Take a deep breath, expanding your belly. Pause. Exhale slowly to the count of five. Repeat four times.
Congratulations. You’ve just calmed your nervous system.
Controlled breathing, like what you just practiced, has been shown to reduce stress, increase alertness and boost your immune system. For centuries yogis have used breath control, or pranayama, to promote concentration and improve vitality. Buddha advocated breath-meditation as a way to reach enlightenment.
Science is just beginning to provide evidence that the benefits of this ancient practice are real. Studies have found, for example, that breathing practices can help reduce symptoms associated with anxiety, insomnia, post-traumatic stress disorder, depression and attention deficit disorder.
“Breathing is massively practical,” says Belisa Vranich, a psychologist and author of the book “Breathe,” to be published in December. “It’s meditation for people who can’t meditate.”
How controlled breathing may promote healing remains a source of scientific study. One theory is that controlled breathing can change the response of the body’s autonomic nervous system, which controls unconscious processes such as heart rate and digestion as well as the body’s stress response, says Dr. Richard Brown, an associate clinical professor of psychiatry at Columbia University and co-author of “The Healing Power of the Breath.”
Consciously changing the way you breathe appears to send a signal to the brain to adjust the parasympathetic branch of the nervous system, which can slow heart rate and digestion and promote feelings of calm as well as the sympathetic system, which controls the release of stress hormones like cortisol.
Many maladies, such as anxiety and depression, are aggravated or triggered by stress. “I have seen patients transformed by adopting regular breathing practices,” says Dr. Brown, who has a private practice in Manhattan and teaches breathing workshops around the world.
When you take slow, steady breaths, your brain gets the message that all is well and activates the parasympathetic response, said Dr. Brown. When you take shallow rapid breaths or hold your breath, the sympathetic response is activated. “If you breathe correctly, your mind will calm down,” said Dr. Patricia Gerbarg, assistant clinical professor of psychiatry at New York Medical College and Dr. Brown’s co-author
Dr. Chris Streeter, an associate professor of psychiatry and neurology at Boston University, recently completed a small study in which she measured the effect of daily yoga and breathing on people with diagnoses of major depressive disorder.
After 12 weeks of daily yoga and coherent breathing, the subjects’ depressive symptoms significantly decreased and their levels of gamma-aminobutyric acid, a brain chemical that has calming and anti-anxiety effects, had increased. The research was presented in May at the International Congress on Integrative Medicine and Health in Las Vegas. While the study was small and lacked a control group, Dr. Streeter and her colleagues are planning a randomized controlled trial to further test the intervention.
“The findings were exciting,” she said. “They show that a behavioral intervention can have effects of similar magnitude as an antidepressant.”
Controlled breathing may also affect the immune system. Researchers at the Medical University of South Carolina divided a group of 20 healthy adults into two groups. One group was instructed to do two sets of 10-minute breathing exercises, while the other group was told to read a text of their choice for 20 minutes. The subjects’ saliva was tested at various intervals during the exercise. The researchers found that the breathing exercise group’s saliva had significantly lower levels of three cytokines that are associated with inflammation and stress. The findings were published in the journal BMC Complementary and Alternative Medicine in August.
Here are three basic breathing exercises to try on your own.
If you have the time to learn only one technique, this is the one to try. In coherent breathing, the goal is to breathe at a rate of five breaths per minute, which generally translates into inhaling and exhaling to the count of six. If you have never practiced breathing exercises before, you may have to work up to this practice slowly, starting with inhaling and exhaling to the count of three and working your way up to six.
1. Sitting upright or lying down, place your hands on your belly.
2. Slowly breathe in, expanding your belly, to the count of five.
4. Slowly breathe out to the count of six.
5. Work your way up to practicing this pattern for 10 to 20 minutes a day.
When your mind is racing or you feel keyed up, try Rock and Roll breathing, which has the added benefit of strengthening your core.
1. Sit up straight on the floor or the edge of a chair.
2. Place your hands on your belly.
3. As you inhale, lean forward and expand your belly.
4. As you exhale, squeeze the breath out and curl forward while leaning backward; exhale until you’re completely empty of breath.
5. Repeat 20 times.
Energizing HA Breath
When the midafternoon slump hits, stand up and do some quick breathwork to wake up your mind and body.
