Teachers in Connecticut who recognize signs of attention deficit/hyperactivity disorder (ADHD) in the children they teach had better watch carefully what they say to parents about addressing the problem from now on.
In June the state became the first in the nation to regulate what teachers, guidance counselors, and other school personnel can recommend in response to children they believe have ADHD. They are specifically prohibited from recommending that students might benefit from methylphenidate (Ritalin) or other related psychostimulants.
The bill, to which state lawmakers gave unanimous approval, also bars teachers and other school staff from recommending any other psychoactive drugs to parents of children showing behavioral problems or other signs of a mental disorder.
If school personnel believe that a child would benefit from psychiatric treatment, their permitted course of action is to recommend to parents that they have their son or daughter evaluated by a psychiatrist or other "medical practitioner." They will also be able, with the parents’ or guardian’s permission, to consult with a psychiatrist or mental health professional about a child’s behavioral problems.
What they cannot do is tell parents that unless they arrange for their child to begin taking a particular medication, that child will not be allowed to remain in his or her current classes.
"Despite the attention the law has received nationwide, I believe its impact will be minimal," Connecticut Psychiatric Society President Brian Benton, M.D., told Psychiatric News.
"What it will do is encourage teachers to make recommendations for students to be evaluated by a professional if they see that one of their students is displaying behavioral problems. We hope that professional will be a psychiatrist," Benton said.
He noted that teachers probably have no business recommending specific medications in the first place and that this law places that responsibility in a strictly medical context, where it belongs.
The original version of the bill said that teachers can have no involvement in this issue at all, but negotiations between the Connecticut Medical Society (CMS) and the bill’s authors softened that prohibition somewhat, which is reflected in the final language.
"There was some very good give and take on both sides" before the compromise wording was agreed to, explained CMS President and former APA Assembly Speaker Al Herzog, M.D.
The new law, known as Public Act 01-124, instructs each local and regional board of education in Connecticut to adopt such a policy as soon as possible.
The statute also makes clear that a parent’s refusal "to administer or consent to the administration of any psychotropic drug" to his or her child cannot be considered grounds for the state’s child welfare department to take a child away from a parent’s or guardian’s custody, unless there is proof that the decision to refuse medication results in the child being neglected or abused.
Connecticut lawmakers reacted strongly to press accounts of children with minor behavioral problems being "drugged" after other attempts to control children’s behavior failed to achieve the desired results. They were so convinced that an epidemic of unnecessary prescriptions for psychostimulants was occurring in their state that they passed the legislation unanimously, and it was quickly signed into law by Governor John Rowland.
On introducing the bill in the Connecticut House of Representatives, its chief sponsor, Rep. Lenny Winkler, who is an emergency room nurse, expressed her shock at the number of children in Connecticut who are taking psychoactive drugs.
"I cannot believe how many young kids are on Prozac, Thorazine, Haldol . . .It blows my mind," she said in a July 17 article in the New York Times. "It’s easier to give somebody a pill than to get to the bottom of the problem." She characterized this use of medication with school children as "a quick fix" for behavior problems.
Winkler indicated that she is troubled by accounts of school personnel recommending specific medications that students should be prescribed when the teachers and guidance counselors do not have the training to draw such conclusions.
In a press release posted on the Connecticut state Web site, Winkler said she is also concerned about the long-term effects of psychoactive drugs when they are prescribed for children. "There is some evidence that teenagers and adults who have been involved in terrible acts of violence were treated with psychiatric drugs as children. Clearly we need to know more about these medications and what they are doing not only to the children of today, but to the teenagers and adults of tomorrow."
She emphasized that she is not opposed to having children take psychoactive drugs if the suggestion to do so comes from a physician who has evaluated the child thoroughly, something school personnel cannot do.
The text of the bill can be accessed on the Web at www.cga.state.ct.us/ by clicking on "Public Act" in the "Quick Search By" box, entering 124 in the box labeled "No.," and clicking on "Public Act No. 01-124." ▪
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