The prevention of unintentional injuries in childhood Gregory K. Fritz, M.D

ISSN 0898-2562

(See Survey, page 6)

Inside This Issue

(See Home schooling, page 4)

Vol. 18, No. 2 February 2002

FREE Client Handout: The Brain’s Response to Steroids


8 Commentary: The prevention of unintentional injuries in childhood Gregory K. Fritz, M.D.

Childhood eating problems may predict adult disorders

National Drug Use Statistics

Adverse events in childhood strongly linked with suicide


Teens surf net for health info


Vegetarians may be at risk for eating disorders, suicide


‘Overall, drug use among America’s teenagers has remained level or declined … but we must remain

vigilant to the threats that heroin, ecstasy, marijuana, alcohol and

other dangerous drugs pose to our youth.’

The home schooling debate: Why some parents choose it, others oppose it By Randal Rockney, M.D.

“My grandmother wanted me to have an education so she kept me out of school.”

— Margaret Mead

I grew up in Los Angeles in the 1960s. I attended Los Angeles public schools from kindergarten through 12th grade and eventually attended profes- sional school at a public university, the University of California at Irvine School of Medicine. When my wife told me she wanted to home school our children I resisted. Public school had been, for me, a mostly positive experience with good teachers in safe and stimulating environments. I also developed a lot of lifelong friendships with my public school classmates.

It never occurred to me not to enroll my children in public schools. Why, I would ask my wife, not put our children in the public schools? Why do any parents choose home schooling over public education?

Home schooling is an increasingly popular way to educate children in this country. On any given day, be- tween 1 and 4 percent of school-aged children are home schooled. Popular

Monitoring the Future survey reveals some positive trends for youth substance use

The most comprehensive survey for measuring youth drug use in America has found that use of most illicit drugs remains stable, while use of cigarettes continues to decline.

The annual Monitoring the Future (MTF) survey was re- leased recently by the U.S. De- partment of Health and Human Services (HHS). The survey found decreases in cigarette and heroin use, and most other sub- stance use remained stable. The survey also found that the use of ecstasy (MDMA) was increasing at a slower rate, while inhalant use has gradually declined, with a significant drop among 12th graders.

However, there also were some troubling findings concerning the per-

ceived risk of smoking marijuana — down more than 2 percent — and disapproval ratings of heroin and ste- roids. Use of steroids increased by almost 1 percent and at the same time,

disapproval of steroid use decreased among seniors.

Since 1975, the MTF has annually studied the extent of drug use among high school students. The 2001 study surveyed about 44,000 students in 424

schools across the country in three grades: 8th, 10th and 12th. The goal is to collect data on past month, past year and lifetime drug use among students in these grade levels. The

survey is conducted by the University of Michigan’s Insti- tute for Social Research and is funded by the National Institute on Drug Abuse (NIDA).

Highlights of the survey The reductions in teenage

smoking come on the heels of increases from the early to mid-1990s and are excellent news in the nation’s battle to reduce the toll exacted by this leading cause of preventable death and disease.



The Brown University Child and Adolescent Behavior Letter


Home schooling from page 1

approval, too, has increased: from 16 percent in a 1985 Gallup poll to 36 percent in 1998. The average home schooling family is larger, more reli- gious and politically conservative than average. Parents who home school tend to have more education and higher incomes than parents who en- roll their children in the public schools. Home schooling is legal in all 50 states, though states vary in terms of the specific regulations affecting families that home school.

Comparing performance Numerous studies have docu-

mented that home schooled children perform as well or better on standard measures of academic achievement than do their peers attending public school. In Alaska, where for practical reasons home schooling is supported by the state, data indicate that the longer a child is in a home-based program, the more likely he or she is to perform better than those in the pro- gram for a shorter period of time.

