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Are Schools Contributing To Skyrocketing ADHD Diagnoses? I’m A Pediatrician, And I Think So

We should stopping pushing 5-year-olds onto ADHD medication and start pushing them to get outside and play.


My patient was struggling in the classroom and at home. His teacher complained that he couldn’t complete his math worksheets without frequent interventions to refocus him. His parents were tired of the nightly struggle to get him to sit still long enough to finish his homework. The Vanderbilt forms confirmed what everyone already knew: a classic case of ADHD.

I filled out a letter for parents to give the school to start the formal process of getting him special classroom accommodations (extra time on assignments, special seating near the front, more frequent breaks, and so on). The parents wanted to pursue therapy, but their insurance wouldn’t cover it. I gave them the best tips I could on homework strategies.

We planned to see how the next month or so went with the extra classroom help, and then we would meet back up to see whether they wanted to proceed with a trial of medication. The parents were understandably reluctant, as was I, to start him on any daily medicine. After all, he was only five years old. 

Taking the Garden out of Kindergarten

The first English language American kindergarten was opened in 1860 by Elizabeth Peabody. Peabody lectured and lobbied widely to spread the word about the benefits of early childhood education, with great success. Within 20 years of the founding of her first school, there were more than 400 kindergartens dotting the nation. Math worksheets, however, were not on the map.

As rates of early childhood ADHD diagnosis continue to rise, it is instructive to visit with our kindergarten pioneer. Peabody’s portrayal of our first kindergartens could not be further from the lives of America’s youngest students today. Kindergarten has not simply been changed into something different, it has become its own worst nightmare.

Kindergarten’s founding goal was to help children cultivate wonder, not complete worksheets. Peabody takes the name of her program quite literally: every school ought to prominently incorporate a real garden. In early childhood, the most important thing — “the first, second, and third thing” — is, quoting Wordsworth, to “come forth into the light of things, let Nature be your teacher.” Through growing flowers, as well as other patient immersions in the gentle rhythms of the natural world, children will develop a more meaningful sense of nature’s God than they could ever hope to glean from a problem set.

Peabody is reluctant to use the word teacher. The true teachers are the child’s innate curiosity and sense of wonder, prompted by the lessons found within the natural world and his own conscience. Nature and imagination are key, and everything is done to encourage flights of fancy.

Storytime, for instance, is not an opportunity to evaluate reading comprehension, but a way of fostering a child’s natural delight and moral development through exposure to “beautiful creations of the imagination.” Herein lies the deeper meaning behind her embrace of the “child garden” model. One does not standardize a child into flourishing, anymore than one could lecture a flower into blossoming.

There was no need, in the kindergartens of our past, for testing academic progress, because academic progress was not the point. Time spent on academic study at that age is not only a counterproductive waste, but an opportunity lost: this is the time to help the children cultivate character and virtue, so that, when they do amass knowledge in the years to come, they will be able to make the most of it. Kindergarten was invented to help children be better people, not get better grades.

Where Have All the Flowers Gone?

Peabody’s most shocking statement to modern ears is yet to come. She explains that “a few hours of Kindergarten in the early part of the day will serve an excellent purpose, using up the effervescent activity of children, who may healthily be left to themselves the rest of the time, to play or rest, comparatively unwatched.”

Don’t let the modern embodiment of the institution fool you. Kindergarten was implemented by popular acclaim nationwide to give children a few short hours a day of valuable socialization and expose them to nature while stimulating their imagination, developing their moral sense, and hopefully burning off a little excess energy.

Read that last sentence again, let it sink in, and then read your local public kindergarten’s curriculum. Here’s a sample sentence from mine: “District assessments, which are aligned to our Mathematics and Language Arts Essential Units of Study, are administered throughout the year as one measure of monitoring progress on state standards.” Where have all the flowers gone?

If you already feel like you’ve stepped through the looking glass, you may want to stop reading now. Peabody depicts a world with not even a hint of the early childhood academics my patients know. After hymns and musical games, the main tasks of each day are playing more games, doing gymnastics, and dancing. No state standards to be met here, unless the state has legislated a standard for totally awesome fun.

Public early childhood education spread to cultivate the moral imagination and work off some wiggles for an hour or two. It is hard to imagine how modern kindergarten could depart any further from its founding promise. Its creators capitalized on a wave of public sentiment opposed to dull instruction and authoritarian taskmasters, promising instead a child-centered world of nature, dance, and song. Today, the only time a kindergartner is liable to encounter a flower is when his workbook asks him to spell r-o-s-e, and he better not start dancing or he’ll have to tango his way to the principal’s office (and then to mine).

Diagnosing the Child Instead of the Instruction

Children don’t change over the centuries, only our approach to them. In truth, school has always been changing. Anyone who has heard of the one-room schoolhouse, or the highly contrasting educations of presidents like Abraham Lincoln and John Adams (either one), understands that to speak of a universal, unchanging American pedagogy is nonsense.

Which brings us to the million-dollar – or, to more precisely reflect pharma company profits, billion-dollar – question: why on earth are we diagnosing children with mental illness based on their reaction to the latest educational fad? Oughtn’t we make the experiment fit the child, rather than the child fit the experiment?

There exists a world in which five-year-olds are encouraged to get dirty, dance, sing, and play while keeping as far as possible from anything redolent of rote recitation or enforced stillness. It is not conceivable that Peabody’s students would be diagnosed with ADHD, even if modern psychiatry existed in her day, because they are never placed in a situation in which the symptoms of ADHD could even manifest themselves, let alone cause impairment. In a world where nobody is expected to sit still, running is not pathological.

Today’s inattentive fidgeters — in high school as well as in kindergarten — are very real. The children I see struggling with ADHD daily are not fabricating their poor report cards. Does that mean ADHD as a diagnosis is legitimate? In the story of America’s first kindergartens, we see a clue that it may be, at least in part, a socially constructed disease.

Keep Peabody’s vision in mind the next time one of those subpar report cards makes its way home. Yes, bad grades might be a reason to doubt the capabilities of your child. On the other hand, they might just as well be a reason to reexamine the methods and purpose of her schooling.