One of the more bewildering aspects of the already high-stress endeavor of 21st-century American parenting is that at some point your child is likely to be identified with a psychiatric diagnosis of one kind or another. Many exist in a gray zone that previous generations of parents never encountered.
A diagnosis of attention deficit hyperactivity disorder is practically a rite of passage in American boyhood, with nearly one in four 17-year-old boys bearing the diagnosis. The numbers have only gone up, and vertiginously: One million more children were diagnosed with A.D.H.D. in 2022 than in 2016.
The numbers on autism are so shocking that they are worth repeating. In the early 1980s, one in 2,500 children had an autism diagnosis. That figure is now one in 31.
Nearly 32 percent of adolescents have been diagnosed at some point with anxiety; the median age of “onset” is 6 years old. More than one in 10 adolescents have experienced a major depressive disorder, according to some estimates. New categories materialize. There is now oppositional defiant disorder, in addition to pathological demand avoidance.
So perhaps it should be little surprise that even among our deeply polarized political leaders, there is broad agreement that America’s children are not well.
Health Secretary Robert F. Kennedy Jr. released a strategy report in September entitled “Make Our Children Healthy Again,” with ideas on how to improve the mental health of children with better diets, less screen time and fewer medications. Illinois’s governor, the Trump antagonist JB Pritzker, recently made his state the first in the nation to require schools to do universal mental health screenings.
No doubt the causes of the mental health crisis are multifaceted. Some disorders tend to run in families. Screens have thoroughly invaded childhood, supplanting the sleep, exercise and socializing in person that can ward off depression and anxiety.
And yet no one in political leadership — or our broader national conversation about mental health — seems to be asking about the environment where children spend most of their waking hours: school.
There is growing evidence that school itself is essential to understanding why so many children seem to be struggling. It can be a cause of stress that exacerbates anxiety or depression; but just as importantly and less frequently acknowledged, it is often where disorder presents, leading many children — and their parents — down the path toward a diagnosis.
The experience of school has changed rapidly in recent generations. Starting in the 1980s, a metrics-obsessed regime took over American education and profoundly altered the expectations placed on children, up and down the class ladder. In fact, it has altered the experience of childhood itself.
This era of policymaking has largely ebbed, with disappointing results. Math and reading levels are at their lowest in decades. The rules put in place by both political parties were well-meaning, but in trying to make more children successful, they also circumscribed more tightly who could be served by school at all.
“What’s happening is, instead of saying, ‘We need to fix the schools,’ the message is, ‘We need to fix the kids,’” said Peter Gray, a research professor at Boston College and the author of “Free to Learn: Why Unleashing the Instinct to Play Will Make Our Children Happier, More Self-Reliant, and Better Students for Life.”
“The track has become narrower and narrower, so a greater range of people don’t fit that track anymore,” he said. “And the result is, we want to call it a disorder.”
No Child Left Behind, No Time to Eat Lunch
School was not always so central to American childhood. In 1950, less than half of all children attended kindergarten. Only about 50 percent graduated from high school, and without much professional penalty. A person spent fewer years of their life in school, and fewer hours in the day furiously trying to learn. However bored a child might become sitting behind a desk, freedom awaited after the final bell rang, with hours after school to play without the direction of adults.
But as the country’s economy shifted from factories and farms to offices, being a student became a more serious matter. The outcome of your life could depend on it.
During an era of global competition, the country’s leaders also began to see school as a potential venue for national glory, or shame. In 1983, a commission created by Ronald Reagan’s secretary of education, Terrel H. Bell, released a dire report on the state of American schools called “A Nation at Risk.” It warned that “if an unfriendly foreign power had attempted to impose on America the mediocre educational performance that exists today, we might well have viewed it as an act of war.”
Over the next decade, Democratic and Republican governors such as Bill Clinton in Arkansas and Lamar Alexander in Tennessee began molding their states’ schools with new standards of testing and accountability. Schools were treated more like publicly traded companies, with test scores as proxies for profits. Before long, schools had public ratings, so ubiquitous they now appear on real estate listings.
The pressure kept rising. By 2001, 30 states had laws that imposed a system of punishments and rewards for schools based on their test scores. The next year, President George W. Bush’s signature education reform law, No Child Left Behind, made the effort national.
With school funding now on the line, there were unmistakable incentives for children to be diagnosed. Starting in the 1990s, students with autism or A.D.H.D. become newly eligible for added support in the classroom. Getting a child treated, potentially with medication, could help an entire classroom achieve higher scores, especially if the child’s behavior was disruptive to others. And in some parts of the country, children with disabilities were not counted toward a school’s overall marks, a carve-out that could boost scores.
The added metrics may well have compelled more children to receive the support they needed. Either way, educational policymaking yielded a change in diagnoses. In states that added new accountability standards, researchers found a clear rise in A.D.H.D. According to one analysis, the rate of A.D.H.D. diagnoses among children ages 8 to 13 in low-income homes went from 10 percent to 15 percent after the arrival of No Child Left Behind.
The impact of the law on autism diagnoses has been less documented. But there is a great deal of overlap among these disorders. Anywhere from 30 to 80 percent of children diagnosed with autism also have A.D.H.D. Experts have also pointed out that the rise in autism has largely taken place on the more subtle end of the spectrum, where psychiatrists expanded the diagnosis. Students with this profile often need educators who can be eminently flexible in their approach, a tough task when an entire classroom has to focus on narrowly mastering certain testable skills.
