This past week I had an opportunity to observe two classrooms of two to three year olds. I had observed both these groups earlier in the year and it was a pleasure to see them again now. Two things surprised and interested me. One group seemed much more mature than the other, so I checked the ages of the children, looking for the explanation. I found that the second group was on the whole, about three months older than the first group. The second surprise, was the degree of maturation that had taken place in the second group from the time I had observed them a number of months ago.
This experience was a welcome reminder to me of the power of development. The children in the second group were just starting to turn three, and it was amazing to see what a difference three months at this stage of life can mean in development. The children were, for the most part, self contained, had good impulse control, were able to focus on the activity at hand, and followed directions well. I was struck in particular by the line-up at the sink for hand washing following a messy project. The children took their places easily. and were able to wait their turn with a minimum of help from the teachers. Quite a difference from a while back when it worked only because of the skill of the teacher.
Even allowing for differences in the children in the two groups besides age, and the difference in composition of the groups, the most striking factor was the development that had taken place in just a few months, accounting for the difference between the groups, and the changes that had taken place in the older group. These changes were a product both of physical maturation, giving them greater ability in many areas, and learning. Their increased ability to focus, attend, and control their bodies, had also given them an increased capacity for learning.
All of this seems especially relevant in light of stories that appeared at the beginning of this month reporting a rapid rise in the diagnosis of hyperactivity, and the concern on the part of doctors that too many children are being medicated. According to a N.Y. Times story of April 1, data from the federal Centers for Disease Control and Prevention show that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point their lives. This reflects a 16 percent increase since 2007, and a 53 percent rise in the past decade.
The Times quotes Dr. William Graf, a pediatric neurologist and professor at the Yale School of medicine saying, “These are astronomical numbers. I’m floored. Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.” The story goes on to say that millions of children may be taking medication merely to calm behavior or to do better in school. The C.D.C Director Dr. Thomas Frieden, likens the rising rates of stimulant prescriptions among children to the overuse of pain medications and stimulants in adults.
Perhaps the most significant comment as it is related to my earlier observations comes from Dr. Jerome Groopman, a professor of medicine at Harvard Medical School: “There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal – if they’re not sitting quietly at their desk – that’s pathological, instead of just childhood.” Several of the children I observed – earlier in a different setting – might have elicited a similar judgment.
Two points emerge from this: First the A.D.H.D. diagnosis is being made too readily, when it is not justified by the behavior. The second point is that children who don’t need medication are at times having it prescribed simply to enhance an already acceptable level of performance. Both seem to be a reflection of current issues in our society. Classes that are too large mean difficulty providing individualized attention, and lead to an emphasis on compliance. The fact of a developmental spectrum, meaning not all children are in the same place at the same time has gotten lost. Children encountering any bumps in the road are too quickly labeled. Normal behavior of childhood is too easily pathologized.
The use of medication to enhance performance seems a result of the pressure today on both children and parents for academic success, measured largely through testing. Parents want the best opportunities for their children, and those opportunities are too often available only through higher and higher test scores. There seems to be little room for children to move ahead at their own pace or to pursue a broader range of interests, or things they are good at.
There is such a thing as Attention Deficit Hyperactivity Disorder which presents a problem for some children. More and more questions are being raised, however, about the use of medication, in terms of negative consequences that are only slowly becoming understood. The fact is, there are other means of helping such children learn and function in school. They require that resources be applied in a different direction, rather than looking for a quick fix in pills.
Children are losing their childhood, a loss for us all. For as we know, a child shall lead us.