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More than two hours of homework may be counterproductive, research suggests.

A Stanford education researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.   "Our findings on the effects of homework challenge the traditional assumption that homework is inherently good," wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .   The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students' views on homework.   Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.   Students in these schools average about 3.1 hours of homework each night.   "The findings address how current homework practices in privileged, high-performing schools sustain students' advantage in competitive climates yet hinder learning, full engagement and well-being," Pope wrote.   Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.   Their study found that too much homework is associated with:   • Greater stress : 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.   • Reductions in health : In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.   • Less time for friends, family and extracurricular pursuits : Both the survey data and student responses indicate that spending too much time on homework meant that students were "not meeting their developmental needs or cultivating other critical life skills," according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.   A balancing act   The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.   Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as "pointless" or "mindless" in order to keep their grades up.   "This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points," said Pope, who is also a co-founder of Challenge Success , a nonprofit organization affiliated with the GSE that conducts research and works with schools and parents to improve students' educational experiences..   Pope said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.   "Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development," wrote Pope.   High-performing paradox   In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. "Young people are spending more time alone," they wrote, "which means less time for family and fewer opportunities to engage in their communities."   Student perspectives   The researchers say that while their open-ended or "self-reporting" methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for "typical adolescent complaining" – it was important to learn firsthand what the students believe.   The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Clifton B. Parker is a writer at the Stanford News Service .

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August 16, 2021

Is it time to get rid of homework? Mental health experts weigh in

by Sara M Moniuszko

It's no secret that kids hate homework. And as students grapple with an ongoing pandemic that has had a wide-range of mental health impacts, is it time schools start listening to their pleas over workloads?

Some teachers are turning to social media to take a stand against homework .

Tiktok user @misguided.teacher says he doesn't assign it because the "whole premise of homework is flawed."

For starters, he says he can't grade work on "even playing fields" when students' home environments can be vastly different.

"Even students who go home to a peaceful house, do they really want to spend their time on busy work? Because typically that's what a lot of homework is, it's busy work," he says in the video that has garnered 1.6 million likes. "You only get one year to be 7, you only got one year to be 10, you only get one year to be 16, 18."

Mental health experts agree heavy work loads have the potential do more harm than good for students, especially when taking into account the impacts of the pandemic. But they also say the answer may not be to eliminate homework altogether.

Emmy Kang, mental health counselor at Humantold, says studies have shown heavy workloads can be "detrimental" for students and cause a "big impact on their mental, physical and emotional health."

"More than half of students say that homework is their primary source of stress, and we know what stress can do on our bodies," she says, adding that staying up late to finish assignments also leads to disrupted sleep and exhaustion.

Cynthia Catchings, a licensed clinical social worker and therapist at Talkspace, says heavy workloads can also cause serious mental health problems in the long run, like anxiety and depression.

And for all the distress homework causes, it's not as useful as many may think, says Dr. Nicholas Kardaras, a psychologist and CEO of Omega Recovery treatment center.

"The research shows that there's really limited benefit of homework for elementary age students, that really the school work should be contained in the classroom," he says.

For older students, Kang says homework benefits plateau at about two hours per night.

"Most students, especially at these high-achieving schools, they're doing a minimum of three hours, and it's taking away time from their friends from their families, their extracurricular activities. And these are all very important things for a person's mental and emotional health."

Catchings, who also taught third to 12th graders for 12 years, says she's seen the positive effects of a no homework policy while working with students abroad.

"Not having homework was something that I always admired from the French students (and) the French schools, because that was helping the students to really have the time off and really disconnect from school ," she says.

The answer may not be to eliminate homework completely, but to be more mindful of the type of work students go home with, suggests Kang, who was a high-school teacher for 10 years.

"I don't think (we) should scrap homework, I think we should scrap meaningless, purposeless busy work-type homework. That's something that needs to be scrapped entirely," she says, encouraging teachers to be thoughtful and consider the amount of time it would take for students to complete assignments.

The pandemic made the conversation around homework more crucial

Mindfulness surrounding homework is especially important in the context of the last two years. Many students will be struggling with mental health issues that were brought on or worsened by the pandemic, making heavy workloads even harder to balance.

"COVID was just a disaster in terms of the lack of structure. Everything just deteriorated," Kardaras says, pointing to an increase in cognitive issues and decrease in attention spans among students. "School acts as an anchor for a lot of children, as a stabilizing force, and that disappeared."

But even if students transition back to the structure of in-person classes, Kardaras suspects students may still struggle after two school years of shifted schedules and disrupted sleeping habits.

"We've seen adults struggling to go back to in-person work environments from remote work environments. That effect is amplified with children because children have less resources to be able to cope with those transitions than adults do," he explains.

'Get organized' ahead of back-to-school

In order to make the transition back to in-person school easier, Kang encourages students to "get good sleep, exercise regularly (and) eat a healthy diet."

To help manage workloads, she suggests students "get organized."

"There's so much mental clutter up there when you're disorganized... sitting down and planning out their study schedules can really help manage their time," she says.

Breaking assignments up can also make things easier to tackle.

"I know that heavy workloads can be stressful, but if you sit down and you break down that studying into smaller chunks, they're much more manageable."

If workloads are still too much, Kang encourages students to advocate for themselves.

"They should tell their teachers when a homework assignment just took too much time or if it was too difficult for them to do on their own," she says. "It's good to speak up and ask those questions. Respectfully, of course, because these are your teachers. But still, I think sometimes teachers themselves need this feedback from their students."

©2021 USA Today Distributed by Tribune Content Agency, LLC.

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Too much homework can be counterproductive

May 31, 2005

University Park, Pa. -- Instead of improving educational achievement in countries around the world, increases in homework may actually undercut teaching effectiveness and worsen disparities in student learning, according to two Penn State researchers.

Most teachers worldwide are not making efficient use of homework, said David P. Baker, professor of education and sociology. They assign homework mostly as drill, to improve memorization of material either in math, science or the humanities. While drills and repetitive exercises have their place in schooling, homework may not be that place.

"Assigning textbook or worksheet questions as a drill assumes that the child has the kind of home environment conductive to supporting drill and memorization practice," noted Gerald K. LeTendre, associate professor of education.

Upper-income parents, who tend to have closer communication with the school and with teachers, are better able to assist their children with homework. But in poorer households -- often headed by single parents, parents with comparatively little education or, in some nations, parents held back by language barriers -- homework may not be cordially received, especially by parents of small children.

