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As I first meet Michael Sturdevant, he has just turned 8 and is in the 2nd grade at Commoner School, a public school in his neighborhood. His parents, Jon and Marci, have called me in the state of stunned anxiety parents enter when they've been told for the first time: "There's something wrong." Midway through the school year, Michael's teacher called them in for a conference; they were further disturbed to learn that she had asked the school psychologist to observe him without their knowledge. Such informal observation doesn't require parents' permission, but it bothered them.

I quickly learn the basics about Michael's school environment: It's fairly typical of grade schools today. There are 32 children in his class. The teacher, Mrs. Gray, has taught at the elementary level for 10 years. She works alone in the classroom without an aide. When she first started teaching, she had about 25 children in her classes and a part-time paraprofessional helping her. Both the physical arrangement of her classroom and her teaching style have changed over the years, reflecting new educational theories. The children's desks and chairs are no longer in parallel rows, nor is the teacher's desk at the front of the class. Indeed, there is no front or back in this classroom, a wedge-shaped arc in a circular building where all the classrooms open to a central community area. The desks and chairs are arranged in "pods," clusters of four desks placed throughout the room. The teacher keeps her materials at several "stations" in the room.

The chief goal of this physical arrangement is to encourage cooperative learning between the children; according to this theory, children can learn best when they interact with and help one another. It also allows Mrs. Gray to teach from several points in the room so that no one group of children has the "favored" position of being nearest the teacher all the time. Mrs. Gray's curriculum guides discourage a didactic approach to teaching. Instead of primarily talking or writing on the chalkboard, she is encouraged to emphasize "experiential" learning, in which the children can leave their seats to "experience," touch, play, and work with what's being taught. This approach is supposed to make learning more fun and effective.

However, Mrs. Gray's curriculum and the school principal also make it clear that certain subjects must be taught and standards of performance met by the children. Such standards reflect the belief that children can learn more at an earlier age, as well as the pressure on educators to get "back to basics" and produce "results" (i.e., improve students' performance on standardized tests). Homework is encouraged: Mrs. Gray regularly assigns her class 20 minutes of homework on weekday nights. Some school authorities have concluded that even children in kindergarten should be given some homework to prepare them for more rigorous assignments to follow and to get their families into the habit of overseeing the homework.

The combination of a flexible classroom along with more-rigid academic requirements has created a double whammy for Michael. At the conference with Jon and Marci, Mrs. Gray noted that Michael was having trouble staying on task with many of his academic assignments. He would talk to his podmates, sometimes disturbing them. If they refused to talk or play with him, he might distract himself with his pencils or doodle. During class discussion, "when he isn't fooling around," she related, "Michael has trouble waiting his turn. He'll blurt out an answer or wave his hand and get so excited and impatient that I feel compelled to call on him."

He seemed bright enough, Mrs. Gray thought, and when she would quiz him individually or insist that he finish his work-which required frequent monitoring on her part-the final product was quite good. Michael had some friends among the boys, but many of the children, especially the girls, gave him a wide berth, especially on the playground. During lunch recess, there were 150 children outside with two parent volunteers on yard duty. Michael would race around the yard in chase games with his buddies and get "benched" on a regular basis when his activity level became too much for another child or the adults.

In conclusion, Mrs. Gray told Jon and Marci that she thought Michael might "have" ADD. She knew children in some of her previous classes who had been diagnosed with the condition and had seen Ritalin's positive effects on their focusing ability and self-control. Two other boys in her class were taking Ritalin, she told them, and on the days when they "forgot" to take their pills, she could tell the difference in their behavior almost immediately. She was pretty sure Michael had ADD, which was why she'd had the school psychologist observe him. The psychologist concurred, and both recommended that Michael be "tested" for an official diagnosis. His pediatrician had referred the family to me.

Sandy-haired and blue-eyed, Michael acted like a friendly, happy child in my office. He seemed almost too comfortable in this new setting, sprawling on the stuffed chair, sometimes strolling around as we chatted. (And he could chat!) He talked to me about Bill Clinton and the Goosebumps books, which he really liked. (Not bad, I thought, for a kid supposed to have reading problems.) He changed topics almost too quickly to follow and rattled off a rapid-fire list of reminders he'd been taught for controlling his temper at school: "Get a drink of water. Blow the fire out. Walk away. Tell the teacher to tell me to stop. Count to 10......." And so on.

He did fidget a lot, but Michael's parents handled him in exemplary fashion, combining strict discipline with humor. He was their only child. Jon observed, "I was just like him when I was a kid. Hell on wheels sometimes. I don't know how my parents stood it." He and Marci demonstrated a nice balance, letting Michael bounce around at times yet firmly reining him in at moments when they needed his attention. Having adapted so well to his behavior, they did not experience it as a problem at home, but they acknowledged that he was having problems at Commoner. They wanted their child to feel successful; they did not want him to take Ritalin. I thought their position was reasonable. Perhaps another kind of classroom might work better for Michael, if one could be found.

