to seizures, attention deficit disorders and addiction. Your post is fantastic to read.
I think situations like this are still happening today. Parents are responsible for their children and (until they turn 18) they get to make many important decisions for them. Sometimes parents can suffer from mental health conditions which can affect their ability to parent their child and/or make sounds decisions for them. Factitious disorder imposed on another (previously called Munchausen syndrome by proxy), is a disorder in which a parent might convince their family, friends, and their child's doctor that their child is ill. The parent would make up stories about their child's symptoms, and this could greatly impact the child's health care services (who might include treatments the child doesn't actually need). This would also certainly cause emotional distress for the child who might doubt their own feelings about their health after hearing for years about an illness they supposedly have. In this specific instance, it would be helpful to have some screening tools that might identify the dysfunction in the family. I always think that person-centered care is key. Take time to talk to the child directly and gain a better understanding of their perspective on the situation. As the practitioner, if something doesn't feel right--listen to that feeling.
ReplyDeleteHi Heather, Fictitious Disorder/Munchhausen's Syndrome by Proxy is a really good example of how parents convince family doctors, etc. that their children have illness which need treatment and medication. I've heard stories of frequent trips to emergency rooms and/or parents who frequent several doctors to try to get a diagnoses and medication...over and over. Developing a relationship with the child early so that they can build trust - may help the child process and have a voice in their own education, treatment and advocacy.
DeleteHi Heather,
DeleteI'm glad you bring up the topic of parent's being the ones who are pushing for the child's diagnosis. I think sometimes parents become too overwhelmed to "deal" with their child's behaviors or want an "easy fix". The person who is supposed to advocate for the child's needs could be the one causing more harm to the child, even more so in the long run if medications are involved. This is why advocacy on part of the practitioner is so important, as you bring up.
You mention in your post that parents at times may report symptoms that aren't true and is affecting the treatment of the child. This is something that i actually experienced while a children's case manager, the parents would report a slue of outrageous symptoms that would label their child as an out right menace and danger to society, so they would continuously book her into treatment facilities. All the treatment facilities would report that the child was a perfect "role model" to the other patients in the facility and the symptoms originally reported where not found at any point in time.
DeleteVessa each time those children were admitted to a facility it gave the parents a break for them to do what they wanted. I wonder if these parent's were ever offered the opportunity to give up their children to adoption vs continuing the fight? I remember the first time I heard a case manager state she was going to talk to a family about putting their child up for adoption, I felt she hadn't done enough with the family. I can see where this is beneficial to the child vs having them be the scapegoat and admitted several times because of made up symptoms. These family dynamics are so complex.
DeleteI agree that it is important to talk directly to the child. It is also important to get multiple perspectves and opinions on treatments that have long-term effects and as you said trust your gut in terms of whether the situation warrants medication.
ReplyDeleteNancy
While lobotomies are thankfully a thing of the past, those therapies have been replaced at times with psychotropic medications for children as young as 3 years old to control symptoms. While a medical model will seek to cure symptoms, and provide medications, life, families and communities are more complex than that. If children and families have access to early childhood education, social and mental health services, they may have more positive outcomes. Where families have the secrets of abuse, financial loss, or disability so severe that it isolates the family, they may be less likely to seek services.
ReplyDeleteSeeing adults who experienced abuse, isolation, over-medication as children...hearing their stories is really tough as one watches the sadness and pain, and how it affected the individual in the long term. I often hear stories of how individuals work for a long time, drink heavily at night (and sometimes on the job). Then something such as a medical event happens which causes the person to enter acute crisis and anxiety mode. What evokes from here is the consumer's stories of how difficult their early life was, how it affected their development into adulthood. The anxiety effused is palpable. Especially if the person cannot return to the job they once performed brings out symptoms and stories of loss, coping and coming to terms with their illness.
