Diagnosing Native children with Attention Deficit Hyperactivity Disorder (ADHD) and treating them with stimulants does nothing to improve their educational or intellectual growth. Even worse, it sets them up for failure. Such an idea may upset the many caretakers, educators and mental health providers who think they are helping so-called “ADHD children,” yet Native children have been sabotaged by a similar mentality for generations.
Long before the ADHD term was invented, children in American Indian boarding schools were labeled feebleminded. Forcibly sent away for a “special education,” the intent was to eliminate the influence of loved ones and their “primitive” communities to make the best of their presumably inferior intellects. Influential Euro-American social scientists convinced of the inferiority of Native parents soon began applying such beliefs to their rebellious, traumatized, inattentive or merely spirited children.
The meaning of “feeblemindedness” was clarified in 1910 by the American Association for the Study of the Feebleminded (AASF), which said it was “generically to include all degrees of mental defect due to arrested or imperfect mental development.” It also described feebleminded subtypes of idiot, imbecile and moron to be identified by a new technology—IQ testing—in order to depict an examinee’s “mental age.”
The AASF ran pseudo-scientific papers about feeblemindedness in its Journal of Psycho-Asthenics until it closed down publication in 1921. Psycho-Asthenic articles combined studies of individuals eventually described as “mentally retarded” alongside those presumed to be racially inferior, delinquent and/or morally defective. In 1904, for example, Dr. Martin Barr described for readers a system describing “mental defectives” developed by the influential British physician, J. Langton Down (discoverer of Down’s Syndrome), in which “physiognomical and ethnological classification” included the “American Indian type” within which, according to Down, “moral and intellectual characteristics can scarcely be said to exist.”
Many Psycho-Asthenics authors were devotees of the false science of eugenics invented by British aristocrat Sir Francis Galton. Sir Francis felt American Indians possessed only “the minimum affectionate and social qualities compatible with the continuance of their race.” His thoughts helped set the stage for the American eugenics movement to target Indigenous people for elimination. These prominent academics planned and promoted a public campaign to eliminate “inferior races” by discouraging reproduction and legally arranging for the “intellectually inferior” to be involuntarily sterilized.
French psychologists Alfred Binet and Theodore Simon pioneered the measurement tools for “mental age” often used in such race psychology studies in their 1916 text, Intelligence of the Feebleminded. Psychologist Lewis Terman, a prominent advisor to the American Eugenics Society, worked quickly to refine Binet’s translated tools into his Stanford-Binet test, simultaneously popularizing IQ, intelligence quotient (the ratio of chronological age to mental age) as one of its summary scores.
In 1915, Terman published a paper in Psycho-Asthenics that he’d presented at the annual meeting of the AASF on “borderline cases” in which he described children having “racial dullness without feeblemindedness in the ordinary sense.” Terman noted:
[O]ur experience shows that the average child of Mexican or half-breed Indian parentage falls somewhere near this level, although there are of course occasional exceptions.
Terman didn’t say what he made of the intelligence of the “full-blood” Indian child, but he was likely even more pessimistic. Ideas of this sort stimulated a whole line of research in boarding schools regarding blood quantum and IQ that I’ll cover in a future article.
In 1916, Terman wrote again of “a low level of intelligence” occurring with “extraordinary frequency among Indians, Mexicans, and Negroes” and noted “[t]heir dullness seems be racial or at least inherent in the family stocks from which they come.” He recommended:
Children of this group should be segregated into special classes and be given instruction which is concrete and practical. They cannot master abstractions but they often can be made efficient workers… There is no possibility at the present in convincing society that they should not be allowed to reproduce…
Race psychologists published and presented their ideas widely beyond the Journal of Psycho-Asthenics and had a major influence upon educators designing curricula focused on vocational and domestic training in boarding schools. In addition to promoting ideas about the inferior intelligence of Native children, they researched and described traits of laziness, rebelliousness and lack of initiative that served to rationalize the regimented, forced labor of Native children in school kitchens, shops, farms, etc.
