- The Washington Times - Sunday, September 6, 2009

Boys are up to three times more likely to be treated for attention deficit hyperactivity disorder as girls; and the prescription of antipsychotic drugs to children — mostly boys — has gone up by 600 percent in the last few years, says psychologist Anthony Rao.

Has boyhood become an illness?

Mr. Rao, author of “The Way of Boys: Raising Healthy Boys in a Challenging and Complex World,” thinks we’re treating it as such.

“The problem really isn’t the boys,” Mr. Rao says. “It’s our expectations of them.”

Young boys need frequent breaks for physical play and release; they often read and write better standing up than sitting down; many find eye contact threatening; and they naturally prefer “doing” and “seeing” over “listening” and “talking,” he says.

But little of what they crave in terms of learning styles and physical needs fits into the traditional preschool or school day, where physical education and active recess time are at an all-time low.

This dichotomy leads many boys to fidget, bounce, act out and be labeled with ADHD, Mr. Rao says.

“A common response is to rush a diagnosis and start medicating immediately,” he says. “But a pill doesn’t teach anything.”

In other words, the impulse control and other self-management techniques these kids so desperately need to develop don’t come in the form of a pill. And yet medication — amphetamine, commonly sold in the form of Aderall, to be precise — is prescribed and FDA-approved for use in children as young as 3.

“Ours has become a culture where we medicate a range of behaviors even in kids as young as 2 and 3 years old,” says Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and a staff writer for the New Yorker.

Dr. Groopman blames both the money-hungry pharmaceutical industry and high-anxiety parents who think that more — as in early intervention — is always better.

He can relate. Because, he says, when he was in elementary school in the late 1950s, he was one of those fidgety, bouncing-off-the-wall kids his fifth-grade teacher in Queens, N.Y., couldn’t stand.

“I’m sure I would have been diagnosed with ADHD. But instead of medicating me, my parents sent me to metal shop,” Dr. Groopman says.

This was only after the teacher had called his parents in to tell them their troublemaker with “schpilkes” — Yiddish for “ants in the pants” — would never be an academic success.

“She told them I was not college material,” Dr. Groopman says.

A few decades later, he is the author of several best-selling books and a Harvard professor.

All this to illustrate that ADHD — which is not a brain disorder, but rather a collection of certain behaviors — doesn’t have to be crippling unless we as a society treat it as such, he says.

Mr. Rao agrees and says parents are well-intentioned, but often anxiously impatient, as they rush to have their seemingly inattentive sons diagnosed and medically treated.

“Parents micromanage in hopes of helping, but their unintended message to their sons is that they are odd, weak or even damaged,” Mr. Rao says.

Mr. Rao is not against medicating, but says parents should hold off until kids are 9 or 10 years old, and even then always pair medication with behavioral intervention and a huge dose of patience. (Research is limited on the long-term effects of the medications on children — although there is some evidence that kids and teens who have used these stimulants are more likely to abuse them in the future.)

Adds Dr. Groopman: “The process a kid goes through to gain impulse control takes a long time. But in the end, that process will help them solve future problems,” he says. “If you smooth things over with a pill, you may never gain the tools you need.”

Aside from patience, Mr. Rao says parents should provide for big doses of outdoor time with free play that can help get rid of the mental and physical jitters.

“There is no such thing as fidgeting when you’re outside,” Mr. Rao says.

He also recommends the following: Take a wait-and-see approach, decrease the pressure to conform to expectations, scan the home environment for inconsistent messages and lack of routine, remember that boys typically develop language skills later than girls, keep a diary to help identify what triggers certain behaviors, discuss with teachers the possibility of standing up while working, and finally, look at sons with wonderment instead of worry, because some qualities — competitiveness and aggression, for example — that are considered unattractive in children can be assets for adults.

“I want parents to start visualizing their sons as healthy, happy adults,” Mr. Rao says. “A boy needs to know that his parents don’t think that he is damaged or disordered.”

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