There are also many stories of teens and young adults who tell stories of how parents open credit cards in their children's name and max out the credit. Children's financial credit is ruined before they ever reach the age of employment, and wrecks the individuals ability to become financial independent.
Prevention at the earliest opportunity (and age) is the key to assisting the person to provide education, access to services, resources and perhaps build confidence that the person does indeed have self-worth and is deserving of respect.
Sue, unfortunately, lobotomies are NOT a thing of the past. They are done all over the world for "refractory OCD," depression, and schizophrenia. The surgical procedures are known as cingulotomy, capsulotomy, leukotomy ...and basically the surgeon uses heat or laser to burn away the brain tissue that they deem to be causing the problem. Mass General, affiliated with Harvard, has a psychosurgery department...you can look it up. This article describes the procedures...
Deletehttp://aycnp.org/psychosurgery_lobotomy_cingulotomy.php
Here is the description of the department at Mass General...
Deletehttps://www.massgeneral.org/neurosurgery/services/treatmentprograms.aspx?id=1666
That is so disturbing....
DeleteSchools are toxic. My mother and I have been working in education collectively for 27 years. She worked at a central Maine H.S. as an English teacher for 17 years and is now working at a day treatment center for H.S. age kids who have been removed from Maine stream classrooms. We believe that children are consistently blamed for the failures of the system of education in the U.S. We seek absolute behavioral control over children through rigorous sets of rules that take away creativity, initiative, and self-sovereignty. We believe that we are preparing them for adulthood which is frankly a lie. Most adults fail to live by the same behavioral standards imposed in school. Children who fail to conform to an arbitrary rule set are pushed out of classrooms into behavioral health programs, where the hands of control close even tighter, and medications are used in a bid to achieve complete behavioral control. Behavioral modification drugs are used on children whose young plastic brains are growing well into their twenties. This is psycho-physiological mutilation in my opinion.
ReplyDeleteI want to provide several examples here from my experience in a BHP room in elementary school.
1) A young seven year old was disallowed eating dry cereal if he refused to eat it with a spoon. He hated milk and preferred to eat it dry. For some reason, we were informed that if he tries to eat the dry cereal with his fingers, we were to take it away from him until he agreed to eat with a spoon. This was during his breakfast at school, which is often the only place many kids get a meal.
2) I was told that part of an 11 year-old's IEP was that he was only allowed to "dip appropriate foods into his mayonnaise". At lunch, if I saw him trying to dip a pear into mayo, I was to block the mayo physically with my hand. He was allowed to dip carrots into mayo. I'm not sure what else was appropriate.
3) A child with autism was taken off his medication because it was affecting his growth patterns. Working on his reading and writing was definitely a challenge when he was off his medication but certainly not impossible. The special education teacher in charge of his room and all the ed techs who worked with him pushed the parents and administration to put him pack on his medication so that it was "easier to teach him to read."
4) A wonderfully creative, beautiful girl in the 3rd grade clearly showed signs of audio and visual hallucinations. She reacted frequently to unknown things with anxiety and anger. She was managed through tight behavioral controls and was often denied access to her shoes, to exercise, or her fidget when her ed techs felt she wasn't doing what she was told. This often caused a significant escalation in her reactionary behavior. A manageable situation often turned into one where she became physically combative because of the decisions to remove those things she found comforting over reasons that she neither understood or were fair. I watched her staff force her physically force her hands to pick up milk-soaked used tissues (from a very sick student) because she had kicked over the trashcan after she was removed from the lunch room for refusing to get in the right line for her grade.
These children are generally medicated or land in very draconian and imperial behavioral modification programs. It's all positively medieval and all in our schools today.
Your first and second examples are "violations" of social folkways. Unfortunately, society all too often does not allow children to do what is right for them. We (schools, etc.) are so caught up in our social conventions that individuality is squelched, even punished.