1. Stand up tall, elbows bent, palms facing up.
2. As you inhale, draw your elbows back behind you, palms continuing to face up.
3. Then exhale quickly, thrusting your palms forward and turning them downward, while saying “Ha” out loud.
4. Repeat quickly 10 to 15 times.
Think about the people in your life who are 65 or older. Some of them are experiencing the usual mental difficulties of old age, like forgetfulness or a dwindling attention span. Yet others somehow manage to remain mentally sharp. My father-in-law, a retired doctor, is 83 and he still edits books and runs several medical websites.
Why do some older people remain mentally nimble while others decline? “Superagers” (a term coined by the neurologist Marsel Mesulam) are those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds. My colleagues and I at Massachusetts General Hospital recently studied superagers to understand what made them tick.
Our lab used functional magnetic resonance imaging to scan and compare the brains of 17 superagers with those of other people of similar age. We succeeded in identifying a set of brain regions that distinguished the two groups. These regions were thinner for regular agers, a result of age-related atrophy, but in superagers they were indistinguishable from those of young adults, seemingly untouched by the ravages of time.
What are these crucial brain regions? If you asked most scientists to guess, they might nominate regions that are thought of as “cognitive” or dedicated to thinking, such as the lateral prefrontal cortex. However, that’s not what we found. Nearly all the action was in “emotional” regions, such as the midcingulate cortex and the anterior insula.
My lab was not surprised by this discovery, because we’ve seen modern neuroscience debunk the notion that there is a distinction between “cognitive” and “emotional” brain regions.
This distinction emerged in the 1940s, when a doctor named Paul MacLean devised a model of the human brain with three layers. An ancient inner layer, inherited from reptiles, was presumed to contain circuits for basic survival. The middle layer, the “limbic system,” supposedly contained emotion circuitry inherited from mammals. And the outermost layer was said to house rational thinking that is uniquely human. Dr. MacLean called this model “the triune brain.”
The triune brain became (and remains) popular in the media, the business world and certain scientific circles. But experts in brain evolution discredited it decades ago. The human brain didn’t evolve like a piece of sedimentary rock, with layers of increasing cognitive sophistication slowly accruing over time. Rather (in the words of the neuroscientist Georg Striedter), brains evolve like companies do: they reorganize as they expand. Brain areas that Dr. MacLean considered emotional, such as the regions of the “limbic system,” are now known to be major hubs for general communication throughout the brain. They’re important for many functions besides emotion, such as language, stress, regulation of internal organs, and even the coordination of the five senses into a cohesive experience.
And now, our research demonstrates that these major hub regions play a meaningful role in superaging. The thicker these regions of cortex are, the better a person’s performance on tests of memory and attention, such as memorizing a list of nouns and recalling it 20 minutes later.
Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.
The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.
This means that pleasant puzzles like Sudoku are not enough to provide the benefits of superaging. Neither are the popular diversions of various “brain game” websites. You must expend enough effort that you feel some “yuck.” Do it till it hurts, and then a bit more.
In the United States, we are obsessed with happiness. But as people get older, research shows, they cultivate happiness by avoiding unpleasant situations. This is sometimes a good idea, as when you avoid a rude neighbor. But if people consistently sidestep the discomfort of mental effort or physical exertion, this restraint can be detrimental to the brain. All brain tissue gets thinner from disuse. If you don’t use it, you lose it.
So, make a New Year’s resolution to take up a challenging activity. Learn a foreign language. Take an online college course. Master a musical instrument. Work that brain. Make it a year to remember.
Some experts think mindfulness is the antidote to distraction, misbehaving–even poor math scores. Are they on to something?
Christina Johnson’s classroom must be the most peaceful place at Cane Run Elementary School in Louisville, Ky. Instead of desks, six rows of black yoga mats line the floor. All the lights are off except for one gently glowing lamp. Underwater sounds gurgle from a pair of speakers.
Today nearly two dozen fifth-graders are sitting on the mats with their shoes off and eyes closed, following Johnson as she guides them through a relaxation exercise. “Take a nice, nice deep breath in, and keep your hands on your anchors, please,” Johnson says. The kids place one hand on their chest, the other on their belly. Johnson taps a chime and the kids know what to do: listen intently, and when the long reverberation stops, their hands shoot up. “Good job,” Johnson says. “We’re ready.”
For the next 45 minutes, Johnson leads the class through exercises that are designed to increase mindfulness–a catchall term for practices that help you focus on the present moment. They learn how to savor the taste of a mint until it dissolves on their tongue; they move their little bodies into poses lifted straight from a yoga studio.
