For half a million school children in Orange County, the doctor is officially in. Pediatrician Marc Lerner has begun his new job as the first-ever medical officer of the county's Department of Education.
He'll advise the department on health issues, including fitness and physical education; serve as a liaison to doctors, community groups and government partners; and work with school nurses to eliminate health barriers to academic performance.
Previously, Lerner was a UC Irvine School of Medicine professor and the chief of developmental and behavioral pediatrics at UCI and Children's Hospital of Orange County.
As a researcher, he led numerous studies and published findings on Attention Deficit and Hyperactivity Disorder (ADHD). Lerner is a former president of the Orange County chapter of the American Academy of Pediatrics and a founding board member of the Prentice School, which serves children with language learning disorders.
Recently, Voice of OC chatted with Dr. Lerner about his new position, the challenges of ADHD and what he hopes to accomplish.
Q: How will you bring your expertise in ADHD to your new position?
A: ADHD is one of many issues I will be addressing. Part of my goal was to work on mental health issues, to look at some of the projects already being rolled out for dealing with disruptive behavior and training in behavior management [of ADHD students] for young teachers. I'll be working on providing support for families and the development of parent training programs.
We at UCI have offered Cuidar, a program of early parent training for disruptive behaviors, to help children have more consistency, get better behavioral messages, to help them to do their best. As I'm new, I'm looking for where I can add my medical background and experience, not just with ADHD but also anxiety, depression and risk for suicide.
Q: Is there too much reliance on medicines to treat ADHD, and is it over-diagnosed?
A: At UC Irvine, we compared medication to behavioral treatment. We found that both treatments can work. Individual children may require one or the other or a combination, so children deserve an experienced clinician and access to the various tools. …
My view is that probably ADHD is both under- and overdiagnosed. Many children with substantial problems can't access health care and services to receive a diagnosis. In other cases the issue is not severe enough to cause impairment across multiple settings.
Q: Is that a way of saying that children of disadvantaged families are underdiagnosed while children of families with ample resources may be overdiagnosed?
A: In some cases, people are trying to make sure their children have every advantage, get identified as special needs so they can have extra time in examinations and resources.
Q: What are some other priorities in your new position?
A: We've had highly publicized tragedies where student athletes have died on the ball fields. We are hoping to promote readiness to respond to emergencies in schools. In some towns this has meant training students to do CPR and providing treatment if there's a cardiac event. There are more automated external defibrillators in schools, but I'd like to see them in all schools.
Q: What experience can you bring to the role of advising school nurses?
A: I have worked through our chapter of the American Academy of Pediatrics with school nurses for a decade, regularly meeting with them. They are a critical and unfortunately scarce resource in our schools.
Q: What are some ways that nurses can improve learning at school?
A: Monitoring wellness so they [students] can be effective learners. Nurses can check on vision and hearing of students. They can make sure students can maintain attendance by having vaccinations when they arrive.
Q: How well is the requirement that all students from grades seven through 12 be vaccinated against whooping cough being enforced?
A: The current short-term emergency is making sure students meet the new state requirement for getting Tdap vaccinations for [tetanus, diphtheria and] whooping cough. The governor passed an amendment that gives kids 30 days from the start of school. Students are now allowed to come to school, but we need to get full vaccination and documentation to the state.
We've had a pertussis [whooping cough] epidemic in the state, and 10 young children have died. We feel that older brothers and sisters may be involved in the transmission of infection.
Q. Voice of OC recently wrote about a declining immunization rate in Orange County. What are your thoughts on this issue?
A: In a recent decision, health officials voted to discontinue personal belief exemptions [which parents sign to exempt children from vaccination requirements]. What is really required is an increase in the quality of education about vaccine risks and benefits.
Our county's health is well served when children who are healthy and able to receive vaccines get them. Sometimes parents struggle on the basis of incomplete information or, I would say, misconceptions of vaccination causing autism. This has led to anxiety and fear about what we recognize to be our most powerful public health protective mechanism, broad immunization.
We need to address people's concerns, provide good education and good science.
— Interview by AMY DePAUL