Should Toddlers Be Medicated for ADHD?
The social contexts for medicating out-of-control toddlers
Posted May 18, 2014
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.
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.
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).
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.
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.
Undercare advocacy. A too-large vocal part of the US culture encourages undercare for babies, for example:
- Letting them cry— It’s based on a misunderstanding of child development.
- Leaving them physically isolated. Since Harlow’s experiments on monkeys, we know this is damaging to a mammalian brain for the longterm.
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.
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.
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.
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&%20Aggress...
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-and-Pr....
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
SERIES ON PLAY