Thursday, May 02, 2002

A Bitter Pill? Black Boys and Ritalin

A Bitter Pill? Black Boys and Ritalin

By Pamela Appea

It’s a common September scenario. A child refuses to stay in his seat or won’t stop acting out in class. He’s restless and fidgety and he likes to talk and talk…and talk. Frustrated teachers quickly think of ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder), and equally frustrated parents quickly acquiesce to requests that their child be evaluated and possibly medicated.

It’s a difficult decision to make, especially amid growing concern that children are being overdiagnosed and overmedicated, especially with the ADD/ADHD miracle drug, Ritalin. A study from the Journal of the American Medical Association found the use of drugs like Ritalin among children aged two to fourteen tripled in the 1990s.

When this problem child is black, the complications only increase. While many in the black community have decried a rush to medicate minority children, especially boys, with Ritalin and other drugs, others have argued that black boys, while disproportionately diagnosed with learning difficulties, in fact receive far less treatment than other students.

“There are a lot of children suffering,” says Dr. Marilyn Benoit, a child psychiatry expert at George Washington University “Many don’t get the treatment they need.”

What they do often get, Benoit and others agree, is a stigmatizing label, and sometimes a one-way ticket to special education classes. The Civil Rights Project at Harvard University found in a 2001 study that black public school students in the US are three times more likely than whites to be identified as mentally retarded or in need of special education services. In addition, the study said, black students with learning disabilities are often misdiagnosed as being “emotionally disturbed.”

Beyond ADD and ADHD, kids now are tested for a veritable alphabet soup of disorders, including Obsessive Compulsive Disorder (OCD), Oppositional Defiant Disorder (ODD) and Pervasive Development Disorder (PDD). But with symptoms for ODD like “often argues with adults,” “often loses temper” and “often deliberately annoys people,” many parents – and teachers – wonder how to tell the difference between a bona fide medical condition and the behavior of a grumpy, spoiled or bratty child.

Such broad definitions, when combined with studies like Harvard’s that suggest how quickly black children are seen as “trouble,” make for a combustible combination.

“I know that a lot of black boys are labeled as having behavior problems and are placed in Special Ed. Classrooms,” says Xoli Dyasi, a fifth-grade teacher in the New York public schools.

The National Medical Association, a DC-based group promoting the interests of black doctors and patients, has spoken out against the disproportionate placement of African American children into special education programs.
Still, Dyasi says, some children do have learning disabilities and benefit from the diagnosis, when followed by proper treatment. She says she leaves the diagnosing to the school psychiatrist. Therein lies the problem, some minority child advocates say. Most teachers are not like Dyasi — a rush to Ritalin is common, with teachers sending notes home to parents demanding that their children be medicated.

What children do need medication? ADHD experts like Dr. Laurence Greenhill, at Columbia University and the New York State Psychiatric Institute, say some tell-tale signs of ADHD among young children are an “insatiable” curiosity or “excessive” temper tantrums. “A child with ADHD may appear restless, aggressive, demanding, argumentative, or noisy,” Greenhill says. Evelyn Polk Green, president of Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD), a Landover, Maryland-based advocacy group, lists some real life examples – the child who has no friends or playmates, who has been expelled from day care centers, who is no longer welcome at larger family functions – that indicate the potential need for medication.

Polk Green, a Chicago resident, early childhood educator and parent of an ADHD teenager, says she struggled with the idea of medicated her child. “His temper tantrums were long and uncontrollable, yet he could be the sweetest, most loving child in the world,” she said.

And it wasn’t the amount of discipline her son received, she says, recalling how she and her husband tried every trick in the book. “None of the standard behavior modification techniques seemed to work,” she says. “Eventually, my husband and I realized that we could not do this alone.”

She says she initially worried ADHD medications would transform her smart, creative son into a zombie. But the decision paid off. Polk Green said her son is doing well today — still on medication but an active, college-bound high school student.Success stories like Polk Greens combine many factors – concerned, committed parents being the main one – that many kids diagnosed with ADD/ADHD lack. When parents lack health insurance, or the school system is uncooperative or even hostile, the results can be disastrous.

Despite laws like Individuals with Disabilities Education Act or IDEA, an amendment that advocates blended classrooms, (in conjunction with the Education for all Handicapped Children Act of 1975), children diagnosed with learning disabilities are often placed in special ed classrooms, taught a watered-down curriculum, or tracked into nonacademic programs.
And even when an ADHD-diagnosed student stays in a regular class, he or she faces counseling sessions, special group times, break times for medication, and other specialized parent-teacher meetings. The stigma can spread to a student’s peers. It’s not a secret who has ADHD, especially among urban school districts. Just ask the kids who takes medication and who doesn’t – they always know.

“I am actually torn with this topic,” said Dyasi. “I think that some medications do more harm than good for the child who is diagnosed as having ADHD. It may work for some kids and it may not. I think it really depends on the seriousness of the symptoms. It's really up to, I think, the experts – the doctors whose interest are really the children and not the doctors who are willing to only test out medications on children that may not need it.”At the same time, she says, all disruptive children should be evaluated immediately once they get into school—at age five or six – rather than letting problems fester.The topic of black children and medication is so controversial that one staff member at Florida A & M university in Tallahassee asked not to be identified when she said she feels more kids and adolescents within the African American community probably should be on medication. While not a popular opinion, her argument is echoed by recent findings in one Virginia school district that, while 17 percent of white boys are on Ritalin, only 9 percent of black boys are. All agree that parents and teachers must communicate better about ADHD and other learning disabilities, and that parents should inform themselves of their children’s rights and the medical and non-medical options for treatment.

After that, says Polk Green, you just make the best decision for your child. “Taking meds is a huge decision and should not be taken lightly,” Polk Green said, but adds, “if my child needed glasses or a hearing aide, or insulin or even chemotherapy, I wouldn’t hesitate to give him the treatment he needed.”

(Article prepared for in 2002)
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