Children: Their Deficiencies,

We are at my 7-year old daughter's annual check-up. After a peering in her ears and mouth, palpating her glands, and listening to her heart, the Doctor points at Zoe's crotch and asks abruptly, "Does anyone ever touch you here?" Zoe is taken aback. She looks at me, then back at the doctor.

"No," she says.

The doctor checks something off on her clipboard. And says, "Good. Those are your private parts. No one should touch them except you." Zoe says nothing. "Do you have a best friend?" the doctor asks.

"Well, my cousin is sort of my best friend, but we fight a lot. I have another friend who is a better best friend. Her name is Hannah. I met her…"

"Okay. Good. Can you read?"

It goes on like this. In the course of the interview, Zoe is asked about wearing a bicycle helmut and using a seat belt. She dutifully recites her phone number and her address, explains she would call 911 in case of emergency, and says she sometimes fights with her sister. Nutrition concerns are dealt with by asking me if she gets at least two glasses of milk a day.

Apparently, the doctor is casting about for behavioral and developmental disorders that might be lurking in my child, and educating her about avoiding accidents - common killers of today's children. This is not bad, per se. If we had a concern about Zoe's behavior or didn't know about certain safety precautions, it might be helpful to talk to a health professional about it. But the interview feels invasive and perfunctory. And I can't help but feel that by the time it's over, what Zoe has learned is more about how to talk in half-truths to authority figures, how to give short answers, and how to anticipate what the doctor wants to hear.

"In times past," says Newton doctor Eugenia Marcus, "pediatricians had to deal with so much infectious disease that there was no time to bring up the fact that, by the way, Johnny is failing in school and violent toward his brother" [Boston Globe, 6/28/99]. But now, with more time to explore behavioral and developmental problems, doctors have come up with a whole list of them. Beyond the disorders we are familiar with, such as mental retardation, language and speech delays and autism, there are some brand new disorders (Watch out! The list is so inclusive, you - and everyone you know - has probably suffered from at least one of these at some time in your life): "toilet-training difficulties, discipline problems, extreme shyness, and being concerned about being adopted or having gay or lesbian parents."

Okay, now that the experts have identified that having gay or lesbian parents can put you at risk for a disorder (and here I've been thinking that homophobia was a disorder - one that puts all our children at risk) they've gone and created a whole new medical discipline called Developmental and Behavioral Pediatrics, complete with tested and certified specialists who will have undergone intensive and standardized training, and who will be tasked with diagnosing your child's disorders and coming up with a treatment plan.

Why am I not comforted? Why am I not feeling secure in the knowledge that whole new graduating classes of experts will be looking out for our children's well-being?

Because we constantly address children in terms of their deficits rather than the poverty of the institutional, cultural and economic lives they lead; we address their behavior in terms of how well it fits into rigid institutional settings; and we search for quick fixes that will ameliorate symptoms, and allow us to overlook, for now, deeper social and political questions.

Let's look at the quick fixes, which seem to include either behavior modification therapy or drug therapy. I will address the latter in a commentary later this month on the recent explosion in the use of ritalin in children. For the former, let's consider an example of the Center for Collaborative Education and Practice's approach to "addressing skill deficits."

The problem child is Jim. He seems to have a hard time listening during class. The Center for Collaborative Education and Practice suggests the following program:

Goal:

During classroom lectures, Jim will make only relevant comments and ask only relevant questions in 80 percent of the opportunities.

Objectives:

Given a 50-minute, large group (i.e., more than 20 students) classroom lecture, Jim will ask one appropriate question and make two relevant comments on each of 3 consecutive school days.

Activities to accomplish the goal and objectives:

[Here, several activities are listed, including, "The teacher will model examples and non-examples of situations when listening is important and assist Jim in identifying the components of active listening (e.g., hands and feet still, eyes facing the speaker, quiet lips, think about what is being said and determine if you need more information, think about how the information makes you feel, and if necessary, make a comment or ask a question); and "Jim will monitor the opportunity and degree to which he actively listens during lectures and will reinforce himself (e.g., `I did a great job!');."]

Now, I'm not going to suggest that adults can never make good use of behavior modification. Who has not bribed their children every once in a while? It works amazingly well. But it's plain old bribery. Not very elegant or constructive. Certainly not a growth moment, though it often buys you a moment or gets you a result.

But is that what the development and behavior specialists want for Jim? A short-term quantifiable result? It seems so. His particular skill deficit calls for at least 80 percent of his comments to be relevant for at least three days in a row. If he achieves his goal, he wins the opportunity to dole out to himself some positive reinforcement (e.g., "I did a great job!").

Of course, I know nothing about "Jim." Maybe it would be helpful to him to experience the rewards of sitting still and listening. But has anyone asked what he's listening to?? What if the lecture - and other school material, for that matter - was required to be "relevant" at least 80 percent of the time? What if the experts put less energy into quantifying and judging the relevance of Jim's comments, and instead worked to ensure that the content and the mode of communicating it was engaging? What if, rather than a degrading self-administered pat on the back, Jim's reward was the process itself - the experience of having been present for something that interested him or moved him?

What the experts communicate to us in their effort to address Jim's "skill deficit," is that they don't believe much in Jim's ability to engage in the world around him, and they don't have faith that Jim's school can be engaging.

According to these experts, if Jim turns out to be a star in his own little success story, he will have learned to follow a script, respond to lectures in a choreographed way, and consider himself done with his part of the effort when he has made the right number of comments at the expected rate of relevance, rather than gained anything personally from the material.

While development and behavior specialists may truly have something to offer some children, I believe experts' attention would be better served evaluating and changing the kinds of institutions and supports we have available for children and families, and identifying the large social disorders that harm our children (such as homophobia). Let's not map out the way our children are deficient in dealing with the social disorders that we heap upon them, and then attempt to rectify the situation by extracting certain behaviors from them.