Cane Run, which requires that students attend the class twice weekly from kindergarten on up, is at the frontier of a growing movement. Mindfulness has come to the classroom. At Cane Run, it’s still an experiment: researchers want to know if a program like this can improve students’ focus, behavior, academic performance–even their empathy. A seven-year study, called the Compassionate Schools Project, is under way in 26 Louisville schools. If all goes as well as researchers expect–and if officials can secure the funding–mandatory mindfulness classes will wind up at every public school in the city.
That mindfulness is taking its place alongside math in elementary school says something about the stressed-out state of kids’ brains these days. Educators increasingly believe that mindfulness can be an antidote to three of the biggest mental-health challenges that kids face: anxiety, trouble paying attention and bullying.
It makes sense. In adults, the benefits of activities such as yoga, meditation and deep-breathing exercises are well established. A robust body of research shows that these exercises lower stress, ease anxiety, improve sleep, ward off sickness, reduce depression and even blunt pain. If mindfulness can work even some of the same wonders in children, the implications would be huge. Up to 20% of kids in the U.S. have anxiety–and anxiety is the No. 1 predictor of depression in adolescence. Diagnoses for attention-deficit/hyperactivity disorder (ADHD) in kids show no signs of slowing, creeping up from 7% in 2003 to 11% in 2011.
Classes in mindfulness, its advocates hope, can make a dent in those worrying numbers, while also teaching kids softer skills, like how to communicate feelings, how to get along with classmates and how to modulate reactions–all skills that researchers believe the practice helps develop. If kids start early, the skills may prove useful down the road at countering the stresses and distractions of adult life. “These are not niceties. These are critical capabilities,” says Patrick Tolan, a professor at the University of Virginia Curry School of Education who is leading the analysis. “If children today don’t learn how to take care of themselves, it’s going to have enormous impact on our health care costs and on the health of our nation.”
Although research on mindfulness in children is still preliminary, studies show that it can help kids who have anxiety and trouble paying attention with their schoolwork, behavior and stress regulation. First-through third-graders who were taught mindfulness and breathing techniques had fewer ADHD symptoms and less test anxiety, one study found. Even for kids without these issues, mindfulness has been shown to increase kindness, sleep quality and even math scores.
This training appears to work in kids as young as 4. Preschoolers who received 12 weeks of a kindness and mindfulness class earned better grades and were more likely to share than counterparts in a control group, according to research by Lisa Flook, a scientist at the University of Wisconsin who is studying a mindfulness program in several schools in Madison. “A body of work shows there are these innate prosocial and altruistic qualities present from a very early age in children,” Flook says. “This is a way of nurturing the seeds of kindness in children.”
In another ongoing study, researchers from the University of North Carolina Wilmington teach preschoolers yoga poses and relaxation exercises. After just two weeks, these kids exhibit better attention, awareness, gratitude and happiness compared with kids who did not have the classes. “What’s amazing is that this brief exposure appears to be so powerful,” says lead researcher Simone Nguyen, a developmental-psychology professor at the university. “A few minutes of breathing, a few minutes of paying attention to the moment are appearing to make a difference.”
A movement is also under way to train teachers in mindfulness. “Our theory is that if we actually produce educators that are more aware and empathic and attuned to children, that in its own right is going to have an effect on kids’ nervous systems,” says Chris McKenna, program director of Mindful Schools, a group in Emeryville, Calif., that trains teachers in mindfulness.
“There’s an almost immediate calming effect of mindfulness practice,” says Randye Semple, an anxiety-disorder expert and assistant professor at the University of Southern California’s Keck School of Medicine. Calm breathing triggers the parasympathetic nervous system–the opposite of the fight-or-flight response–which slows heart rate and makes blood pressure go down, she says. Mindfulness training also encourages kids to focus attention on whatever is happening in the moment. “Essentially, mindfulness is attention training,” she says. “We’re showing them that attention can be increased, that it can be ramped up and it can be trained.”
Another study this summer found that students had higher levels of the stress hormone cortisol if their teachers reported being burned out. But if stress is contagious, so is its opposite. In a study of hundreds of teachers across 36 public elementary schools in New York City, half of the teachers received mindfulness and stress-reduction training while the other half did not. Those who were trained in mindfulness became better at handling their own stress–and as it turns out, the benefits appeared to spread to the kids too. According to Tish Jennings, associate professor of education at the Curry School of Education at the University of Virginia, the teachers who got the training were more sensitive to their students’ needs and better at fostering a productive environment for learning.
