She knows that, if he is not treated by classroom and home-based interventions and possibly medication, his academic career, and indeed his life into adulthood, will be severely compromised by this disorder. She has had other children with ADHD in her classes and has seen the difference in their learning and performance after treatment. But she is very frightened.
She has to be very careful not to violate state school board regulations in telling Michael's parents that his behavior needs to be evaluated, and she has heard that there may even be a state law that makes it a criminal offense for a teacher to ask parents to have a child tested for behavioral problems.
She had earlier saved the life of another pupil, quite literally, by noticing behavioral changes in the child during and after exercise. The child did not have physical signs when she was examined, but a high-tech medical evaluation showed her to have cardiomyopathy, a life-threatening illness, which has now been stabilized.
Ms. Emhart is struck by the similarity of the two children in her class - each has a condition that threatens his/her life, one immediately, the other over the long term. Each child alerted her by behavioral problems, neither could be diagnosed simply by physical or chemical signs, and each requires sophisticated testing to determine the real cause of the problem.
But she can only deal appropriately with one of them. Why?
In fact, a review of the Utah State Board of Education policy reveals that a teacher may provide information and observations to parents regarding health and behavior, but may not require a student to take a specific medication and cannot recommend a "single specific health care professional" but may provide a list of two or more to parents.
No one, not parents, teachers, or the school board, wants teachers diagnosing and/or forcing treatment of disorders on their pupils. Yet Rep. Mike Morley, sponsor of last year's HB 42, the so-called anti-Ritalin bill, is planning to run similar legislation this session, to prohibit school personnel from recommending that parents seek behavioral treatment or psychotropic medication for their child.
His bill would essentially reiterate the school board policy, or might be even more restrictive. Among his allies are Scientologists, who believe ADHD and other mental and emotional diagnoses are not real disorders, and the Eagle Forum, defending families against state intervention.
I am a pediatrician in Salt Lake City. I have approximately 55 children in my practice diagnosed as having ADHD by appropriate psychometric testing, often with other behavioral or emotional conditions. I have interviewed Morley; Sandra Lucas, a Scientologist and spokesperson for the Citizens Commission for Human Rights (CCHR), a group "dedicated to investigating and exposing psychiatric violations of human rights"; Patty Harrington, state school superintendent; and Carol Lear, director of school law for the state school board. My references are available on request.
First, ADHD is a well-documented disorder, with increasing evidence for a functional, anatomic basis in the brain. This runs contrary to the belief of Scientologists and some others that it is a construct foisted on the public by money-hungry psychiatrists and drug companies, and not diagnosable by physical or chemical means.
Magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission computerized tomography (SPECT), and magnetic resonance spectroscopy (MRS) all show abnormalities in children with ADHD compared to normal controls: reductions in total brain volume as well as in specific areas of the brain which regulate impulsivity and attention.
Treatment with psychostimulants produces changes toward normal in these children. When children and adults with ADHD are scanned while performing various behavioral/cognitive tasks, they do not activate areas associated with memory and emotion to the same extent as the control subjects. Hence, the behaviors of these ADHD children are the result of very real, physical brain dysfunction.
Thus, both cardiomyopathy and ADHD can be diagnosed through sophisticated means not even dreamed of when L. Ron Hubbard founded Scientology in 1954.
Morley has had personal experience with ADHD and other behavioral disorders. He believes these disorders are very real and can be most threatening, and he believes they are treatable with counseling and often medication.
His intent in running the legislation is straightforward. He has said that he feels the restrictions on teachers should be codified in state law to prevent the current or future school boards from loosening them. Harrington said that the school board is not apt to loosen these restrictions any time soon, and that any changes that are made in the near future are likely to be more restrictive, not less.
Having worked closely with teachers and school psychologists with each of my ADHD patients, I can say without exception that teachers do not make medical or behavioral diagnoses. They simply tell parents their child should be evaluated for problems. Even school psychologists, who are qualified to test children and render appropriate impressions, send me information and observations based on their testing, not diagnoses or medication recommendations.
Thus Morley's legislation is unnecessary. Legislation should be a last resort, when other, lower-level regulations are either not possible or do not deal effectively with an issue. If a future school board loosened its policy, a legislative bill could be passed in less than a year to remedy the situation.
I ask that Morley withdraw his legislation from the agenda, to avoid the rancorous, time-wasting debate of the past two years, and let the school board govern the schools. As for the Scientologists, they need to update their tenets to reflect the current state of science, which has advanced incredibly since the time of their founding father in 1954.
Tom Metcalf is a Salt Lake pediatrician.