Before You Talk Medication, Talk Stability

“He won’t sit still.”

That is the complaint of a foster mother who had three-year-old Jesse delivered into her care. Not only will he not sit still, she said, but he fidgets while she is trying to read him a story and gets up from the dinner table without asking. He frequently bumps into things when he wanders around the house because he doesn’t watch where he’s going.

He has trouble falling asleep and often wakes, crying, during the night. He squirms when she is trying to dress him. He quickly loses interest in activities.

The woman is beside herself because he just doesn’t seem to pay attention to her. She tells the caseworker that she thinks he should have medication for Attention Deficit Hyperactivity Disorder (ADHD) to help him calm down.

Jesse was placed into foster care when he was found roaming the halls of a residential hotel. His mother had left him with a couple that had recently moved into the hotel, saying that she would pick him up later that day. Two days later, she still had not returned.

This is Jesse’s third foster home in the last year. He has been removed from the two previous homes because the foster parents were unable to manage his behavior. If, as is likely, his caseworker is beginning to panic that she will have to remove him and find yet another placement, it is quite possible that Jesse will be taken for an evaluation of ADHD and receive medication to help him “calm down.”

Photo courtesy of electrictuesday.
Photo courtesy of electrictuesday.

Jesse certainly does need help in calming himself. He is, after all, only three years old and needs the reassurance of adults to manage his understandable anxiety. From what little we know of his history, we can reasonably assume that Jesse has had little experience of being comforted by a reliable adult.

Not having been soothed by another, Jesse is unable to soothe himself. Not only is Jesse’s three-year-old neurological system developmentally immature, the lack of care and instability he has endured in his young life has likely resulted in his cognitive, social, and emotional development lagging considerably behind what we would expect of a well-cared-for child of his age.

Of course Jesse can’t focus. Why would we expect that he could? He’s a kid, a child who has had a traumatic introduction to life. He is a child who has every reason to be anxious, to be constantly on the lookout and on the move.

And yet, there is a significant chance that he will be given medication when what he needs is a stable caregiver who can lend him her calm mind and soothing presence. Jesse needs to be held and rocked. He needs to hear lullabies and comforting words. He needs to see smiles and bright eyes when he looks into a loving face. This is how Jesse will develop a mind of his own.

It is likely that Jesse is no more able to control his mind than he is to control his behavior. When we rush to medicate children’s brains, we fail to attend to their minds. And when we turn to substances to control behavior we would do well to remember that “a mind is a terrible thing to waste.”

Toni Heineman is a clinical social worker and psychologist, and is the founder and executive director of A Home Within.

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Toni Heineman
About Toni Heineman 15 Articles
I am licensed as a Clinical Social Worker and Clinical Psychologist and serve on the Clinical Faculty in the Department of Psychiatry at UCSF. I am the founder and Executive Director of A Home Within, and the author of numerous articles on identifying and meeting the emotional needs of children, youth, and young adults in foster care.

1 Comment

  1. Wow Toni – this article is so important and relevant. I wish everyone thought this in-depth before medicating ANY foster child.

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