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Comment: Schools and the misuse of antipsychotic drugs

A Nov. 20 Times Colonist editorial (“Reduce use of antipsychotics”), echoing the views of medical experts, raises serious concerns over the misuse of antipsychotic drugs with children.

A Nov. 20 Times Colonist editorial (“Reduce use of antipsychotics”), echoing the views of medical experts, raises serious concerns over the misuse of antipsychotic drugs with children.

What isn’t discussed is that the school system, unintentionally, might be contributing to the problem.

Health studies in the U.S. and Canada report that the age at which a patient started school is a predictor of the diagnosis and treatment of attention deficit and hyperactivity disorder. In other words, the youngest child in a class is more likely to be medicated for ADHD than the oldest child.

In B.C., children enter kindergarten in September provided they turn five by Dec. 31 in the calendar year. This means that older children who turn five in January wait until September before starting kindergarten. The youngest children enter kindergarten when they are still four years of age and don’t turn five until December.

The gap between the oldest and youngest kindergarten child is one year, a 20 per cent difference in development at that point.

A University of British Columbia study, which examined health records of more than 900,000 B.C. children, reported that children born in December, the youngest in the grade, were 39 per cent more likely to be diagnosed with ADHD than the older children, born in January.

The younger children were also 48 per cent more likely to be treated with medication than their January classmates.

The researchers suggest that younger, less mature children are inappropriately being diagnosed with ADHD. They express concerns about the medicalization of the normal range of childhood behaviours, particularly for boys.

Education research shows similar linkages between birth date and student achievement. A University of California study, which used B.C. high-school transcript data, reported that younger students, born late in the year, were 13 per cent less likely to be university-bound than older students, born early in the year.

In an analysis I carried out with the Education Ministry, we tracked the progress of more than 47,000 B.C. kindergarten students. We found that 12 to 15 per cent of the younger children were less likely than their older classmates to meet Grade 4 and 7 reading and numeracy standards on time.

These birth-date effects could be viewed as the logical consequence of how schools are structured. Children are organized and taught in one-year age groupings called grades, and are expected to move in unison from one grade to the next and reach key education milestones all at the same time.

It’s not surprising that some of the younger, less mature children are more likely to struggle with these academic expectations and suffer the consequences of being inappropriately labelled with ADHD.

Unlike other factors that influence student learning, such as the child’s home environment, policies governing how children are grouped and taught are within the full control of the school system. They can be changed.

In an effort to address the reality that all young children don’t grow and develop in a straight line, the Education Ministry in 1989 took a bold move and changed the lock-step grade structure, which had been in place for more than 100 years.

The ministry introduced a dual-entry system for kindergarten and linked it to a new non-graded primary program, replacing the traditional K-3 graded structure. The purpose of this change was to reduce the age gap in each kindergarten group, and to encourage teachers to accommodate developmental differences among young children.

Initial public response was positive. Once the implementation process began, however, major concerns surfaced. Parents and teachers complained that they were not provided with a clear understanding of how the ungraded program was to be implemented and how student learning would be evaluated and reported.

In 1991, facing growing opposition, the government abandoned the new policies. Schools quickly returned to the traditional graded structure and single kindergarten entry date.

More recently, the Education Ministry adopted changes to modernize what is taught in classrooms. Schools across the province are now in the process of implementing new curriculum for grades K to 9.

A major intent of the new policies is similar to what was attempted more than 25 years ago: to provide more curriculum flexibility so that teachers are better able to adapt their teaching to the developmental needs and interests of individual students.

Here’s hoping these new reforms are embraced and that younger children in kindergarten are just as successful over time as their older classmates.

Whatever approaches are used to organize children for instruction, care should be taken to ensure they don’t lead to the prescription of antipsychotic drugs for children who don’t need them.

Jerry Mussio is a former senior manager with the Ministry of Education.