DeleteI think what I'm most frustrated about is that these children have significant behavioral, emotional, or cognitive disabilities and social folkways seem really trivial and arbitrarily imposed ONLY for these children. We tighten the noose of control on children and adults with cognitive and psychiatric disabilities because I believe we are afraid of them. When I pointed out to other ed techs that mainstream kids seemed to be eating with more freedom of choice of how and with what, the shoulders were shrugged. Somehow those same rights didn't apply to these kids. And I want to know why.
DeleteIt makes me angry to hear that these experiences occurred within the schools. For many students, school may be the only place where they can feel safe and cared for, and it is really frustrating to hear that is not the case. I agree that the first step is to identify what has been accepted in the past and really looking at why it is done this way and who it is really serving--the student or staff?
DeleteI also want to highlight that there are positive school programs that exist as well to support individuals in becoming more independent and gaining life skills for a successful transition. I had worked in a school for students with language based learning disabilities (and many with mental health challenges as well) in which juniors and seniors alternated their weeks between going to school and working. They were expected to manage their school work during these work weeks similar to college students (with the understanding that they needed the opportunity to learn these organizational and time management skills to be successful); many of them felt that the best skill they learned in this program was self-advocacy, and it was most important in their ability to achieve their post-secondary goals. Programs like these that understand that project based, life-skills focused, hands on experiences help engage students on another level are hopefully the standard instead of exception. Also, the trend for schools, medical offices, and other programs to provide trauma informed care indicates that there are attempts to try to make things better.
Hi Bronte,
DeleteThese personal accounts you mention here are awful and make me sad for those children. I think there are many times where school staff try to push medication onto students by telling their parents that the child's behavior is troublesome or they aren't "easy" to teach. I don't think they're always thinking of what is best for the child in these situations. The third example you gave illustrates this perfectly. When a student becomes "too difficult" to teach, teachers and classroom aides should collaborate and brainstorm different ways to approach teaching the child, rather than assuming the best bet is to medicate them.
Yes, this certainly happens today. We see kids admitted to the hospital and left there with nowhere to discharge to because the parent refuses to take them back. Parents drop kids off at a CSU or an ER because they "need a break." Sends a terrible message to the kid.
ReplyDeleteWhat I found interesting was that Freeman's records demonstrated a significant amount of time and energy spent on Howard's case. I don't think a child would be given that many appointments with a provider before interventions were initiated in today's day. They would be much quicker to medicate. I have worked with kids who have had DHHS involvement. Those kids do have problems. They perhaps aren't to blame for their problems. But they are there.
As providers we can help the child feel that we are "in their corner." (I take this approach with all of my clients adult or child.) Building rapport and trust takes time. Letting the child know it is not their fault. But still they get what they get so, helping them cope and manage the circumstances that they do need to face is important. Perhaps processing and grieving their parents/caregivers inadequacies as child gets older/ has good insight. While working with the child, building a relationship with the parent to potentially plant the seed that they could utilize professional services as well. Sometimes they are interested. Connecting parents to services like support groups, educational resources, etc., if they are open. This should be done cautiously as to not offend the parent so that they withdraw the child from services.
Hi Jessica,
DeleteI agree with you about it being important as providers to let children know that we're "on their side". I think children in these situations can have negative experiences with adults in respect to whatever behavioral issues may be going on. Letting the child know that we aren't there to further chastise them or blame them is a great first step to building a positive rapport. I also like your idea of possibly suggesting to parents that they look into services themselves, whatever that may mean for them individually. Having kids is hard enough, let alone if there are other challenges the child may be facing. Having other parents or a professional to talk to may help them out a bit and give them insight into how to best handle the situations they're dealing with.
I absolutely believe that what happened to Howard (not transorbital lobotomy of course) happens today, albeit in different forms. Today, it tends to happen via chemical means. It seems that practitioners, often led astray by parents who do not understand child development or simply do not want to care for an active child, are quick to diagnose ADHD or other disorders in children and prescribe medication. In today's world with its paucity of psychiatrists, many times these children are diagnosed by their overworked pediatrician who, often without observing the child for a significant, meaningful amount of time, will diagnose children primarily based upon their parents' description of behaviors.
