Why Teenagers Act Crazy

Photo

CreditGary Panter

ADOLESCENCE is practically synonymous in our culture with risk taking, emotional drama and all forms of outlandish behavior. Until very recently, the widely accepted explanation for adolescent angst has been psychological. Developmentally, teenagers face a number of social and emotional challenges, like starting to separate from their parents, getting accepted into a peer group and figuring out who they really are. It doesn’t take a psychoanalyst to realize that these are anxiety-provoking transitions.

But there is a darker side to adolescence that, until now, was poorly understood: a surge during teenage years in anxiety and fearfulness. Largely because of a quirk of brain development, adolescents, on average, experience more anxiety and fear and have a harder time learning how not to be afraid than either children or adults.

Different regions and circuits of the brain mature at very different rates. It turns out that the brain circuit for processing fear — the amygdala — is precocious and develops way ahead of the prefrontal cortex, the seat of reasoning and executive control. This means that adolescents have a brain that is wired with an enhanced capacity for fear and anxiety, but is relatively underdeveloped when it comes to calm reasoning.

Photo

CreditGary Panter

You may wonder why, if adolescents have such enhanced capacity for anxiety, they are such novelty seekers and risk takers. It would seem that the two traits are at odds. The answer, in part, is that the brain’s reward center, just like its fear circuit, matures earlier than the prefrontal cortex. That reward center drives much of teenagers’ risky behavior. This behavioral paradox also helps explain why adolescents are particularly prone to injury and trauma. The top three killers of teenagers are accidents, homicide and suicide.

The brain-development lag has huge implications for how we think about anxiety and how we treat it. It suggests that anxious adolescents may not be very responsive to psychotherapy that attempts to teach them to be unafraid, like cognitive behavior therapy, which is zealously prescribed for teenagers.

What we have learned should also make us think twice — and then some — about the ever rising use of stimulants in young people, because these drugs may worsen anxiety and make it harder for teenagers to do what they are developmentally supposed to do: learn to be unafraid when it is appropriate to do so.

As a psychiatrist, I’ve treated many adults with various anxiety disorders, nearly all of whom trace the origin of the problem to their teenage years. They typically report an uneventful childhood rudely interrupted by adolescent anxiety. For many, the anxiety was inexplicable and came out of nowhere.

OF course, most adolescents do not develop anxiety disorders, but acquire the skill to modulate their fear as their prefrontal cortex matures in young adulthood, at around age 25. But up to 20 percent of adolescents in the United States experience a diagnosable anxiety disorder, like generalized anxiety or panic attacks, probably resulting from a mix of genetic factors and environmental influences. The prevalence of anxiety disorders and risky behavior (both of which reflect this developmental disjunction in the brain) have been relatively steady, which suggests to me that the biological contribution is very significant.

One of my patients, a 32-year-old man, recalled feeling anxious in social gatherings as a teenager. “It was viscerally unpleasant and I felt as if I couldn’t even speak the same language as other people in the room,” he said. It wasn’t that he disliked human company; rather, socializing in groups felt dangerous, even though intellectually he knew that wasn’t the case. He developed a strategy early on to deal with his discomfort: alcohol. When he drank, he felt relaxed and able to engage. Now treated and sober for several years, he still has a trace of social anxiety and still wishes for a drink in anticipation of socializing.

Of course, we all experience anxiety. Among other things, it’s a normal emotional response to threatening situations. The hallmark of an anxiety disorder is the persistence of anxiety that causes intense distress and interferes with functioning even in safe settings, long after any threat has receded.

We’ve recently learned that adolescents show heightened fear responses and have difficulty learning how not to be afraid. In one study using brain M.R.I., researchers at Weill Cornell Medical College and Stanford University found that when adolescents were shown fearful faces, they had exaggerated responses in the amygdala compared with children and adults.

The amygdala is a region buried deep beneath the cortex that is critical in evaluating and responding to fear. It sends and receives connections to our prefrontal cortex alerting us to danger even before we have had time to really think about it. Think of that split-second adrenaline surge when you see what appears to be a snake out on a hike in the woods. That instantaneous fear is your amygdala in action. Then you circle back, take another look and this time your prefrontal cortex tells you it was just a harmless stick.

Thus, the fear circuit is a two-way street. While we have limited control over the fear alarm from our amygdala, our prefrontal cortex can effectively exert top-down control, giving us the ability to more accurately assess the risk in our environment. Because the prefrontal cortex is one of the last brain regions to mature, adolescents have far less ability to modulate emotions.

Fear learning lies at the heart of anxiety and anxiety disorders. This primitive form of learning allows us to form associations between events and specific cues and environments that may predict danger. Way back on the savanna, for example, we would have learned that the rustle in the grass or the sudden flight of birds might signal a predator — and taken the cue and run to safety. Without the ability to identify such danger signals, we would have been lunch long ago.

But once previously threatening cues or situations become safe, we have to be able to re-evaluate them and suppress our learned fear associations. People with anxiety disorders have trouble doing this and experience persistent fear in the absence of threat — better known as anxiety.

Another patient I saw in consultation recently, a 23-year-old woman, described how she became anxious when she was younger after seeing a commercial about asthma. “It made me incredibly worried for no reason, and I had a panic attack soon after seeing it,” she said. As an older teenager, she became worried about getting too close to homeless people and would hold her breath when near them, knowing that “this was crazy and made no sense.”

B. J. Casey, a professor of psychology and the director of the Sackler Institute at Weill Cornell Medical College, has studied fear learning in a group of children, adolescents and adults. Subjects were shown a colored square at the same time that they were exposed to an aversive noise. The colored square, previously a neutral stimulus, became associated with an unpleasant sound and elicited a fear response similar to that elicited by the sound. What Dr. Casey and her colleagues found was that there were no differences between the subjects in the acquisition of fear conditioning.

But when Dr. Casey trained the subjects to essentially unlearn the association between the colored square and the noise — a process called fear extinction — something very different happened. With fear extinction, subjects are repeatedly shown the colored square in the absence of the noise. Now the square, also known as the conditioned stimulus, loses its ability to elicit a fear response. Dr. Casey discovered that adolescents had a much harder time “unlearning” the link between the colored square and the noise than children or adults did.

IN effect, adolescents had trouble learning that a cue that was previously linked to something aversive was now neutral and “safe.” If you consider that adolescence is a time of exploration when young people develop greater autonomy, an enhanced capacity for fear and a more tenacious memory for threatening situations are adaptive and would confer survival advantage. In fact, the developmental gap between the amygdala and the prefrontal cortex that is described in humans has been found across mammalian species, suggesting that this is an evolutionary advantage. This new understanding about the neurodevelopmental basis of adolescent anxiety has important implications, too, in how we should treat anxiety disorders. One of the most widely used and empirically supported treatments for anxiety disorders is cognitive behavior therapy, a form of extinction learning in which a stimulus that is experienced as frightening is repeatedly presented in a nonthreatening environment. If, for example, you had a fear of spiders, you would be gradually exposed to them in a setting where there were no dire consequences and you would slowly lose your arachnophobia. The paradox is that adolescents are at increased risk of anxiety disorders in part because of their impaired ability to successfully extinguish fear associations, yet they may be the least responsive to desensitization treatments like cognitive behavior therapy precisely because of this impairment.