"An unintended consequence may be that those children who need extra work and drill the most are the ones least likely to get it. Increasing homework loads is likely to aggravate tensions within the family, thereby generating more inequality and eroding the quality of overall education," Baker said.

LeTendre and Baker are co-authors of the book, "National Differences, Global Similarities: World Culture and the Future of Schooling," recently published by Stanford University Press. Chapter Eight, "Schoolwork at Home? Low-Quality Schooling and Homework," was written in collaboration with Motoko Akiba, assistant professor of educational leadership and policy analysis at the University of Missouri-Columbia.

The researchers analyzed data from the Third International Study of Mathematics and Sciences (TIMSS), which in 1994 collected a large amount of data from schools in 41 nations across the fourth, eighth and 12th grades. For some analyses, they employed figures from the TIMSS 99, an identical study carried out in 1999 with 50 nations.

Their findings indicated a frequent lack of positive correlation between the average amount of homework assigned in a nation and corresponding level of academic achievement. For example, many countries with the highest scoring students, such as Japan, the Czech Republic and Denmark, have teachers who give little homework. "At the other end of the spectrum, countries with very low average scores -- Thailand, Greece, Iran -- have teachers who assign a great deal of homework," Baker noted.

"The United States is among the most homework-intensive countries in the world for seventh- and eighth-grade math classes. U.S. math teachers on average assigned more than two hours of mathematics homework per week in 1994-95," said LeTendre. "Contrary to our expectations, one of the lowest levels was recorded in Japan -- about one hour a week. These figures challenge previous stereotypes about the lackadaisical American teenager and his diligent peer in Japan."

During the early 1980s, many U.S. schools and teachers ramped up their homework assignments, at least to younger children, in reaction to intense media focus on studies comparing the mediocre performance of American students to the industriousness of their Japanese counterparts. At the same time, ironically, Japanese educators were attempting to reduce the amount of homework given to their students and allow them more leisure from the rigors of schooling. Neither the American nor the Japanese educational reform of the 1980s seems to have affected general achievement levels in either country, according to the book.

"American students appear to do as much homework as their peers overseas -- if not more -- but still only score around the international average," LeTendre said. "Undue focus on homework as a national quick-fix, rather than a focus on issues of instructional quality and equity of access to opportunity to learn, may lead a country into wasted expenditures of time and energy."

If schools expect every family to reinforce the child's learning process at home, they need to realize that, when families are unequal to the task, students will not receive the same quality of education. The addition of homework will only exacerbate existing inequities within a nation's student population and pull down overall scores, said Baker.

"Those families that are better able to marshal resources to support outside school learning will likely gain disproportionate advantage," he added.

"However, even in affluent nations, parents are extremely busy with work and household chores, not to mention chauffeuring young people to various extracurricular activities, athletic and otherwise," LeTendre said. "Parents might sometimes see exercises in drill and memorization as intrusions into family time."

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Is homework a necessary evil?

After decades of debate, researchers are still sorting out the truth about homework’s pros and cons. One point they can agree on: Quality assignments matter.

By Kirsten Weir

March 2016, Vol 47, No. 3

Print version: page 36

• Schools and Classrooms

Homework battles have raged for decades. For as long as kids have been whining about doing their homework, parents and education reformers have complained that homework's benefits are dubious. Meanwhile many teachers argue that take-home lessons are key to helping students learn. Now, as schools are shifting to the new (and hotly debated) Common Core curriculum standards, educators, administrators and researchers are turning a fresh eye toward the question of homework's value.

But when it comes to deciphering the research literature on the subject, homework is anything but an open book.

The 10-minute rule

In many ways, homework seems like common sense. Spend more time practicing multiplication or studying Spanish vocabulary and you should get better at math or Spanish. But it may not be that simple.

Homework can indeed produce academic benefits, such as increased understanding and retention of the material, says Duke University social psychologist Harris Cooper, PhD, one of the nation's leading homework researchers. But not all students benefit. In a review of studies published from 1987 to 2003, Cooper and his colleagues found that homework was linked to better test scores in high school and, to a lesser degree, in middle school. Yet they found only faint evidence that homework provided academic benefit in elementary school ( Review of Educational Research , 2006).

Then again, test scores aren't everything. Homework proponents also cite the nonacademic advantages it might confer, such as the development of personal responsibility, good study habits and time-management skills. But as to hard evidence of those benefits, "the jury is still out," says Mollie Galloway, PhD, associate professor of educational leadership at Lewis & Clark College in Portland, Oregon. "I think there's a focus on assigning homework because [teachers] think it has these positive outcomes for study skills and habits. But we don't know for sure that's the case."

Even when homework is helpful, there can be too much of a good thing. "There is a limit to how much kids can benefit from home study," Cooper says. He agrees with an oft-cited rule of thumb that students should do no more than 10 minutes a night per grade level — from about 10 minutes in first grade up to a maximum of about two hours in high school. Both the National Education Association and National Parent Teacher Association support that limit.

Beyond that point, kids don't absorb much useful information, Cooper says. In fact, too much homework can do more harm than good. Researchers have cited drawbacks, including boredom and burnout toward academic material, less time for family and extracurricular activities, lack of sleep and increased stress.

In a recent study of Spanish students, Rubén Fernández-Alonso, PhD, and colleagues found that students who were regularly assigned math and science homework scored higher on standardized tests. But when kids reported having more than 90 to 100 minutes of homework per day, scores declined ( Journal of Educational Psychology , 2015).

"At all grade levels, doing other things after school can have positive effects," Cooper says. "To the extent that homework denies access to other leisure and community activities, it's not serving the child's best interest."

Children of all ages need down time in order to thrive, says Denise Pope, PhD, a professor of education at Stanford University and a co-founder of Challenge Success, a program that partners with secondary schools to implement policies that improve students' academic engagement and well-being.

"Little kids and big kids need unstructured time for play each day," she says. Certainly, time for physical activity is important for kids' health and well-being. But even time spent on social media can help give busy kids' brains a break, she says.

All over the map

But are teachers sticking to the 10-minute rule? Studies attempting to quantify time spent on homework are all over the map, in part because of wide variations in methodology, Pope says.

A 2014 report by the Brookings Institution examined the question of homework, comparing data from a variety of sources. That report cited findings from a 2012 survey of first-year college students in which 38.4 percent reported spending six hours or more per week on homework during their last year of high school. That was down from 49.5 percent in 1986 ( The Brown Center Report on American Education , 2014).