ReplyDeleteAs practitioners we should ensure that the parents of children who seek help from us understand child/adolescent development. We should make it our mission to educate, educate, educate. Moreover, if the opportunity arises, we should gently but steadily describe, not only the benefits of medications, but also their potential deleterious effects on ever-changing brains. All the while, of course, never making parents feel guilty or inadequate for allowing their child to take prescribed medication.
Lisa, I really appreciate your comments about education for parents. I hear from parents that they do not understand the state benefits, programs, and post-secondary options available, especially when we discuss the transition from high school. There are many parents who did not know what they could ask for and thought that the educator must know best.
DeleteOn the other side, there are also parents who unfortunately utilize their children in a negative way, looking to be their guardian and/or payee with limited/no decision making or involvement with the child. I have unfortunately worked with individuals whose parents continue to be payees after they turn 18 and do not provide information about their benefits (or give the adolescents any of the money).
Hi Lisa,
DeleteI think further education is a great idea. Often times, parents will go to their children's healthcare providers and explain the behaviors their child is having, wanting a quick fix to make things easier. The provider may not have all of the information about the background of the behaviors, their context, etc., but could still prescribe medications. I'm sure there are many parents who aren't made aware of the dangers these drugs can have on their growing child's brain, which is the fault of the provider. I think giving a child medication should be taken seriously, which means giving adequate time to find out more about the situation and taking it from there without rushing to find a solution.
This comment has been removed by the author.
ReplyDelete
ReplyDeleteI believe that children are, unfortunately, often viewed as the scapegoats in a family or school situation as the “identified patient” or person to blame. The words "resistant" or "difficult" get attached to a child by a parent or educator, and these are hard to lose, as they follow them everywhere for a very long time.
It seems to be much easier to externalize and lay the blame on someone that cannot defend themselves, when in fact the child is just trying to find a way to express emotion in an impossible situation. Howard Tully states, "A 12-year old couldn't stand against that" in describing his stepmother’s pursuit in Walter Freeman doing a transorbital lobotomy on him. His father’s excuse of being manipulated by the stepmother again shifts the blame to someone else; adults in society are supposed to help protect the vulnerable from abuse, when in this situation these very adults were horrible and the source of the abuse. I was just so angry that his father did not apologize or attempt to provide something other than an excuse or stating that he “does not dwell on the negative”.
As counselors and practitioners, it is our role to foster autonomy in individuals from an early age. There are students that I meet graduating from high school who have no idea that they have a disability, how it affects them, and what they may potentially need for accommodations in the future. When this happens, then something vital is missed in the child’s learning process. This information is important to discuss with students as they developmentally grow and change, and to have it a normal part of conversation that does not reflect who they are but helps them understand how they learn and interact with the world. Students can also be encouraged to identify and utilize their strengths, as well as practice resiliency.
We also have a duty to ensure that we are keeping our own prejudice and judgments out of the discussions with children, and always remember that there is a power differential that exists as adult and child. Whenever we forget that our behavior has a direct impact on those around us, like when we nonchalantly tell a child to be quiet when we are having a bad day, it leaves a lasting impression. Children have rights as well.
I feel many children in today’s society are victimized. Quite often both by their parents and again by the systems designed to help or protect them. I have known children who go to school hungry, and dirty, because they have a home life with variables like uneducated/uninvolved parents, parents with alcohol or drug abuse disorders, parents or family members who abuse them, etc. These children can have emotional outbursts as a result of their circumstances. Other children have trouble simply sitting for long periods of time and become fidgety. If a child acts out (is defiant, causes outbursts, does not sit still, etc.) they may be labeled as disobedient, or has having ADHD or an emotional/mental health disorder (oppositional defiant, bipolar, etc.). If parents take their child to a doctor, that doctor may prescribe medication(s) solely based on school suggestions and reports of behavior, without listening to the child. Many children, in my opinion, are unnecessarily medicated. I have known of some kids that were labeled ADHD and punished for not “behaving” when they just physically needed to move.