This presents a huge clinical challenge since young people are generally risk takers who are more prone to exposure to trauma as a direct result of their behavior, to say nothing of those who were exposed to the horrors of the wars in Iraq and Afghanistan or the mass shootings like those in Newtown and Aurora. Many of them will go on to develop post-traumatic stress disorder, which is essentially a form of fear learning. Now we have good reason to think that exposure therapy alone may not be the best treatment for them. A recent study of children and adolescents with anxiety disorders found that only 55 to 60 percent of subjects responded to either cognitive behavior therapy or an antidepressant alone, but 81 percent responded to a combination of these treatments. And in another study, there was preliminary evidence that adolescents responded less well to cognitive behavior therapy than children or adults.

This isn’t to say that cognitive therapy is ineffective for teenagers, but that because of their relative difficulty in learning to be unafraid, it may not be the most effective treatment when used on its own.

And there is potentially something else to worry about with our anxious adolescents: the meteoric rise in their use of psychostimulants like Ritalinand Adderall. In theory, stimulants could have a negative impact on the normal developmental trajectory of anxious teenagers.

According to the health care data company IMS Health, prescription sales for stimulants increased more than fivefold between 2002 and 2012. This is of potential concern because it is well known from both human and animal studies that stimulants enhance learning and, in particular, fear conditioning. Stimulants, just like emotionally charged experiences, cause the release ofnorepinephrine — a close relative of adrenaline — in the brain and facilitate memory formation. That’s the reason we can easily forget where we put our keys but will never forget the details of being assaulted.

Might our promiscuous use of stimulants impair the ability of adolescents to suppress learned fear — something that is a normal part of development — and make them more fearful adults? And could stimulants unwittingly increase the risk of PTSD in adolescents exposed to trauma? In truth, we haven’t a clue.

But we do know this: Adolescents are not just carefree novelty seekers and risk takers; they are uniquely vulnerable to anxiety and have a hard time learning to be unafraid of passing dangers. Parents have to realize that adolescent anxiety is to be expected, and to comfort their teenagers — and themselves — by reminding them that they will grow up and out of it soon enough.

A Gossip App Brought My High School to a Halt

Here’s an article from New York Magazine about social networking gone awry at Staples HS in Westport.  Warning, the article contains some graphic language.

M., a high school junior, was rushing to class last Thursday morning when a friend stopped to ask if she was okay. Taken by surprise, she laughed and answered that she was fine. Continuing down the hall, she was met by strange glances and similar inquiries. She was at a loss. What had she done to become a celebrity overnight? It wasn’t until she sat down for her first period class that someone finally told her about Yik Yak.

Yik Yak is an application that allows individuals to post comments anonymously, essentially operating as a Twitter without handles. Sitting at her desk, M. grabbed a friend’s phone and began scrolling through a feed of posts.

“L. M. is affiliated with Al Qaeda.”

“The cheer team couldn’t get uglier.”

“K. is a slut.”

“J. N. is a fag.”

“The fact that O. P. has diabetes makes me happy.”

“S. D. + 10 years = trailer park.”

“Nobody is taking H. to prom because nobody has a forklift.”

“J. T.’s gonna get lynched at SMU.”

“How long do we think before A. B. kills herself?”

“N. likes the taste of thick pussy and wheelchair pussy.”

“99% of guys have tits bigger than J.”

“I probably heard about 10–15 nasty things written about me, some of which I couldn’t even finish reading,” M. says. “M. will let anybody anally finger her.” “M. gave dome for $6.” She had come under more intense attack than most students, but her experience on Thursday was similar to those of dozens of students at Staples High School.

I’m a student at Staples, too. It’s a good, medium-sized public school in Westport, Connecticut. We don’t walk through metal detectors on our way to class, and the main job of our school “security force” is to hand out tickets when students’ Jeeps and Audis park in staff parking spaces. John Dodig, our genial and openly gay principal, greeted my freshman class in 2010 by welcoming us to a school that was “different,” a school that rose above petty high school malice. And as a senior, I’ve found Staples to be a happy, functional, though complexly hierarchical place. The three most popular senior girl groups are the Bots, the Bedfords, and Acrimonious. There are Albone and the Rowdies, both popular senior boy groups. There are the Amigos (popular junior girls), the Cool Asians (none of whom are actually Asian), the Fairies (the soccer team, not the theater kids), the Players (the theater kids, not the soccer team), and many others.

Yik Yak arrived at Staples from Fairfield, the neighboring town, by way of the Dominican Republic, where students from Staples joined students from Fairfield Warde High School on a service trip earlier this month. Fairfield had already been rocked by the app. Students described a scene of pandemonium that eventually resulted in legal action against some who were charged with cyber-bullying. After the service trip was over and the volunteers returned to Staples, word of Yik Yak spread fast.

When you watch stupid movies about teenagers in high school, you roll your eyes at the classic fallout scene in which the hallways are filled with whispering students all gossiping about the same thing. This was exactly what Thursday afternoon looked like at Staples. “Walking through the hallways, everyone was staring at their phones,” says one target. In the course of a few periods, the most private, deplorable thoughts of the Staples student body had been put into writing. And the worst part was that no one knew who was writing this stuff — maybe the asshole you’d expect it from, or maybe the quiet girl in the back of Spanish class.

In the period after lunch, everyone was waiting for the next post. Feeds were refreshed; new batches of unsigned obscenities entertained the student body. “I remember sitting there in class refreshing the page, waiting for someone to say something horrible and awful about me,” said one junior girl. Ms. S. was fully aware of the cause for her European History class’s distraction, as apparently many teachers had downloaded and perused the app during their lunch period. With each post, another girl left class to cry in the bathroom, vent to her guidance counselor, or drive home. “I was shocked, mortified, and embarrassed,” M. says. “I then called my mom and told her I was leaving school.”

During the last period of the day, a demoralized voice came over the loudspeaker: Principal Dodig had decided to address the school. Staples has dealt with social media explosions in the past, most notably the spread of Snapchat sexting and a Facebook cyber-bullying incident whose sexual depravity made high school boys blush. But I’ve never seen Principal Dodig as upset before. Between his sentences were heavy sighs and moments of reflection.

“To all the students in the school, I urge you at least not to look at the site,” he said. “I’ve heard several people today have read some things about them and they’re in tears. Don’t look at it. And if you don’t see it, it won’t bother you.”

His announcement gave Yik Yak new momentum.

