Hi, I’m Dr. Thomas Armstrong. This is part 6 of my 12-part video series on The Myth of the ADHD Child. This video is entitled ‘’Is It ADHD, or All-Boy Behavior?’’
Let me preface this presentation by saying that I DO believe that ADHD symptoms exist. But I believe after 50 years of studying this issue, that the hypothesis that there is a specific medical disorder called ADHD causing these symptoms is wrong and that there are many other points of view that can account for these symptoms. In part 1 of this video series, I explain why I call ADHD a myth. In this video, I look at ADHD from the standpoint of normal gender differences.
First, some statistics. Almost 13% of males will be diagnosed with ADHD sometime during their lives compared with less than 5% of girls. Right away, this should get people thinking, why are so many boys diagnosed with ADHD? The explanation usually given is that girls are underdiagnosed, often because they have the ‘’quieter version’’ of ADHD, displaying what are called internalizing behaviors such as forgetfulness, daydreaming, and lack of organization.
But even with this explanation it seems curious to see such a wide disparity in diagnoses between boys and girls. I’m going to suggest in this video that there are more boys than girls labeled ADHD because normal male behavior is often confused with the symptoms of ADHD, that what used to be called ‘’all-boy behavior’’ is now pathologized and seen as symptomatic of attention deficit hyperactivity disorder.
Let’s look at normal gender differences between boys and girls at play. Keep in mind that I’m speaking generally, and that there are plenty of girls who play in ways similar to boys and boys who play in ways that girls do. But on average these distinctions that I’m going to outline apply to each gender. Research suggests, for example, that boys tend to change activities more often than girls.
You probably notice this in your own household. Who changes channels the most when watching television – the males or the females? A boy’s attention span moves more quickly at least as far as it’s observed by his outer behaviors.
Girls on the other hand, tend to stay with one activity for a longer period of time.
It was a girl, for example, that caught Maria Montessori’s attention one day when she was totally absorbed in the task of working with Montessori’s famous materials. Regardless of outer stimuli, the girl kept on playing. At one point she even picked the girl up and moved her with her materials to another part of the room and still she continued to play. You can read about this in Montessori’s book The Secret of Childhood.
Boys tend to play more with vehicles and weapons.
This shouldn’t come as a surprise to anyone who has observed boys at play. They love monster sports cars and trucks and demolition derbies and crashing things together. Lots of action and movement and excitement.
Girls on the other hand generally prefer playing with dolls and domestic toys.
This is a quieter less disruptive form of play. For the most part, you don’t see girls smashing two dolls against each other, or having dolls race each other across the floor.
As the previous examples demonstrated, boys play more actively, more physically.
They may prefer playing outdoors where there is more space and more permission to act physically. And, by the way, by ‘’play’’ I don’t mean competitive sports like soccer, but the free play that kids engage in spontaneously when they have the chance (andI should say parenthetically that they have less and less opportunity to play like this in today’s technologically-supercharged society).
Girls tend to play more verbally and domestically.
Here [slide 15] is a girl applying lipstick to another girl. Girls also like to play dress-up, play house, play with miniature dolls in doll houses and the like. Keep in mind that there’s a lot of gender stereotyping that goes on in our culture accounting for these differences, in spite of our trying to change these fixed beliefs about gender differences. I’m not saying that these differences are okay, or that we shouldn’t do something about them. I’m just pointing out that the research suggests that when in free play situations boys tend to play differently from girls.
Just as the image you see [slide 16] makes plain, boys tend to hit, trip, and push each other in playful ways four times more often than girls when they are engaged in play situations.
This is called ‘’rough-and-tumble play, ’’ it’s a good thing, and unfortunately, it’s not nearly as common as it used to be in our culture. One neuroscientist, Jaak Panksepp suggests that the decline of rough-and-tumble play in our culture is tied to the rise in the incidence of ADHD.
Girls on the other hand, tend to spend more time engaged in play activities that involve nurturing and kindness.
Here [slide 19] you see girls helping each other as they engage in a play scenario.