ReplyDeleteSome children may have a physiological, chemical imbalance from improper nutrition. Others might have a medical condition that manifest with certain behaviors. I feel badly when a child is labeled in school because those labels are hard to shake, no matter the amount of information that is presented after the fact.
I know of one child from several years ago. He was 11 and quite jittery, had difficulty sitting still and paying attention, could not grasp what was taught in class (like he could not focus enough to engage in learning, etc.) His teachers were frustrated with him and his inability to follow direcitons, sit still, pay attention, etc. He finally went to have some assessments done and it was discovered that his very long day was filled with a lot of sitting. His day started at 5 a.m. He had ‘block instruction’ in his classes (2 hour long blocks of instruction in a specific topic), 30 minutes for lunch and recess, if that, then more block instruction. After school, he went to an aunt’s home to do homework until going home at 7. He ate supper after that, took a bath and went to bed by 9. He had no time or really move around and expend any real energy from his muscles. All that built up in him and effected his learning.
Teachers thought he was difficult and defiant when he would fidget. They thought he had a learning disability because he wasn’t grasping the content instructed. They thought he had a behavioral problem, too. Talk of medication with Adderall was debated and strongly encouraged by the school psychotherapist.It was becoming a vicious cycle that was going to have great impacts on his future. Once his doctors encouraged his mother to enroll him in a different school, and in gymnastics, his grades improved and his demeanor, too. He was happier, and less frustrated.
This is just an example of how children can get stuck in a bad situation because of adults. Had his mother not decided to seek another opinion by her trusted family physician, and gone with the opinions and recommendations of the school staff, her son would likely have been medicated unnecessarily. The side effects of Adderall are also interesting. For a child with ADHD, who are hyperactive (overactive) and have difficulty paying attention and staying focused, Adderall’s side effects of restlessness, irritability, agitation, fear, dizziness, headache, anxiety, etc., seem to show that Adderall can cause the very problems it is prescribed to fix.
Fortunately, it is not as dramatic or severe as a lobotomy, but some medical professional who practice medicating, without fully knowing a child or their circumstances, seems to be an ongoing issue that is not isolated.
I agree with you Liz. I experienced a similar case and wrote about it on a comment above. I think the therapy community pushes people towards medication. I wonder if they even try any interventions first. Did you know there is a type of CBT designed specifically for ADHD. You could teach a kid tools to manage their distraction, fit tasks into time units they can hold attention for, etc. I wonder how much is tried before referrals for medication occur. It's fine if not much has occurred yet, because the combination of therapy with medications is said to be the most effective treatment approach. But I wonder how much therapists really do any teaching new skills.
DeleteI just watched the documentary "Take Your Pills" on Netflix the other day. Seems relevant. I think the problem is more of a systemic one. To fix it would mean a complete overhaul of how our society views success.
I think that there is a huge push for pills. I am not sure if t is because the drug companies offer huge incentives ? or for other reasons. I am not sure where one would begin to overhaul the system and how to change attitudes is means changing the stories we tell and the stories we hear.
DeleteNancy
Hi Liz,
DeleteMy friend who is a teacher has taken some classes in incorporating physical movement. This class focused specifically on dance. She recognizes that recess is cut short as well as lunch and physical activity. She incorporates dancing and moving around into her teaching lessons. Also, she has authority to go out and play games in the green area when the kids are starting to get fidgety. I think that in order to help children not be misdiagnosed, it takes everyone. It takes the parent, the doctor, the teacher and who else the child is with.
Thanks for sharing!