The Brookings report also explored survey data from the National Assessment of Educational Progress, which asked 9-, 13- and 17-year-old students how much homework they'd done the previous night. They found that between 1984 and 2012, there was a slight increase in homework for 9-year-olds, but homework amounts for 13- and 17-year-olds stayed roughly the same, or even decreased slightly.

Yet other evidence suggests that some kids might be taking home much more work than they can handle. Robert Pressman, PhD, and colleagues recently investigated the 10-minute rule among more than 1,100 students, and found that elementary-school kids were receiving up to three times as much homework as recommended. As homework load increased, so did family stress, the researchers found ( American Journal of Family Therapy , 2015).

Many high school students also seem to be exceeding the recommended amounts of homework. Pope and Galloway recently surveyed more than 4,300 students from 10 high-achieving high schools. Students reported bringing home an average of just over three hours of homework nightly ( Journal of Experiential Education , 2013).

On the positive side, students who spent more time on homework in that study did report being more behaviorally engaged in school — for instance, giving more effort and paying more attention in class, Galloway says. But they were not more invested in the homework itself. They also reported greater academic stress and less time to balance family, friends and extracurricular activities. They experienced more physical health problems as well, such as headaches, stomach troubles and sleep deprivation. "Three hours per night is too much," Galloway says.

In the high-achieving schools Pope and Galloway studied, more than 90 percent of the students go on to college. There's often intense pressure to succeed academically, from both parents and peers. On top of that, kids in these communities are often overloaded with extracurricular activities, including sports and clubs. "They're very busy," Pope says. "Some kids have up to 40 hours a week — a full-time job's worth — of extracurricular activities." And homework is yet one more commitment on top of all the others.

"Homework has perennially acted as a source of stress for students, so that piece of it is not new," Galloway says. "But especially in upper-middle-class communities, where the focus is on getting ahead, I think the pressure on students has been ratcheted up."

Yet homework can be a problem at the other end of the socioeconomic spectrum as well. Kids from wealthier homes are more likely to have resources such as computers, Internet connections, dedicated areas to do schoolwork and parents who tend to be more educated and more available to help them with tricky assignments. Kids from disadvantaged homes are more likely to work at afterschool jobs, or to be home without supervision in the evenings while their parents work multiple jobs, says Lea Theodore, PhD, a professor of school psychology at the College of William and Mary in Williamsburg, Virginia. They are less likely to have computers or a quiet place to do homework in peace.

"Homework can highlight those inequities," she says.

Quantity vs. quality

One point researchers agree on is that for all students, homework quality matters. But too many kids are feeling a lack of engagement with their take-home assignments, many experts say. In Pope and Galloway's research, only 20 percent to 30 percent of students said they felt their homework was useful or meaningful.

"Students are assigned a lot of busywork. They're naming it as a primary stressor, but they don't feel it's supporting their learning," Galloway says.

"Homework that's busywork is not good for anyone," Cooper agrees. Still, he says, different subjects call for different kinds of assignments. "Things like vocabulary and spelling are learned through practice. Other kinds of courses require more integration of material and drawing on different skills."

But critics say those skills can be developed with many fewer hours of homework each week. Why assign 50 math problems, Pope asks, when 10 would be just as constructive? One Advanced Placement biology teacher she worked with through Challenge Success experimented with cutting his homework assignments by a third, and then by half. "Test scores didn't go down," she says. "You can have a rigorous course and not have a crazy homework load."

Still, changing the culture of homework won't be easy. Teachers-to-be get little instruction in homework during their training, Pope says. And despite some vocal parents arguing that kids bring home too much homework, many others get nervous if they think their child doesn't have enough. "Teachers feel pressured to give homework because parents expect it to come home," says Galloway. "When it doesn't, there's this idea that the school might not be doing its job."

Galloway argues teachers and school administrators need to set clear goals when it comes to homework — and parents and students should be in on the discussion, too. "It should be a broader conversation within the community, asking what's the purpose of homework? Why are we giving it? Who is it serving? Who is it not serving?"

Until schools and communities agree to take a hard look at those questions, those backpacks full of take-home assignments will probably keep stirring up more feelings than facts.

Further reading

• Cooper, H., Robinson, J. C., & Patall, E. A. (2006). Does homework improve academic achievement? A synthesis of research, 1987-2003. Review of Educational Research, 76 (1), 1–62. doi: 10.3102/00346543076001001
• Galloway, M., Connor, J., & Pope, D. (2013). Nonacademic effects of homework in privileged, high-performing high schools. The Journal of Experimental Education, 81 (4), 490–510. doi: 10.1080/00220973.2012.745469
• Pope, D., Brown, M., & Miles, S. (2015). Overloaded and underprepared: Strategies for stronger schools and healthy, successful kids . San Francisco, CA: Jossey-Bass.

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How Much Homework Is Enough? Depends Who You Ask

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Editor’s note: This is an adapted excerpt from You, Your Child, and School: Navigate Your Way to the Best Education ( Viking)—the latest book by author and speaker Sir Ken Robinson (co-authored with Lou Aronica), published in March. For years, Robinson has been known for his radical work on rekindling creativity and passion in schools, including three bestselling books (also with Aronica) on the topic. His TED Talk “Do Schools Kill Creativity?” holds the record for the most-viewed TED talk of all time, with more than 50 million views. While Robinson’s latest book is geared toward parents, it also offers educators a window into the kinds of education concerns parents have for their children, including on the quality and quantity of homework.

The amount of homework young people are given varies a lot from school to school and from grade to grade. In some schools and grades, children have no homework at all. In others, they may have 18 hours or more of homework every week. In the United States, the accepted guideline, which is supported by both the National Education Association and the National Parent Teacher Association, is the 10-minute rule: Children should have no more than 10 minutes of homework each day for each grade reached. In 1st grade, children should have 10 minutes of daily homework; in 2nd grade, 20 minutes; and so on to the 12th grade, when on average they should have 120 minutes of homework each day, which is about 10 hours a week. It doesn’t always work out that way.

In 2013, the University of Phoenix College of Education commissioned a survey of how much homework teachers typically give their students. From kindergarten to 5th grade, it was just under three hours per week; from 6th to 8th grade, it was 3.2 hours; and from 9th to 12th grade, it was 3.5 hours.

