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Boy Behavior Leads to ADD Diagnoses

“In our experience it is evidence that most of what is being called ADD today would not have been called ADD fifteen or twenty years ago and that much of it falls within the range of normal boy behavior.” – Dan Kindlon, Ph.D. and Michael Thompson, Ph.D., from “Raising Cain: Protecting the Emotional Life of Boys.”

The person most likely to be diagnosed with ADD is a boy in grade school. If you are the parent of such a child, you would do well to consider whether your child’s behavior is actually within the normal range of behaviors for boys, especially if his problem is mostly at school.

Some neurologists contend that the DSM IV criteria used to diagnose ADD result in too many children labeled ADD, especially boys. In a Brazilian study, school children were selected at random and evaluated for ADD, first by using the current DSM IV criteria, and then using alternative “neuropsychologic criteria” which included items such as “altered tone: hypotonia or paratonia” and “difficulty in learning.” [1] When the DSM IV criteria were used, 25% of the boys were classified as ADD while 11% of the girls were so classified. But when the alternative criteria were used, 4% of both boys and girls were considered ADD. The researchers concluded that the use of DSM IV criteria overestimates the prevalence of ADD, especially among boys.

The 25% diagnostic rate for boys cited above may seem rather unbelievable. Yet in a Virginia study of 30,000 children in two school districts, a full 20% of the 5th grade white boys were found to be taking medications for ADD in school. [2] All of these boys were officially diagnosed with ADD by “qualified” professionals. The potential rate of diagnosis must be even higher, since there were undoubtedly many parents who either refused to have their boys diagnosed with ADD or, if diagnosed, refused to medicate.

Compared to girls, young school-aged boys are about one year behind in verbal abilities. They are less organized, more impulsive, have worse handwriting, are more active, and more impulsive that girls. And it is unlikely that their teacher was ever a boy and could really understand. Most teachers in grade school are women who enjoyed school when they were young.

Most women teach to the girls, the little versions of what they used to be: organized, obedient, attentive and quite verbal. In the first few grades the focus is reading, writing, handwriting, listening to instructions, and being neat. I experienced this first-hand when my son was in first grade. He was complaining to me of being bored in school, and his teacher said he was often the first one done with classroom assignments. At home I could see he had abilities in math, science, geography and was a good reader, skills that my husband and I, both in technical fields, considered most important. But when I spoke to the school about accelerating him they countered that he had sloppy handwriting, was a poor speller, didn’t “write as much as some of the girls”, had a fidgeting problem, and was incapable of the organizational requirements of the next grade (in which all children were required to maintain daily planners to keep track of all their homework assignments!). In other words, he didn’t act enough like a girl to be accelerated. Math, science, history and geography took a back seat to sitting still and being organized.

“When normal boy activity levels and developmental patterns are accommodated in the design of schools, curricula, classrooms, and instructional styles, an entire stratum of ‘boy problems’ drops from sight…Boys can achieve a high standard of self-control and discipline in an environment that allows them significant freedom to be physically active.” – Dan Kindlon, Ph.D. and Michael Thompson, Ph.D., from “Raising Cain: Protecting the Emotional Life of Boys.”

Adults often have unrealistic expectations about boys, for example, that they can sit still and be quiet all day, when they desperately need to run around and play. The human race evolved with men as the hunters and warriors. Boys instinctively mimic hunting and fighting in their play because it is good practice for the life of a future warrior and hunter. Historically, teenage boys often hunted and fought alongside the men. The instinct for boys to practice their hunting and fighting skills is undoubtedly wired into our species. Every fiber of their being tells them to move, to get physical, to play-fight. And then we ask them to get dressed promptly for school, sit quietly while they ride the bus for half an hour, sit in a chair quietly for six hours and listen to a teacher, organize their backpacks, sit still for another half hour ride on the bus, and then when they get home, do their homework! Should we be surprised when our more active boys show signs of emotional distress by acting out?

If you have a young boy in this situation, you need to become his advocate. Don’t expect perfect behavior or perfect grades. Don’t overschedule your son: let him play. Let him move. Consider homeschooling. Tell your school district and teachers that you don’t want a lot of homework for young children. Don’t let the teacher take away recess as a punishment. And when your son doesn’t act like a perfect little girl, don’t assume he has a defect!

