It’s one of those “unintended consequences” of a government program started with the best of intentions — help the poorest of the poor families in our society get adequate treatment for their severely disabled child.
Yes, I’m talking about Supplemental Security Income (SSI) and The Boston Globe ran an in-depth investigative piece yesterday about some of those consequences, including rampant diagnosing of very young children and the over-prescribing of medication for them. “Many cash-strapped parents have come to believe that if only they can muster the necessary array of medical records, their children have a good shot at this benefit, even if it means carrying the stigma of the word “disabled.’’”
A program that was supposed to help only a small minority of children — those with serious health or mental health disabilities — is now serving 53 percent of the 1.2 million children who qualify for SSI benefits, according to the article.
The number one “disabled” diagnosis? Attention deficit hyperactivity disorder, or ADHD.
Now, don’t get me wrong. This is a good program that indeed does serve the needs of many poor families with severely disabled children. But because of losing a legal case in 1990, the program now has expanded to include things that aren’t automatically “disabilities” in any traditional definition of the term.
Indeed, one of the most disturbing parts of the program seems to be the mandate by federal government officials who administer the program that in order for a child to be considered seriously disabled (at least in the government’s eyes), they need to be on psychiatric medications — whether the parents wants them to be or not:
To qualify, a child had to be disabled. And if the disability was mental or behavioral — something like ADHD — the child pretty much had to be taking psychotropic drugs.
Fielding never liked the sound of that. She had long believed too many children take such medications, and she avoided them, even as clinicians were putting names to her boys’ troubles: oppositional defiant disorder, depression, ADHD. But then, as bills mounted, friends nudged her about SSI: “Go try.’’
Eventually she did, putting in applications for her two older sons. Neither was on medications; both were rejected. Then last year, school officials persuaded her to let her 10-year-old try a drug for his impulsiveness. Within weeks, his SSI application was approved.
Why do poor parents do it? Sometimes it comes down to basic economics — you get more money from the government if your children are labeled as being “disabled.”
For many, the motivation to apply comes down to economics: SSI payments can be a lifeline in a bad economy, and they beat welfare checks in almost every way. For a Massachusetts parent with two children, welfare pays a maximum of about $600 a month. If one of those two children is approved for the SSI program, the total government benefit can be twice as much.
Of course, the reality is that most children who have attention deficit disorder aren’t anywhere close to the classic definition of “disabled.” And even serious mental disorders can be treated just as readily with psychotherapy and behavioral treatments as they can with psychiatric medications. But that won’t get the SSI office to open up their pocketbooks. So parents are caught in an unintended reward situation where if they agree to medicate their child, they find they suddenly qualify for more money from the government.
Perhaps this might explain the discrepancy in diagnosis of children with attention deficit disorder — those who are poorer (on Medicaid) have a larger percentage of ADHD diagnoses:
A 2008 study found, for example, that 12 percent of children on Medicaid were diagnosed with ADHD, compared with 8 percent of children on private insurance. Other national studies using Medicaid data have found that poorer children with behavioral and mental diagnoses are also medicated with ADHD drugs and antipsychotic medications at higher rates.
All of this is both eye-opening and a bit disturbing. The article goes into some detail explaining why the program has ballooned like it has to cover virtually any poor child who qualifies for SSI benefits, once they agree to be medicated. It’s worth the read.
Read the full article: With SSI program, a legacy of unintended side effects