“Mr. Dodig molested me with a weed wacker.”

“John Dodig touched my no-no parts.”

*

Yik Yak has been available for download since last November, and anonymity has existed since the dawn of the internet. So why did the app literally bring Staples to a halt last week? Maybe it was a form of emotional release for students who were beginning to relax after months of academic stress. Perhaps it was a way for students to get their bitterness out about their classmates, teachers, and administrators. Or perhaps it was simply the newest, must-have social media thing.

One student told Inklings, the school newspaper, that “kids are just mean these days, and they needed a new way to insult each other.” Maybe. I remember when Formspring and Honesty Box infiltrated my middle school hallways. But Yik Yak felt different. It wasn’t just a new tool for the school’s bullies; it was also an equalizer. No one was safe, regardless of his or her place on the social pyramid. Bots and Amigos were targeted just as much, if not more, than the gays, the fat kids, the nerds, the friendless. “K. sounds like she has a cock in her mouth 24/7,” went a typical attack on an Amigo. Staples Guidance counselor Victoria Capozzi says that one student, prior to finding himself the target of a homophobic post, was completely unaware that his peers even questioned his sexuality. Suddenly, the social 1 percent was subject to the same sort of cyber torment that had in the past been directed at the students at the bottom of the pyramid. Yik Yak gave everyone a chance to take down enemies, reveal secrets, or make shit up in order to obliterate reputations. You didn’t need internet popularity in order for your post to be seen; you just needed to be within a 1.5-mile radius of your target and your audience.

Over the weekend, targets turned to their friend groups for comfort. Group chats were flooded. A sample from one of the popular groups:

“Why am I getting ripped apart?”

“I feel like I’m in Mean Girls.”

“I was really rattled and red in school, I left for last period.”

“I cried.”

“H. will be forever known as the fat girl.”

M. still wasn’t in school on Friday. A senior girl who had also been attacked on Yik Yak told me over the weekend that she dreaded going back. “How do you look a classmate or teacher in the eye knowing that they might have read something about you? Or worse, they might have written something about you?”

Some students want to see the IP addresses of the authors identified. I would too, though I have the depressing suspicion that the students who wrote the worst posts don’t care about the lasting impact that they have had on peoples lives. In conversations with our teachers, guidance counselors, and parents, we constantly hear, “We didn’t have this when we were growing up.” Well, neither did we. Yik Yak and its capacity for anonymous, targeted destruction is new to all of us. By the end of the week Yik Yak had been blocked on Staples property, but it also had raised $1.5 million in funding. So I wouldn’t be surprised if there’s a competitor to Yik Yak on everyone’s phones next week. Are we just supposed to ignore it? I see no solution in sight, and personally, I am thrilled to be graduating in a few weeks.

*Names have been anonymized, and one or two details have been altered slightly, to not make it even worse.

Students Reading E-Books Are Losing Out, Study Suggests

The New York Times Motherlode Blog

Could e-books actually get in the way of reading?

That was the question explored in research presented last week by Heather Ruetschlin Schugar, an associate professor at West Chester University, and her spouse, Jordan T. Schugar, an instructor at the same institution. Speaking at the annual conference of the American Educational Research Association in Philadelphia, the Schugars reported the results of a study in which they asked middle school students to read either traditional printed books or e-books on iPads. The students’ reading comprehension, the researchers found, was higher when they read conventional books.

In a second study looking at students’ use of e-books created with Apple’s iBooks Author software, the Schugars discovered that the young readers often skipped over the text altogether, engaging instead with the books’ interactive visual features.

While their findings are suggestive, they are preliminary and based on small samples of students. More substance can be found in the Schugars’ previous work: for example, a paper they published last year with their colleague Carol A. Smith in the journal The Reading Teacher. In this study, the authors observed teachers and teachers-in-training as they used interactive e-books with children in kindergarten through sixth grade. (The e-books were mobile apps, downloadable from online stores like iTunes.)

While young readers find these digital products very appealing, their multitude of features may diffuse children’s attention, interfering with their comprehension of the text, Ms. Smith and the Schugars found. It seems that the very “richness” of the multimedia environment that e-books provide — heralded as their advantage over printed books — may overwhelm children’s limited working memory, leading them to lose the thread of the narrative or to process the meaning of the story less deeply.

This is especially true of what the authors call some e-books’ “gimmicks and distractions.” In the book “Sir Charlie Stinky Socks and the Really Big Adventure,” for example, children can touch “wiggly woos” to make the creatures emit noise and move around the screen. In another e-book, “Rocket Learns to Read,” a bird flutters and sounds play in the background.

Such flourishes can interrupt the fluency of children’s reading and cause their comprehension to fragment, the authors found. They can also lead children to spend less time reading over all: One study cited by Ms. Smith and the Schugars reported that children spent 43 percent of their e-book engagement time playing games embedded in the e-books rather than reading the text.

By contrast, the authors observed, some e-books offer multimedia features that enhance comprehension. In “Miss Spider’s Tea Party,” for example, children hear the sound of Miss Spider drinking as they read the words “Miss Spider sipped her tea.” In another e-book, “Wild About Books,” sounds of laughter ring out as the reader encounters the line “Hyenas shared jokes with the red-bellied snakes.”

The quality of e-books for children varies wildly, the authors said: “Because the app market allows for the distribution of materials without the rigorous review process that is typical of traditional children’s book publishing, more caution is necessary for choosing high-quality texts.”

They advise parents and teachers to look for e-books that enhance and extend interactions with the text, rather than those that offer only distractions; that promote interactions that are relatively brief rather than time-consuming; that provide supports for making text-based inferences or understanding difficult vocabulary; and that locate interactions on the same page as the text display, rather than on a separate screen. (E-books recommended by the authors are listed below.)

Once the e-books are selected, parents and teachers must also help children use them effectively, Ms. Smith and the Schugars said. This can include familiarizing children with the basics of the device. Although adults may assume that their little “digital natives” will figure out the gadgets themselves, the researchers have found that children often need adult guidance in operating e-readers.

Parents and teachers should also help children in transferring what they know about print reading to e-reading. Children may not automatically apply reading skills they have learned on traditional books to e-books, and these skills, such as identifying the main idea and setting aside unimportant details, are especially crucial when reading e-books because of the profusion of distractions they provide.

Lastly, adults should ensure that children are not overusing e-book features like the electronic dictionary or the “read-to-me” option. Young readers can often benefit from looking up the definition of a word with a click, but doing it too often will disrupt reading fluidity and comprehension. Even without connecting to the dictionary, children are able to glean the meaning of many words from context. Likewise, the read-to-me feature can be useful in decoding a difficult word, but when used too often it discourages children from sounding out words on their own.

Research shows that children often read e-books “with minimal adult involvement,” Ms. Smith and the Schugars said. While we may assume that interactive e-books can entertain children all by themselves, such products require more input from us than books on paper do.

