i mean considering low-income children of color are disproportionately represented in special education programs for kids with mental disabilities and/or behavioral problems……who is surprised by this…like obviously poor brown & black kids are not genetically predisposed to these things as compared to rich white kids, so it has something to do with their living conditions.
a child living in an unstable, violent home typically has the same “level” of PTSD as a veteran returning from a warzone—no wonder they act out and struggle in school (particularly considering many of the teachers sent to teach at these places are from outside the community and thus have no cultural competency to see the situation for what it is). behavior that’s a natural response to what’s going on in their lives is pathologized as a mental disability, bc it’s easier for the educators, administrators, and health care professionals that are assigned to the child to think that there is something biologically “off” with a low-income child of color than it is for them to attempt to empathize with them and understand the social realities the child lives in.
Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD). These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus. When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.
“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,” she said of treating her patients according to guidelines for ADHD. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.”…Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence. To test her hypothesis beyond Baltimore, Brown analyzed the results of a national survey about the health and well-being of more than 65,000 children. Brown’s findings, which she presented in May at an annual meeting of the Pediatric Academic Societies, revealed that children diagnosed with ADHD also experienced markedly higher levels of poverty, divorce, violence, and family substance abuse. Those who endured four or more adverse childhood events were three times more likely to use ADHD medication…“We need to think more carefully about screening for trauma and designing a more trauma-informed treatment plan,” Brown says.
Dr. Kate Szymanski came to the same conclusion a few years ago. An associate professor at Adelphi University’s Derner Institute and an expert in trauma, Szymanski analyzed data from a children’s psychiatric hospital in New York. A majority of the 63 patients in her sample had been physically abused and lived in foster homes. On average, they reported three traumas in their short lives. Yet, only eight percent of the children had received a diagnosis of post-traumatic stress disorder while a third had ADHD.
…Caelan Kuban, a psychologist and director of the Michigan-based National Institute for Trauma and Loss in Children, knows the perils of this gap well. Four years ago she began offering a course designed to teach educators, social service workers and other professionals how to distinguish the signs of trauma from those of ADHD…In the daylong seminar, Kuban describes how traumatized children often find it difficult to control their behavior and rapidly shift from one mood to the next. They might drift into a dissociative state while reliving a horrifying memory or lose focus while anticipating the next violation of their safety. To a well-meaning teacher or clinician, this distracted and sometimes disruptive behavior can look a lot like ADHD.
…Jean West, a social worker employed by the school district in Joseph, Missouri, took Kuban’s course a few years ago. She noticed that pregnant teen mothers and homeless students participating in district programs were frequently diagnosed with ADHD. This isn’t entirely unexpected: Studies have shown that ADHD can be more prevalent among low-income youth, and that children and adolescents with the disorder are more prone to high-risk behavior. Yet, West felt the students’ experiences might also explain conduct easily mistaken for ADHD.
…Though stimulant medications help ADHD patients by increasing levels of neurotransmitters in the brain associated with pleasure, movement, and attention, some clinicians worry about how they affect a child with PTSD, or a similar anxiety disorder, who already feels hyper-vigilant or agitated. The available behavioral therapies for ADHD focus on time management and organizational skills, and aren’t designed to treat emotional and psychological turmoil.
Instead, West teaches a traumatized child how to cope with and defuse fear and anxiety. She also recommends training and therapy for parents who may be contributing to or compounding their child’s unhealthy behavior. Such programs can help parents reduce their use of harsh or abusive discipline while improving trust and communication, and have been shown to decrease disruptive child behavior.
When speaking to traumatized children inappropriately diagnosed with ADHD, Dr. Heather Forkey, a pediatrician at University of Massachusetts Memorial Medical Center, offers them a reassuring explanation of their behavior. The body’s stress system, she says, developed long ago in response to life-or-death threats like a predatory tiger. The part of the brain that controls impulses, for example, shuts off so that survival instincts can prevail. “What does that look like when you put that kid in a classroom?” Forkey asks. “When people don’t understand there’s been a tiger in your life, it looks a lot like ADHD to them.”
Gabor mate has been saying the same thing for a while
a farm on my drive to work is growing these bad boys along with zinnias, cosmos, and marigolds around the perimeter of their cornfield. i want to think it’s because of companion planting, it might just be because the farmer thinks they’re pretty. either way, +1 to commute.