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
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
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
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
The problem child is Jim. He seems to have a hard time listening during
class. The Center for Collaborative Education and Practice suggests the
During classroom lectures, Jim will make only relevant comments and ask
only relevant questions in 80 percent of the opportunities.
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
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
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.