Recommended E-Books

For beginning readers

“Blue Hat, Green Hat” by Sandra Boynton

“Go, Clifford, Go!” by Norman Bridwell

“Meet Biscuit” by Alyssa Satin Capucilli

“Nickelby Swift, Kitten Catastrophe” by Ben Hecht

“Miss Spider’s Tea Party” by David Kirk

“A Fine Musician” by Lucy Thomson

For fluent readers

“Slice of Bread Goes to the Beach” by Glenn Melenhorst

“Who Would Win? Killer Whale Vs. Great White Shark”by Jerry Pallotta

“Wild About Books” by Judy Sierra

“The Artifacts” by Lynley Stace and Dan Hare

Read more of the latest research on how children learn, like “How to Build Children’s ‘Print Knowledge’ While You Read Together,” and “Get Your Kids Using Their Devices to Learn — With an App Purge,” on Annie Murphy Paul’s Brilliant Blog. Ms. Paul is the author of “Origins,” a book about the science of prenatal influences, and “Brilliant: The Science of How We Get Smarter,” to be published by Crown in 2015.

Parents Should Coach Academics as Seriously as They Do Sports

The New York Times, Motherlode Blog

By JENNIFER ARROW

 APRIL 9, 2014

Monica Almeida/The New York Times

It sometimes seems that the American success ethic stops at the schoolhouse door. We encourage ambition in youth sports and entrepreneurial enterprise, but our families are often suspicious of the value of scholastic competition.

If you told your neighbors you had little Seymour in gymnastics with an eye to the 2028 Summer Olympics, they’d likely laugh but agree it was important to start early with a lofty goal like that. Were you to tell the neighbors that Sofia was doing abacus training as preparation for the 2028 International Math Olympiad, conversation might simply stop, because, well, who does that?

We should. Quanyu Huang, a professor at Miami University of Ohio and the author of the new book “The Hybrid Tiger: Secrets of the Extraordinary Success of Asian-American Kids,” argues that a subtle shift in mind-set transforms the study hall from a demoralizing workhouse to sweaty training gym, where hours of toil pay off during the big fight. If to be a student is to be a warrior (not a prisoner or a victim), suddenly a million familiar sports metaphors apply: free throws and math problems become interchangeable signifiers of a rigorous and inherently worthy training regimen. And a great coach, either at home or at school, is a beloved ally rather than an suspect adversary.

Dr. Huang’s book asserts that Asian families begin with the end in mind, that the progression from preschool to graduate school is perceived as not dissimilar to the hero’s journey of monomyth, and that culturewide certainty of purpose is fundamental: “Education is a life-or-death struggle,” he writes. “Education is a battle of elimination won through selection and competition. … For Chinese and Chinese-American children, their introduction to education is the beginning of a lifelong battle that they must win at any and all costs.”

“Can you think of the last time someone told you a story that made studying long and hard seem heroic?”

Practically, “Hybrid Tiger” suggests that Chinese-American families are structured so that the children are considered star academic competitors and the parents have a significant but clearly secondary role as their devoted trainers.

Dr. Huang describes touring colleges with his son and observing unencumbered Chinese kids trailed by parents “loaded up like pack mules … allowing [the kids] to wander about entirely unburdened.” (One is reminded of Rocky Balboa in the ring, shrugging off his robe and handing it back to Mickey.)

Amanda Ripley’s book “The Smartest Kids in the World: And How They Got That Way” had a similar observation about the role of parents in promoting academic success:

Coach parents … spent less time attending school events and more time training their children at home: reading to them, quizzing them on their multiplication tables while they were cooking dinner, and pushing them to try harder. They saw education as one of their jobs. This kind of parenting was typical in much of Asia — and among Asian immigrant parents living in the United States. Contrary to the stereotype, it did not necessarily make children miserable. In fact, children raised in this way in the United States tended not only to do better in school but to actually enjoy reading and school more than their Caucasian peers enrolled in the same schools.

Khan Academy’s founder, Salman Khan, writing in One World Schoolhouse, also found power in the idea of coaches:

Have you ever noticed that some kids tend to loathe and detest their teachers but worship and adore their coaches? … I believe that a big part of the reason kids revere and obey their coaches is that the coaches are specifically and explicitly on the student’s side. Coaches are helping them be the best they can be, so that they can experience the thrill of winning. In team sports, coaches inculcate the atavistic spirit and focus of a hunting clan. In individual sports, the coach stands tall as the main if not the only ally. When kids win, coaches celebrate along with them; when they lose, the coach is there to comfort and find a lesson in defeat.

“Hybrid Tiger” itself is shot through with the kind of inspirational aphorism familiar to anyone who follows Dwayne Johnson, better known as the Rock, on Facebook: “Happiness is always connected to competition,” and “In order to win, one must be able to withstand suffering.” Dr. Huang also lays this on us: “Here are two ancient stories all Chinese children know: A man, whose name was Sun Jing, tied his hair on the beam that ran through his house when he studied, so that he would wake painfully if he began to fall asleep while studying. Another man, whose name was Su Qin, jabbed his hip with a needle to keep himself awake while he studied.”

Can you think of the last time someone told you a story that made studying long and hard seem heroic?

Dr. Huang’s thoughtful book makes a persuasive argument that, in light of the demands of our current cutthroat global economy, American parents may do well to think of themselves as cognitive coaches for their kids. We should look at the homework spread across the dining room table playing field and say with all appropriate gusto: “Game on.”

Jennifer Arrow is a stay-at-home mom and freelance writer who blogs about preschooling, afterschooling and children’s literature at Post-Apocalyptic
Homeschool
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Raising a Moral Child

What does it take to be a good parent? We know some of the tricks for teaching kids to become high achievers. For example, research suggests that when parents praise effort rather than ability, children develop a stronger work ethic and become more motivated.

Yet although some parents live vicariously through their children’s accomplishments, success is not the No. 1 priority for most parents. We’re much more concerned about our children becoming kind, compassionate and helpful. Surveys reveal that in the United States, parents from European, Asian, Hispanic and African ethnic groups all place far greater importance on caring than achievement. These patterns hold around the world: When people in 50 countries were asked to report their guiding principles in life, the value that mattered most was not achievement, but caring.

Despite the significance that it holds in our lives, teaching children to care about others is no simple task. In an Israeli study of nearly 600 families, parents who valued kindness and compassion frequently failed to raise children who shared those values.

Are some children simply good-natured — or not? For the past decade, I’ve been studying the surprising success of people who frequently help others without any strings attached. As the father of two daughters and a son, I’ve become increasingly curious about how these generous tendencies develop.

Genetic twin studies suggest that anywhere from a quarter to more than halfof our propensity to be giving and caring is inherited. That leaves a lot of room for nurture, and the evidence on how parents raise kind and compassionate children flies in the face of what many of even the most well-intentioned parents do in praising good behavior, responding to bad behavior, and communicating their values.