There are two points to note. First, these are the amounts given by individual teachers. To estimate the total time children are expected to spend on homework, you need to multiply these hours by the number of teachers they work with. High school students who work with five teachers in different curriculum areas may find themselves with 17.5 hours or more of homework a week, which is the equivalent of a part-time job. The other factor is that these are teachers’ estimates of the time that homework should take. The time that individual children spend on it will be more or less than that, according to their abilities and interests. One child may casually dash off a piece of homework in half the time that another will spend laboring through in a cold sweat.

Do students have more homework these days than previous generations? Given all the variables, it’s difficult to say. Some studies suggest they do. In 2007, a study from the National Center for Education Statistics found that, on average, high school students spent around seven hours a week on homework. A similar study in 1994 put the average at less than five hours a week. Mind you, I [Robinson] was in high school in England in the 1960s and spent a lot more time than that—though maybe that was to do with my own ability. One way of judging this is to look at how much homework your own children are given and compare it to what you had at the same age.

Many parents find it difficult to help their children with subjects they’ve not studied themselves for a long time, if at all.

There’s also much debate about the value of homework. Supporters argue that it benefits children, teachers, and parents in several ways:

• Children learn to deepen their understanding of specific content, to cover content at their own pace, to become more independent learners, to develop problem-solving and time-management skills, and to relate what they learn in school to outside activities.
• Teachers can see how well their students understand the lessons; evaluate students’ individual progress, strengths, and weaknesses; and cover more content in class.
• Parents can engage practically in their children’s education, see firsthand what their children are being taught in school, and understand more clearly how they’re getting on—what they find easy and what they struggle with in school.

Want to know more about Sir Ken Robinson? Check out our Q&A with him.

Q&A With Sir Ken Robinson

Ashley Norris is assistant dean at the University of Phoenix College of Education. Commenting on her university’s survey, she says, “Homework helps build confidence, responsibility, and problem-solving skills that can set students up for success in high school, college, and in the workplace.”

That may be so, but many parents find it difficult to help their children with subjects they’ve not studied themselves for a long time, if at all. Families have busy lives, and it can be hard for parents to find time to help with homework alongside everything else they have to cope with. Norris is convinced it’s worth the effort, especially, she says, because in many schools, the nature of homework is changing. One influence is the growing popularity of the so-called flipped classroom.

In the stereotypical classroom, the teacher spends time in class presenting material to the students. Their homework consists of assignments based on that material. In the flipped classroom, the teacher provides the students with presentational materials—videos, slides, lecture notes—which the students review at home and then bring questions and ideas to school where they work on them collaboratively with the teacher and other students. As Norris notes, in this approach, homework extends the boundaries of the classroom and reframes how time in school can be used more productively, allowing students to “collaborate on learning, learn from each other, maybe critique [each other’s work], and share those experiences.”

Even so, many parents and educators are increasingly concerned that homework, in whatever form it takes, is a bridge too far in the pressured lives of children and their families. It takes away from essential time for their children to relax and unwind after school, to play, to be young, and to be together as a family. On top of that, the benefits of homework are often asserted, but they’re not consistent, and they’re certainly not guaranteed.

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Education scholar Denise Pope has found that too much homework has negative effects on student well-being and behavioral engagement. (Image credit: L.A. Cicero)

A Stanford researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.

“Our findings on the effects of homework challenge the traditional assumption that homework is inherently good,” wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .

The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students’ views on homework.

Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.

Students in these schools average about 3.1 hours of homework each night.

“The findings address how current homework practices in privileged, high-performing schools sustain students’ advantage in competitive climates yet hinder learning, full engagement and well-being,” Pope wrote.

Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.

Their study found that too much homework is associated with:

* Greater stress: 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.

* Reductions in health: In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.

* Less time for friends, family and extracurricular pursuits: Both the survey data and student responses indicate that spending too much time on homework meant that students were “not meeting their developmental needs or cultivating other critical life skills,” according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.

A balancing act

The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.

Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as “pointless” or “mindless” in order to keep their grades up.

“This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points,” Pope said.

She said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.

“Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development,” wrote Pope.

High-performing paradox

In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. “Young people are spending more time alone,” they wrote, “which means less time for family and fewer opportunities to engage in their communities.”

Student perspectives

The researchers say that while their open-ended or “self-reporting” methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for “typical adolescent complaining” – it was important to learn firsthand what the students believe.

The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Media Contacts

Denise Pope, Stanford Graduate School of Education: (650) 725-7412, [email protected] Clifton B. Parker, Stanford News Service: (650) 725-0224, [email protected]

Do our kids have too much homework?

by: Marian Wilde | Updated: January 31, 2024

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Many students and their parents are frazzled by the amount of homework being piled on in the schools. Yet many researchers say that American students have just the right amount of homework.

“Kids today are overwhelmed!” a parent recently wrote in an email to GreatSchools.org “My first-grade son was required to research a significant person from history and write a paper of at least two pages about the person, with a bibliography. How can he be expected to do that by himself? He just started to learn to read and write a couple of months ago. Schools are pushing too hard and expecting too much from kids.”

Diane Garfield, a fifth grade teacher in San Francisco, concurs. “I believe that we’re stressing children out,” she says.

But hold on, it’s not just the kids who are stressed out . “Teachers nowadays assign these almost college-level projects with requirements that make my mouth fall open with disbelief,” says another frustrated parent. “It’s not just the kids who suffer!”

“How many people take home an average of two hours or more of work that must be completed for the next day?” asks Tonya Noonan Herring, a New Mexico mother of three, an attorney and a former high school English teacher. “Most of us, even attorneys, do not do this. Bottom line: students have too much homework and most of it is not productive or necessary.”

Research about homework

How do educational researchers weigh in on the issue? According to Brian Gill, a senior social scientist at the Rand Corporation, there is no evidence that kids are doing more homework than they did before.

“If you look at high school kids in the late ’90s, they’re not doing substantially more homework than kids did in the ’80s, ’70s, ’60s or the ’40s,” he says. “In fact, the trends through most of this time period are pretty flat. And most high school students in this country don’t do a lot of homework. The median appears to be about four hours a week.”

Education researchers like Gill base their conclusions, in part, on data gathered by the National Assessment of Educational Progress (NAEP) tests.

“It doesn’t suggest that most kids are doing a tremendous amount,” says Gill. “That’s not to say there aren’t any kids with too much homework. There surely are some. There’s enormous variation across communities. But it’s not a crisis in that it’s a very small proportion of kids who are spending an enormous amount of time on homework.”

