Differences versus deficits

Pediatrics for Parents, April, 2004 by Michael K. Meyerhoff

Last semester I had a noteworthy student in the human development class I teach at a local college. During class this young man would fidget constantly in his seat. Whenever he had a question he would blurt it out without bothering to first raise his hand and wait to be recognized. If another student was making a comment and he had something to say about it, he usually would jump right in even before his classmate was completely finished.

About three weeks into the semester, he approached me after class and said rather sheepishly, "You'll have to forgive me, I'm ADHD [Attention Deficit Hyperactivity Disorder]."

I looked him in file eye, smiled, and calmly replied, "You are not ADHD--you are a pain In the butt."

The fact of the matter is that a lot of people are occasional pains in the butt for many reasons. Sure, this young man's behavior was problematical now and then, but he was a good kid--quite bright and very personable--and he was essentially well liked by his professor and his peers. And though there were times when his outbursts were somewhat disruptive, they were never devastatingly so. I just didn't see a compelling need for his periodically annoying antics to result in him being labeled diseased, disabled, defective, or disordered In any way. And I certainly didn't see a need for him to be removed from the class and/or medicated.

As I had been teaching In my class and would continue to teach, human development Is not a neat and orderly affair. Every Individual has his or her own unique rate and pattern of development, every individual has his or her own unique learning style, and every individual has his or her own unique collection of personality and behavioral characteristics. Like snowflakes, sunsets, and other miracles of nature, no two human beings are ever exactly alike.

Unfortunately, our present-day public school system and our modern society in general tend not to respect this fundamental principle of human development. It seems as if there is a growing trend to use standardized curricula, standardized tests, standardized procedures. and standardized everything else. And it seems as if the standards are becoming more narrow mad rigid. Furthermore, any deviation from these standards now results in some kind of label being applied, followed by the administration of drugs and/or placement in a special program. Woe to any individual who happens to fall outside the little box.

As I've indicated in previous columns (see Volume 19 Number 3 and Volume 20 Number 7), this trend has resulted in "Attention Deficit Hyperactivity Disorder" and "Learning Disabilities" reaching virtually epidemic status. And it is clear to me--and it should be clear to anyone with a knowledge of human development--that the epidemics are largely the result of drastic and widespread changes In expectations rather than massive and multitudinous changes in the behavior and performance of children. By narrowing the definition of "normal" we have turned what used to be mere "differences" ha development Into developmental "deficits," and we consequently have created a slew of "problems" that previously were non-existent.

Sometimes there is a simple lack of knowledge involved. For example, I recently saw a set of guidelines suggesting that a child who was not yet speaking by 18 months of age should be labeled has having an "Early Expressive Language Delay." However, specialists in human development have long recognized that the true normal range for the onset of expressive language extends all the way up to the second birthday. Many children who eventually exhibit superb language skills do not say much prior to 23 or 24 months of age--at which time they often begin speaking in complete sentences. To label a child as "delayed" at 18 months may be reflective of attitudes in our competitive present-day society, but it is inaccurate, unfair, and not particularly productive.

Sometimes it is a lack of tolerance that is Involved. For example, several decades ago I was working In a program for autistic children. Back then, "Autism" was a diagnosis for kids who made no eye contact, could not speak, and spent the entire day rocking back and forth lost in their own private world. Although there were degrees of the disease, the Dustin Hoffman character in the movie "Rain Man" would have been considered at the outer limits of the diagnosis.

Today we have "Autistic Spectrum Disorders" and spin-offs such as "Asperger's Syndrome." Children diagnosed with one of the more "mild" forms of this "disease" are typically quite functional but not quite "normal." These are the kids we used to think of as a bit strange, weird, odd, etc.--but we never considered referring to them as diseased, defective, disabled, or disordered.

What is behind this alarming trend? In my opinion, it stems from tight finances and family comfort. On one hand, standardization is a very Inexpensive route to take. Requiring everyone to do everything at the same time and in the same way eliminates the need for keeping the number of students in the classroom small enough so that every child gets the individual attention he or she needs and deserves. On the other hand, once the little box has been created, it is unsettling for a child's parents when their offspring falls outside and Is perceived as problematical. Under these circumstances, especially in our competitive modern society in which mothers and fathers are constantly comparing their child's performance and progress to that of other children, it is nice to have some kind of disease, disability, defect, or disorder--a convenient demon--upon which to place the blame when their kid is designated as "delayed" or "different."