Moral Landscapes

Living the life that is good for one to live

Should Toddlers Be Medicated for ADHD?

The social contexts for medicating out-of-control toddlers

A new report raises alarms regarding perhaps 10,000 USA 2-3 year olds on ADHD drugs.

Why should you care? Emotion dysregulation in early life is predictive of later mental illness and a propensity for violence (R. J. Davidson, Putnam, & Larson, 2000; R. J. Davidson & Slagter, 2000). So this should be a society-wide concern. We all have to live with the consequences.

How could it be that adults would think it proper to give ADHD drugs to toddlers? In the New York Times article, doctors say that it has been recommended sometimes as a last resort for parents at their wits’ end. How does a family get to this point? How do toddlers become out of control? Let’s look at the players in the world of the child.

THE BABIES

Babies can be irritable from maternal stress during pregnancy or interference at birth, making them harder to care for (Davis & Sandman, 2010).

Babies who experienced drugs in the system (from drugs during labor or other) may be sluggish and less responsive to parental overtures (Ransjo-Arvidson et al., 2001).

Epigenetic inheritance of things such as anxiety can make babies more difficult to care for (Bohacek & Mansuy, 2012).

Babies who are born early, before full term (40-42 weeks of gestation—which is so important), can be underdeveloped and delayed in self-regulation as well as many other systems (Behrman & Butler, 2005).

Lack of fit with caregiver(s). Lack of match between the baby’s needs and the care received can undermine baby’s development. An irritable baby needs a patient caregiver. An undemanding baby needs a stimulating (but responsive) caregiver. More here and here.

Lack of extensive experience with pleasurable synchronous communication. For self-regulation development governed by the orbitofrontal cortex (which is set up in the first year of life), babies need lots of successful social experience with caregivers (Schore, 1996; 2003a, 2003b). In my travels around town, I see too many parents not attending to communicating with their babies, missing opportunities to build these capacities during a sensitive period.

THE DOCTORS

Convenience. Medical practices around childbirth are often done for the convenience of medical personnel (e.g., giving sugar water to babies to keep them quiet—which undermines breastfeeding and healthy gut/immune system development). The “baby-friendly” hospital initiative seeks to turn this around. See more here.  

Trauma. Babies remember the painful procedures at birth (Anand, 2000). Babies who have traumatic experiences during birth (e.g., separation from mom, pain inducement) may establish defensive postures to life, making them less cooperative or stress reactive. For example, gastric suction procedures at birth is linked to hypervigilance (Anand, Runeson, & Jacobson, 2004).

THE PARENTS AND FAMILY

Lack of understanding of babies’ needs. Babies have many needs, which include nearly constant holding with movement, breast milk, meeting needs quickly so that crying does not become a habit (babies have a hard stopping crying for many weeks). When these needs are not met, the baby will be less self-regulated (for reviews see Narvaez, Panksepp, Schore & Gleason, 2013).

Lack of social support. When parents have little or no social support for taking care of the baby it can lead to neglect or worse (Hrdy, 2009). Mothers who feel abandoned by society are likely to be poor caregivers, as they are distracted with their own basic needs.

Nutrition. Early nutrition has epigenetic effects (Attig et al., 2010). The processed food supply is filled with chemicals that make you want to keep eating it. These are called excitotoxins because they overexcite brain chemistry and actually damage it (Blaylock, 1997). If children’s diets are primarily processed foods which are filled with sugar and other carbohydrates (and which have many other issues like pesticides, herbicides, antibiotics, genetically-modified organisms, preservatives, coloring and other additives), self-regulatory capacities may be thrown off kilter.

Neglect. The inability to regulate intense feelings can be a signal of early neglect or abuse (van der Kolk & Fisler, 1994). See more about what babies need: Ten things everyone should know about babies.

Punishment. Many parents are physically punishing their babies and toddlers. Spanking increases aggression in children. At such a young age it will make the child distrustful and stress reactive—leading to aggression or withdrawal. In current studies we are doing with adults, a single question about corporal punishment in childhood is linked to poor mental and physical health as well as self-protective morality (including aggression).

THE COMMUNITY

Babies are sent to understaffed childcare centers. Ideally, the ratio of adults to baby should be 3 to 1, as in an extended family. In many childcare centers, the ratio is the opposite.

Child care providers are uneducated about babies’ needs. As the USA lacks parenting education and wise elders to guide child caregivers, there is much ignorance about babies and they can be treated like dogs or plants instead of dynamic systems whose early experience is the foundation of a life trajectory.

