This is the best paragraph that I’ve read all day:
Today many sociologists and neuroscientists believe that regardless of A.D.H.D.’s biological basis, the explosion in rates of diagnosis is caused by sociological factors — especially ones related to education and the changing expectations we have for kids. During the same 30 years when A.D.H.D. diagnoses increased, American childhood drastically changed. Even at the grade-school level, kids now have more homework, less recess and a lot less unstructured free time to relax and play. It’s easy to look at that situation and speculate how “A.D.H.D.” might have become a convenient societal catchall for what happens when kids are expected to be miniature adults. High-stakes standardized testing, increased competition for slots in top colleges, a less-and-less accommodating economy for those who don’t get into colleges but can no longer depend on the existence of blue-collar jobs — all of these are expressed through policy changes and cultural expectations, but they may also manifest themselves in more troubling ways — in the rising number of kids whose behavior has become pathologized.
Apt. 11d 
Laura, have you read Quiet? It’s a book about introverts, especially in light of the modern world’s strong preference to extroverts.
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I have always believed this, and I would add that upper middle class life in particular has become more stressful. Fifty or a hundred years ago, my daughter would have been described as “smart enough, but not very bookish,” and would have done non-bookish things with her life. Her Upper East Side private school would have suited her fine. But that school is much more demanding now, the girls all want to go to high-powered colleges (not dumb rich girl colleges), and she won’t get a decent job without decent academic credentials. So instead of a description, she has a diagnosis of ADHD, and took adderall just to stay in school.
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We recently sold our house and are now renting in one of the wealthiest areas of our city. It’s my son’s first year of K-12 schooling and it has been a bit of shock just how academically focused upper middle class families (and above) have become. If my son started school when I did he would be considered totally typical and maybe a little advanced: he knows all of his letters, most letter sounds, many sight words and is just starting to put sounds together to read words. In my middle-class, suburban early 80’s K class, very few kids started school with that knowledge and only a couple were reading by the end of the year. In my son’s class, he is probably on the lowest end of development of his academic knowledge.
Even though I know that he is developmentally totally typical I have to constantly remind myself that it is ok that he is relatively behind this particular set of classmates. Most of them had a professional parent who has been fully devoted to their development and so while they are ahead at this point it is really not an indication that they are advanced or that my son has any learning problems. But I can very easily see how the pressure of keeping up with classmates had lead to totally typical kids taking medication for fear of falling further behind.
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I have a child who is a late bloomer. She has finally gotten serious about her academics — in her junior year! Whoo hoo! We knew that eventually things would click with her, but it has been a very long and frustrating wait until this point. She will tell you herself that she just wasn’t serious until this year. She also understands that she will be unable to compete with kids who got serious in eighth grade.
We were encouraged to begin medicating her in high school but decided not to give her the ADD drugs because she has a heart condition that would have made it very dangerous — but it was hard not to stand up to the pressure. It’s my theory that what we call ADD now would previously have been called immaturity.
Strangely enough, as we begin to navigate the college admissions circus, we’re having this interesting experience where often it appears that Admissions counselors don’t know what to do with my nonconformist kids who have refused to jump through all the right hoops on schedule (and their parents, who feel the same way). My son recently had an interview at a well-regarded liberal arts college where he sat in an office and told the admissions counselor that he plays the violin five hours a day and that explains the D in math AND the lessons at Juilliard. My sense is that admissions people are often open to quirky, weird kids who don’t play by the rules.
(For what it’s worth, I sent my youngest to school at age five — She had been reading for two years, but had decided that her name was Kojo Nambe, who is one of the announcers on NPR — and refused to answer to anything else. Her sister wore a Cinderella halloween costume every day for well over a year. I have no idea how other people get their kids to conform, behave in a developmentally appropriate way, or do things on schedule. I think the world is a better place when they don’t have to.)
