During a meeting with the mother of a preschooler she received a call on her cellphone. Looking worried, she recognized the number as that of the director of her son’s school and immediately assumed this meant something bad had happened. She explained that her son had been having difficulties with impulse control and questions were being raised about attention and hyperactivity disorder.
Such concerns have been raised with increasing frequency in recent years. Has there really been an increase in these disorders or are there other factors leading to an increase in the diagnosis being made?
In fact, there is a large subjective element in this diagnosis. When does active become hyperactive? When does a high activity level, or restlessness, become an attention deficit? What is the tolerance level of a particular parent or teacher? What are the expectations for behavior of the children about whom there is concern?
While it is important to acknowledge that there are children who are clearly having a hard time managing their bodies or their behavior and do not seem able to meet appropriate expectations, there are numerous factors that have blurred the answer to the questions raised above.
One factor, is the pressure on teachers to meet designated requirements in their classrooms for achievement standards that ultimately relate to funding for schools and often to their own personal advancement as well. Large classes make individual attention difficult and this leads to a greater demand for compliance and conformity.
Another factor is that in recent years children attend groups at younger ages. Once children are in a group — no matter how young they are — there is a tendency for adults to think of them as being in school. Judgments are often made of their behavior in relation to expectations that exist for appropriate school behavior. But functioning in a group requires skills that young children have not yet developed or are still developing, like impulse control, frustration tolerance, separating from caregivers, turn-taking, and most of all acquiring language with which to express needs and feelings.
The development of these skills is a process that takes place over time and proceeds at a different pace for different children. As a consequence, not all children of the same chronological age are at the same place in their development. Unfortunately, this fact of a developmental range within any group of children has been lost, creating misleading adult expectations for behavior.
Particularly when it comes to activity level there is great variation in young children. Motor activity plays an important role in the early years as children gain increasing mastery of their bodies and of their environment. Sitting at attention in a circle or at a table or desk can be very challenging for some children. As they go forward in school, this may become a significant factor in their readiness to attend in the manner a teacher may require or wish for. It is here that a teacher’s ability to allow for such variation plays an important role.
Variations in development in the context of school expectations is challenging for parents as well as children. Professional and work commitments for mothers as well as fathers have led to a greater reliance on early group child care and school-based programs. The existence of early intervention while desirable, has also led to a focus on disorders with fewer resources within classrooms to deal with individual differences in children that may require more individualized attention.
Bumps on the developmental path are not what you expect when you are expecting, making unexpected demands of, and creating stress for parents.
— Elaine Heffner, LCSW, Ed.D., has written for Parents Magazine, Fox.com, Redbook, Disney online and PBS Parents, as well as other publications. She has appeared on PBS, ABC, Fox TV and other networks. Dr. Heffner is the author of “Goodenoughmothering: The Best of the Blog,” as well as “Mothering: The Emotional Experience of Motherhood after Freud and Feminism.” She is a psychotherapist and parent educator in private practice, as well as a senior lecturer of education in psychiatry at Weill Cornell Medical College. Dr. Heffner was a co-founder and served as director of the Nursery School Treatment Center at Payne Whitney Clinic, New York Hospital. And she blogs at goodenoughmothering.com.