What is normal?

back to normal book cover imageThere is a new book that parents of boys might be interested in: Back to Normal: Why Ordinary Childhood Behavior is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder by Enrico Gnaulati. I learned about this book from a NPR interview in which Dr. Gnaulati said that many of the problems that he saw were based on normal boy behavior, which had been mistaken for pathology. Don’t get me wrong, there are plenty of children with these devastating disorders, but there are more who are misdiagnosed because, as I have said for years and as Dr. Gnaulti now confirms, many mental health professionals do not understand normal growth and development of children, particularly of boys.

Every year, in my introductory Psychology class, I read the diagnostic behaviors for Attention-Deficit/Hyperactivity Disorder to my students and ask if they think that a person with those symptoms would have a hard time doing well in school. They usually agree until I point out that I have many of those symptoms, enough to qualify me for a diagnosis. What makes me different is that I have good verbal skills and I’ve acquired techniques to help me deal with some of the behaviors that interfere with schoolwork. For example, I have trouble remembering what I hear – great memory for what I do or see, just not what I hear – so I learned to take verbatim notes in class and then type up the notes later. If I were a student in primary school today, I’d bet that my inability to sit still, my predilection for blurting out answers as well as questions that don’t seem connected to the topic, and my disorganized backpack would at least put me on the list for children to be tested.

It’s absurd that simply being male should put a child at risk for all sorts of mental disorders.  Among them are those now listed in the DSM-V (the new version of the book that psychological professionals use to diagnose mental disorders) under the heading of “Disruptive, Impulse-Control, and Conduct Disorders.” Some of these disorders are frightening and are correlated with behavior that is illegal, like fire setting. It’s difficult to point the finger at anyone, but Dr. Gnaulti believes that some of the reasons that have led to an environment that moves normal boy behavior into criminal behavior are rooted in poor training – both for psychologists and for teachers – in normal development, and a pharmacological approach to treatment.

Teachers know that the most effective treatments for most children identified with ADHD are behavioral approaches that are classroom-based. The problem is that teachers don’t have the time or support to institute these strategies. It’s easier simply to give a child a pill, but the pill does not solve the problem or give the child strategies with which he can manage his own behavior. He is “sick” with this disorder. Boys who have teachers with the skills and time to teach the child how to access the classroom on the child’s level are neither sick nor disabled.  They are simply students who learn in different ways.

I’m not sure what you as parents can do other than point out to teachers and schools this information. The problem is that the professional educators who are not trained in psychological treatment follow the guidelines of the professionals in that area. Compounding this situation is that few psychological professionals have ever been in a school or have any understanding of what happens in a classroom. They teach at the university level and do not understand that teaching children whose bodies and brains are still developing is entirely different from teaching adults who are fully formed.

At least there are a few folks out there who get the point. Dr. Gnaulati, thanks so much.