By age 2, children experience some moral emotions — feelings triggered by right and wrong. To reinforce caring as the right behavior, research indicates, praise is more effective than rewards. Rewards run the risk of leading children to be kind only when a carrot is offered, whereas praise communicates that sharing is intrinsically worthwhile for its own sake. But what kind of praise should we give when our children show early signs of generosity?

Many parents believe it’s important to compliment the behavior, not the child — that way, the child learns to repeat the behavior. Indeed, I know one couple who are careful to say, “That was such a helpful thing to do,” instead of, “You’re a helpful person.”

But is that the right approach? In a clever experiment, the researchers Joan E. Grusec and Erica Redler set out to investigate what happens when we commend generous behavior versus generous character. After 7- and 8-year-olds won marbles and donated some to poor children, the experimenter remarked, “Gee, you shared quite a bit.”

The researchers randomly assigned the children to receive different types of praise. For some of the children, they praised the action: “It was good that you gave some of your marbles to those poor children. Yes, that was a nice and helpful thing to do.” For others, they praised the character behind the action: “I guess you’re the kind of person who likes to help others whenever you can. Yes, you are a very nice and helpful person.”

A couple of weeks later, when faced with more opportunities to give and share, the children were much more generous after their character had been praised than after their actions had been. Praising their character helped them internalize it as part of their identities. The children learned who they were from observing their own actions: I am a helpful person. This dovetails with new research led by the psychologist Christopher J. Bryan, who finds that for moral behaviors, nouns work better than verbs. To get 3- to 6-year-olds to help with a task, rather than inviting them “to help,” it was 22 to 29 percent more effective to encourage them to “be a helper.” Cheating was cut in half when instead of, “Please don’t cheat,” participants were told, “Please don’t be a cheater.” When our actions become a reflection of our character, we lean more heavily toward the moral and generous choices. Over time it can become part of us.

Praise appears to be particularly influential in the critical periods when children develop a stronger sense of identity. When the researchers Joan E. Grusec and Erica Redler praised the character of 5-year-olds, any benefits that may have emerged didn’t have a lasting impact: They may have been too young to internalize moral character as part of a stable sense of self. And by the time children turned 10, the differences between praising character and praising actions vanished: Both were effective. Tying generosity to character appears to matter most around age 8, when children may be starting to crystallize notions of identity.

Praise in response to good behavior may be half the battle, but our responses to bad behavior have consequences, too. When children cause harm, they typically feel one of two moral emotions: shame or guilt. Despite the common belief that these emotions are interchangeable, research led by the psychologist June Price Tangney reveals that they have very different causes and consequences.

Shame is the feeling that I am a bad person, whereas guilt is the feeling that I have done a bad thing. Shame is a negative judgment about the core self, which is devastating: Shame makes children feel small and worthless, and they respond either by lashing out at the target or escaping the situation altogether. In contrast, guilt is a negative judgment about an action, which can be repaired by good behavior. When children feel guilt, they tend to experience remorse and regret, empathize with the person they have harmed, and aim to make it right.

In one study spearheaded by the psychologist Karen Caplovitz Barrett, parents rated their toddlers’ tendencies to experience shame and guilt at home. The toddlers received a rag doll, and the leg fell off while they were playing with it alone. The shame-prone toddlers avoided the researcher and did not volunteer that they broke the doll. The guilt-prone toddlers were more likely to fix the doll, approach the experimenter, and explain what happened. The ashamed toddlers were avoiders; the guilty toddlers were amenders.

If we want our children to care about others, we need to teach them to feel guilt rather than shame when they misbehave. In a review of research on emotions and moral development, the psychologist Nancy Eisenberg suggests that shame emerges when parents express anger, withdraw their love, or try to assert their power through threats of punishment: Children may begin to believe that they are bad people. Fearing this effect, some parents fail to exercise discipline at all, which can hinder the development of strong moral standards.

The most effective response to bad behavior is to express disappointment. According to independent reviews by Professor Eisenberg and David R. Shaffer, parents raise caring children by expressing disappointment and explaining why the behavior was wrong, how it affected others, and how they can rectify the situation. This enables children to develop standards for judging their actions, feelings of empathy and responsibility for others, and asense of moral identity, which are conducive to becoming a helpful person. The beauty of expressing disappointment is that it communicates disapproval of the bad behavior, coupled with high expectations and the potential for improvement: “You’re a good person, even if you did a bad thing, and I know you can do better.”

As powerful as it is to criticize bad behavior and praise good character, raising a generous child involves more than waiting for opportunities to react to the actions of our children. As parents, we want to be proactive in communicating our values to our children. Yet many of us do this the wrong way.

In a classic experiment, the psychologist J. Philippe Rushton gave 140 elementary- and middle-school-age children tokens for winning a game, which they could keep entirely or donate some to a child in poverty. They first watched a teacher figure play the game either selfishly or generously, and then preach to them the value of taking, giving or neither. The adult’s influence was significant: Actions spoke louder than words. When the adult behaved selfishly, children followed suit. The words didn’t make much difference — children gave fewer tokens after observing the adult’s selfish actions, regardless of whether the adult verbally advocated selfishness or generosity. When the adult acted generously, students gave the same amount whether generosity was preached or not — they donated 85 percent more than the norm in both cases. When the adult preached selfishness, even after the adult acted generously, the students still gave 49 percent more than the norm. Children learn generosity not by listening to what their role models say, but by observing what they do.

To test whether these role-modeling effects persisted over time, two months later researchers observed the children playing the game again. Would the modeling or the preaching influence whether the children gave — and would they even remember it from two months earlier?

The most generous children were those who watched the teacher give but not say anything. Two months later, these children were 31 percent more generous than those who observed the same behavior but also heard it preached. The message from this research is loud and clear: If you don’t model generosity, preaching it may not help in the short run, and in the long run, preaching is less effective than giving while saying nothing at all.

People often believe that character causes action, but when it comes to producing moral children, we need to remember that action also shapes character. As the psychologist Karl Weick is fond of asking, “How can I know who I am until I see what I do? How can I know what I value until I see where I walk?”

Adam Grant is a professor of management and psychology at the Wharton School of the University of Pennsylvania and the author of “Give and Take: Why Helping Others Drives Our Success.”

I Refuse To Be Busy

The New York Times Motherlode Blog

If the road looks like this, it's time to slow down.If the road looks like this, it’s time to slow down.

I’m not busy.

Are you shocked? It feels almost wrong to say, in this moment when all my fellow parents reply to my “Hey, how’s it going?” with “Busy! Always busy!” and even fill in the same response for me: “How are you? Busy, I’m sure!”