Reading Disabilities: Learning disabilities, especially verbal ones, are common among boys labeled ADD. Some of these “disabilities” are undoubtedly simple cases of boys being expected to read and write as well as girls:

“From kindergarten through sixth grade, a boy spends more than a thousand hours a year in school, and his experiences and the attitudes of the teachers and other adults he encounters there are profoundly shaping. The average boy faces a special struggle to meet the developmental and academic expectations of an elementary school curriculum that emphasizes reading, writing, and verbal ability – cognitive skills that normally develop more slowly in boys than in girls. Some boys are ahead of the others on that developmental curve, and some girls lag behind, but when we compare the average boy with the average girl, the average boy is developmentally disadvantaged in the early school environment.” – Dan Kindlon, Ph.D. and Michael Thompson, Ph.D., “Raising Cain.”

Parents who homeschool their boys sometimes report that a developmental threshold is reached between the ages of eight and ten, after which boys suddenly start to read and write with ease. That’s between the third and fifth grades. But in public schools boys are expected to read and write in kindergarten or first grade, and if they do not they are labeled with a “reading disability.” Boys especially hate writing, which combines most of their weaknesses into one humiliating exercise: penmanship, spelling, grammar and vocabulary. Although my son was a good reader, his first grade teacher complained that he “didn’t write as much as some of the girls.” When I asked him about it he told me what his classmates had told him: “Writing is for girls!” Boys, when faced with an activity that makes them appear inept, will often attempt to save face by pretending they are not interested in that activity. And they may go so far as accuse other boys who do well in that activity as “acting like girls.” Soon there is ample peer pressure for boys to not to do well.

While homeschooling I required my son to do two brief book reports each week. I discovered that my son had a much easier time writing once he could type on the computer and was writing about books that really interested him. His wild enthusiasm over books like “Bombers of World War II” and “Attack Submarines” translated directly into quicker book reports and made writing appear more masculine (and acceptable) to him.

Discipline: Boys also attract harsher discipline than girls. They are more active, more accident prone, more likely to break things, more likely to get into fights, and less likely to try and please you. Parents of boys with chronic discipline problems often start out by having unrealistic expectations. It is especially problematic when a boy is compared to his sisters and found wonting. Such parents will make rules that boys cannot comply with, such as sitting still or picking up each toy before they take out another one. This results in a lot of yelling, removal of privileges, and nagging. In some cases it even leads to hitting or verbal abuse, such as telling a child he is a “no-good loser”.

Many parents also just expect their boy to follow the rules out of the goodness of his heart. How naļve! Boys test the rules, and parents must be prepared for this by enacting reasonable consequences. Many parents and teachers are not even clear about the rules in the first place, and if they are, they do not let a boy know just how far he can push the rules or what will happens if he pushes too far. Many parents do not consistently enact consequences. Instead, they nag and threaten repetitively until one day they blow-up and over-react harshly. As the boy grows older there is often pressure to “crack down” on the boy.

“The same raw energy and activity level that often put boys at odds with the school environment create similar tensions at home. A toddler runs toward the street, a young boy hits another child or runs recklessly through the house and causes damage, an adolescent disregards the household rules or defies his parents’ expectations. From the time a boy is old enough to get around freely, many parents view parenting as a struggle to determine whose will shall prevail.” – Dan Kindlon, Ph.D. and Michael Thompson, Ph.D. “Raising Cain.”

Inconsistent discipline, harsh discipline, verbal abuse and unrealistic expectations can result in oppositional behavior, especially in children who have personality types inspired by independence and freedom. It is important for parents to realize that oppositional behavior may be a perfectly rational response to hostile parenting or teaching. Too often oppositional behavior is viewed as some sort of biological defect that adults can do nothing about.

[1] “Prevalence of Attention-Deficit Hyperactivity Disorders in Students – Comparison Between DSM-IV and Neuropsychological Criteria”, Ana Guardiola MD, Flavio D. Fuchs MD, and Newra T. Rotta MD, Arq. Neuro-Psiquiatr. vol.58 n.2B Sao Paulo June 2000.

[2] ” The Extent of Drug Therapy for Attention Deficit­ Hyperactivity Disorder Among Children in Public Schools G. B. LeFever, A. L. Morrow, and K. V. , The American Journal of Public Health – Sept. 1999

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