Historically, compulsory public education is the more recent innova- tion. Through the end of the 19th cen- tury, a substantial percentage of chil- dren received their education at home from parents, tutors or teachers of specific skills. Compulsory formal public education in the United States originated in the early 20th century to meet the basic educational require- ments demanded by society, help re- cent immigrants to acculturate, and promote certain public values while discouraging perceived ills, however defined by the community at the time. In the 1960s and 1970s, though, some parents became concerned that com- pulsory attendance had replaced com- pulsory education.

Who chooses homeschooling? The majority of parents who choose

to home school their children do so because of religious reasons. These

parents want their children to learn fundamentalist religious doctrine first and foremost. Their religious doctrine is often cited in support of a conserva- tive political and social viewpoint that emphasizes the family as the center of society. These parents are often unhappy with the contemporary so- cial order and seek to shield their children from influences they deem destructive, whether exposure to these influences comes from teachers, other students or popular media.

Ironically, these parents are more likely to structure their children’s learn- ing in a fashion that closely mimics traditional schools. In fact, they will often go so far as to create a class- room atmosphere in the home. They purchase curricular materials that mir- ror their own beliefs and monitor and assist their children to attain the goals defined by the suppliers of the cur- riculum. These parents are less inter- ested in a divergent process of educa- tion than they are with teaching their children specific knowledge and val- ues, though these parents do tend to become less reliant on outside cur- ricula as they gain experience as home educators.

Other parents choose to home school their children because of dis- satisfaction with the way children are taught in school rather than the con- tent of the in-school education. These parents object to the tendency for schools to ignore the diversity of learn- ing styles of children. They value spon- taneity, creativity and adaptability more than adherence to a fixed timeline for educational achievement. These par- ents, too, are concerned that schools too readily sort and label children according to limited measures of ability.

Parents who home school for peda- gogical rather than ideological rea- sons are more likely to experiment with alternative techniques or materi- als when they educate their children. Rather than instilling a fixed body of knowledge and attitudes, they are more concerned with teaching critical think- ing skills.

Another, albeit much smaller group of home schooling parents combine

features of both groups though they most closely resemble the parents who home school for pedagogical reasons. These are the pagan or counterculture parents, who are sometimes given the label New Age. Christian Fundamen- talist families choose home schooling to avoid exposure to ideas and values they don’t support.

Other families may hesitate to en- roll their children in public schools in communities where “Christian Val- ues” are prominent and with policies, such as support for the teaching of Creationism, they find inimical to their sense of reality. The New Age group seeks to instill, first and foremost, a respect for nature and the earth. Like the parents who home school for peda- gogical reasons, they are also very concerned that their children learn to think independently.

What do the critics say? There are many critics of home

schooling. Surveys of school superin- tendents and others associated with organized schooling indicate a lack of support for what is often perceived as a subversive activity. This should come as no surprise, as withdrawing chil- dren from school or not enrolling chil- dren in school is the most dramatic assertion of discontent with public education that a parent can make. It also removes the children from the educational and behavioral monitoring that is an important function of public schooling.

Some social critics view home schooling, at least in some instances, as fanaticism that should not be toler- ated in the interests of a democratic state.

The argument is well expressed by one such critic, David Blacker, in an article from the American Journal of Education:

“… a democratic society, in order to remain and reproduce itself as such, has a compelling interest in securing at least a minimal set of civic virtues in its citizens. Foremost among these, par- ticularly under conditions of pluralism such as those that obtain in the con- temporary United States, is a minimal



February 2002


Childhood eating problems may predict adult disorders

A study of more than 800 children over a 17-year period was conducted to examine the longitudinal course of eating problems in childhood, adoles- cence and adulthood. The investiga- tors used structured psychiatric inter- views of children and their mothers from 1975, 1983, 1985 and 1992 to answer two questions: 1) “How stable are eating disorder symptoms and di- agnoses over a 17-year interval from childhood to adolescence to adult- hood?” and 2) “Do early childhood eating problems or early or late ado-

