As we approach the new school year, parents and teachers of young children have an opportunity, if not a responsibility, to prevent those little ones who are out of step in their ability to pay attention; listen; follow directions; stay seated, still, and productive; and, keep from talking out of turn, from receiving a false ADHD diagnosis. The latest numbers out of the Centers for Disease Control and Prevention indicate that eleven percent of American children have ADHD, the average age of children with the diagnosis being seven years old. As recent as 2003, 7.8 percent of American children were thought to have ADHD. The alarming rise of this condition among young children requires that we step back and look for more common-sense social and developmental explanations for the sort of problematic behavior that gets kids assigned an ADHD diagnosis. As a child psychologist and writer on children’s mental health issues, I’ve studied these concerns for over thirty years and have zeroed in on three core questions parents and educators can ask themselves when a child’s behavior rises to a level where an ADHD diagnosis is entertained:
Ample opportunity to engage in socio-dramatic, active, imaginary play is essential for young kids to learn rudimentary social skills, discharge pent up excitement and frustration, acquire expressive mastery of aggression, and even build executive functions.
Let me explain. Take a simple game of tag in the backyard, or school playground. Kids need to somehow self-contain their frustration over being tagged, and excitement over averting being tagged in order for the fun game to persist. Feeding of each other’s shifting emotions, they can’t get flooded and become overly silly, or unruly. Wounded pride over being tagged can’t get acted out by refusing to play, or pursuing one’s tagger with vengeance. Celebratory pride over tagging can’t get acted out in vain or arrogant gestures. Sensitive, developmentally-informed parents and educators are on hand to step in when necessary to socially manage outbursts, prompt and cue kids with more mature ways to express primal emotions, and broker resolutions as conflicts arise. These rudimentary social-and-emotional skills are not pre-formed in kids brains, waiting to emerge lockstep with maturation. It is in the context of seemingly mundane play scenarios like this that kids actually learn rudimentary social-and-emotional skills. As such, play-deprived kids are at a disadvantage in terms of their social and emotional development, and at risk for a false ADHD diagnosis.
Rough-and-tumble play—or games involving chasing and fleeing, mock fighting, and pretend wrestling—is widespread among young children across cultures. Play scholars, like Anthony Pellegrini and Jaak Panksepp, claim that one of the main functions of rough-and-tumble play for young children is social bonding. The sheer delight on the faces of kids as they chase and flee, use mock wrestling moves to overpower, or to be overpowered by each other, conveys how they are cementing a personal relationship. Rough-and-tumble play is also the evolutionary-based, time-honored way in which young children safely experiment with and acquire expressive mastery of their own, and other’s aggression, as well as deal with power dynamics in relationships. Despite parents’ and educators’ fears that such play causes harm and should be forbidden, studies by the sociologist Peter K. Smith show that by age ten upwards of ninety-six percent of children are able to distinguish between play fighting and real aggression. The vast majority of kids by this age also act on mutual desires to hold back from causing real harm and to trade dominator and dominating roles to ensure that the enlivening game persists. In so far as we forbid and derail preschool and early-elementary school children from engaging in rough-and-tumble play we deprive them of nature’s way of assisting them with the acquisition of social skills and expressive mastery of aggression. We put them in a false ADHD diagnosis red-zone.
Research also shows that imaginative play can promote executive functions, or the capacity to think before acting, and stay organized in one’s thoughts and actions. The Soviet developmental psychologist, Lev Vygotsky, stated that children achieve the “maximum display of will power,” or self-control while in the act of pretend play. Adults don’t often appreciate how much impulse-control building, social cooperation, and conformity to rule-governed behavior is embedded in something as simple as a pretend game of fire-fighters: Taking time to find just the right clothes and props to look like fire fighters, hunting around for just the right play objects that could represent hoses, cuing all involved to approach the fire from the right directions, knowing when and how to make siren noises, and so forth. Pretend-play rich, early educational and home environments are necessary to make little kids un-ADHD like.
Is my child, or this student, emotionally and behaviorally disregulated as a reaction to a kindergarten curriculum that perpetually exceeds their developmental capacities?
It’s old news that heavy emphasis on reading, writing and arithmetic skills has displaced play-based activities in kindergarten. The everyday outcome to this is that kids across America are expected to sit and listen, keep their bodies still, work independently, and verbally navigate minor social conflicts at younger and younger ages as a marker of kindergarten readiness. This, despite the fact that fifty-three percent of American children (Annie E. Casey Foundation annual Kids Count figure) enter kindergarten without any pre-school experience, where they would have been socially prepared for such behavioral realities. It stands to reason that those younger in age, or slower to mature in terms of their social-and-emotional development, are at risk for a false ADHD diagnosis, simply as a consequence of a developmentally-unfriendly educational setting and curriculum. In fact, data support this conclusion. A few years ago, the Michigan State University economist, Dr. Todd Elder calculated that as many as one million kindergartners are misdiagnosed with ADHD at any given time merely because they are the youngest and most immature in the class.
Developmentally-unfriendly kindergarten classrooms may disproportionately affect boys, who are two- to three-times more likely to receive an ADHD diagnosis compared with girls. The average boy is almost a year behind the average girl in the main things that seem to matter in kindergarten these days: self-regulation (paying attention and controlling one’s impulses) and reading and writing fluency.
Is my child, or this student, being raised in a household that holds fast to routines, disciplinary methods, and structure that promotes good self-discipline?
Young children are naturally impulsive, distractible, disorganized, forgetful, and prone to taking the easy way out. Their self-discipline is a perpetual work-in-progress. If they are to mature into older children with the adequate ability to show self-restraint, focused attention, and conscientious work habits they need home environments where there is structure and predicable routines.
The brain is a social organ. Relatively speaking, organized brains require organized households. Set bedtimes, with soothing rituals (dim lights, being read to in a soft voice) regulate kids’ brains. So, too, does predictable access to a parent’s non-reactive, sensitive attention when needed. Chaotic households, with unpredictable schedules, inhabited by overworked, distracted and preoccupied caregivers, can have dysregulating effects on a kid’s emotions, behavior, and brain.
All in all, before rushing to an ADHD diagnosis, parents and educators need to honestly address environmental and developmental factors that might be having a causal influence. Often these factors are within the adult’s power to change and can have instantaneous results: Giving a young kid “a gift of a year,” by holding back him or her back from entering kindergarten and locating a pre-school that emphasizes social-and-emotional development for placement; More ready access to socio-dramatic, rough-and-tumble, and pretend play at home and school while acting as “floating/background mentor” judiciously and sensitively stepping in when necessary to coax mature behavior; Devoting oneself to family lifestyle changes that support good self-control through predictable routines, schedules, and non-reactive interactions.
Less under the control of parents and educators is the public policy issue of returning kindergarten to the glory days, with more finger painting, rearranging blocks, playing dress up, tag, and mock wrestling! But that should not prevent us from being able citizens and lobbying our local school districts to restore this developmentally-advantageous situation, one of the only factors, I believe, that will reduce the burgeoning number of false ADHD diagnoses.
About the Author
Enrico Gnaulati is a clinical psychologist based in Pasadena, California. He is the author of Back to Normal: Why Ordinary Childhood Behavior is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder. His work has been featured on Al Jazeera America, KPCC Los Angeles, and online at the Atlantic and Salon. Visit his website: gnaulati.net.