But I’m not. I hate being busy. Busy implies a rushed sense of cheery urgency, a churning motion, a certain measure of impending chaos, all of which make me anxious. Busy is being in one place doing one thing with the nagging sense you that you ought to be somewhere else doing something different. I like to be calm. I like to have nothing in particular to do and nowhere in particular to be. And as often as I can — even when I’m dropping a child off here or there, or running an errand, or waving in the carpool line — I don’t think of myself as busy. I’m where I need to be, doing, for the most part, what I want to do.

I’ll throw in the necessary caveat that I am scarcely sitting around eating bonbons. (I’m not even sure I like bonbons.) I’m the working parent of four children. There are things going on, some days more than others, and there are things I need to do, many of which are not optional. But most of the time, “busy” is a choice, and it’s a choice I refuse to make.

We can’t control everything. For me, whether I go to meet with the school about one child’s Individualized Education Program is not a choice; taking another to the dentist is not a choice; dealing with my dented, rusting bumper is not a choice. But doing those things one a time, and not on a day with other deadlines or while trying to squeeze in one more meeting, email or phone call often is a choice. Not always, but often.

In her book “Overwhelmed,” Brigid Schulte looks at “Work, Love and Play When No One Has the Time.” As she writes, some of what makes us (particularly as parents) overwhelmed is outside of our immediate control. Most of us can’t choose to live in a country that doesn’t actively make it more difficult to be both caregiver and breadwinner. We cannot just pick paid family leave and sick days, or work hours that align with school hours, or readily available and affordable day care or a society that encourages real leisure from a menu. But while we collectively work toward change, most of us individually can make at least a few changes — starting with admitting that we choose how we spend at least some of our time, and we choose whether to feel “busy” or not.

We, as parents, choose some of what makes us “busy.” We choose Kumon. We choose the yoga class that’s just far enough from an after-violin-lesson pick up that it’s a rush every single time. We choose to let one child do swimming and the other soccer, on the same afternoon. We choose to add in the stop at the dry cleaner and the ATM. And maybe those choices make us feel rushed and unhappy, and maybe they don’t.

At some point during the past year, I looked at our “busy schedule” of two working parents; both with big volunteer commitments during different seasons; and four children with school, homework and three hockey teams among them (along with a few other assorted things), and I thought “this is what we wanted.” And I looked at a few other activities, and I thought “this, we can do without.” We had a lot going on this winter, but it was all good stuff. They choose to play hockey over other options, and we choose to support that, and are lucky we can. I choose my volunteer commitment, and so does my husband, and we say no to other things; not “no, I don’t have time,” but “no, that’s not how I choose to use my time.” The result doesn’t feel busy. It feels happy. It feels good. And it feels even better now that the season is over, and we’ve said no to the sports and activities that aren’t passions, and are looking ahead to the rest of the school year without a single scheduled afternoon of the week.

Maybe you love that yoga class so much that it’s worth the anxious will-I-be-there-on-time drive to pick-up (and maybe you could declare that you’ll be five minutes late every single week, and ask for help). Maybe your family is passionate about Kumon. Or maybe “busy” is the way you like to be, and if that’s the case, truly you should revel in it.

But busy isn’t for me. Busy leaves me with my shoulders pulled up tight to my ears, yelling about every little thing and driving too fast on a road I don’t even want to be on. Busy isn’t right for my children, who like to get good and deep into every activity from Lego building to some insane repetitive game they play in the space between the kitchen island and the family room involving a tennis ball on a string, and who need a lot of unstructured time in which to do those things. Busy isn’t right for my oldest, who is hovering between that tennis ball on a string game (which he invented) and teenage life, and who asked me a few weeks ago if I thought he should play lacrosse this spring.

“Do you love lacrosse?” Not like hockey, he said. It’s O.K. It’s fun.

I asked him: Lacrosse or hanging out with your best friend all afternoon? Lacrosse or helping to build the fence around the garden? Lacrosse or hiking out back and watching the waterfall finally melt? Lacrosse or — let’s be honest — re-reading Harry Potter for the 10th time, and lying on your back on the floor throwing a ball in the air and daydreaming? You can play lacrosse. But if you do, that’s three afternoons a week plus weekends, so be sure lacrosse is really what you want to do with that time.

It wasn’t. Which is good, because I’m choosing to build that fence around the garden, and I’m going to need his help.

Follow KJ Dell’Antonia on Twitter at @KJDellAntonia or find her on Facebook and Google+.

Secrets of the ADHD Brain

ADDitude

Most people are neurologically equipped to determine what’s important and get motivated to do it, even when it doesn’t interest them. Then there are the rest of us, who have attention deficit.

 

Learn the secrets of the ADHD brain

ADHDers know that they are bright and clever, but they are never sure whether their abilities will show up when they need them.

ADHD is a confusing, contradictory, inconsistent, and frustrating condition. It is overwhelming to people who live with it every day. The diagnostic criteria that have been used for the last 40 years leave many people wondering whether they have the condition or not. Diagnosticians have long lists of symptoms to sort through and check off. The Diagnostic and Statistical Manual of Mental Disorders has 18 criteria, and other symptom lists cite as many as 100 traits.

Practitioners, including myself, have been trying to establish a simpler, clearer way to understand the impairments of ADHD. We have been looking for the “bright and shining line” that defines the condition, explains the source of impairments, and gives direction as to what to do about it.

My work for the last decade suggests that we have been missing something important about the fundamental nature of ADHD. I went back to the experts on the condition — the hundreds of people and their families I worked with who were diagnosed with it — to confirm my hypothesis. My goal was to look for the feature that everyone with ADHD has, and that neurotypical people don’t have.

I found it. It is the ADHD nervous system, a unique and special creation that regulates attention and emotions in different ways than the nervous system in those without the condition.

The ADHD Zone

Almost every one of my patients and their families want to drop the term Attention Deficit Hyperactivity Disorder, because it describes the opposite of what they experience every moment of their lives. It is hard to call something a disorder when it imparts many positives. ADHD is not a damaged or defective nervous system. It is a nervous system that works well using its own set of rules. Despite ADHD’s association with learning disabilities, most people with an ADHD nervous system have significantly higher-than-average IQs. They also use that higher IQ in different ways than neurotypical people. By the time most people with the condition reach high school, they are able to tackle problems that stump everyone else, and can jump to solutions that no one else saw.

The vast majority of adults with an ADHD nervous system are not overtly hyperactive. They are hyperactive internally.

Those with the condition don’t have a shortage of attention. They pay too much attention to everything. Most people with unmedicated ADHD have four or five things going on in their minds at once. The hallmark of the ADHD nervous system is not attention deficit, but inconsistent attention.

Everyone with ADHD knows that they can “get in the zone” at least four or five times a day. When they are in the zone, they have no impairments, and the executive function deficits they may have had before entering the zone disappear. ADHDers know that they are bright and clever, but they are never sure whether their abilities will show up when they need them. The fact that symptoms and impairments come and go throughout the day is the defining trait of ADHD. It makes the condition mystifying and frustrating.