Etta Kralovec, author of The End of Homework: How Homework Disrupts Families, Overburdens Children, and Limits Learning , disagrees, saying NAEP data is not a reliable source of information. “Students take the NAEP test and one of the questions they have to fill out is, ‘How much homework did you do last night’ Anybody who knows schools knows that teachers by and large do not give homework the night before a national assessment. It just doesn’t happen. Teachers are very clear with kids that they need to get a good night’s sleep and they need to eat well to prepare for a test.

“So asking a kid how much homework they did the night before a national test and claiming that that data tells us anything about the general run of the mill experience of kids and homework over the school year is, I think, really dishonest.”

Further muddying the waters is an AP/AOL poll that suggests that most Americans feel that their children are getting the right amount of homework. It found that 57% of parents felt that their child was assigned about the right amount of homework, 23% thought there was too little and 19% thought there was too much.

One indisputable fact

One homework fact that educators do agree upon is that the young child today is doing more homework than ever before.

“Parents are correct in saying that they didn’t get homework in the early grades and that their kids do,” says Harris Cooper, professor of psychology and director of the education program at Duke University.

Gill quantifies the change this way: “There has been some increase in homework for the kids in kindergarten, first grade, and second grade. But it’s been an increase from zero to 20 minutes a day. So that is something that’s fairly new in the last quarter century.”

The history of homework

In his research, Gill found that homework has always been controversial. “Around the turn of the 20th century, the Ladies’ Home Journal carried on a crusade against homework. They thought that kids were better off spending their time outside playing and looking at clouds. The most spectacular success this movement had was in the state of California, where in 1901 the legislature passed a law abolishing homework in grades K-8. That lasted about 15 years and then was quietly repealed. Then there was a lot of activism against homework again in the 1930s.”

The proponents of homework have remained consistent in their reasons for why homework is a beneficial practice, says Gill. “One, it extends the work in the classroom with additional time on task. Second, it develops habits of independent study. Third, it’s a form of communication between the school and the parents. It gives parents an idea of what their kids are doing in school.”

The anti-homework crowd has also been consistent in their reasons for wanting to abolish or reduce homework.

“The first one is children’s health,” says Gill. “A hundred years ago, you had medical doctors testifying that heavy loads of books were causing children’s spines to be bent.”

The more things change, the more they stay the same, it seems. There were also concerns about excessive amounts of stress .

“Although they didn’t use the term ‘stress,'” says Gill. “They worried about ‘nervous breakdowns.'”

“In the 1930s, there were lots of graduate students in education schools around the country who were doing experiments that claimed to show that homework had no academic value — that kids who got homework didn’t learn any more than kids who didn’t,” Gill continues. Also, a lot of the opposition to homework, in the first half of the 20th century, was motivated by a notion that it was a leftover from a 19th-century model of schooling, which was based on recitation, memorization and drill. Progressive educators were trying to replace that with something more creative, something more interesting to kids.”

The more-is-better movement

Garfield, the San Francisco fifth-grade teacher, says that when she started teaching 30 years ago, she didn’t give any homework. “Then parents started asking for it,” she says. “I got In junior high and high school there’s so much homework, they need to get prepared.” So I bought that one. I said, ‘OK, they need to be prepared.’ But they don’t need two hours.”

Cooper sees the trend toward more homework as symptomatic of high-achieving parents who want the best for their children. “Part of it, I think, is pressure from the parents with regard to their desire to have their kids be competitive for the best universities in the country. The communities in which homework is being piled on are generally affluent communities.”

The less-is-better campaign

Alfie Kohn, a widely-admired progressive writer on education and parenting, published a sharp rebuttal to the more-homework-is-better argument in his 2006 book The Homework Myth: Why Our Kids Get Too Much of a Bad Thing . Kohn criticized the pro-homework studies that Cooper referenced as “inconclusive… they only show an association, not a causal relationship” and he titled his first chapter “Missing Out on Their Childhoods.”

Vera Goodman’s 2020 book, Simply Too Much Homework: What Can We Do? , repeats Kohn’s scrutiny and urges parents to appeal to school and government leaders to revise homework policies. Goodman believes today’s homework load stresses out teachers, parents, and students, deprives children of unstructured time for play, hobbies, and individual pursuits, and inhibits the joy of learning.

Homework guidelines

What’s a parent to do, you ask? Fortunately, there are some sanity-saving homework guidelines.

Cooper points to “The 10-Minute Rule” formulated by the National PTA and the National Education Association, which suggests that kids should be doing about 10 minutes of homework per night per grade level. In other words, 10 minutes for first-graders, 20 for second-graders and so on.

Too much homework vs. the optimal amount

Cooper has found that the correlation between homework and achievement is generally supportive of these guidelines. “We found that for kids in elementary school there was hardly any relationship between how much homework young children did and how well they were doing in school, but in middle school the relationship is positive and increases until the kids were doing between an hour to two hours a night, which is right where the 10-minute rule says it’s going to be optimal.

“After that it didn’t go up anymore. Kids that reported doing more than two hours of homework a night in middle school weren’t doing any better in school than kids who were doing between an hour to two hours.”

Garfield has a very clear homework policy that she distributes to her parents at the beginning of each school year. “I give one subject a night. It’s what we were studying in class or preparation for the next day. It should be done within half an hour at most. I believe that children have many outside activities now and they also need to live fully as children. To have them work for six hours a day at school and then go home and work for hours at night does not seem right. It doesn’t allow them to have a childhood.”

International comparisons

How do American kids fare when compared to students in other countries? Professors Gerald LeTendre and David Baker of Pennsylvania State University conclude in their 2005 book, National Differences, Global Similarities: World Culture and the Future of Schooling, that American middle schoolers do more homework than their peers in Japan, Korea, or Taiwan, but less than their peers in Singapore and Hong Kong.

One of the surprising findings of their research was that more homework does not correlate with higher test scores. LeTendre notes: “That really flummoxes people because they say, ‘Doesn’t doing more homework mean getting better scores?’ The answer quite simply is no.”