Finally, boys tend to respond more to non-verbal sounds.
Boys, for example, are more likely to be drawn to the window in a preschool or kindergarten if a fire engine goes racing down the street.
Girls, on the other hand, are more likely to respond to verbal sounds, like the classroom teacher’s voice.
So, when you look at this list [slide 24], who would you say the average preschool, kindergarten, or elementary school classroom is set up for? Girls who stick with one activity longer, enjoy sharing nurturing behaviors, and relate to others more frequently through verbal interactions? Or boys who like to change activities more often, engage in rough-and-tumble play, and interact with vehicles and weapons? I think you can see how the typical primary or elementary school classroom favors girls over boys. And that may go a long way toward explaining why there are three times as many boys identified as ADHD as girls.
When we look at brain development, these differences become easier to understand. Here [slide 25] you see in the bottom graph the volume of gray matter in the brains of boys and girls from age 4 to age 22. The arc for the boys is in black and you can see that the arc is quite a bit higher in terms of brain volume than the girls. Now when it comes to brain volume, less actually means more. In early development the brain goes through a process of ‘’pruning’’ or eliminating of excess synaptic connections between brain cells. These connections send signals throughout the brain. This pruning results in a more efficient and productive brain. So, girls, according to this graph, are showing they have more efficient brains than boys starting fairly early in life.
Now think about this brain maturation of girls in terms of emotional self-control or the ability to restrain one’s impulses (remember that impulsivity is one of the three cardinal symptoms of ADHD). You can see [slide 26] that girls’ impulse control is consistently higher than boys from ages 10 to 25. And notice the yellow circles. They suggest that the impulse control of a young man at age 24-25 is equal to that of a girl at age 10-11. Pretty mind blowing, eh?
Now, juxtapose all that we’ve been saying so far, with statistics on the number of females versus males in preschool and primary school. As you can see [slide 27], there’s an overwhelmingly percentage of female teachers in these classrooms. Females with their own behavior expectations based on their particular female perspectives. By high school, there’s more of a parity between males and females and then more men teachers at the university level. But in the early grades, when kids’ attitudes are being formed, and when most kids get identified as having ADHD, it’s overwhelmingly female teachers who are making the phone call to the parent about problem behavior, which can lead to a referral to a doctor who then diagnoses ADHD and prescribes Adderall or some other drug. The system seems to be stacked against normal male behavior.
Research also suggests that mothers are by far more involved in the process of taking their child to the physician, getting the ADHD diagnosis, and then advocating for appropriate ADHD interventions for their child. Fathers tend to be what one study called “reluctant believers” or “tolerant nonbelievers’’ and tend to be absent from the research and clinical literature on ADHD. So again, we’re seeing females as the primary movers and shakers in terms of getting their male children diagnosed with ADHD.
I want to conclude with these words from Pulitzer Prize winning New York Times reporter Natalie Angier, who wrote in the New York Times: ‘’Today, the world is no longer safe for boys. A boy being a shade too boyish risks finding himself under the scrutiny of parents, teachers, guidance counselors, child therapists — all of them on watch for the early glimmerings of a medical syndrome, a bona fide behavioral disorder . . . Is he fidgety, impulsive, disruptive, easily bored? Perhaps he is suffering from attention-deficit hyperactivity disorder, or ADHD, the disease of the hour and the most frequently diagnosed behavioral disorder of childhood.’’
How many boys would lose their ADHD diagnosis overnight if they were just regarded as behaving according to the old dictum: ‘’boys will be boys?’’
For more information about gender differences and ADHD, and other themes of this video series, see my book The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span without Drugs, Labels, or Coercion. It’s available through online stores like Amazon, national chains like Barnes and Noble, and independent bookstores worldwide. It’s also available as an audio recording on Audible. See also my book for K-12 educators: ADD/ADHD Alternatives in the Classroom. And make sure to watch my other videos in this series on You Tube. Thanks so much!
This blog post was brought to you by Thomas Armstrong, Ph.D. and www.institute4learning.com.
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