Taya
Taya, I am so glad that you mentioned the movement/activity component. I think that recesses are getting shorter and shorter, as are lunchtimes, in order to meet the academic requirements. My boys talk about getting one recess for 20 minutes or so; they are 7 and 9! In thinking about children's learning styles and general energy level, sitting in seats for extended periods time is asking so much. If a child has not had a proper meal before school, has not been able to have a bath, or has clothes that have not been laundered recently, or is concerned about someone's health or safety at home, all of these impact his/her/their ability to focus.
DeleteShifting back to Howard Tully's story, I have no doubt that he "acted out" when he lost his mother, his father seemed absent, and he knew that his stepmother disliked him and wanted him out of the house. That is going to impact a child on many levels, including ability to focus, stay on task, and manage stressful situations. He was trying to process and understand a situation that could not be explained, and it did not appear that anyone in his world stepped up to help him figure it out.
Liz,
DeleteYour post enlightens of what the current culture has been and is like presently in the United States. Why didn’t this exist as much in the 50’s – 80’s? It probably did exist in a lower scale but today children seem to be growing up harder often being neglected than years prior. Could parenting skills today be the reason how hard children are growing up today. We can place blame at all four corners of the state but when it comes down to it each household has control on how their children are brought up. Parental abandonment comes to question in the past few years until the present. Parental abandonment can take place in the home as parents neglect their children on a weekly basis or if a parent parents give up parenting all together. Absolutely, what goes on in a home can severely impact a child’s physiological wellbeing that can cause a child or young teenager to act out and the acting out can be viewed has a psychological behavioral disorder. Being diagnosed at an early age for an Axis I diagnosis with medication can lead to the child’s future destruction, this will create a history of the child to believe “I have a history of a mental illness”, and will never function at their fullest potential in academics and in sports. This will keep a child on their medication from youth and on to their adult lives never allowing for the fullest potential to be unlocked. Parents have to understand that it may not be the child on why they are acting out. Parents may have to go through counseling to reset their parenting skills to perhaps make some parenting modifications for their child to see if that can assist in changing the child’s personal problems that may be linked to parenting. This may be difficult for a parent to accept because all parents believe they are doing their best in bringing up their children. Enjoyed reading your post.
I think this does happen today, probably more frequently than we’d like to think. What immediately comes to my mind is a case I read recently in one of my classes. An 8 year old boy had been diagnosed with ADHD and had been prescribed medication for it due to his inability to focus in school or relate with peers. After this, the boy and his mother met with a clinical social worker to talk about the issue further. The social worker finds out that this mother and son live by themselves in a very poor neighborhood with a lot of gang violence. The boy’s father was shot and killed in their neighborhood over drug violence when the boy was younger. The boy’s mother didn’t want him to play outside for fear of him getting shot, so he spends his free time inside by himself. The boy says that he is often worried for his mother’s safety and is worried about her getting killed. The mother has to travel across the city to get to her job, which means the boy is often home by himself after school for a couple hours.
ReplyDeleteAfter this deeper inspection of the boy’s life, the social worker concludes that the “symptoms” his teachers were complaining about were just the boy’s reactions to his living environment. If you were living in this type of neighborhood and worried daily about your mother’s life and your own safety, wouldn’t you find it difficult to pay attention in school or interact with your peers? With this particular example in mind, I think that as practitioners we need to explore our client’s lives beyond their symptoms. We need to take the time (as difficult as that may be sometimes with time restrictions) to get to know our clients and understand their symptoms in the context of their lives before we diagnose them or prescribe them medications. This is especially true when dealing with children, as these diagnoses will often affect and label them for life. When medications are involved, it’s important to see that as one of the last options because of the effects they can have on children’s still-growing brains.
Noelani,
DeleteThank you so much for sharing that awesome story. I completely agree with you about taking the time to look at the individual as a whole. I work for the Division for the Blind and Visually Impaired and it is so important to take time to understand the individual as a whole. I want to know about the support system, job, housing, transportation, and how they became blind or visually impaired. Sometimes, they have been told that they are never going to be able to work, but there is so much potential. I think that is how young kids are approached sometimes, like they cannot make it with their outburst or misbehavior. Therefore, they need medication to "fix" it.
