The Brain Health of American Kids Depends On Donald Trump

In my mind, coral reefs and the human brain have always been linked: When I was in medical school, my teacher held up a piece of coral on the first day of neuroanatomy to show us how the shape of the brain and this form of marine life had a very similar design and underlying geometry.

I was reminded of that image once again by the growing crescendo of news stories about the demise of the Great Barrier Reef. Though many coral reefs have adapted to shifts in local ecologies, coral were not designed for the higher temperatures and carbon dioxide levels that we humans have mindlessly forced into their habitat. So even though ocean temperatures are increasing just a degree or so, and the acidity is up only slightly, these seemingly small changes are enough to cause many coral reefs to melt away.

In addition to resembling some species of coral, the developing human brain is similarly robust and in many ways comparably fragile. Just as climate change is slowly warming the oceans and devastating the coral, our children are experiencing analogous, and perhaps equally damaging, changes as their “mental environments” heat up. As we burn more fossil fuels to make our world spin faster, and the heat outside slowly rises, our kids are also exposed to more and more pressures, stresses, and anxieties they cannot handle.

While many children travel a developmental path marked by what might be considered normal or appropriate challenges—those that build character, grit, and skills that are necessary to succeed in the modern world—there are growing numbers of young people that experience more than their fair share of stress and anxiety, living in environments that do little to buffer them from daily assaults nor support them on the road to adulthood. 

This is too often true for the more than 40 percent of kids growing up in single-parent homes; the 44 percent in under-resourced households (below 200 percent of the federal poverty level); the many children raised in unstable homes and unsafe communities where exposures to chaos and violence inside and outside the home elevate their stress hormones; for the countless kids bombarded by market-driven electronic media that colonizes their brains at an early age, and addicts them by adolescence; for the growing numbers of “well-off” kids that are being rushed through childhood and driven up an ever steepening slope of academic achievement—for all those kids, the temperature is going up. 

Unfortunately, too often the realities of modern childhood range from toxic stresses that result from violence and conflict at home or school, to the ubiquitous pressures felt by children growing up in families that are squeezed for time, necessary resources, and basic services, like affordable child care so parents can work and make ends meet. No wonder that more of our children have ADHD, anxiety, depression and other emotional and behavioral disorders than ever before. Far too many children are exposed, day in and day out, as the pressure on their fragile mental ecosystems almost imperceptibly rises.

And how are we responding to these new realities? One sign of how bad things are getting is reflected by a recent report documenting that more than 10,000 US toddlers are now on ADHD medications that are rarely indicated for kids younger than four years of age. These medications are being used to turn down the temperature in their still-developing brains.

Not only are our children feeling the effects of chaotic environments at younger ages, but the cumulative burden of these stresses is affecting more and more children. This is confirmed by recent reports from the Centers for Disease Control and Prevention documenting that over 20 percent of American children and youth suffer from an impairing mental disorder. The numbers of children affected have been rising for a decade, if not more.

For more than 30 years I have been studying rising rates of disability in children. My own research has documented that from 1960 to 2010, the prevalence of childhood disability has increased fourfold. We have also described how the face of disability has also changed from a girl on crutches in the March of Dimes posters of the 1960s, to a little boy with autism or ADHD today.

Recent research also shows that many forms of mental illness first appear in adolescence and even sometimes in early childhood, and that 50 percent of adults who will be diagnosed with anxiety and depression are diagnosable by age 14, and 75 percent by age 24. Mental disorders are now the leading cause of disability for all Americans 18 to 44 years of age. What is not as widely recognized is that teens that begin to suffer from mental health problems and chronic mental disabilities during their early working years will also experience an accelerated onset of chronic medical problems like heart disease, high blood pressure, and diabetes as they move into their fifties. This means that they will not only be sicker earlier than expected, but a much longer course of illness will result in even higher healthcare costs.

Without attention to the psychosocial supports that help children develop, flourish and thrive, we are likely to continue to add to the ranks of the disabled and dependent. While the impact of this slow-moving human ecological train wreck may seem less important than bringing down the cost of Medicare or reforming Social Security, it is actually part of the root cause and solution of both these policy challenges as well. Over the history of our mostly pay-as-we-go Social Security program, we have moved from 16.5 workers paying for each retiree in 1950, to 5.1 workers in 1960, 2.9 in 2010, and by 2040 the ratio will have dropped to 2.1. 

Right now, the current Social Security program is not a strict pay-as-you-go program, because a sizable trust fund still exists. However, the projections indicate that the Social Security trust fund will be exhausted in 2040, and the low worker-to-beneficiary ratio will present a significant challenge to policymakers if Social Security is going to remain solvent—if those who are now under 40 want to count on having Social Security in their future. Clearly we cannot have a quarter or more of our young people disabled if we plan on retaining Social Security as we know it, even with possible increases in the retirement age. 

A prudent and forward-looking social policy would plan for the future, and make sure that we are not adding to the ranks of the dependent and disabled because of preventable mental disabilities, and that we have a healthy workforce that can continue to support older Americans as the age out of the workforce. Similarly, if we want to control spiraling Medicare costs, we need to reduce the number of people with chronic health conditions, especially the expanding pipeline of young people with preventable mental health and behavioral problems.

But how can we start to reverse these trends? A good start would be to act on the considerable science of human health and brain development, which clearly shows the profound benefits to stronger investments in early childhood. This includes, home visiting, Early Head Start, Head Start, universal full-day preschool, and expanded early intervention programs, for starters. Family policies that bring the US in line with most other advanced countries, and even many emerging ones, would help too: Paid parental leave and more flexible work schedules can reduce the squeeze on families and help them cope with the growing demands of raising children in our increasingly complex and globalized world. Expansion of the full range of pediatric mental health services, including prevention, treatment and rehabilitation services, is also sorely needed.

Though some will argue that the US cannot afford such investments—that it will make us less competitive and lead to higher unemployment—the evidence is exactly the opposite. As Nobel laureate James Heckman has clearly shown, the return on investment in children’s health development is as good as any investment on the market. New “pay for success” approaches and Social Impact Bonds can also be aligned with the longer time horizons required by investing in children. We also might need the childhood equivalent of a carbon tax, a kid’s levy on the mind-boiling-polluters that can in turn be used to provide the essential supports and protections they need.

Rather than rising to this clear and present danger, the Trump administration has submitted a budget that boosts military spending and deeply cuts into the “discretionary spending” that focuses on children, their mental health, and the wellbeing of our future workforce. While their first attempt of dismantling the Affordable Care Act has now failed, they still have their sights on Medicaid. Capping or block-granting Medicaid, to dramatically decrease the flow of federal funds to the states, will slowly strangle child health, mental health and early intervention services for the nearly 40 percent of all children who depend on this federal entitlement for their basic healthcare needs.

It may be too late to save the world’s coral reefs, but the same is not true for our children’s brains. Perhaps we can convince President Trump to take the target sign off of Medicaid, and adopt other policies designed to turn down the heat on our kids, so that they have the best chance of thriving.

Neal Halfon is a pediatrician and professor of pediatrics, public health and public policy at UCLA where he directs the UCLA Center for Healthier Children, Families and Communities.