Delinquency, Terman proposed, was a sign of moral defect, and “future intelligence tests will bring tens of thousands of these mental defectives under the surveillance and protection of society.” Indian children who defiantly spoke their own language, refused to work in the fields, smoked tobacco, ran away, burned down the boarding school, or sought to hang the principal—all incidents uncovered by Red Lake Ojibwe researcher Brenda J. Child—were considered “morally defective.” One means of teaching them and their peers greater obedience, industry and self-discipline were the “outing” programs, wherein these youth were pushed into indentured service to white homes and farms.
Reflecting a mainstream perspective shared by at least six presidents of the American Psychological Association, Terman theorized that a national eugenics movement would assist in “curtailing the reproduction of feeblemindedness and in the elimination of an enormous amount of crime, pauperism, and industrial inefficiency.” It would also reduce immorality because:
Morality depends upon two things: a) the ability to foresee and to weigh the possible consequences for self and others of different kinds of behavior; and b) upon the willingness and capacity to exercise self-restraint.
Throughout the first half of the 20th century, race psychologists published their highly biased findings attempting to demonstrate the racial inferiority of Native children while pushing social policies aimed at “population control.” Terman’s Stanford-Binet test was used until the 1960s to satisfy legal criteria governing compulsory sterilization of the feebleminded in numerous state laws, affecting an unknown number of Native children and adults. Such laws were closely scrutinized (and admired) by visiting German psychiatrists charged with constructing the Nazi race extermination policies.
With the discovery of its role in the Jewish Holocaust, eugenics came under greater public scrutiny after World War II. Yet the eugenics movement survived within a revised, softer, non-racial language now targeting the poor. In 1949, for example, the chair of the Department of Mental Hygiene at John Hopkins University, Paul Lemkau, wrote in his influential text, Mental Hygiene in Public Health:
Children of the markedly feeble-minded will in all likelihood exist in the lowest socioeconomic stratum… income will be low, the housing inadequate, the education neglected, the infant mortality and morbidity high, and venereal disease and tuberculosis rates above the community average…
Lemkau also offered subtle and somewhat ambiguous guidance:
…there is perhaps some truth in the allegation that the subsidy of illegitimate dependents with their mothers actually encourages further illegitimate births. . . all this has not yet been made the responsibility of public health, and public health does not appear to be reaching out very actively to take the responsibility.
The U.S. public health system expanded through the 1960s, and physicians at the newly created Indian Health Service began “reaching out very actively to take the responsibility” by sterilizing thousands of Native women without their consent or often even their knowledge. In this way, a mental health system stereotype of the Dumb Indian effectively drew down the birth rate for Native children from 3.3 per woman in 1970 to 1.3 by 1980.
This stereotype became so robust that by 1969 a Special Senate Subcommittee on Indian Education chaired by Senator Edward Kennedy found one-quarter of elementary and secondary school teachers preferred not to teach American Indian students due to their “below average” intelligence. Associated hearings charged the U.S. Department of Education and the Bureau of Indian Affairs (BIA) in the failure of Native children to achieve academically. Many boarding schools were threatened with closure, and public schools also came under fire when a Northwest Educational Lab study found up to 85 percent of Native youth were dropping out prior to graduation.
All of this occurred prior to the invention of the ADHD label, at a time when another term, minimal brain dysfunction, or MBD, was applied to Native children. Psychiatric researchers persisted with MBD well into the 1970s, providing checklists for teachers to rate child behavior, just as currently happens with ADHD, and as they had for decades, theorizing about a link between brain or genetic defects and distractibility, hyperactivity and delinquency. In 1968, another label overlapping with MBD, hyperkinetic disorder of childhood, was created by the American Psychiatric Association for the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II).
Surprisingly, the old feebleminded label remained in use into the 1970s. Israeli educational psychologist Dr. Karl Frankenstein (his real name) relied upon it for his academic textbook, Varieties of Juvenile Delinquency:
[F]eeblemindedness… finds its expression in rigidity as well as in easy distractibility, in perseverative tendencies as well as in lack of perseverance. Non-cognitive factors, such as a relative inability to resist the interference of emotions or impulses with thought processes, are intrinsic…
Many features of today’s ADHD are embedded in Dr. Frankenstein’s description of feeblemindedness.
