“Boys will be boys,” the old saying goes, but have we forgotten today that tumultuous, moody, energetic and occasionally contrary behavior is natural for boys? Are we at risk of turning boyhood itself into a pathological disorder? Author and psychologist Anthony Rao, Ph.D., thinks that in many ways we are. In his new book, The Way With Boys: Raising Healthy Boys In a Challenging and Complex World, Dr. Rao explores what it means to be a boy. He delves into the unique behavioral and developmental characteristics of boyhood, and explains how, in his view, the behavioral health profession, parents and schools may have become too quick to diagnose and medicate for behavior that, while certainly disorderly at times, is not a disorder.

“Boys are diagnosed two, three, sometimes four times more frequently than girls with ADHD, and it has become one of the most common pediatric problems in the United States,” Dr. Rao says. “Those diagnoses have quadrupled over a recent ten-year period, from 1987. Along with that, we’re seeing in more and more boys diagnoses of bipolar disorder, which has increased 4,000 percent in all youth in the United States from 1994 onward. And we’re also looking at more serious medications such as anti-psychotics — a 600-percent increase since 1993.”

Boys are From Mars, Girls Are From Venus

The trend alarms Dr. Rao, who feels that we may be guilty of expecting a standard of behavior from boys that is simply not possible due to the unique nature of their development. “If we look from the very beginning of their lives, there are three really big things that they don’t do as well as girls, and I think it gets them in trouble with early education,” Dr. Rao explains. “One of them is they don’t make as much eye contact. We look at eyes in order to read facial cues, so right there is a problem that later on is going to become very important when they’re asked to sit and look up and pay attention when they get to preschool or kindergarten or first grade. They also don’t hear as well. Girls have better hearing acuity in a range that’s particularly important for speech discrimination. So by the time boys and girls are around 18 months, girls have about twice the vocabulary that boys do. [And] motor activity — boys are just more motorically active. They move more and they explore more. They’re hands-on. So their learning is really quite different.”

While in the past this was considered normal and expected behavior from boys, today, with our earlier emphasis on teaching reading and writing, combined with the educational system’s increasing reliance on standardized testing, boys are being asked to perfect abilities that many simply aren’t capable of at that age — at least not with the same level of proficiency as girls. “When these little guys hit, say, preschool, kindergarten and first grade, they’re already about a year behind in some of their speech and language compared to girls,” he explains. “They’re more visual and spatially oriented. That’s what they are better at. But they’re being asked to sit longer and longer hours and they’re beginning to be tested more and more for early preparation around reading and writing, which is something pretty new in the last few years.”

Quick Results But Longterm Effects

Dr. Rao emphasizes that he is not against medication when warranted, but fears that our healthcare system, with its emphasis on quick results, may have pushed the pendulum too far in that direction, when more traditional behavioral therapies may offer a better chance at resolving issues with fewer long-term side effects or internalized stigmatization. “A pill suggests to a kid that there’s something wrong with your brain. That you have a disorder and this is something that corrects it,” he says. “That message is difficult for a kid who’s growing up and needs to gain confidence to be able to do things on his own later on.”

Additionally, Dr. Rao is concerned that within that message is a suggestion to impressionable young minds that when things get tough in life, drugs are the answer. He feels that’s a dangerous notion at a time when drug abuse is rampant in our society. “There’s something a lot of people don’t know, and that’s that psychostimulants work on everyone. You don’t have to have ADHD or to have a diagnosis in order to see improvement if you were to take the same medication. It works on everybody,” he says. “We now have a longer term consequence of pumping a lot of this medication into the population of the United States. A lot of kids in college, a lot of kids even in high school, are selling these pills to each other or using them recreationally. And they’re very, very dangerous! Grinding up, say, Ritalin or, say, one of these psychostimulants and snorting it is chemically equivalent to cocaine. And it’s something that the DEA now is actually looking at and is very, very worried about.”

In his own practice, Dr. Rao believes in making cognitive behavioral therapy (CBT) his first-line treatment modality in most cases, turning to medication only when necessary to help the therapy along or for patients who are not amenable to CBT. When children are very young, he directs his therapy mostly to parents. “I use behavioral techniques with parents of children who are seven, eight and younger, but those are very simple techniques of, ‘Hey, let’s look at your parenting strategies. Let’s look at how you reward, how you discipline, how consistent you are throughout the day. How do you handle transitions? How do you understand the development of your child?’

For older children, Dr. Rao finds that CBT techniques are often effective at creating long-lasting change without drugs. “If we look at kids that are older — maybe ten, eleven, twelve and up — we’re able to do more one-on-one, more of what is called cognitive therapy. Which is, ‘Let’s look at how you see the world, how you see yourself.’ The ability to stop and say, ‘Hmm, maybe I’m not making the best choices for myself,’ or, “I tend to distort how I see things this way and that makes me feel depressed or less likely to engage socially with my peers.’ So, in the office, we’ll do some activities around that and we’ll even practice with kids, for example, who have anxiety or phobias, on how to address those fears directly. We find that when people expose themselves to the things they’re afraid of, in safe, stepped and very careful ways, they end up proving to their own brain that there’s nothing to be afraid of.”

Diagnosing for Dollars

If we truly do have a problem with over-diagnosing, over-medicating, and essentially over-pathologizing natural childhood behavior, particularly for boys, Dr. Rao feels the nature of our contemporary healthcare system, with managed care’s emphasis on quick results, may have a lot to do with it. In particular, he cites the very nature of our healthcare reimbursement system, where in order to be considered for payment, claims have to include a diagnosis code. “We all know that we need to give a diagnosis every time. Otherwise, there’s no reimbursement,” he says of behavioral healthcare professionals. “So we’re forced into categories. But if every kid who goes for help, even if to rule something out, ends up with a psychiatric diagnosis, to me that’s not good. That’s more about bureaucracy, not the accuracy of trying to figure out what’s best for that kid or that parent or that school.” (…)

 

Source: Behavioral Health Central – http://tinyurl.com/yaj628e