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“Her Upper East Side private school would have suited her fine. But that school is much more demanding now, the girls all want to go to high-powered colleges (not dumb rich girl colleges),”
I went to a school like this one, and yes, when I went there we were on the threshold of this change — it would start within 3 years and is in full force now. The kid contained a range of “smart enough” rich kids (a few, but only a few of whom were barely smart enough), smart rich kids (a few of whom were really smart), really smart poor (and middle class) kids. The really smart kids filled out the top ranks of the academic classes, which in turn were limited to those kids (the classes were by invitation only). The smart enough kids didn’t particularly want to be in those classes (why burn your brains out spending 4 hours on calculus HW if it wasn’t your thing?).
Within 3 years, everyone had to look “really smart” on paper, which meant everyone had to take calculus, even the kids who struggled. That in turn meant the school had to figure out a way to offer calculus to everyone (no longer “invitation only”). My sister was in the class 3 years younger and there were still a few who bucked the trend then (the kids who didn’t want to take Calculus didn’t). But, now, my HS is a high pressure college prep academy for everyone who goes there.
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PS: And, yes, ADHD drugs have similar effects on everybody. They are like caffeine: they might not affect everyone in the same way, but it’s not the case that there’s one class of people (people with DSM ADHD) form whom they “fix” a deficiency.
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And, like with coffee, I don’t have an issue with people making the decision in conjunction with their doctor that the benefits of adderall outweigh the risks for whatever life they wish to live. But, I guess I don’t know who gets to make the decision that the benefits outweigh the risks when the benefits are keeping up in Calculus in 12th grade v keeping up in 10th grade.
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I was supposed to ask my doctor if I can drink coffee?
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Not that I’m going to ask. I already figured out that drink with the drinking. Never have more than ten drinks a week that you tell your doctor about.
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I notice that my elderly relatives who drink coffee like fiends seem to be very long-lived.
I suspect that coffee has a lot of health benefits, although it may be that the sort of person who drinks more coffee in order to get more done is also the sort of person who is going to live a long, productive life, coffee or no coffee.
“Newer studies have also shown that coffee may have benefits, such as protecting against Parkinson’s disease, type 2 diabetes and liver cancer. And it has a high content of antioxidants.”
http://www.mayoclinic.com/health/coffee-and-health/AN01354
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The thing that struck me when I read this article was that the author was diagnosed with ADHD in adulthood. What does it mean to have ADHD and be a college-educated, successful author and journalist at a young age? She doesn’t mention the specifics of her diagnoses so it is impossible to know how her ADHD negatively affected her in her childhood and young adult years but it sort of points to the grey area that ADHD falls into that makes it a different kind of diagnoses from other mental or emotional health problems. You can have ADHD, go unmedicated, and live a fully functional and thriving life so where is the tipping point on the decision to medicate or not medicate?
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For my daughter, the decision was easy, since it meant staying in school with her friends and doing better.
For the parents, one of whom developed an unhealthy methamphetamine dependency in law school, the decision was difficult.
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From the article: “According to … professor of … this is part of a broader trend in America: the medicalization of traits that previous generations might have dealt with in other ways. Schools used to punish kids who wouldn’t sit still. Today we tend to see those kids as needing therapy and medicine.”
Wait, “therapy and medicine” are suddenly constructed as … bad? Tom Cruise could’ve written that.
Can’t this “broader trend” also be seen as something of a net positive change in our society? Bear with me here: I’d rather be asked to take a pill or to find a new school than to go back to the regime where I’d have no choice but to allow a teacher hit and degrade me as a child (hello, lifetime scars for The Greatest Generation and Boomers).
I’ll take the imperfect ways our current generation deals with it, thank you very much. The choice we have now to take medicine and or to seek therapy for what ails us = good. The choice to decide that whatever irks a particular educator is not what really and truly ails a student = awesome. The spaces on the internets that will help us find a way to do whatever we want to do = amazing. Do we have ample room to improve? Absolutely. But can we honestly say that the concerns about overmedicating kids rise to the level of a real and true “crisis” where the readership of the NYT have such an increasing array of choices these days? Buy in or get out – hurtful to hear that, yes, but since when is that stance so wrong, especially where there is far more demand for seats at a particular school than there is supply?