What’s New in Research

level of tolerance for worldviews and cultural practices different from one’s own. Tolerance, in turn, presupposes an ability to grasp that there may be (and in fact is) a heterogeneity of reasonable value commitments held by one’s fellow citizens …” [Blacker D: Fanaticism and Schooling in the Democratic State. American Jour- nal of Education 1998; 106:241-272]

Public education, that author as- serts, is an important counter-force to fanaticism which he defines as a set of beliefs or an outlook which is compre- hensive and single-minded to the ex- tent that it informs or directs every sphere of activity within a family or a group. Adults should be free to order their lives according to such a com- prehensive and single-minded worldview as long as it does not harm others and is in compliance with society’s laws, but imposition of such a worldview on children is inimical to our society’s most basic values.

Pediatricians, too, are not in gen- eral supportive of home schooling. The only citation for home schooling in the medical literature (Klugewicz SL, Carraccio CL: Home Schooled Chil- dren: A Pediatric Perspective. Clini- cal Pediatrics 1999; 38:407-411) pre- sents a survey of pediatricians in two states (Wisconsin and Maryland) re- garding knowledge and attitudes about home schooling. Only 18 percent sup- ported home schooling.

Despite evidence in the educa- tional literature that home schooled children do at least as well or better on standardized achievement tests than children educated in school, pediatri- cians express concern about the edu- cational achievement and maturity of home schooled children.

Also of concern to pediatricians is the important public health role that schools perform, including scoliosis screening, sports physicals, tuberculo- sis screening, sex education and provi- sion of information regarding birth control and prevention of sexually trans- mitted diseases. Schools also provide an opportunity for the community to dis- cover evidence of abuse, neglect and other issues that pertain to the physical and mental health of children. The au- thors of that study wisely alert pediatri- cians to the necessity to provide these services to home schooled children.

Making time for socialization The most common concern I hear

when I mention that my children are home schooled is that home schooled children miss opportunities for social- ization that presence in a conventional school would provide. This is the rea- son pediatricians express concern that home schooled children might be less mature than their peers. Based on my family’s experience with home school- ing, this is one concern I do not share with the pediatricians surveyed in the

previously mentioned study. My children and most home

schooled children spend a lot of time with other home schooled children in shared educational activities like field trips, group lessons, shared curricula or special projects. In one study, 90 percent of home schooled children spent more than 20 hours per month in organized community activities. One very attractive aspect of home school- ing is that children tend to be less segregated by age when involved in home schooling activities as compared to what occurs in conventional schools. Socialization with other children and with children of varying ages is a near certainty within a home schooling com- munity because the home schooled families tend to be larger.

Home schooled children often en- roll part-time in conventional schools especially in the later grade levels when subjects, for example chemis- try, require expertise or equipment that is difficult to reproduce at home. Also, especially in adolescence, home schooled children eagerly take advan- tage of sports or arts programs of- fered by the public schools. Home schooled children generally assimilate well into conventional school and have had good success in the most competi- tive colleges and universities. Dr. Rockney is an associate professor in the Department of Pediatrics at Brown Univer- sity in Rhode Island.

lescent eating disorders predict eating disorders in adulthood?”

The study found that having bu- limia nervosa in early adolescence was correlated with a nine-fold in- crease in risk for having the disorder in late adolescence and with a 20-fold increase for having the disorder as an adult. Bulimia nervosa in late adoles- cence was associated with a 35-fold increase in risk for having the disorder as an adult.

Additionally, anorexia nervosa in adolescence was associated with hav- ing the disorder in adulthood. Gender, as well as eating symptoms in adoles-

cence, was predictive of eating disor- der symptoms in young adults for both bulimia nervosa and anorexia nervosa. Eating conflicts, struggles with food and unpleasant meals in childhood were all found to be risk factors for the development of eating disorders. The authors state, however, that while eating problems in adolescence were found to be associated with the devel- opment of eating disorders in young adulthood, most adolescents with symptoms will not have an eating dis- order as adults.

“The relatively high stability of eating disorder symptoms from ado-

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