People with ADHD primarily get in the zone by being interested in, or intrigued by, what they are doing. I call it an interest-based nervous system. Judgmental friends and family see this as being unreliable or self-serving. When friends say, “You can do the things you like,” they are describing the essence of the ADHD nervous system.

ADHD individuals also get in the zone when they are challenged or thrown into a competitive environment. Sometimes a new or novel task attracts their attention. Novelty is short-lived, though, and everything gets old after a while.

Most people with an ADHD nervous system can engage in tasks and access their abilities when the task is urgent — a do-or-die deadline, for instance. This is why procrastination is an almost universal impairment in people with ADHD. They want to get their work done, but they can’t get started until the task becomes interesting, challenging, or urgent.

How the Rest of the World Functions

The 90 percent of non-ADHD people in the world are referred to as “neurotypical.” It is not that they are “normal” or better. Their neurology is accepted and endorsed by the world. For people with a neurotypical nervous system, being interested in the task, or challenged, or finding the task novel or urgent is helpful, but it is not a prerequisite for doing it.

Neurotypical people use three different factors to decide what to do, how to get started on it, and to stick with it until it is completed:

1. the concept of importance (they think they should get it done).

2. the concept of secondary importance–they are motivated by the fact that their parents, teacher, boss, or someone they respect thinks the task is important to tackle and to complete.

3. the concept of rewards for doing a task and consequences/punishments for not doing it.

A person with an ADHD nervous system has never been able to use the idea of importance or rewards to start and do a task. They know what’s important, they like rewards, and they don’t like punishment. But for them, the things that motivate the rest of the world are merely nags.

The inability to use importance and rewards to get motivated has a lifelong impact on ADHDers’ lives:

How can those diagnosed with the condition choose between multiple options if they can’t use the concepts of importance and financial rewards to motivate them?

How can they make major decisions if the concepts of importance and rewards are neither helpful in making a decision nor a motivation to do what they choose? This understanding explains why none of the cognitive and behavioral therapies used to manage ADHD symptoms have a lasting benefit. Researchers view ADHD as stemming from a defective or deficit-based nervous system. I see ADHD stemming from a nervous system that works perfectly well by its own set of rules. Unfortunately, it does not work by any of the rules or techniques taught and encouraged in a neurotypical world. That’s why:

ADDers do not fit in the standard school system, which is built on repeating what someone else thinks is important and relevant.

ADDers do not flourish in the standard job that pays people to work on what someone else (namely, the boss) thinks is important.

ADDers are disorganized, because just about every organizational system out there is built on two things — prioritization and time management — that ADDers do not do well.

ADDers have a hard time choosing between alternatives, because everything has the same lack of importance. To them, all of the alternatives look the same.

People with an ADHD nervous system know that, if they get engaged with a task, they can do it. Far from being damaged goods, people with an ADHD nervous system are bright and clever. The main problem is that they were given a neurotypical owner’s manual at birth. It works for everyone else, not for them.

Don’t Turn ADHDers into Neurotypicals

The implications of this new understanding are vast. The first thing to do is for coaches, doctors, and professionals to stop trying to turn ADHD people into neurotypical people. The goal should be to intervene as early as possible, before the ADHD individual has beenfrustrated and demoralized by struggling in a neurotypical world, where the deck is stacked against him. A therapeutic approach that has a chance of working, when nothing else has, should have two pieces:

Level the neurologic playing field with medication, so that the ADHD individual has the attention span, impulse control, and ability to be calm on the inside. For most people, this requires two different medications. Stimulants improve an ADHDer’s day-to-day performance, helping him get things done. They are not effective at calming the internal hyperarousal that many with ADHD have. For those symptoms, the majority of people will benefit by adding one of the alpha agonist medications (clonidine/Kapvay or guanfacine/Intuniv) to the stimulant.

Medication, though, is not enough. A person can take the right medication at the right dose, but nothing will change if he still approaches tasks with neurotypical strategies.

The second piece of ADHD symptom management is to have an individual create his own ADHD owner’s manual. The generic owner’s manuals that have been written have been disappointing for people with the condition. Like everyone else, those with ADHD grow and mature over time. What interests and challenges someone at seven years old will not interest and challenge him at 27.

Write Your Own Rules

The ADHD owner’s manual has to be based on current successes. How do you get in the zone now? Under what circumstances do you succeed and thrive in your current life? Rather than focus on where you fall short, you need to identify how you get into the zoneand function at remarkable levels.

I usually suggest that my patients carry around a notepad or a tape recorder for a month to write down or explain how they get in the zone.

Is it because they are intrigued? If so, what, specifically, in the task or situation intrigues them? Is it because they feel competitive? If so, what in the “opponent” or situation brings up the competitive juices?

At the end of the month, most people have compiled 50 or 60 different techniques that they know work for them. When called on to perform and become engaged, they now understand how their nervous system works and which techniques are helpful.

I have seen these strategies work for many ADDers, because they stepped back and figured out the triggers they need to pull. This approach does not try to change people with an ADHD nervous system into neurotypical people (as if that were possible), but gives lifelong help because it builds on their strengths.

Giving Good Praise To Girls: What Messages Stick

MindShift

  April 24, 2013

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How to praise kids: It’s a hot topic for many parents and educators. A lot of the conversation around it has stemmed from studies by Carol Dweck, professor of psychology at Stanford who has been researching this specific topic for many years.

“My research shows that praise for intelligence or ability backfires,” said Dweck, who co-authored a seminal research paper on the effects of praise on motivation and performance. “What we’ve shown is that when you praise someone, say, ‘You’re smart at this,’ the next time they struggle, they think they’re not. It’s really about praising the process they engage in, not how smart they are or how good they are at it, but taking on difficulty, trying many different strategies, sticking to it and achieving over time.”

But what some might not know is that this paradox is strongest for girls.

Dweck’s research, which focuses on what makes people seek challenging tasks, persist through difficulty and do well over time, has shown that many girls believe their abilities are fixed, that individuals are born with gifts and can’t change. Her research finds that when girls think this way, they often give up, rather than persisting through difficulties. They don’t think they possess the ability to improve, and nowhere is the phenomenon stronger than in math.

“Of all the subjects on earth, people think math is the most fixed,” Dweck said. “It’s a gift, you either have it or you don’t. And that it’s most indicative of your intelligence.” This attitude presents an especially sticky problem to educators working to boost girls’ interest and passion for science, technology, engineering and math – STEM subjects. For many boys, believing math is a fixed ability doesn’t hamper achievement — they just assume they have it, Dweck said. But girls don’t seem to possess that same confidence, and in their efforts to achieve perfection, Dweck’s research shows they shy away from subjects where they might fail.

[RELATED READING: Girls and Math: Busting the Stereotype]

“We have research showing that women who believe math is an acquired set of skills, not a gift you have or don’t have, fare very well,” Dweck said. “Even when they have a period of difficulty and even when they’re in an environment that they say is full of negative stereotyping.” This research suggests parents and educators should rethink what implicit and explicit messages are being sent to young girls about achievement.