Remember, most schools in this country are actually not elite East Coast prep schools armed with thoughtful counselors and useful data points on their students. Too many schools are actually not terribly invested in student achievement – they honestly could use a dash of what the kids at the proverbial pressure cooker schools are having.
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Tom Cruise could’ve written that.
Not without help, he couldn’t have.
Also. there’s a great deal of difference between opposed to giving medication to an adult with schizophrenia than a child with some difficulty paying attention.
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Folks should be told “there are meds for this” more often. Up to them to make the choice. They get to do their own cost/benefit analysis.
Another problem with too many articles like this is that while raising awareness of choices (good), they risk silencing the professionals who could offer real help in some situations – and they perpetuate the taboo against taking medications for mental health issues generally.
I can just hear the parents now – “You’re not trying to offer DRUGS to my child with some difficulty paying attention, are you, Doctor! I mean it’s not like she’s an adult with schizophrenia.”
So no, I don’t think it’s generally helpful to hide the existence of medication from families. It’s not helpful for the adults and the professionals in the room to remain silent where there is a valid health concern. To fail to mention to a parent that there’s something perfectly legal that might help their child feels very wrong. To not mention the existence of meds is really about making the choice for them.
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You shifted from “school” to “doctor”.
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“But, I guess I don’t know who gets to make the decision that the benefits outweigh the risks when the benefits are keeping up in Calculus in 12th grade v keeping up in 10th grade.”
I say, it’s the parents. Thus, I tend to agree with hush’s observation that they should be told what their options are, even if I’d be real reluctant to medicate my children if faced with most of the scenarios described here.
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Parent preferences should weigh heavily in determining whether to medicate or not to medicate but parents shouldn’t be expected to do a cost benefit analysis involving complex subjects in which they have no expertise every time they need to make a decision about their children’s medical care. They should be able to trust that a doctor will give them sound medical advice that is in the best interest of their specific child even if that isn’t a quick fix.
Children from low-income or otherwise at-risk families are prescribed ADHD drugs at a much higher rate than middle-class children so either they have genetic predisposition to attention problems (unlikely) or there is something else going on that their behaviors are more likely to be labeled a problem. Drugs can work well for some children but if they are being used as a blunt instrument in lieu of a more robust treatment plan involving behavioral therapy (in combination with a societal campaign to check our expectations of what is typical behavior for children) then the overuse of them is indeed an issue.
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“Children from low-income or otherwise at-risk families are prescribed ADHD drugs at a much higher rate than middle-class children so either they have genetic predisposition to attention problems (unlikely) or there is something else going on that their behaviors are more likely to be labeled a problem.”
Drugs shouldn’t be the entire intervention plan for children with attention issues. However, why is it so hard to believe that poor children might be genetically more predisposed to attention problems? Out in real life, for a person of average intelligence, having no attention span and being unable to stick to anything for long is one of the express routes to poverty.
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” . . . . it sort of points to the grey area that ADHD falls into that makes it a different kind of diagnoses from other mental or emotional health problems.’
It’s not, really, there are a number of “mental/emotional health problems” where the decision to medicate is a continuum. Depression, anxiety, OCD, etc. are all examples. I know I’ve mentioned the conversation I had with a well known ADD researcher who told us in all sincerity that maybe everyone would be better off if they took ritalin & prozac.
I also think people should be offered the opportunity to medicate, and allowed to make their own choice (with the aid of doctors, who do need to warn them of all the risks, including the potential that there might be unknown risks).
I don’t really understand how the interaction with the school works — I know a teacher might suggest ADD medication as a way for the child to fit into the classroom. But they can’t prescribe it or make the kid take it and kids still have to be taught even if they don’t medicate, right? Are there circumstances where a school can insist that medication be a part of an IEP, against the wishes of the parent? Does a school get to set parent behavior? Like, say, requiring that a child be wearing a brace, or that they be fed a snack before coming to school in an IEP?
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maybe everyone would be better off if they took ritalin & prozac.