Shifting caregivers. Children need steady relationships in early life to develop attachment and its related neurobiological underpinnings. When caregivers suddenly disappear, it undermines their development. See here. Even among the wealthy, nannies might be employed for a while but then dismissed when the child is a toddler. This causes great damage to the child as their primary attachment figure suddenly disappears. Children can grieve for months about this and some may never recover.

Environmental toxins. Lead is still inherent in many homes and soil of neighborhoods. Lead is related to impulsivity and aggression as well as cognitive deficits. See more here.

Joint-custody craziness. Among the uneducated are judges and lawyers who advocate for joint custody for babies! Outside of knowledge of baby development this may seem like a just option but it’s more like King Solomon’s suggestion of slicing the baby in two for the disputing mothers. Babies attach to one or two caregivers—but they need to be consistently present on an hour to hour basis or attachment can be undermined (and it’s a signal for how well the social brain is developing). The research shows that joint custody of babies harms them.

THE CULTURE

Undercare advocacy. A too-large vocal part of the US culture encourages undercare for babies, for example:

These and other undercaring practices undermine a child’s capacities for self-regulation and their interest in trusting and cooperating with others.

Lack of parental leave. The greatest social policy travesty may be the lack of institutionalized paid parental leave (at least one year’s worth) which allows families to adjust to a new baby and provide for its needs, getting things off to a good start.

THE OUTCOMES

What are the outcomes of treating children in the evolutionarily abnormal ways mentioned above? Children who have little self-regulation, are angry, distrustful and aggressive, “looking for love” in all the wrong ways.

ASSIGNING BLAME

Notice that none of these things are the fault of the baby. They are all about inheritances, environments and experiences that adults do or do not provide.

WHAT IS NEEDED

Baby-development education for all citizens. Read The Science of Parenting or other smart, baby-friendly books (careful, there are a lot of baby-unfriendly books and advisers who see parenting as an us-against-them activity). Avoid books that assume that parents should control the baby. Baby is part of the family, ready to learn to move and be with the family, not against the family.

What you can do every day on the street. Communicate respectfully with babies you see (you might need to practice) so that they have a pleasant social interaction.

 

References

Anand, K.J.S, Runeson, B., & Jacobson, B. (2004). Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life. The Journal of Pediatrics, 144 (4), 449-454.

Anand, K.J.S. (2000). Pain, plasticity, and premature birth: A prescription for permanent suffering? Nature Medicine, 6, 971-973. doi: 10.1038/79658.

Attig, L., Gabory, A., & Junien, C. (2010). Early nutrition and epigenetic programming: chasing shadows. Curr Opin Clin Nutr Metab Care, 13(3), 284-293.

Blaylock, R.L. (1997). Excitotoxins: The taste that kills. Albuquerque, MN: Health Press NA Inc.

Bohacek, J., & Mansuy, I.M. (2012). Epigenetic inheritance of disease and disease risk. Neuropsychopharmacology Reviews, 38, 220-236. doi:10.1038/npp.2012.110

Davidson, R.J., & Slagter, H.A. (2000). Proving emotion in the developing brain: Functional neuroimaging in the assessment of the neural substrates of emotion in normal and disordered children and adolescents. Mental Retardation and Developmental Disabilities Research Reviews, 6(3), 166-170.

Davidson, R.J., Putnam, K.M., & Larson, C.L. (2000). Dysfunction in the neural circuitry of emotion regulation: A possible prelude to violence, Science, 289(5479), 591-594.

Davis, E.P., & Sandman, C.A. (2010). The timing of prenatal exposure to maternal cortisol and psychological stress is associated with human infant cognitive development. Child Development, 81(1), 131-148.

Hall, R. W., Huitt, T. W., Thapa, R., Williams, D., K., Anand, K.J.S., Garcia-Rill, E. (2008). Long-term deficits of preterm birth: Evidence for arousal and attentional disturbances. Clinical Neurophysiology 119 (6): 1281–1291.

Hrdy, S. (2009). Mothers and others: The evolutionary origins of mutual understanding. Cambridge, MA: Belknap Press.

Masters, R.D. (2002). Toxins, Disease, and Behavior. Downloaded from http://dianabuckland.webs.com/Div%20Added%20Files/Fluoride%20&%20...

Narvaez, D., Panksepp, J., Schore, A., & Gleason, T. (Eds.) (2013). Evolution, Early Experience and Human Development: From Research to Practice and Policy. New York: Oxford University Press.

Needleman, H.L. (1991). Human lead exposure. New York: CRC Press.

R.E. Behrman and A.S. Butler (Eds) for Institute of Medicine, Committee on Understanding Premature Birth and Assuring Healthy Outcomes and Board on Health Sciences Policy. (2005). Preterm birth: Causes, consequences, and prevention.  Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2006/Preterm-Birth-Causes-Consequences....