Commoner's cooperative style of learning, with its "pod" arrangement of desks, is currently in educational vogue. Though this system offers advantages to most children in the classroom, it may be counterproductive for the child who is sensitive to stimuli and tends toward spontaneity. This child finds it harder to stay focused when his neighbor is within arm's reach and his teacher is speaking from somewhere behind his back. If Michael's class setting allowed him to sit in the front of the class, in a first-row seat right next to the teacher's desk, it would probably be easier for both of them. He would have her intensity, which is what he needs to stay focused, and he wouldn't have the distraction of classmates sitting right next to him. Mrs. Gray would have easier access for monitoring his work. She could provide the needed immediate reinforcers-perhaps an admonitory look or a light touch on his shoulder-that would remind him to stay on task.

As it is, Michael's only opportunity to learn in a less stimulating, more controlled environment comes at the cost of being stigmatized in his class: He gets sent to a quieter part of the room only after he's gotten into trouble or has been identified in some way as different from the other children. Mrs. Gray sends Michael to the corner of the room when he doesn't do his work. It's quieter there, and he has less distraction. He also is less bothersome to the rest of the class. Paradoxically, though, this makes it even harder for her to monitor his performance.

After meeting with me, the Sturdevants scheduled a conference at the school, which I attended. Mrs. Gray and her colleagues listened politely to the parents' feelings about what was best for Michael, which I supported, but there was an undertone that indicated the school's decision was already made. They subtly suggested that Michael was an ADD kid who could benefit from medication. Jon and Marci soon decided to look for another school; luckily, they found one within the district whose principal was quite sympathetic to working with the family on its terms. Michael's parents tightened up the rules some around the house, and as of my last contact with them, he was doing OK.

For the ADD-temperament child, today's typical American elementary school can be a minefield. I've thought a lot about why this is so-why so many 6- to 12-year-olds are lining up for their noontime Ritalin doses-and while I don't have conclusive answers, a few observations make sense to me. A hundred years ago, ADD per se did not exist, though the temperament or biological predisposition for it surely did. Among the reasons why it did not manifest itself as a serious problem was, no doubt, that children's environments ironically offered more alternatives than is true today. Then, if it was too hard for children to sit still in school, they could go back to helping on the farm, for example, or work in the family's store, or help care for younger siblings.

The 20th century brought compulsory education to the industrialized world-certainly a good thing in general-and for the first time, children en masse had to function in this environment for about six hours a day. This was a new evolutionary challenge for all children but especially for those we label as having ADD. In the bad old days, there was a ready response to children who misbehaved in school: They were likely to be beaten into submission. Rejecting that option, as we've rightly chosen to do, has created a double bind that I believe feeds into the ADD/Ritalin boom: We're no longer willing to intimidate children into compliance, but we might just be willing to drug them into it.

More recent changes in the school setting have been a factor, too. Michael Sturdevant's 2nd grade class is an all-too-common example of how pupil/teacher ratios have been creeping up; thanks to tax-cutting measures like California's Proposition 13, many classrooms have more than 30 children per teacher. Large classes produce more distractions, permit less flexibility, and make it hard for a teacher to attend to each child's individual needs. ADD-type children require close monitoring and immediate reinforcement for good or bad behavior, but the teacher in a classroom of 30-plus simply does not have the time or energy to be effective with the more demanding children.

Amazingly, there are no studies that specifically address the relationship of class size to the incidence of ADD. I suspect the data would confirm what's intuitive. Special kids who need more attention do better when they get it.

Children prone to ADD symptoms also are especially vulnerable to the rising academic competitiveness at the elementary level. Subjects like multiplication and division are introduced a year earlier than in the curriculum of 25 years ago. After-school work for a 4th grader at Commoner averages about an hour nightly. Parents tend to be ambivalent about the increased workloads. On one hand, they've been told that academic success is the best guarantee for economic success later in life; the prospect of a child falling behind causes more anxiety than ever. At the same time, their children complain, and everyone feels hurried much of the time.

Parents generally sense that both they and their children are overloaded and there's no free time for anyone in the family. Not just nightly homework but a whole raft of extracurricular and social activities-in which parents are perforce involved-fills to overflowing the lives of today's kids: sports, theatricals, field trips, cultural-enrichment clubs, parties, community benefits, and more. In part, the need to fill every corner of the child's day is a safeguard against boredom, which parents fear will lead to too much television and possible delinquency or alcohol and drug use. But the desire to give our kids every advantage also plays a role, as does simple peer pressure: All the other parents are doing it.

Vol. 10, Issue 2, Pages 50-53

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