One Doctor's Opinion: The Failure of Middle Schools

Middle schools were initially developed for several good reasons and with several good ideas. The plan was to provide a transition school for this "in between" age group of 11-14 year olds, to help them transition from the standard elementary school to the standard high school. The feeling was that the old junior high 7th and 8th or 7th to 9th grade model was not optimal and became just a high school experience two years earlier. Additionally, as we moved out of the 50's into the 80's, preadolescent and early adolescents were changing. Specifically, they were growing up faster, much faster in many ways; good and not so good. Puberty continues to hit earlier for many; thus these kids are bigger and have changing interests. The thought was that many 6th graders physically and emotionally needed to be moved out of elementary school - for their own good and the good of the younger elementary kids.

Much thought was given about how to accomplish this in the best interests of each age group while providing teaching staff and supports geared to each group's developmental level. In most plans the 6th graders (ages 11 and 12) were to be substantially separated from the 7th and 8th graders.

The 6th graders were to be given more nurturance, longer classes or blocks of 90 minutes to 2 hours, and thus less teacher changes to adjust to, less classrooms to find, a lunch period separate from "the big kids", their own area to hang out in, and a smaller staff to student ratio so that each teacher, counselor, and administrator could more easily get to know well each student assigned to them. The 7th and 8th graders' schedule and routine was to more closely approximate steps up to the high school schedule while the 6th graders' was to more closely approximate a gradual step up from elementary school. This plan also built in continuity over the full 3 years of middle school by varying methods such as keeping the same "homeroom", or counselor, or certain teachers, or small group of peers throughout all 3 years of middle school. The ideal model also included meaningful involvement and input for parents. The layout and size of the physical plant was set up to handle at most 450 to 650 kids to provide a more supportive and less threatening environment. This model even allowed for, in bigger districts, having some of the elementary schools continue a 6th grade class for the kids whose parents and teachers felt an extra year of elementary school seasoning would better fit their developmental path (i.e., physical and emotional growth pattern, readiness for multiple teachers and classes.)

Does all this sound like your child's middle school? Unfortunately, the answer is typically "No!" Children in middle school usually have 30 kids in each of 6 to 10 periods of 40 to 55 minutes, with 6 to 8 different teachers a day. Each teacher often has 150 to 250 students a day.

School nurses and counselors have hundreds of students assigned to them, while school social workers and psychologists each have multiple schools assigned to them. Personal and supportive relationships lasting through middle school is well beyond the scope of most teachers and staff who struggle to even learn the first and last names of their charges; they are more focused on crowd control.

Special education services are routinely cut with the change to middle school; the attitude being "fail first" rather than to provide support, removing the support if doing well. The actual teacher to student and staff to student ratios prevent formal and informal accommodation follow through. Assignments are uncoordinated. Students need daily planners or full time parents just to keep track of assignments, tests and projects. Parents often feel unwelcome and not listened to while their pre and early teens too often become turned off to, rather than excited by, learning. Meanwhile, middle school has become high school starting at age 11. The elementary school including 6th grade is now virtually extinct. The age at which the variety in developmental level is greatest gets the least developmentally appropriate education.

I am more surprised that so many kids do OK than I am that so many others struggle or become overwhelmed changing to middle school, especially 6th grade. Although I prefer a free and public education for all, I am not surprised by and support the increasing number of families pursuing smaller, more structured yet flexible, private schools, home schooling programs, alternative schools and charter schools, or fighting for their children's needs in public school.

Wellbutrin SR (Zyban) approved to help stop smoking
Wellbutrin, an antidepressant that also helps with attention, works primarily through its effects in the brain on the neurotransmitters norepinephrine and less so on dopamine. Wellbutrin is also used to counteract the sex drive side effects that may occur with Prozac, Zoloft, or Paxil. During its use to treat depression, many people found it easier to stop smoking cigarettes; likely by its decreasing nicotine withdrawal symptoms. Studies were then done nationally, including here in Tucson, which clearly proved this benefit. This year the FDA (Food and Drug Administration) approved the use of Buproprion (Wellbutrin's generic name) in the slow release form (SR) 150 mg twice a day doses as an additional option or aid in smoking cessation. Unfortunately, the company making Wellbutrin chose to market it for smoking cessation with another name, Zyban, although it is the same medication. Now the same medicine, Buproprion, exists in exactly the same form but with two completely different names. Nonetheless, this side benefit of Wellbutrin is a substantial advance and an extra benefit for helping those who smoke and want to quit, whether they are also depressed, have a history of depression, or not.

The slow release form (SR) of Wellbutrin is an advantage for those who prefer the convenience of this once or twice a day version over the regular immediate release original version Wellbutrin which is typically taken twice or three times a day. The SR form is usually smoother, less likely to energize, "rev up" or make one feel like they have had too much caffeine as can occur with the regular form of Wellbutrin. Of course, some people prefer the extra energy that the regular form may provide. This is where customizing the medicine to the individual patient comes in. Wellbutrin SR is covered by many insurance plans but is not yet covered by local HMO's.

As you have probably heard, "Fen/Phen" has been recently shown to increase the risk of an unusual heart valve abnormality that can be bad for your health. The problem seems related to the combination of Fen/Phen, since neither fenfluramine (Pondimin) or phentermine (Fastin or Ionamin), which have both been around for a bunch of years, have reportedly caused the problem alone. The best estimate is that the primary culprit is the fenfluramine and its closely related, newly marketed cousin dexfenfluramine (Redux). Thus fenfluramine and dexfenfluramine, as well as their brand name versions Pondimin and Redux, are now off the market and cannot be prescribed by doctors. Phentermine is still available.

If you have any fear you may have any heart valve problem from taking this medicine combination, see your doctor for a physical exam.

By the way, avoid "Herbal Fen/Phen" which is usually a mix of various vitamins, herbs, and minerals of variable value that do not cause weight loss except when the potentially dangerous chemical ephedrine (or ephedra) is included. Refer to the first issue of Medical Memo for cautions about this now unregulated "speed" found to be unsafe for doctors to prescribe but available, often unknown to the consumer, in certain herbs and supplements.

There are a number of other medications being studied to help with healthy weight control; several appear promising. However, time will tell. It is probably best to wait until new medicines have been on the general market for a year before trying them, except in severe situations. This is comparable to not buying a new car or appliance model the first year....let them "get the bugs out".

It is also wise to be very cautious about the media hype and junk science in the unregulated herbal, vitamin and supplement market place.