Encouraged by results such as these, a growing group of researchers, advocates and parents are pushing for mindfulness to be taught in all public schools. In some places, like Louisville, it could replace an enrichment or health course, while other districts will pick and choose parts of the practice to incorporate into existing classes. Other schools may try to create a more mindful culture by training teachers instead of adding a dedicated class. Private and charter schools across the country have been on to this for some time. “Self-regulation and attention can benefit kids on both ends and throughout the [socioeconomic] spectrum,” says Flook.
Not everyone thinks mindfulness belongs in schools. Classroom time is more prized than ever–and resources are scant. “If you can’t get art and music in a curriculum, you’re not going to be able to get this,” says McKenna. Nor do all parents find the material acceptable. One school district in Ohio piloted a mindfulness program in 2011 and found the results so impressive that it soon expanded to other schools. But parents complained that they felt the practice was teaching religion–Buddhism–and had no place in the classroom. In 2013, the district, in Canton, shuttered the program.
It’s a criticism researchers have heard before. “I don’t think any of us deny that most of these general practices and concepts come from Buddhism,” says Semple. “But we’re not teaching Buddhism. We’re teaching kids how to pay attention.”
Jennings too is careful to identify her program as “100% secular.” “We don’t teach anything related to other parts of yoga that might be considered spiritual or religious.” That’s part of the reason researchers are studying it closely. If the results show what they expect–a nearly universal benefit for kids–researchers hope it will lead to even broader adoption nationwide.
In Louisville, Christina Johnson knows it’s already working on her fifth-graders. She talks them through their final movements–raising both arms to the sky in a pose she calls “sunrise,” then releasing “all that negative stuff” as they flop over their toes–and then tells them to close their eyes and check in with their feelings. Moments later, a boy’s soft sniffle breaks the stillness. Johnson hugs and holds him as he whispers to her about problems at home. No one snickers. No one even opens their eyes.
“When the brain gets still and everything gets calm, the feelings come out,” Johnson says later. “That’s why this needs to be in schools.”
James Gaines, September 22, 2016
Imagine you’re working at a school and one of the kids is starting to act up. What do you do?
Traditionally, the answer would be to give the unruly kid detention or suspension.
But in my memory, detention tended to involve staring at walls, bored out of my mind, trying to either surreptitiously talk to the kids around me without getting caught or trying to read a book. If it was designed to make me think about my actions, it didn’t really work. It just made everything feel stupid and unfair.
But Robert W. Coleman Elementary School has been doing something different when students act out: offering meditation.
Photo from Holistic Life Foundation, used with permission.
Instead of punishing disruptive kids or sending them to the principal’s office, the Baltimore school has something called the Mindful Moment Room instead.
The room looks nothing like your standard windowless detention room. Instead, it’s filled with lamps, decorations, and plush purple pillows. Misbehaving kids are encouraged to sit in the room and go through practices like breathing or meditation, helping them calm down and re-center. They are also asked to talk through what happened.
Meditation and mindfulness are pretty interesting, scientifically.
Photo from Holistic Life Foundation, used with permission.
Mindful meditation has been around in some form or another for thousands of years. Recently, though, science has started looking at its effects on our minds and bodies, and it’s finding some interesting effects.
One study, for example, suggested that mindful meditation could give practicing soldiers a kind of mental armor against disruptive emotions, and it can improve memory too. Another suggested mindful meditation could improve a person’s attention span and focus.
Individual studies should be taken with a grain of salt (results don’t always carry in every single situation), but overall, science is starting to build up a really interesting picture of how awesome meditation can be. Mindfulness in particular has even become part of certain fairly successful psychotherapies.
Back at the school, the Mindful Moment Room isn’t the only way Robert W. Coleman Elementary has been encouraging its kids.
After-school yoga. Photo from Holistic Life Foundation, used with permission.
The meditation room was created as a partnership with the Holistic Life Foundation, a local nonprofit that runs other programs as well. For more than 10 years the foundation has been offering the after-school program Holistic Me, where kids from pre-K through the fifth grade practice mindfulness exercises and yoga.
“It’s amazing,” said Kirk Philips, the Holistic Me coordinator at Robert W. Coleman. “You wouldn’t think that little kids would meditate in silence. And they do.”
I want to be as cool as this kid one day. Photo from Holistic Life Foundation, used with permission.
There was a Christmas party, for example, where the kids knew they were going to get presents but were still expected to do meditation first.
“As a little kid, that’s got to be hard to sit down and meditate when you know you’re about to get a bag of gifts, and they did it! It was beautiful, we were all smiling at each other watching them,” said Philips.
The kids may even be bringing that mindfulness back home with them.