Homework is a complicated thing

To be effective, homework must be used in a certain way, he says. “Let me give you an example. Most homework in the fourth grade in the U.S. is worksheets. Fill them out, turn them in, maybe the teacher will check them, maybe not. That is a very ineffective use of homework. An effective use of homework would be the teacher sitting down and thinking ‘Elizabeth has trouble with number placement, so I’m going to give her seven problems on number placement.’ Then the next day the teacher sits down with Elizabeth and she says, ‘Was this hard for you? Where did you have difficulty?’ Then she gives Elizabeth either more or less material. As you can imagine, that kind of homework rarely happens.”

Shotgun homework

“What typically happens is people give what we call ‘shotgun homework’: blanket drills, questions and problems from the book. On a national level that’s associated with less well-functioning school systems,” he says. “In a sense, you could sort of think of it as a sign of weaker teachers or less well-prepared teachers. Over time, we see that in elementary and middle schools more and more homework is being given, and that countries around the world are doing this in an attempt to increase their test scores, and that is basically a failing strategy.”

Quality not quantity?

“ The Case for (Quality) Homework: Why It Improves Learning, and How Parents Can Help ,” a 2019 paper written by Boston University psychologist Janine Bempechat, asks for homework that specifically helps children “confront ever-more-complex tasks” that enable them to gain resilience and embrace challenges.

Similar research from University of Ovideo in Spain titled “ Homework: Facts and Fiction 2021 ” says evidence shows that how homework is applied is more important than how much is required, and it asserts that a moderate amount of homework yields the most academic achievement. The most important aspect of quality homework assignment? The effort required and the emotions prompted by the task.

Robyn Jackson, author of How to Plan Rigorous Instruction and other media about rigor says the key to quality homework is not the time spent, but the rigor — or mental challenge — involved. ( Read more about how to evaluate your child’s homework for rigor here .)

Nightly reading as a homework replacement

Across the country, many elementary schools have replaced homework with a nightly reading requirement. There are many benefits to children reading every night , either out loud with a parent or independently: it increases their vocabulary, imagination, concentration, memory, empathy, academic ability, knowledge of different cultures and perspectives. Plus, it reduces stress, helps kids sleep, and bonds children to their cuddling parents or guardians. Twenty to 30 minutes of reading each day is generally recommended.

But, is this always possible, or even ideal?

No, it’s not.

Alfie Kohn criticizes this added assignment in his blog post, “ How To Create Nonreaders .” He cites an example from a parent (Julie King) who reports, “Our children are now expected to read 20 minutes a night, and record such on their homework sheet. What parents are discovering (surprise) is that those kids who used to sit down and read for pleasure — the kids who would get lost in a book and have to be told to put it down to eat/play/whatever — are now setting the timer… and stopping when the timer dings. … Reading has become a chore, like brushing your teeth.”

The take-away from Kohn? Don’t undermine reading for pleasure by turning it into another task burdening your child’s tired brain.

Additional resources

Books Simply Too Much Homework: What Can We do? by Vera Goodman, Trafford Publishing, 2020

The Case Against Homework: How Homework is Hurting Children and What Parents Can Do About It by Sara Bennett and Nancy Kalish, Crown Publishers, 2007

The Homework Myth: Why Our Kids Get Too Much of a Bad Thing by Alfie Kohn, Hatchett Books, 2006 The End of Homework: How Homework Disrupts Families, Overburdens Children, and Limits Learning by Etta Kralovec and John Buell, Beacon Press, 2001.

The Battle Over Homework: Common Ground for Administrators, Teachers, and Parents by Harris M. Cooper, Corwin Press, 2001.

Seven Steps to Homework Success: A Family Guide to Solving Common Homework Problems by Sydney Zentall and Sam Goldstein, Specialty Press, 1998.

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What’s the Right Amount of Homework?

Decades of research show that homework has some benefits, especially for students in middle and high school—but there are risks to assigning too much.

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Many teachers and parents believe that homework helps students build study skills and review concepts learned in class. Others see homework as disruptive and unnecessary, leading to burnout and turning kids off to school. Decades of research show that the issue is more nuanced and complex than most people think: Homework is beneficial, but only to a degree. Students in high school gain the most, while younger kids benefit much less.

The National PTA and the National Education Association support the “ 10-minute homework guideline ”—a nightly 10 minutes of homework per grade level. But many teachers and parents are quick to point out that what matters is the quality of the homework assigned and how well it meets students’ needs, not the amount of time spent on it.

The guideline doesn’t account for students who may need to spend more—or less—time on assignments. In class, teachers can make adjustments to support struggling students, but at home, an assignment that takes one student 30 minutes to complete may take another twice as much time—often for reasons beyond their control. And homework can widen the achievement gap, putting students from low-income households and students with learning disabilities at a disadvantage.

However, the 10-minute guideline is useful in setting a limit: When kids spend too much time on homework, there are real consequences to consider.

Small Benefits for Elementary Students

As young children begin school, the focus should be on cultivating a love of learning, and assigning too much homework can undermine that goal. And young students often don’t have the study skills to benefit fully from homework, so it may be a poor use of time (Cooper, 1989 ; Cooper et al., 2006 ; Marzano & Pickering, 2007 ). A more effective activity may be nightly reading, especially if parents are involved. The benefits of reading are clear: If students aren’t proficient readers by the end of third grade, they’re less likely to succeed academically and graduate from high school (Fiester, 2013 ).

For second-grade teacher Jacqueline Fiorentino, the minor benefits of homework did not outweigh the potential drawback of turning young children against school at an early age, so she experimented with dropping mandatory homework. “Something surprising happened: They started doing more work at home,” Fiorentino writes . “This inspiring group of 8-year-olds used their newfound free time to explore subjects and topics of interest to them.” She encouraged her students to read at home and offered optional homework to extend classroom lessons and help them review material.

Moderate Benefits for Middle School Students

As students mature and develop the study skills necessary to delve deeply into a topic—and to retain what they learn—they also benefit more from homework. Nightly assignments can help prepare them for scholarly work, and research shows that homework can have moderate benefits for middle school students (Cooper et al., 2006 ). Recent research also shows that online math homework, which can be designed to adapt to students’ levels of understanding, can significantly boost test scores (Roschelle et al., 2016 ).

There are risks to assigning too much, however: A 2015 study found that when middle school students were assigned more than 90 to 100 minutes of daily homework, their math and science test scores began to decline (Fernández-Alonso, Suárez-Álvarez, & Muñiz, 2015 ). Crossing that upper limit can drain student motivation and focus. The researchers recommend that “homework should present a certain level of challenge or difficulty, without being so challenging that it discourages effort.” Teachers should avoid low-effort, repetitive assignments, and assign homework “with the aim of instilling work habits and promoting autonomous, self-directed learning.”