Thanks again!
Taya
I believe that it is still happening to this day. I have a good friend that is a 6th grade teacher and she has mentioned how recess and other physical activities have decreased. That being said, the kids are staying in the classroom more often and sitting still. I think that there is a correlation between the diagnoses of ADHD/ADD and lack of physical activity. I think that children are prescribed medication rather than using other outlets and services. Also, a lot of refugees/new americans (I apologize for not using the correct term) reside in Burlington. A lot of these children may seem as disruptive or misbehaved but there are so many other factors that play into that. For instance, new culture, new set of standards, trauma from their past, and many other things. Plus there is a language barrier. I work with the Division for the Blind and Visually Impaired and I have worked with a couple of students that are refugees. From my experience, the father did not believe his son was visually impaired and it took a lot of advocacy to help the student and for the father to accept the adaptive aids. So, I guess this takes an opposite approach. But, overall I think that prescribing medications to deal with these “abnormal" behaviors may be happening more than we know.
ReplyDeleteHi Taya,
DeleteI'm glad you bring up the topic of physical activities and recess. I've heard so many accounts of recess time being cut back, which seems crazy to me. I don't think it's fair or realistic to expect kids to sit still, inside, and not lose any focus for 6-7 hours a day. There are also instances where kids get their recess time taken away if they aren't paying attention or aren't focusing "enough" in class. It seems kind of obvious that if a kid is already having a hard time focusing, then taking away their only outlet to let out some energy is only going to make things worse.
Taya,
DeleteAfter doing research on Adderall which is used to treat ADHD, it is a very addictive drug. People who take it can concentrate to a fault, they can become so focused that the rest of the world around them doesn't matter, the will get the task at hand finished and will be sure they do their best. The reason I mention this is for some parents this drug becomes the reason they are so focused on the diagnosis of ADHD for their children, because they may be misusing their child's drug. In the documentary "Take Your Pills" it is noted that Adderall is a drug that is as damaging as the opiate crisis, it is socially acceptable because it is used to treat a common disorder ADHD. Again this is another big Pharma drug that is helping kids sit in those seats instead of looking at the behavior and figuring out how to support the child through different methods of education. I keep thinking about how schools feed into the medication/Pharm business vs looking at other ways to support the child...does it go back to their budgets?
I believe that recesses are being cut back more and more and it does not have a positive impact on children's abilities to manage their behavior. They need a release of energy, and when that does not happen then other, less acceptable behaviors can occur. My 7 year old son would come home and tell me stories about behaviors other kids engaged in, and how frustrated he would get when they could not control themselves-- they got one recess throughout the day!! I wonder if we are seeing more diagnoses for young children because of the increase of academic expectations at younger and younger ages which always results in decreases in recess and activities like gym, music, or art in which you can express yourself. This would also explain the increase in need for medication, because children are not able to manage their behavior for these long periods of time (nor should they have to) without any break or release. Children are expected to perform, and when they do not, alternatives like medication may be explored.
DeleteI most certainly believe that children can be used as scape goats and have sadly seen it from very mild cases to cases resulting in trauma, unnecessary treatment, and even death. In my previous employment as a case manager I worked with ages as young as 4 to as old as 75. I found working with children proved to be more challenging due to the parents, the parents are suppose to be an allie and engage in the treatment options best suited for the child and their needs, but what typically happened for me was that the parents were the barrier. If a child's behavior doesn't match to what the parents want then the child is automatically labeled as having "something wrong". This is something I came into contact with on several occasions and children were sent to residential treatments when all they really needed was for someone in their home to care about them and their needs. I will say this is not the case for every situation but for the purpose of this post I will only speak to those cases that correlate with this topic. I have experienced parents blaming their young children for the downfall of their relationships and property damage that could only have been done by a much larger individual then a 7 year old. It is heart breaking but is something that a light needs to be shinned on.