I would argue that Prozac is in a different class than Ritalin. As you say, Ritalin will have an effect on everyone whether or not they have attention problems, Prozac will not. Prozac doesn’t even work on a lot of people with diagnosed depression. If your statement was limited to “maybe everyone would be better off if they took Ritalin” then I think you’re getting at the crux of what is uniquely challenging about ADHD, that most people would see some benefit from taking medication and so it’s more challenging than other psychiatric disorders to decide when to not medicate.
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I think there’s a slightly different question when people are being asked to medicate to exceed rather than meet standards (and by standards, I mean, an unmedicated mean of a typical population). That’s part of the argument here, that the standards in the 1st grade classroom are being ratcheted up to the expectations of the top 20% (or where you put the cutoff) and in whatever achievement you set (from reading to math to sitting still). ay if you end up designing a classroom where everyone might end up medicated. And then, kids are being asked to medicate so they can meet the standards of that 20%: The result: Kindergarten classroom as professional cycling, where doping is required to compete.
There’s also a perception that there might be some high pressure environments where nearly everyone needs to medicate themselves to meet the expected standards (which are apparently atypical for an average child). Then there’s almost a requirement to medicate which is a problem, too.
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Oh everyone isn’t really better off if they take ritalin, just like some people are jittery and uncomfortable with caffeine, some people don’t benefit from ritalin. Ritalin doesn’t help everyone who has trouble focusing, either, just like prozac doens’t help everyone with depression. The similarity between drugs to treat depression and add is that they sometimes help some people feel more focused or less depressed, and mostly, you decide whether the person has add or depression when the drug helps them.
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Yea. Stimulants really don’t play well with some people.
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Ian is on meds. It gives him enough of a boost to push him over the special ed line into the mainstream world. That’s a fairly huge difference in his world. That’s the ONLY reason that we give them to him. He’s been on them for 3 or 4 years and we’ve seen some rather horrible side effects. Last spring, the stuff he was on gave him huge purple spots on this face and the doctor was worried that he had hemophilia. He went cold turkey for four months and then we started new stuff this September. So far, so good.
Up until recently, Jonah was a certain type of boy — slightly immature, active, forgetful, smart, completely uninterested in competition and grades. He doesn’t have ADHD, but I could have TOTALLY gotten him meds. Totally. I decided that he was fine if he got B+’s and we would just wait for him to grow up and remember to hand in his math homework. The difference between B+’s and A’s wasn’t huge enough to medicate him. He didn’t miss out on any opportunities by getting B+’s. And he learns more at home than from school anyway.
It’s just amazing how much a kid can grow up in six months. Not just in height. I’m so, so, so proud.
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Not to beat a dead horse, but there’s also that whole problem of kindergarten redshirting. Our kids started out in an ultracompetitive school district where there were seven year olds in kindergarten. These guys had already had three years of pre-K, one of “junior kindergarten,” and had lost all their baby teeth.
If you get enough of this in a classroom, all of a sudden your typical 5 year old is the problem — because he can’t sit still like a 7 year old, has a bunch of weird five year old sensory issues, hasn’t yet learned how to use his inside voice, has trouble with holding a pencil and coloring inside the lines, etc.
I was really uncomfortable with a system that was ok with 7 year olds in kindergarten, but they had a problem with 5 year olds acting like 5 year olds. They ended up encouraging parents to medicate the 5 year olds and send them to OT. It would have been cheaper and easier to put the 7 year olds in the correct grade, which was second grade.
Currently, both of my sisters-in-law have held their kids back TWO years. It’s kind of weird because my daughter is 14 and a freshman in high school, and she has a cousin who is 12 and in fifth grade. My daughter thinks it’s kind of creepy when her aunt posts pictures of him dressed up like the Cat in the Hat for book reading day when she just took the PSAT. But it goes to show how far apart the standard can be for kids of similar ages these days — in my opinion, someone is helping to warp that standard, but I’m going to go with my ultracompetitive sisters in law.
