village-of-the-damned

The introduction to Esquire’s new article “The Drugging of the American Boy” sounds like the blurb on the back of a dystopian young adult novel: By the time they reach high school, nearly 20 percent of all American boys will be diagnosed with ADHD. Millions of those boys will be prescribed a powerful stimulant to “normalize” them . . . The shocking truth is that . . . most of those boys are being drugged for no good reason—simply for being boys. Ostensibly, Ryan D’Agostino’s article is a call to action, urging us to embrace our rambunctious boys and not immediately slap an ADHD diagnosis on them.

Instead, what emerges is a vast conspiracy against anyone younger than 20 with a penis. Lazy parents, bad teachers, greedy drug companies and feminists are destroying manhood as we know it. One gets the impression that in 50 years, America will be the inverse of China, with parents bemoaning the birth of a boy when they could have had a nice, obedient girl. Boys, in the inflammatory words of Esquire editor David Granger, are “under attack.” And ADHD is the opposing side’s weapon of choice.

I am writing to you from the war zone. My six-year-old son has ADHD, and I fight battles for him every day. But the enemy is not the diagnosis. It’s people who refuse to accept that childhood isn’t the same as it was a generation ago. And just because we don’t know why, doesn’t mean it’s not true.

The ten-year increase in ADHD diagnoses is, to put it mildly, alarming. The author and I can agree on that. But that factor does not exist in isolation. Autism diagnoses have also increased, from 1 in every 150 children to 1 in every 68 over the course of ten years. Overall, according to the CDC, developmental disabilities now affect every 1 in 6 kids.

A normal human reaction to these statistics is to wonder if they’re even true. There’s a great deal of controversy and speculation in the medical community as to why the numbers have leapfrogged. If there’s a general consensus, it’s that part of that statistic reflects increased awareness and better diagnostic materials. The other part of it is, most likely, that more kids have these disorders than did in the past.

Most schools don’t want to slap an ADHD label onto all boys. Frequently, the opposite is true.

Just ask a teacher. In the Esquire piece, as in many similar articles, schools are largely responsible for demonizing boyhood behavior. One of D’Agostino’s experts points to the “girlification” of the classroom, a misnomer that blames the women’s movement for increased emphasis on testing and early achievement (a result of No Child Left Behind), as well as schools’ intolerance for horseplay (true, but that has more to do with an overblown fear of litigation than contempt for manliness). Another subject of the Esquire article was upset at receiving a snap ADHD diagnosis from a school psychologist.

Inept school psychologists notwithstanding, most schools don’t want to slap an ADHD label onto all boys. Frequently, the opposite is true. Teachers from multiple schools have told me that they’re forbidden to use the term “ADHD” unless parents bring it up themselves. Cash-strapped public schools often can’t accommodate too many children with special needs, and if a child is clinically proven to require extra help, the schools are legally obligated to provide it. Parents of ADHD and autistic children frequently find themselves fighting the schools to get basic accommodations, like individualized education plans (which could amount to something as simple as a few extra minutes to take tests). Schools are not eager to hand out diagnoses that will ultimately cost them more money.

But that’s an issue of bureaucracy—not one of individual teachers, who, by and large, are interested in helping their students any way they can. And talking to career teachers is enlightening. Nearly every one I’ve spoken with has reported a dramatic, sudden increase of children with learning problems. Not children who come into the classroom with diagnoses, per se, but children whose issues are immediately apparent to someone who’s been teaching for thirty years. Teachers know normal and abnormal behavior. One teacher at my son’s school confided that she has half a dozen children with severe issues in her current classroom; in her earlier years of teaching, it was rare that she saw more than one or two.

All of which is to say: ADHD is real. And yes, D’Agostino does acknowledge this in his article, offering a litany of testimonies from parents and doctors whose “defensiveness is understandable.” Yet he goes on to enumerate the deleterious effects of medication, implying that parents who think their children are benefitting from ADHD meds are actually deluding themselves. Your son “might not be the same seven-year-old boy once he starts (meds), and he may never be the same boy again,” he ominously warns parents. D’Agostino’s medical consultant of choice, a family therapist named Howard Glasser, gushes about how ADHD children are “very interesting human beings” when they’re not taking their medication.