When today’s proponents of ADHD (including officials at the CDC) describe how the disorder was “discovered,” they enjoy quoting British pediatrician Sir George Still, who suggested in 1902 that “sustained attention” problems contribute to a “moral defect” in children, leading to aggression and defiance. They appear much more reluctant, however, to connect the dots between today’s ADHD and the feebleminded label used widely during the boarding school era.
Attention Deficit Disorder (ADD) was first defined in 1980 using specific “symptoms” composed by an influential guild of professional elites (the American Psychiatric Association) intending to convince the public of a new medical disease. More accurately, the birth of ADD was an attempt to unite existing competing labels for disruptive children into a single diagnosis for the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III). In addition to inattentiveness and distractibility, ADD children were said to exhibit “associated” MBD and hyperactive disorder symptoms of “obstinacy, stubbornness, bossiness, bullying, [moodiness], low frustration tolerance, temper outbursts, low self-esteem, and lack of response to discipline.” In 1987, the ADD label was updated into ADHD within the DSM-III-Revised (DSM-IIIR).
Amazingly, the DSM-IV, released in 1994, made it possible to diagnose ADHD without a child exhibiting any attention problems. An ADHD diagnosis could now be made using either “inattention” or “hyperactivity-impulsivity” lists of symptoms. Additionally, an “ADHD, Not Otherwise Specified” label was created that allowed even more latitude for labeling when even these liberal criteria could not be fully met. In this way, any misbehaving, bored, or spirited Native child was thereby made eligible. Like the old feeblemindedness label, ADHD still retained its close connection to misconduct and juvenile delinquency.
The widely criticized DSM-V, published in 2013, separated ADHD from these conduct disorders and other “disorders first identified in childhood,” and placed it in a new chapter covering “neurodevelopmental disorders.” Advocates of ADHD as a neurodevelopmental disorder are as enthusiastic about their dubious brain science as race psychologists were about their “research” into racial-genetic inferiority. The intelligence tests of the earlier days have been replaced by the new technology of CT, fMRI and PET scans purporting to show ADHD at a brain level.
Such slides of brains now permeate the media and mainstream medicine, but there’s seldom any mention that there is no way to locate or diagnose ADHD in an individual brain. An exhaustive review of such brain-scanning research published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2009 left researchers humbled:
…the large overlap of values between clinical and control populations currently precludes diagnostic use… There is no identified “lesion” common to all, or even
most, children with the most frequently studied disorders of … attention-deficit/hyperactivity disorder…
Even DSM-IV Task Force leader Alan Frances was compelled to admit in his book, Saving Normal, that the “expectation that there would be a simple gene or neurotransmitter or circuitry explanation for any mental disorder has turned out to be naïve and illusory.” Prominent psychobiology and neuroscience researcher Jaak Panskepp, who still believes “a genetically based temperamental variability… contributes to the diagnosis of ADHD,” recently allowed that “most, albeit not all, of ADHD reflects a cultural ailment rather than a biological disease.”
Psychologist Jay Joseph, author of The Gene Illusion and The Missing Gene, concluded: “The evidence suggests that genes for the major psychiatric disorders… do not exist.” Scientific American writer John Horgan recently issued a provocative challenge to behavioral geneticists to cite just one finding ever repeated in their follow-up research. “When it comes to behavioral genetics,” Horgan opined, “so far there is no baby; there’s only bathwater.”
Undaunted, ADHD proponents continue to label and dose thousands of Native children. Psychiatrist Elise Leonard, a deputy director of behavioral health for IHS Phoenix, asserted during an April 2013 webinar to IHS providers that ADHD is “about 80 percent genetically determined.” In this way, a pseudoscience connected to the race psychology of the boarding school era continues to be imposed upon Native children with devastating repercussions.
Statistics from the National Indian Child Welfare Association and the CDC show at least 170,000, nearly 11 percent, of the 1.6 million American Indian and Alaska Native children under age 18 are labeled with ADHD, including an estimated 115,000 Native boys. The rate of ADHD diagnosis for Native children has consistently tracked as the highest of any ethnic category, climbing steadily since 1997, and only in the last few years have rates for children from other backgrounds caught up.