In the August 2016 issue of Oprah Magazine, Holistic Life Foundation co-founder Andres Gonzalez said: “We’ve had parents tell us, ‘I came home the other day stressed out, and my daughter said, “Hey, Mom, you need to sit down. I need to teach you how to breathe.”‘”
The program also helps mentor and tutor the kids, as well as teach them about the environment.
Building a vegetable garden. Photo from Holistic Life Foundation, used with permission.
They help clean up local parks, build gardens, and visit nearby farms. Philips said they even teach kids to be co-teachers, letting them run the yoga sessions.
This isn’t just happening at one school, either. Lots of schools are trying this kind of holistic thinking, and it’s producing incredible results.
Oh, and by the way, the schools are seeing a tangible benefit from this program, too.
Philips said that at Robert W. Coleman Elementary, there have been exactly zero suspensions last year and so far this year. Meanwhile, nearby Patterson Park High School, which also uses the mindfulness programs, said suspension rates dropped and attendance increased as well.
Is that wholly from the mindfulness practices? It’s impossible to say, but those are pretty remarkable numbers, all the same.
By JAN HOFFMAN
So why aren’t more teenage girls out on the playing fields?
Research shows that girls tend to start dropping out of sports and skipping gym classes around the onset of puberty, a sharp decline not mirrored by adolescent boys.
A recent study in The Journal of Adolescent Health found a surprisingly common reason: developing breasts, and girls’ attitudes about them.
In a survey of 2,089 English schoolgirls ages 11 to 18, nearly three-quarters listed at least one breast-related concern regarding exercise and sports. They thought their breasts were too big or too small, too bouncy or bound too tightly in an ill-fitting bra. Beginning with feeling mortified about undressing in the locker room, they were also self-consciously reluctant to exercise and move with abandon.
Experts on adolescent health praised the study for identifying and quantifying an intuitive thought.
“We make assumptions about what we think we know, so it’s important to be able to say that as cup size increases, physical activity decreases for a lot of girls,” Dr. Sharonda Alston Taylor, an assistant professor of pediatrics at Baylor College of Medicine in Texas, who focuses on adolescent obesity.
The challenge is what to do about it.
After reading the study, some pediatricians and adolescent health specialists said they needed to do a better job informing girls about breast health and development. Almost 90 percent of the girls in the study said they wanted to know more about breasts in general, and nearly half wanted to know about sports bras and breasts specifically with respect to physical activity.
Joanna Scurr, the lead author of the study and a professor of biomechanics at the University of Portsmouth in England, said the breast itself had little internal support, so when a girl’s body moved, the breast moved independently, and the movement increased with breast size. In up to 72 percent of exercising women, she said, that movement was a cause of breast pain or discomfort.
Yet while sports and physical education programs frequently recommend protective gear for boys, like cups, athletic supporters and compression shorts, comparable lists for young women rarely include a mandatory or even recommended sports bra.
Only 10 percent of the girls surveyed said they always wore a sports bra during sports and exercise. More than half had never worn one.
Dr. Taylor said that lack of education about bra fitting and sizing was commonplace in her practice.
“The mom will say, ‘I don’t know what size she is,’ and the patient will say, ‘I just grab my sister’s or my mother’s bras to wear.’”
Using data from this study and others, the researchers from sports and exercise health departments at three British universities are trying to design school-based educational programs.
When researchers asked the girls how they would prefer to receive breast information — via a website, an app, a leaflet or a private session with a nurse — the overwhelming majority replied that they wanted a girls-only session with a female teacher.
At what age? “Most of them said 11,” Dr. Scurr said.
Andria Castillo, now 17 and a junior at Mather High School in Chicago, says she remembers that when she was around that age, she was painfully self-conscious about her breast size; she thought she was developing more slowly than everyone else.
“I felt boys and girls were making fun of me,” she said. “Even though no one called me out, I felt they were, behind my back. I was taking taekwondo, and I would look in the big mirror and try to find ways to cover myself up and hide. I asked my dad if I could stop going.”
She had a friend who had been active in sports. But in the sixth grade, the girl’s breasts developed rapidly. “She eventually stopped going to gym altogether,” Ms. Castillo said. “Instead, she just went to a classroom and did her homework.”
In time, Ms. Castillo turned her attitude around; she is now on her school’s varsity water polo and swim teams. She credits not only her mother, but also a Chicago-based project, Girls in the Game, which has body-positive, confidence-building programs, including single-sex athletics.
Some experts in female adolescent obesity and fitness suggested that young girls would be more comfortable in single-sex gym classes. But others said that option had its disadvantages, too.
