- Shopping Bag ( 0 items )
The problem isn't with boys, it's with our expectations of them
In a book that's part advice and part exposé, psychologist and expert on boyhood development Dr. Anthony Rao challenges some of the potentially harmful assumptions, attitudes, and behaviors we've developed toward young boyhood over the last few decades. This is not an indictment of medication therapies—in some important instances, Dr. Rao argues that medication is appropriate and necessary. Rather, The Way of ...
The problem isn't with boys, it's with our expectations of them
In a book that's part advice and part exposé, psychologist and expert on boyhood development Dr. Anthony Rao challenges some of the potentially harmful assumptions, attitudes, and behaviors we've developed toward young boyhood over the last few decades. This is not an indictment of medication therapies—in some important instances, Dr. Rao argues that medication is appropriate and necessary. Rather, The Way of Boys is a celebration of natural, constructive boyhood development and an expert, definitive handbook on what to look for and expect in normal growth. Ask yourself these questions:
Is his behavior serious enough to interfere with functioning? Does it keep him from sleeping, eating, attending school, or staying safe?
Does it persist over a few weeks or more? Does it show itself more than a few isolated times per day?
Does it happen in different settings? Has it been reported by different people?
If your answer is yes to any of these, your son may have symptoms that need further assessment by a pediatrician or other qualified developmental specialist. But a yes answer doesn't mean your son has a lifelong disorder or that the first line of defense is medication.
Boys are being bombarded with a slew of diagnoses—ADHD, Asperger's, bipolar disorder—at an alarming rate and at younger ages. The Way of Boys urges parents, educators, pediatricians, psychologists, and other developmental experts to reevaluate and significantly change how we deal with our youngest boys.
It's time we stopped trying to "fix" young boys. When parents understand the wide spectrum for normal boy development, they can successfully communicate with their son—and everyone in their son's life—and help him grow into a healthy, smart, strong man.
The Way of Boys
Raising Healthy Boys in a Challenging and Complex World
Your Problem Is Spelled B-O-Y
Sandy stood in my office on the verge of tears. Her four-year-old son, Tommy, had recently been kicked out of preschool after slapping a teacher and throwing a toy, which hit another child in the face. Before Sandy could even hand me the packet of information containing the results of Tommy's testing and school materials, he had climbed aboard a swivel chair, reclined it, and stood on top of it like a surfer. He ignored her pleas to get down. Sandy apologized to me, and I could see that her days were filled with anxiety about what her son might do next and how others might perceive him. She was constantly vigilant and miserable and very worried about her son.
Sandy and I managed to engage Tommy with LEGOs, and then I listened to the details of her story. Sadly, it's one I've heard over and over again in my practice. After asking Sandy to withdraw her son from preschool, the director of that school told Sandy and her husband that Tommy wasn't developing normally. She told them that Tommy had trouble transitioning from one activity to another because he was either too engrossed or too bored. He would have tantrums and throw things or bother the other kids at craft time. The director referred them to a specialist who treats young children for developmental disorders. After a quick twenty-minute appointment in which Sandy completed one behavioral checklist, the doctor announced that Tommy had ADHD, or attention deficit/hyperactivity disorder. "He's going to struggle with this long term," the doctor said. "This is a lifelongissue. The earlier we treat it, the better." He handed Sandy a prescription for Ritalin.
"I don't want to give him pills," she said.
The doctor didn't seem to be listening. "I've had good luck with this in the past," he said. "Let's see how he does on it before we decide."
Sandy left that doctor's office in tears, feeling that she had no choice but to go along with his treatment plan.
Luckily, Sandy's next move was to reach out for some help, in this case a second opinion. Through word of mouth, she had heard that, over the past twenty years, first at Children's Hospital/Harvard Medical School and then in my own practice, Behavioral Solutions, I'd become known as a psychologist who treats young boys who are struggling, without relying solely on medication. I looked at Tommy's packet and was not surprised by anything I saw in it. The school reports and the specialist's checklist could justify a diagnosis of ADHD, but that isn't saying much. It's an easy diagnosis to hand out. Worse, in order to give that diagnosis, a clinician would have to ignore the other glaring possibility: there was absolutely nothing wrong with this boy. It was possible, and in my view probable, that Tommy was experiencing nothing more than a developmental glitch.
First of all, the fact that Tommy is having trouble in preschool is not surprising, nor is it an indication of a fundamental problem. There is an entire subset of boys who are not ready for circle time, for rigid transitions, for following complex directions or listening to a lot of talk until well past their sixth birthdays. The problem isn't the boys, it's our expectations of them.