ADHD’s rampant popularity is a new and significant educational barrier for Native children living in poverty. Between 1998 and 2009, ADHD diagnosis among all U.S. children living in poverty increased by 50 percent under policies of “early intervention” promoted by the CDC, IHS and other agencies. Children receiving benefits under Temporary Assistance for Needy Families (TANF) are now diagnosed with ADHD at a rate 1.7 times higher than children not on TANF. In their 2014 book, The ADHD Explosion, Steve Hinshaw and Richard Scheffler found the standards-based No Child Left Behind Act to be a major factor contributing to a 57 percent increase in ADHD diagnoses between 2003 and 2007 among children living within 200 percent of the federal poverty limit. Each ADHD-labeled child qualifies for special education services, which may bring Medicaid and other funding sources into poorer, less-resourced schools but also creates an incentive to diagnose even more kids with ADHD.
A long-term crisis in Native education is now being driven by runaway application of the ADHD label. For all U.S. children, the peak period for ADHD diagnosis comes during 3rd grade, when increased academic demands are typical in most public schools. Students in the chronically failing Indian country educational system are clearly more likely to be labeled ADHD—they are often not proficient in math or reading by the 8th grade, have far less access to higher-level high school subjects, and have the lowest high school graduation rates of any U.S. ethnicity. In 2008, the National Education Association, noted “American Indian [and] Alaska Native children receive special education labels and services at twice the rate of the general student population,” “tend to remain in special education classes” and “encounter a limited, less rigorous curriculum” that “can lead to diminished academic and post-secondary opportunities.” Only 17 percent of Native students engage in any form of post high school education.
The outrageousness of bogus science and rising ADHD rates in Indian country combines with the uselessness of prescribed drugs in improving academics. While there’s little question that stimulants help anyone stay awake and can sedate children, they offer no advantages for learning, retention of information or higher-order thinking. In a recent research review, psychologists Gretchen LeFever Watson, Andrea Powell Arcona, and David Antonuccio were unable to locate a single study demonstrating ADHD stimulant medication improves scholarship and instead found “compelling new evidence” that “indicates ADHD drug treatment is associated with deterioration in academic and social/emotional functioning.” They also assert that “neither drug addicts nor lab rats can distinguish the difference between cocaine and methylphenidate” the generic for Ritalin.
At least 57,000 Native children labeled ADHD are currently prescribed some form of stimulant. These numbers approach the 1973 peak student population at American Indian boarding schools of 60,000. The “special education” that once locked up feebleminded Native children inside boarding schools has moved inside the bodies of this generation’s children as they line up to receive their stimulant medication from the school nurse.
Adding to this calamity is considerable research and commentary suggesting the ADHD label may mask the effects of sexual and physical abuse. In brief, children subjected to violence and traumatic loss are often anxious, bereaved, hypervigilant, demotivated and preoccupied, and have trouble settling and focusing. Yet the entire approach toward diagnosing children with ADHD—the loose diagnostic criteria, reliance upon superficial rating scales and classroom observations, and the many stigmatizing biases held against children who don’t conform—make the traumatized child even less likely to disclose the factors behind their behavior. How tragically ironic if epidemic child abuse in Indian country, often thought to originate in families with traumatized boarding school ancestors, is being obscured by ADHD, a label tied historically to those ancestors’ presumed feeblemindedness.
What if this ADHD psychopharmaceutical complex was dismantled and its funding used to enrich the education of Native children? There are numerous ethical codes and professional “best practices” that contradict what currently occurs, yet providers in Indian country still tag Native children having trouble in school with ADHD and prescribe them stimulants. Instead of analyzing and critiquing the U.S. mental health system’s practices in Indian country, academics, clinicians, and counselors professing their alliance with communities are often actively involved in researching ADHD and other psychiatric labels applied to Native people. Educators and policy-makers appear reluctant to address the many ways ADHD recapitulates the historical oppression of Native children within today’s special education approaches. Until this system reflects upon its own complicity and resistance to reform, a “structural racism” fashioned from boarding school bricks, labels, and drugs will continue to stigmatize and imprison Native children.