For Esquire to conclude that parents just need to be nicer instead of pursuing medical treatment for their children is breathtakingly irresponsible.

And this, ultimately, is my big issue with the Esquire piece. D’Agostino pins his hopes for the future of boyhood on Glasser, a man whose qualifications for helping ADHD children include a master’s degree, a motivational speaking career and a really crappy childhood. He’s not a doctor — he’s not in Big Pharma’s pocket, no sir! — but he stays “awake at night sometimes,” worrying about boys growing up like he did, thinking they’re “no good.” His solution is something called The Nurtured Heart Approach, which amounts to showering overenergetic children with positive feedback when they’re being well behaved. If the kids feel loved and supportive, he says, they’ll have an incentive to do better.

D’Agostino writes that watching Glasser at work is “a marvel.” I have another name for it: “extremely basic therapy.” When my son first started exhibiting problems at preschool—pushing other children for no reason, refusing to follow directions, running around at nap time—we took him to the local nonprofit clinic (one of the few covered by our insurance) to find out what was going on. The young, well-meaning therapists didn’t want to rush into a diagnosis, instead offering pointers for helping him to be still and encouraging better behavior. One kept reinforcing an idea called “labeled praise,” which is exactly the same as Esquire’s description of The Nurtured Heart Approach. As the months went by and the behaviors worsened, she clung to that idea like a life raft: “Are you doing the labeled praise? Are you doing it enough?”

Two years later, I continue to give my son lots of labeled praise from my nurturing heart or whatever, in hope that it counters all the negativity and self-doubt that accompanies his ADHD. But for the Esquire article to conclude that this is all it takes—that parents just need to be nicer instead of pursuing medical treatment for their children—is breathtakingly irresponsible. It’s reminiscent of the mid-century “refrigerator mother” theory of autism, which blamed autistic behaviors on parents who didn’t show their children enough love. When in doubt, blame the parents.

We as a society need to stop hiding behind this idea that ADHD is a conspiracy against boyhood. It is the new reality of boyhood.

And that is what I see happening, over and over, in articles like this. Judging from mainstream media coverage of ADHD, you’d think that parents immediately hear those four letters, dumbly nod, fill a prescription from the Ritalin vending machine at CVS, and never give it another thought. In my experience, it’s the parents who do not seek treatment—who refuse to acknowledge that anything could possibly be wrong with their child—who are refusing to think things through. The parents who medicate tend to agonize over it; not only are the potential side effects frightening, but the judgment against them is harsh. (“Do not put him on medication,” is an unsolicited response I hear often, particularly from people over 40, when I mention my son’s condition.) Furthermore, parents know that medication is not an easy cure-all. ADHD is different for every child, and it frequently manifests in combination with conditions like autism spectrum disorder, sensory-integration disorder and bipolar disorder. Medication often eases some symptoms and exacerbates others. Some meds work for a while, then stop being effective, or start causing strange side effects. There’s no such thing as putting an ADHD child on a pill and then forgetting about it. It’s a constant, exhausting, high-stakes game of trial and error.

So what can we do to protect boyhood from extinction? It would be helpful for the Department of Education to acknowledge that ADHD and autism are at epidemic levels, and recommend curriculum changes that would benefit all the kids falling through the cracks—not just the ones who’ve been diagnosed. Medical research is imperative. Teachers and parents should be encouraged to show compassion for children who behave differently, rather than thinking in terms of fixing them.

Mostly, we as a society need to stop hiding behind this idea that ADHD is a conspiracy against boyhood. It is the new reality of boyhood, and having ADHD (or autism, or any other condition that disproportionately affects boys) doesn’t make our kids deficient. We need to fight for their needs to be acknowledged, rather than getting entangled in a web of fear and blame.

Looking the truth in the face is hard. Blaming parents, or drug companies, or teachers is easy. To do so is strangely comforting, a false reassurance that we understand the problem and know how to fix it.

It’s almost like a drug.