Moreover, I told Sandy that in six months or so Tommy would be a completely different little boy from the one careening around my office. I told her that it was likely that the areas of his brain that control impulses were developing more slowly in him than in his peers. But I also told her that there was no evidence in the behavioral checklist that this would be a problem for him in the long run. My aim was to convince Sandy to stop worrying, to buy Tommy some time. In six months, he would likely be more settled, more able to concentrate, more verbal. Six months after that, he would be even further along. There was no pressing need to diagnose and medicate him so young. I knew in time he would settle down a bit more and change, even if he never takes a single pill. That's how fast a four-year-old's brain is developing. For the Tommys of the world who are struggling in preschool or day care, there are other techniques, behavioral methods for helping them learn to settle down when they have to and to keep them from hurting others when they play excitedly or act impulsively. In most cases, though, simply waiting a bit and giving a boy's brain a chance to catch up on its own is the best approach.
I wish this were the only example in my practice of very young boys sidelined by some kind of quick diagnosis or kicked out of preschool because of a transient behavioral problem or their quirky developmental path. But I meet boys like Tommy all the time. It's not just aggression or hyperactivity that is cited as a problem. I meet boys rushed into diagnoses with Asperger's syndrome because they line up their toys or don't make enough eye contact; other boys are tagged as antisocial loners because they haven't graduated to cooperative play at their third birthday; some get labeled with sensory processing issues or nonverbal learning disorder because they are not mature enough to stay on task during craft time, because they don't take turns readily or verbalize their needs, or because they move clumsily. While early intervention does help with certain diagnoses, such as speech impediments, prolonged language delay, and clear signs of autism, the truth is that the vast majority of young boys don't have a disorder. They aren't lagging in any permanent way. There is nothing wrong with them. They are just developing, sometimes unevenly, which is the way development takes place in many boys.
From the earliest days of my practice, I found myself getting many more referrals for boys than girls, and I soon learned that the vast majority of kids receiving psychiatric referrals are boys. But over the past ten years, I've noticed another trend that is alarming. Younger and younger boys are coming into my practice with what seems to me exaggerated and inappropriate diagnoses for disorders more commonly assigned to adults or teens. These very young boys are being labeled in alarming numbers as having ADHD, bipolar disorder, various learning disabilities, oppositional disorders, pathological anger, serious social skills deficits, and more. Their parents have read or been told that these disorders have a genetic basis and that they are best treated in a medical way, and that means drugs.
Yet when I work with these boys, I often find them to be in a developmental culdesac that is causing them to seem different from their peers, when in reality they are just lagging a step or two behind. What is shocking to me about this quick culture of diagnosis is that no one is explaining to parents that there is no way to say with certainty that a three-, four-, or five-year old boy is going to struggle with aggression, extreme shyness, or a lack of impulse control for the rest of his life. No one is informing parents that most of these odd developmental pathways are quite normal and don't mean anything in the long term. The data are clear on this. Accurate long-term predictions for these disorders for kids under age five or six are very, very poor. These diagnostic labels mean nothing in the long term because boys, especially young ones, grow and change so fast.The Way of Boys
Posted June 25, 2010
I Also Recommend:
"Your Problem is Spelled B-O-Y." Can you relate? Then you definitely want to read this book. Dr. Rao's approach is different than what you may hear or read about in other books. If a boy is behind in social skills or seems to be having trouble in school, the popular approach has been to diagnose the boy with ADHD or ADD and medicate him. While Dr. Rao does say that medication could help some boys, he strongly advises taking an alternate approach by taking steps to help the boy change his behavior: Provide "clear rules and boundries; consequences before lectures; (and) rewards for each milestone." The reason, Dr. Rao says, is that boys develop differently than girls - they often times are slower to develop language skills and often have difficulties controlling impulses. This is perfectly normal and does not mean that a boy has some disorder that requires medication.
Dr. Rao covers many scenerios that one may encounter with a boy: "He Doesn't Have Any Friends," "He's a Bully," "He Won't Sit Still," "He Runs the Household," "He Has to Win or Else," "He Hates School," to name a few. In each scenario, Dr. Rao gives case examples of boys he has worked with, and what he and the parents did to help improve the boys' behavior. He offers excellent suggestions for coping with challenges and staying positive through the process.
Dr. Rao also covers topics of what to do if "The Teacher Thinks He Needs Testing, " or if "He Has Already Been Labeled." For parents who are experiencing difficulties with their son in school, these chapters are invaluable. At the end of the book Dr. Rao offers hope to parents who have challenges with the young boys in their lives. In the chapter, "What Will He Be Like as a Grown Man?" Dr. Rao interviews young men who were once his patients. These men have grown into responsible, successful adults. They recount their days as rambunctious four-year-olds and their appreciation for the guidance they received from Dr. Rao and their parents.
As a mother of a five-year-old boy, I agree whole-heartedly that boys are challenged by today's faster pace. They are expected "to sit, listen, and use social skills that won't be fully up and running until they reach the second grade." It is encouraging to know that this is normal and that with loving guidance, a boy can grow up to be a socially responsible, successful man.
Thank you Dr. Rao fo sharing your invaluable insights. I highly recommend this book and will be adding it to my list of favorite parenting books. Comment | Permalink
2 out of 2 people found this review helpful.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.