The demands on performance in higher grades trickled down into younger and younger ages. In 2009, the Obama administration offered greater funding to schools that adopted new national learning standards called the Common Core. These included an emphasis on reading by the end of kindergarten, even though many early childhood experts believe that not all children are developmentally ready to read at that age.
With each new wave of reforms, the tenor of kindergarten changed. Rote lessons in math and reading crept into classrooms, even though experts say young children learn best through play. Researchers discovered that in the span of about a decade, kindergarten had suddenly become more like first grade.
Preschool was not far behind, as even toddlers were expected to stay still for longer stretches of time to imbibe academic lessons. This again defied the consensus among early childhood experts. Children, parents and teachers struggle through this mismatch daily. In 2005, a study showed that preschoolers were frequently being expelled for misbehavior, and at rates more than three times that of school-age children.
“We’re not aligning the developmental needs of kids with the policies and practices that go on daily with schools,” said Denise Pope, senior lecturer at Stanford University and co-founder of Challenge Success, a nonprofit group that works with schools to improve student well-being.
The pressure to learn more led to a restructuring of the school day itself. Before the 1980s, American children usually had recess breaks throughout the day. By 2016, only eight states required daily recess in elementary schools. And when researchers studied what had become of lunchtime, they learned that children often had just 20 minutes to not only eat but stop to use the bathroom after class, walk to the cafeteria and wait in line for food.
Pope pointed to the bizarrely packed schedules for middle and high schoolers. “You’ve got seven different homework assignments that you’ve got to remember each night. Think of the cognitive load of a sixth-grade boy,” she said. “I challenge many adults to do this.”
Some parents may see children who simply need to toughen up. The world that awaits is not easy either. What they may not realize is how much children have begun to see school as an endless chore to be endured — the means to some promised end on the other side of childhood. This makes it only harder for them to learn the very skills they need most as adults.
Anxiety and depression seem inevitable when school is a field in a game for economic survival, played by children hoping to secure enough stability to last the rest of their lives. In a 2020 paper, Yale researchers found that nearly 80 percent of high schoolers said they were stressed; almost 70 percent reported being bored.
“Overall, students see school as a place where they experience negative emotions,” explained Marc Brackett, a co-author of the report when it was released.
The Children Who Don’t Fit
In the face of an unyielding education system, more parents are discovering that their children simply don’t fit, a terrifying possibility when achievement in school can determine achievement in life. At that point, the best thing to do is to prove that your child has a mental disorder. With a doctor’s diagnosis, at least, adaptations are possible.
In this way, the rise in diagnoses is also a revolt against education policymaking that strips away the particulars of people, treating them as interchangeable data points. The best teachers understand that every child has a distinct way of learning. This is especially true for children who fall outside the ever-diminishing definition of normal.
The people clamoring loudest for a diagnosis of A.D.H.D. or autism are often parents. For many families, the medications criticized by Kennedy allow their children to participate in school at all.
The need for special services in school has become so severe that families have lobbied the American Psychiatric Association to maintain a broad definition of autism, in order to avoid being pushed out of a diagnosis. The number of children with disabilities receiving support in public schools last year hit a record 7.5 million, a 17 percent increase since the 2012-13 school year. In some states, such as New York and Pennsylvania, as many as 21 percent of students are supposed to receive some adaptation.
Some of the support being requested — for instance, being allowed to move more, rather than sitting so long — would likely benefit all children. Instead, school districts try to mash individual needs into a system antithetical to them. The sheer cost and logistics of this are unsustainable. Many students who are legally entitled to support do not receive them.
Meanwhile, the Trump administration has threatened to gut the Department of Education’s civil rights division, which enforces the federal law guaranteeing that children with disabilities receive a free public education.
School districts are trying to address the mental health crisis by teaching children how to better manage their emotions. Funding has poured into counseling services. But these approaches do not lift a larger mirror to school itself as a major source of stress and anxiety. Meanwhile, the teachers of America also report overwhelming levels of burnout.
Rather than wait for changes to come, many parents are giving up on the system altogether. A poll in 2023 found that about one in three home-schooling parents were unhappy with how their schools had educated their children with special needs, prompting them to leave. Parents are also increasingly turning to microschools, essentially learning pods with small numbers of children who can receive more individual attention.
Some of these parents identify as being part of an “unschooling” movement, in which they believe that school has done more harm than good for their children. They may be onto something. A 2016 paper showed that many young adults with childhood diagnoses of A.D.H.D. saw their symptoms improve once they left school and began working in a field that interested them.
This discontent helps empower the conservative effort to defund the public school system and let parents pick their own schools, with taxpayers covering the tuition. Each child who no longer seems to fit into the country’s education system — and more often than not they are boys — potentially expands the constituency for these ideas. And trust erodes further in the progressive project of a democracy built on giving everyone a free and equal education.
The chief defender of that project, the Democratic Party, is ill-suited to addressing this crisis. Not only must it navigate teachers unions who may be skeptical of still more grandiose ideas on how to fix schools. The party has also become the political home of the meritocratic elite, the people perhaps least likely to see flaws in the system that crowned them as winners.
By turning childhood into a thing that can be measured, adults have managed to impose their greatest fears of failure onto the youngest among us. Each child who strays from our standards becomes a potential medical mystery to be solved, with more tests to take, more metrics to assess. The only thing that seems to consistently evade the detectives is the world around that child — the one made by the grown-ups.
The post America’s Children Are Unwell. Are Schools Part of the Problem? appeared first on New York Times.
