A Father’s Sadness about Schizophrenia and Schools

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Paul Gionfriddo, formerly a state legislator in Connecticut, writes about his son, who showed signs of schizophrenia when very young and whose life has been ravaged by the disease. (Article, My Son Is Schizophrenic—the Reforms I Worked for Have Worsened His Life in the October 15, 2012, edition of the Washington Post.)

“Tim is homeless. But when he was a toddler, my colleagues in the Connecticut state legislature couldn’t get enough of cuddling him. Yet it is the policies of my generation of policymakers that put that formerly adorable toddler, now a troubled 6-foot-5 adult, on the street. And unless something changes, the policies of today’s generation of policymakers will keep him there.

“If you were to encounter my son, Tim, a tall, gaunt man in ragged clothes, on a San Francisco street, you might step away from him. His clothes, his dark unshaven face and his wild curly hair stamp him as the stereotype of the chronically mentally ill street person.

“People are afraid of what they see when they glance at Tim. Policymakers pass ordinances to keep people who look like him at arm’s length. But when you look just a little more closely, what you find is a young man with a sly smile, quick wit and an inquisitive mind. When he’s healthy he bears a striking resemblance to the youthful Muhammad Ali.”

Gionfriddo documents the signs of major illness that went unrecognized and misunderstood for years. His son had difficulty making friends, even in kindergarten. Early on the schools identified low organizational skills and “low self esteem.” His principal said “he just needs to follow the rules” and one teacher said “he has overprotective parents.” Once he wore inline skates and tried to skate on a state highway.

Later he got into fights. He tried marijuana. He was finally diagnosed with schizophrenia when he was seventeen years old. (Typically there are premorbid signs of schizophrenia and the illness is not diagnosed for ten years.) Problems ensued with insurance companies and when he became a young adult none of the “programs” were able to engage with him and he became homeless.

“More than one educator has told me that I shouldn’t blame the schools: Their purpose is to educate children, not to treat them. I understand this. But I also learned from personal experience that ignoring a child’s special needs makes meaningless the special-education concepts of ‘appropriate’ and ‘least restrictive’ education that are embodied in the laws we passed.”

Federal law does include regulations mandating that schools identify, classify, and treat emotional and behavioral disorders (EBD) as these affect a child’s ability to learn during the school day. If one has an understanding of major psychiatric disorders in children, conditions such as schizophrenia, bipolar disorder, and major depression can be seen as falling under this umbrella.

However, those who are not specialists in clinical child psychiatry—and this includes teachers, administrators, and sometimes even school psychologists—may not recognize these conditions when they observe them nor know that they are covered as conditions relevant to the Committee of Special Education Process.

The Code of Federal Regulations, Title 34, Sec. 300.7(b)(90) defines emotional and behavioral as including these factors: (a) inability to learn that cannot be explained by intellectual, sensory, or health factors; (b) an inability to build or maintain satisfactory relationships with peers and teachers; (c) inappropriate types of behavior under normal circumstances; (d) general and pervasive mood of unhappiness or depression; (e) tendency to develop symptoms or fears associated with personal or school problems.

This definition clearly includes schizophrenia and its symptoms such as hallucinations, delusions, alienation from others, and impaired learning due to these preoccupations. However, since it doesn’t specifically say “schizophrenia,” even by acknowledging that is is rare in children and likely to not have been observed by many teachers in the elementary school years, this presence in children is often unrecognized.

For over twenty-five years I have taught classes in abnormal psychology and psychopathology, which include detailed descriptions of child psychiatric conditions. Students become familiar with schizophrenia, major depression, and bipolar disorder. This semester, for the first time, I am teaching the course Exceptional Child with students who major in education. We are using the thirteenth edition of an esteemed textbook that has been in print over thirty years.

Surprising, the word schizophrenia cannot be found in the entire book. The chapter on “Emotional and Behavior Disorders” includes discussions on identifying and intervening with aggression, attention deficit disorder, ethnic risk factors, violent video games, bullying and suicide (all important!) but does not inform students about psychoses—and these are the children and teens who often need help the most.

Cynics or even prudent budget-minders might speculate that the government and schools may have designed this situation on purpose—perhaps to discourage identifying those for whom care and treatment can total over one million dollars before a student reaches age twenty one. (If a student needs residential treatment, an intervention that can cost $200 thousand per year, the education department typically pays the school day component while social service pays the residential component. Sometimes private insurance adds to this. However, for this to occur a diagnosis needs to be made.)

Gionfriddo reflects on his experiences as a legislator and father and offers these ideas to create a functional collaboration among professionals and agencies:

“But we legislators in Connecticut and many other states made a series of critical misjudgments.

“First, we didn’t understand how poorly prepared the public schools were to educate children with serious mental illnesses.

“Second, we didn’t adequately fund community agencies to meet new demands for community mental health services; ultimately forcing our county jails to fill the void.

“And third, we didn’t realize how important it would be to create collaborations among educators, primary-care clinicians, mental-health professionals, social-services providers, even members of the criminal justice system, to give people with serious mental illnesses a reasonable chance of living successfully in the community.”

AMHF recommends that Mr. Gionfriddo’s ideas be taken seriously by everyone.

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