Kimberly Burdette, a doctoral candidate in psychology at Loyola University Chicago who looks at the psychological factors that promote well-being and healthy weight in girls, says such separation might be helpful at a time when adolescent girls had a heightened awareness that others were looking at their bodies.
“It’s hard to be in the zone, focusing on athletic movement, on what your body can do, if you’re thinking about what others think your body looks like,” she said. “I like programming that is for girls only, where a girl can try a sport, regardless of her ability, without the male gaze.”
But Elizabeth A. Daniels, an assistant professor of developmental psychology at the University of Colorado, Colorado Springs, disagreed. “I’m not sure the concern or embarrassment is always just about boys,” she said, noting that girls can make derisive comments about one another. “So do we change the structure of the gym class or address respectful behavior?”
New research shows that the youngest students in a classroom are more likely to be given a diagnosis of attention deficit hyperactivity disorder than the oldest. The findings raise questions about how we regard those wiggly children who just can’t seem to sit still – and who also happen to be the youngest in their class.
Researchers in Taiwan looked at data from 378,881 children ages 4 to 17 and found that students born in August, the cut-off month for school entry in that country, were more likely to be given diagnoses of A.D.H.D. than students born in September. The children born in September would have missed the previous year’s cut-off date for school entry, and thus had nearly a full extra year to mature before entering school. The findings were published Thursday in The Journal of Pediatrics.
While few dispute that A.D.H.D. is a legitimate disability that can impede a child’s personal and school success and that treatment can be effective, “our findings emphasize the importance of considering the age of a child within a grade when diagnosing A.D.H.D. and prescribing medication for treating A.D.H.D.,” the authors concluded. Dr. Mu-Hong Chen, a member of the department of psychiatry at Taipei Veterans General Hospital in Taiwan and the lead author of the study, hopes that a better understanding of the data linking relative age at school entry to an A.D.H.D. diagnosis will encourage parents, teachers and clinicians to give the youngest children in a grade enough time and help to allow them to prove their ability.
Other research has shown similar results. An earlier study in the United States, for example, found that roughly 8.4 percent of children born in the month before their state’s cutoff date for kindergarten eligibility are given A.D.H.D. diagnoses, compared to 5.1 percent of children born in the month immediately afterward.
So how should we interpret data showing different rates of A.D.H.D. diagnosis among populations of children who are similar in everything other than relative age at school entry? Cautiously, says Michael Manos, the head of Cleveland Clinic Children’sA.D.H.D. Center for Evaluation and Treatment.
“The kind of attention that you have to use in school is the kind of attention that’s difficult for a person with A.D.H.D.,” so attention deficits are more readily recognized in a classroom situation, he said. “If the diagnoses are performed accurately, then some kids are getting noticed sooner than other kids,” he said. If younger children with A.D.H.D. are starting treatment earlier because they’re starting school earlier, then that’s a good thing.
But that presumes the diagnosis is an accurate one. “When you take people who are in a 15-minute pediatric primary care physician’s office visit, and the mother describes hyperactivity and the physician automatically prescribes medication, that’s a problem,” Dr. Manos said. Many parents who describe concerns about children’s behavior “aren’t describing developmentally inappropriate behavior,” he said. “They’re describing behavior that does not meet certain expectations,” and that can be the issue in classroom settings as well, where some students are older than others.
“I think the link between age at school entry and A.D.H.D. diagnoses are not really about being young or ‘not ready,’” said Daphna Bassok, an assistant professor at the University of Virginia’s Curry School of Education who has studied kindergarten readiness, by email. “Instead, I think they are about a child’srelative age. “
“In early childhood classrooms, where a month or two age difference can make a big difference,” she continued, “ teachers perceive the youngest children in the class as having more attention struggles, and behavioral struggles, than the older children, irrespective of the child’s actual age.” When those teachers flag those struggles, the path to a diagnosis is paved, but the diagnosis itself still depends on the expertise of the clinician.
Stephen Hinshaw, co-author of “A.D.H.D: What Everyone Needs to Know,” said that early recognition of attention deficits “could be an opportunity for early intervention for all kindergartners, as our society struggles to balance achievement gaps, ever earlier and stronger achievement expectations, and high student-teacher ratios in Transitional K programs, as well as for evidence-based intervention for 4-year-olds with bona fide A.D.H.D.”
“On the other hand, if this is the ticket for overzealous labeling of kids, mainly boys, who are simply needing more time to mature, that’s not what we need,” Dr. Hinshaw said.