In other words, it’s the quality of homework that matters, not the quantity. Brian Sztabnik, a veteran middle and high school English teacher, suggests that teachers take a step back and ask themselves these five questions :

• How long will it take to complete?
• Have all learners been considered?
• Will an assignment encourage future success?
• Will an assignment place material in a context the classroom cannot?
• Does an assignment offer support when a teacher is not there?

More Benefits for High School Students, but Risks as Well

By the time they reach high school, students should be well on their way to becoming independent learners, so homework does provide a boost to learning at this age, as long as it isn’t overwhelming (Cooper et al., 2006 ; Marzano & Pickering, 2007 ). When students spend too much time on homework—more than two hours each night—it takes up valuable time to rest and spend time with family and friends. A 2013 study found that high school students can experience serious mental and physical health problems, from higher stress levels to sleep deprivation, when assigned too much homework (Galloway, Conner, & Pope, 2013 ).

Homework in high school should always relate to the lesson and be doable without any assistance, and feedback should be clear and explicit.

Teachers should also keep in mind that not all students have equal opportunities to finish their homework at home, so incomplete homework may not be a true reflection of their learning—it may be more a result of issues they face outside of school. They may be hindered by issues such as lack of a quiet space at home, resources such as a computer or broadband connectivity, or parental support (OECD, 2014 ). In such cases, giving low homework scores may be unfair.

Since the quantities of time discussed here are totals, teachers in middle and high school should be aware of how much homework other teachers are assigning. It may seem reasonable to assign 30 minutes of daily homework, but across six subjects, that’s three hours—far above a reasonable amount even for a high school senior. Psychologist Maurice Elias sees this as a common mistake: Individual teachers create homework policies that in aggregate can overwhelm students. He suggests that teachers work together to develop a school-wide homework policy and make it a key topic of back-to-school night and the first parent-teacher conferences of the school year.

Parents Play a Key Role

Homework can be a powerful tool to help parents become more involved in their child’s learning (Walker et al., 2004 ). It can provide insights into a child’s strengths and interests, and can also encourage conversations about a child’s life at school. If a parent has positive attitudes toward homework, their children are more likely to share those same values, promoting academic success.

But it’s also possible for parents to be overbearing, putting too much emphasis on test scores or grades, which can be disruptive for children (Madjar, Shklar, & Moshe, 2015 ). Parents should avoid being overly intrusive or controlling—students report feeling less motivated to learn when they don’t have enough space and autonomy to do their homework (Orkin, May, & Wolf, 2017 ; Patall, Cooper, & Robinson, 2008 ; Silinskas & Kikas, 2017 ). So while homework can encourage parents to be more involved with their kids, it’s important to not make it a source of conflict.

Six Ways To End the Tyranny of Homework

E very evening, after a full day of classes, usually followed by a two-hour basketball practice, my son, Nathaniel, climbs the stairs to his room lugging a heavy backpack and disappears into a black hole. As a 10th-grader in an academically rigorous Los Angeles high school, this is his nightly homework routine: three to four hours of English, history, Spanish, science and math.

Besides a short break for family dinner—a nightly ritual that my husband and I insist on, lest we risk never seeing him during the week—Nathaniel pretty much keeps his head down until at least 11 pm, when he and I start to tussle over bedtime.

Given this relentless reality, it is not surprising that a recent study about homework from Stanford University caught my eye. The researchers sampled 4,317 students from 10 high performing high schools—both private and public—in upper-middle-class California communities and found that they averaged more than three hours of homework each night, just like my boy.

They also found that students with such heavy homework loads experienced high stress; health issues like stomach aches, exhaustion, headaches, weight loss, weight gain and sleep deprivation; and less time for friends, family and extracurricular activities. (Full disclosure: Nathaniel, who certainly feels the stress, attends one of the schools that participated in the study.)

Depending on his basketball schedule, Nathaniel typically leaves the house at 7:30 a.m. and gets home 10 hours later, sometime around 6 p.m. With a little downtime “to chill,” a quick shower and dinner, he often doesn’t even start his homework until 8 p.m.

“Some kids are putting in adult loads, and they’re not adults,” says Denise Pope, a senior lecturer at Stanford’s Graduate School of Education, who led the research. “It’s exhausting to be in school for eight hours—always being on, listening, being engaged and then coming home to face hours of homework.”

To be sure, not all kids struggle to keep up with this nightly crush. In fact, most don’t. A new report from the Brookings Institution points out that, overall, homework loads haven’t changed much in three decades, with the majority of high school students doing just an hour per night. Citing a 2007 MetLife survey, the Brookings scholars noted that there are more U.S. parents who think their kids have too little homework rather than too much—25% compared with 15%.

All of which got me thinking: What is that Goldilocks-like sweet spot when it comes to how much homework a kid should have? And what is homework really meant to accomplish in the first place?

For some answers, I turned to Pope, who is the co-founder of Challenge Success , a nonprofit out of Stanford that works with schools and families to create a more balanced and academically fulfilling life for kids. Here are some principles she suggests for creating an ideal homework environment:

1. Give high school students two hours of homework a night. Like most experts, Pope believes that this is just the right amount. After that, the link between homework and achievement drops, stress increases and learning declines.

2. Just because a lot of homework is assigned doesn’t necessarily mean it is intellectually demanding. “There is a lot of confusion between rigor and load on the part of teachers, administrators and parents,” Pope says.

With this in mind, she advises teachers to always ask themselves a list of questions before assigning homework: What is the purpose of the assignment? How long will it take an average student to do it? Is it clear? Is the homework valuable and meaningful to students? What is the quality of the homework being assigned? In other words, does it serve to engage students more deeply with the material—or is it just busy work?

3. Homework should be tailored to each individual’s needs, whenever possible. Although this can be challenging, especially for public school teachers with large classes, Pope says customization is essential for maximizing learning. For example, rather than give an entire class 25 math problems to complete, students with a good grasp of the concepts might get fewer but more challenging problems; kids who are struggling could be assigned problems specifically designed to help them master the basics.

4. In preparing kids for what will happen in class, homework should concentrate on tasks that can’t be done effectively during the school day. This includes things like reading chapters from a book, collecting specimens in the backyard for a science experiment or interviewing someone from the community for an oral history project.