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Agreed. Most kids (barring severe learning challenges) will be reading fluently by 8 years of age. Some will be developmentally ready to read by 5. An outlier or two by 4. Expecting them ALL to be reading fluently in grade 1 isn’t realistic. Too much stress on the kids and the parents.
I’m a HUGE literacy hound so am definitely in support of all sorts of activities that encourage reading readiness. But to expect more than what a particular child is developmentally ready to handle? A great way to turn them off reading.
An analogy is walking – some walk at 9 months and some don’t walk til 16 months. All within the normal range. But if the expectation is walking at 12 months, then suddenly the late walkers look like they have a problem that needs to be solved. And the 9 month walkers look like super stars.
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I think the focus on the last 30 years might be misplaced. Recently I was reading one of those “Americans were much better educated 50 years ago” stories – I don’t remember the stats, but clearly our collective level of knowledge of history, math, etc. has gone down. Maybe the 1980s was when we bottomed out, and we’re just getting back to a higher level. Though I totally agree that standardized testing is way overemphasized, I wonder if there was really less pressure to conform and do well in school100 years ago, or 50 years ago. It’s true that blue-collar jobs were available to those who didn’t do as well in school, but if the problem is that “kids are expected to be miniature adults,” this was probably much more the case for farm kids, kids who started working in factories at 16, etc. Maybe they had more unstructured time, though.
Anyway, it’s an interesting discussion about the last 30 years, but I think more of a historical perspective would be helpful.
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Last week, I got a tour of an elementary school in our highly competitive town/school district. It was very, very different from the other elementary schools that my kids attended in working-class, less competitive towns. This school is unstructured, has no grades/tests/quizzes, focuses on large, year-long projects. There is no instruction on grammar rules and spelling. The other elementary schools did a lot of worksheets and workbooks. The projects in this new school are very creative, multiple disciplinary, and impossible to evaluate. Kids learn how to write exciting introductions to essays, instead of memorizing rules for formulaic essays.
Standardized tests in this town drop in 6th grade and then pop up in 7th grade. Why? Because the kids are unprepared for the more structured middle school. An army of educated SAHMs and tutors step in and bring the kids up to speed.
I don’t necessarily think that this new creative, unstructured school is bad. Ian has made a lot of progress in certain areas. All those worksheets that my kids did in their previous schools were kind of stupid. I just thought it was interesting how parents and their paychecks help ease kids into a different academic environment.
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That’s our school — well not literally–and yes, they do have to address the testing issue, at the 6-7 level. Some kids leave after 5th for this reason — needing more tests and evaluations. Some kids really do thrive with more testing and competition — I know two who learn more and are happier with more testing and feedback and don’t like impossible to evaluate projects. I think they will be doctors when they grow up.
We are now seeing a ramping up of the competitiveness, because performance and evaluation now matters as the kids leave the k-8.
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Our youngest was recently diagnosed with inattentive ADD. The diagnosis makes perfect sense to us, as it explains some really weird stuff he did. No one would have picked him out as ADD at first, because his really high verbal intelligence masked a lot. I’m now sure he bluffed his way through elementary school, and the effort of hiding his challenges came across as a kid who was lazy and a chatterbox.
In hindsight, it does hurt that we were criticizing him for character flaws which were symptoms that he was trying to hide weaknesses he was very worried about. I wish I could go back in time to tell his kindergarten teacher he wasn’t lazy–he was frightened.
We can’t medicate; he has other issues. At any rate, we are finding success for him with other therapies, such as simplifying his school supplies, cutting back on his extracurricular schedule, and doing neurofeedback. He is happier and more successful now.
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“I’m now sure he bluffed his way through elementary school, and the effort of hiding his challenges came across as a kid who was lazy and a chatterbox.”
I know a young woman who when she was in junior high or high school managed to bluff her way through science by submitting little science-themed poems to her teacher in lieu of the expected assignment. They ate up all that creativity with a spoon, not realizing that she was shirking. Years later, in college, she was finally diagnosed with ADHD and started medication. (She got addicted to it, but that’s a different story.)
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