ReplyDeleteI do believe that children can become the scapegoat for many different reasons. I wonder about children that have experienced sexual abuse within a family and the family is in denial. Out of a situation like this there is trauma and behavioral differences. It would be much easier for a family to use medication or other treatments for the child than admitting to the abuse that has happened. This could also happen if there were physical abuse, how can the family cover things ups so they can hide behind the child.
ReplyDeleteCindy
Prescriptions and medications have been part of our daily lives going back many years ago. Our ancestors have used medicinal herbs, natural elixirs many years back. In the 1950’s, 60’s and 70’s the common cold was treated with over the counter medicine we don’t see today. Over the years the stage of medication and prescriptions have changed. Medication and pharmaceutical drugs have become big business and everyone from infants to the elderly need their medication prescribed by their primary care to live life as routinely as possible. Recently doctors have not been filling medication for patients who use up their prescriptions earlier than their dosage allowance per prescriptions given. Doctors are now educated to address medication misuse for those who are labeled as drug seekers and are known to misuse their prescriptions. For those who consume their prescriptions faster than their prescribed medication should last, turn to other ways of medicating themselves. Some user’s addiction is so high that they must medicate themselves with drugs that are sold on the streets and often end up in an over dose episode by buying cheap drugs to have a fix for their addiction. This epidemic is not stopping anytime soon. It seems like every two weeks you hear on the news that someone has passed from a drug overdose. We as practitioners have to re-educate the public of proper medication usage and how important it is not to consume more than your daily consumption allowance of your prescription told by your doctor. Women who are nursing need also be cognizant to not to breast feed if they are on medication for safety of their infant. The infant could pass of an overdose from breastfeeding or get addicted to the medication that its mother is passing to the infant. The study that I read from Kane, JM., (2005) was completed for those of ages of 18 to older adults for treating schizophrenia. Schizophrenia being part of Axis 1 of DSM has been known to be recurrent and disabling and a delusional disorder. Schizophrenia is also a disorder that curtails the development of learning, hearing voices and can also cause emotional disturbance which can play havoc on a person’s ability to function in society in a positive manner. In a six-week study in which included 460 participants took the drug haloperidol which assisted in correcting the imbalance in dopamine and serotonin levels. The medication showed improvement in the patient’s schizophrenia condition in which was measured weekly for six weeks. Lately what we have been telling ourselves is that medication can assist us in living our daily lives bringing balance and normalcy in coping with a mental illness. Psychosocial interventions and pharmacological treatments can improve a person’s condition and can improve a person’s functioning levels thus promoting recovery from schizophrenia if caught early. Preventing relapse is key for recovery so we need to have contact teams or a person that can be there in a moments instance if a patient feels they may be gravitating towards relapsing. On recent news Demi Lovato who is challenged with bipolar disorder recently relapsed after six years of sobriety. if she had someone to talk to or someone she trusted to reach out to she probably would not have relapsed. Demi crashed hard and I am sure she felt bad about it even to this day. I hope should she ever relapse again that she will call someone who can help her champion being sober for the next years to come.
ReplyDeleteref:
The history of prescription drugs, http://www.goodmedicinebadbehavior.org/explore/history_of_prescription_drugs.html , retrieved 8/02/2018.
Kane, JM, Cohen, M., Zhao, J., Alphs, L., Panagides, J., (2005), Efficacy and Safety of Asenapine With Placebo and Haloperidol Kane JM, Cohen M, Zhao J, Alphs L, Panagides J. Efficacy and safety of asenapine in a placebo- and haloperidol-controlled trial in patients with acute exacerbation of schizophrenia. J Clin Psychopharmacol. 2010 Apr;30(2):106-15. doi: 10.1097/JCP.0b013e3181d35d6b.