Ransjo-Arvidson, A.B., Matthiesen, A. S., Nissen, E. Widstrom, A. N., & Uvnas-Moberg, K., (2001). Maternal analgesia, during labor disturbs newborn behaviour: effects on breastfeeding, temperature, and crying, Birth, 28, 5-12.

Schore, A. (1996). The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of development psychopathology. Development and Psychopathology, 8, 59-87.

Schore, A.N. (1994). Affect regulation and the origin of the self. Hillsdale, NJ: Erlbaum.

Schore, A.N. (2003).  Affect regulation and the repair of the self. New York: Norton.

van der Kolk, B.A., & Fisler, R. (1994). Childhood abuse and neglect and loss of self-regulation. Bulletin of the Menninger  Clinic, 58, 145-168.

 

ADDITIONAL POSTS ON PARENTING ISSUES AND CHILD DEVELOPMENT

Sleep Series:

Baby Sleep Training: Mistakes “Experts” and Parents Make

'Let Crying Babes Lie'? So Wrong

Simple Ways to Calm a Crying Baby

Normal, Human Infant Sleep: Feeding Method and Development

Normal Infant Sleep: Changing Patterns

Normal Parent Behaviors and Why They Won’t Hurt Your Child

Normal Infant Sleep: Night Nursing's Importance

More Normal Parenting for Sleep

Understanding and Helping Toddler Sleep

Understanding and Helping Toddler Sleep-Tiredness?

Understanding and Helping Toddler Sleep--Preparing Success

SIDS: Risks and Realities

Bed Sharing With Babies: What is the Hype About?

Bedsharing or Co-Sleeping Can Save Babies' Lives

Dangers of "Crying it Out"

BIRTH

New Moms Need Social Support

Painkillers for Childbirth? The Few Pros and Many Cons

What's the Use of Midwives and Doulas?

Jesus Had a Home Birth

What if Jesus Had Been Born in the USA?

CIRCUMCISION

Why Continue to Harm Boys from Ignorance of Male Anatomy?

What Is the Greatest Danger for an Uncircumcised Boy?

Circumcision Ethics and Economics

Circumcision: Social, Sexual, Psychological Realities

More Circumcision Myths You May Believe: Hygiene and STDs

Myths about Circumcision You Likely Believe

BREASTFEEDING

Stand Up For Breastfeeding

Talk About Breastfeeding With Your Family, Friends and Doctor

Breastmilk Wipes Out Formula: Responses to Critical Comments

In Light of Last Week's Posts: Is Pushing* Formula Evil?

Breastfeeding Resources

The REAL Truth about Breastfeeding

5 Things You Thought You Knew about Breastfeeding

The TREMENDOUS Benefits of Doing What is Normal: Breastfeeding

Myths you probably believe about infant formula

Your assumptions about infant formula are probably wrong

It’s Breastfeeding Week: Why should you care?

SERIES ON PLAY

Happiness and Growth Through Play

Playing with Heart

Children May Be Playing, But Their Brains Are Working

Is Pretend Play Good For Kids?

Playing at School: More Important Than We Thought?

Does Too Much Screen Time Make Kids Sick?

Infant Couch Potatoes 

What's Better: Indoor or Outdoor Play

Why Play with a Child?

PARENTING: GENERAL

Research on Spanking: It's Bad for ALL Kids

What Happened to Ethics in Pediatric Medicine?

Baby-, Parent- or Life-Centered Parenting?

Ten Ways to Truly Respect Motherhood

Slings and Heroes

Parents Should Know the Limitations of Science Experiments

Babies "don’t cry in Africa," why should they cry in the USA?

Blame the baby or blame the experts?

Dumb Parent(ing), Dumberer Child

How to Grow a Smart Baby

Are you treating your child like a prisoner?

Undercare: The bane of American life?

Promoting Thriving in School-Aged Children: A Checklist

Is it good to make kids afraid?

How NOT to Ruin a Child

Are you or your child on a (touch) starvation diet?

Mother’s touch of dead baby causes “miracle”

What Does Good Parenting Look Like? You Decide.

CHILDREN’S RIGHTS

Childism Revisited

Are You a “Childist?" Test Yourself

Babies Are Needy—Does That Bug You?

Do We Need Declaration for the Rights of the Baby?

Where Are the Happy Babies?

The Decline of Children and the Moral Sense

Believing "children are resilient" may be a fantasy

How America Morally Fails its Children: What Needs to Change

Increase the well-being of children around you

 

 

Darcia Narvaez is a Professor of Psychology at the University of Notre Dame and Executive Editor of the Journal of Moral Education.

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