5. Rethink giving points for homework . Assigning points for completed homework may give kids a chance to improve their overall grade in a particular class—showing their organizational skills, ability to follow directions and work ethic—but Pope says it does little to demonstrate their actual command of a subject.

6. Parents shouldn’t help with homework or be the homework police. They can advocate for smart homework policies at their children’s school. But “let teachers intervene if the student isn’t doing homework correctly or regularly,” Pope says.

Parents can help, she adds, by respecting their children’s working style—some need a quiet space, others like to listen to music while doing calculus. They can also make sure their kids aren’t overscheduled and that they get enough sleep; research indicates that teenagers need more than nine hours of sleep each night, but that most get about seven.

Hmm. It looks like Nathaniel’s light is still on as I type this. Time for him to trade the books for bed.

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Psychopharmacology

5 common medications that can kill people, five dangerous common drugs and what to watch out for..

Posted August 16, 2019 | Reviewed by Jessica Schrader

• What Is Psychopharmacology?
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Medications are prescribed to save lives, yet medications can be extremely dangerous and bring people to the emergency room with life-threatening problems. The same medications that can save our lives could take our lives when we least expect it.

Here are the five most dangerous medications. Let’s see if you can guess what went wrong in the case studies below.

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) including Ibuprofen, Naproxen (Aleve) or Ketorolac (Toradol), among others.

People tend not to worry about taking over-the-counter medications like Ibuprofen or Naproxen, yet problems frequently happen.

Alice had right knee pain and took over-the-counter Naproxen (Aleve)—two tablets, twice a day for two months. At the end of the second month, she noticed a little bit of blood in her stools, which didn’t really worry her. A few days later, the little bit of blood became a lot of blood, which accompanied each bowel movement. Completely panicked, she went to the ER.

Can you guess what her problem was? What did she do wrong? What should she have done differently?

The high dose and prolonged use of Naproxen gave her stomach ulcers and made her stomach bleed. She could have bled to death.

What should Alice have done?

She should have taken the anti-inflammatory drug for only a short time (one week). She should have taken it on a full stomach with additional anti-ulcer medication to prevent stomach ulcers, especially if she had needed an extra week of treatment.

2. Warfarin (Blood thinner also called Coumadin).

It was the 41st most prescribed medication in 2016 in the USA with over 18 million prescriptions.

Tom had been taking the blood thinner Warfarin (Coumadin) for several years without any problem. One night, after eating a questionable food item, he had headaches, vomiting and diarrhea. For the two following days, he was unable to eat solid food, but he drank a lot of fluids and continued taking his Warfarin. He took Aspirin for his headache and Pepto Bismol for his diarrhea. One day later, when he woke up, he had a lot of blood in his urine and his stools were bright red. Panicked, he went to the ER. He could have bled to death.

Can you guess what his problem was? What did he do wrong? What should he have done differently?

The other name for Pepto Bismol is Bismuth subsalicylate, which means it contains a Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) of the same family as Aspirin, which increases bleeding. In addition, Tom took Aspirin (which is also a blood thinner) for his headaches, which increased the risk of bleeding even more. The third thing that happened is that Tom, when he was eating normally, was eating green leafy vegetables like broccoli every day, which made the Warfarin less active.

When Tom stopped eating green leafy vegetables every day (because of his upset stomach), the Warfarin became even more active.

When Tom took over-the-counter Aspirin and Bismuth subsalicylate for two days, his Warfarin became a super-potent deadly blood thinner, a real rat poison, which is what it was originally created for: to kill.

What should Tom have done?

Instead of Aspirin, Tom should have taken Tylenol for his headache and instead of Pepto Bismol, he should have simply drank a lot of fluids the first day, then, the second day, he could have added some over-the-counter Imodium. He should have called his doctor to help him decrease his Warfarin dose until he was able to go back to his normal green leafy vegetables every day.

3. Antibiotics.

Shehab and colleagues ( JAMA Nov. 2016) say that the most frequent antibiotics leading to an ER visit in 2013 and 2014 were Amoxicillin, Sulfamethoxazole-Trimethoprim and Cephalexin, which gave moderate to severe allergic reactions. People also need to be aware that those antibiotics make the above Warfarin anticoagulant more potent. Watch out for drug interactions.

4. Insulin (anti-diabetic agent).

Insulin was the 22nd most prescribed medication in 2016 with over 26 million prescriptions in the USA, an increase of 14% over the previous year.

Emily was used to taking Insulin and Metformin every day for her diabetes. While on vacation in Mexico, she had an upset stomach and couldn’t eat very much for three days. Yet, she continued taking her usual medications. On the third day, she felt dizzy then lost consciousness, fell and hit her head on a table next to her. She could have died. She was transported to the ER.

Can you guess what her problem was? What did she do wrong?

Emily continued taking Insulin and Metformin (anti-diabetic drugs) at their usual dose even though she wasn’t able to eat very much for three days. As a consequence, the Insulin she took made her blood sugar drop into dangerously low levels. She became hypoglycemic, which caused her dizziness then her loss of consciousness and her fall. Hypoglycemia can be deadly because our human cells rely on sugar to live.

What should have Emily done differently?

Emily should have brought her glucometer, checked her blood sugar on a regular basis especially when she ate less, and she should have decreased the amount of Insulin she was taking.

For diabetic people, especially as they get older, it is safer to err on the side of a little too high blood sugar rather than too low.

5. Opioid analgesics.

Acetaminophen-hydrocodone and Acetaminophen-oxycodone are frequently the cause of ER visits with complaints of severe constipation, nausea, dizziness, somnolence and breathing problems that could lead to death. They are addictive and, as a general rule, they should not be taken for periods longer than a few days (unless the diagnosis is untreatable cancer).

What is the take-home message?

Medications, even if they are over-the-counter, lifesavers and approved by the FDA, are dangerous. So, let’s keep informed of their side effects and drug interactions and let’s remain vigilant for ourselves and our loved ones.

For toxicity in children 2 years old or younger, read " 10 surprising substances that can kill a toddler. "

https://www.ncbi.nlm.nih.gov/pubmed/27893129

https://clincalc.com/DrugStats/Top300Drugs.aspx

https://www.sciencedirect.com/science/article/pii/S1542356514016206

https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_0…

Chris Gilbert, M.D., Ph.D. , is a physician and writer specializing in holistic, integrative, and mind-body medicine and the author of “The Listening Cure,” 2017 (SelectBooks).

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