If adults emphasize that all skills are learned through a process of engagement, value challenge and praise efforts to supersede frustration rather than only showing excitement over the right answer, girls will show resilience. It also might help to provide a roadmap to correct the gender imbalance that already exists in fields requiring math and science, jobs that often involve setbacks, “failing,” and overcoming challenges.

Dweck has found that socialization and beliefs about learning ability are developed at early ages. “Mother’s praise to their babies, one to three years of age, predicts that child’s mindset and desire for challenge five years later,” Dweck said. “It doesn’t mean it is set in stone, but it means that kind of value system — what you’re praising, what you say is important — it’s sinking in. And the kids who are getting this process praise, strategy and taking on hard things and sticking to them, those are the kids who want the challenge.”

Dweck understands it isn’t easy to praise process and emphasize the fun in challenging situations. Kids like direct praise, but to Dweck lauding achievement is like feeding them junk food – it’s bad for them.

[RELATED READING: How Important is Grit in Student Achievement?]

An implicit argument here is that failure in small doses is good. Dweck’s not the first person to make that argument; advocates of game-based learning say one of its strongest attributes lies in a player’s ability to fail and start over without being stigmatized. Students learn as they go, getting better each time they attempt a task in the game. But the current education system leaves little room for failure, and consequently anxious parents often don’t tolerate small setbacks either.

“If you have little failures along the way and have them understand that’s part of learning, and that you can actually derive useful information about what to do next, that’s really useful,” Dweck said.

She believes families should sit around the dinner table discussing the day’s struggles and new strategies for attacking the problem. In life no one can be perfect, and learning to view little failures as learning experiences, or opportunities to grow could be the most valuable lesson of all.

3 Next Steps Fro Developing Girls’ Leadership

Edutopia

MARCH 18, 2014

Photo credit: Thinkstock

During the month of March, in many educational settings, women’s history is addressed. Images of famous female leaders are pulled out to decorate walls; special assemblies are held; picture books are read; girl power is acknowledged and celebrated. This is all good, but there are some next steps that educators (both men and women) need to take if we’re going to truly empower girls and set them up for leadership roles. We need to offer expanded definitions of leadership, take on the “Lean In” vs. “Recline” debate, and walk the talk.

#1 Explore Definitions of Leadership

It wasn’t until I read Susan Cain’s masterpiece about introverts, Quiet, that I truly recognized and embraced myself as a leader. I’d been schooled on a traditional definition of leadership: a skilled and charismatic orator who immerses himself with the people. Cain’s book propelled me into deep reflections about what it means to be a leader, about how introverts exert leadership, and of the different terrains and domains in which we exercise leadership.

Leadership is not about the role you’re in — it’s about the stance you take and the way you feel and the actions you take in any number of moments. It’s not only about being able to speak to thousands and lead them somewhere. In fact, leadership may be about the opposite, about guiding others to find their own paths, discover their own power, and speak their own truths.

When we limit our definitions of leadership, we limit possibilities. Ask a twelve-year-old girl to name a leader she admires. I bet she’ll name a known figure, if she names anyone at all. If we don’t learn to recognize the leadership that surrounds us, that exists within our own families and communities, we lose credibility when we tell girls that they can be leaders because the number of female leaders that they know will be few.

And so this month, whether with the girls in your class or in your families, explore these ideas together:

  • What does it mean to be a leader?
  • Why is leadership important?
  • What qualities must a leader have?
  • What kinds of leadership qualities do you admire, respect, and want to emulate?
  • In what ways do you take leadership everyday?
  • How can you take leadership?

#2 To “Lean In” or “Recline”?

Any discussion of women and leadership needs to explore the debate between Sheryl Sandberg’s injunction that women need to Lead In and Rosa Brooks’ recently published response urging women to “Recline: Why ‘Leaning In’ Is Killing Us”. (Anne-Marie Slaughter’s “Why Women Still Can’t Have It All” was an earlier challenge to Sandberg and is worth reading.) Brooks’ article struck a chord in me and reminded me of my commitment to slow down, as I describedin this blog.

At the core of these arguments is a discussion about what it means to be a woman and how we chose to show up in the world. These are discussion that have been going on for a millennia and that deserve to be taken up with our young girls and boys.

#3 Walk the Talk

The messages we send to girls are confusing. We tell them, “You can be anything you want!” but then what do we show them? What do they see? This leads me to my third next step if we want to develop leadership in girls.

Women (and men, too) are going to have to do some hard thinking and talking and decision-making if we’re going to develop our daughters and female students into leaders. Once we decide whether we’re going to lean in or recline, (or do a little of both), once we’re clear on our values and options, then we need to walk the talk. That means women might need to lean in to some places and men might need to step down and make space. In classrooms, schools, central offices, and so on, in traditional seats of power, men still hold far more positions. At home, who does the majority of the cooking and cleaning? We can start to make dents in structures when at the very least we discuss what’s happening and why things are the way they are. We can start to remove the notion that this is just “natural.” And perhaps we can start to make little changes here and there.

March offers an opportunity for us to expand definitions and challenge traditional concepts about leadership, explore what it means to be a woman and the various roles and ways in which we express that identity, and finally, to do something different. In order for girls to feel empowered to explore the domain of leadership, they’ll need to engage in many of these conversations and explorations. And as we guide our girls in these, we demonstrate our leadership.

Doctor: ADHD Does Not Exist

Time

Dr. Richard Saul

March 14, 2014

Adderall
Getty Images

Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children — and now adults — who can’t live without stimulants is no solution

This Wednesday, an article in the New York Timesreported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.

If someone finds it difficult to pay attention or feels somewhat hyperactive, attention-deficit/hyperactivity disorder has those symptoms right there in its name. It’s an easy catchall phrase that saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. What I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.

Allow me to explain what I mean.

Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the DSM changed the label numerous times, from hyperkinetic reaction of childhood (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition) to the current label, ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.

Today, the fifth edition of the DSM only requires one to exhibit five of 18 possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list, look it up. It will probably bother you. How many of us can claim that we have difficulty with organization or a tendency to lose things; that we are frequently forgetful or distracted or fail to pay close attention to details? Under these subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts they’re a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive-compulsive disorder and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

What’s so bad about stimulants? you might wonder. They seem to help a lot of people, don’t they? The article in theTimes mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.

First, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; Big Pharma is understandably not as concerned.

Second, there are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are also consequences that are even less well known. For example, many patients on stimulants report having erectile dysfunction when they are on the medication.

Third, stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living over the long term.

For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.

It’s time to rethink our understanding of this condition, offer more thorough diagnostic work and help people get the right treatment for attention deficit and hyperactivity.

Dr. Richard Saul is a behavioral neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is p