Competition Is Ruining Childhood. The Kids Should Fight Back.

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CreditDan Koeck for The New York Times

Like the crack of a starting pistol, November begins the official college application season. But for students, this race started long ago.

Many of today’s kids have lived their entire lives, from sunup until midnight, in a fierce tournament with their peers. (I was one of them. A decade after graduation, I still can’t think of a period when I’ve worked harder than in high school.) From kindergarten to 12th grade, schools brag about how “competitive” they are. That means it’s not enough for students to do their best. Whether in the classroom, on the athletic field or at home on the computer, they must always be better. Youth has become a debilitating endurance test.

The thing is, we don’t even really know what we are racing for, much less how to tone down the competition. And most people don’t seem to be benefiting from this frantic contest, either as students or as adult workers. Americans are improving themselves, but the rewards keep flowing uphill to the 1 percent.

Everyone tells students that the harder they work to develop their job skills — their “human capital” — the better off they will be. It’s not true. In fact, the result is the opposite: more and better educated workers, earning less.

An analysis in September of Census Bureau data by the Economic Policy Institute, a think tank, found that between 2000 and 2016 — years when many millennials first entered the job market — there was “little to no gain” in median annual earnings. This isn’t some limited fallout from the 2008 financial crisis; it’s a different type of phenomenon and part of a longer trend of wage stagnation that reaches back to the 1970s.

Educational achievement, on the other hand, follows a different trend. According to the National Center for Education Statistics, over the same period (2000 to 2016), the percentage of young people with a high school diploma or its equivalent passed 90 percent for the first time. In the same period, the portion of graduates seeking and obtaining both two- and four-year degrees increased consistently, and the percentage of people ages 25 to 29 with postgraduate degrees jumped to 9 percent from 5.

And this cohort of young Americans hasn’t only put in the classroom work — to say nothing of extracurricular activities and internships. This cohort of young Americans has also taken on incomprehensible amounts of debt in order to do it.

Despite what we’ve heard, money isn’t a reward America hands out for hard work. Not only is more education not leading to higher wages, there isn’t even a positive correlation between the two. If anything, the flood of human capital puts employers in a position to offer workers a shrinking slice of the pie and get more in return. Kids are getting conned. I got conned, too.

If enough students manage to master cutting-edge job skills, it will be great for the “economy,” but as workers they will find themselves rewarded with lower wages. The dynamic may seem counterintuitive but not totally unexpected. In the ’70s, the economist Gary Becker theorized that employers would shift the costs of developing human capital onto workers, from paid on-the-job training to unpaid schooling. He figured that, though they need skilled labor, corporations would be disinclined to pay for training since other companies could then lure away “their” human capital.

As training left the factory and the office for the classroom, it also meant that work could be shifted to children, who are mostly not eligible for wage labor but can, it turns out, do a whole lot of school. If firms want workers who can speak Mandarin or code Python, why should they pay trainees to learn when they can scare kids into training themselves? Within this system, all an individual kid can do is try to put a sufficient number of their peers between themselves and poverty.

There are some winners, but the real champions are the corporate owners: They get their pick from all the qualified applicants, and the oversupply of human capital keeps labor costs down. Competition between workers means lower wages for them and higher profits for their bosses: The more teenagers who learn to code, the cheaper one is.

The struggle for success has heavy financial and psychological costs for the participants. Constant competition has affected how young Americans see themselves in relation to the world. That’s why the United States has measured huge increases in youth anxiety and depression, as well as a sharp decline in social trust. If kids are told to find comfort in the idea that they are sacrificing their mental health now for security in adulthood, they are being tricked once more.

At the end of their journey into adulthood they aren’t reimbursed for their efforts. And in this winner-take-all economy, most of them just lose. They can’t increase the size of Harvard’s freshman class just by working harder; all they can do is drive one another to anxiety, depression, paranoia and exhaustion. That, and save money for their future bosses.

It doesn’t have to be this way. The kids don’t have to keep getting conned.

This system may work for a small number of bosses and shareholders, but it’s not in the interest of education in a broad, exploratory sense — and it’s clearly not in the interests of young people themselves. But even though older adults are ostensibly worried about the kids, policymakers will never scale back academic competition, and most educators and parents are understandably loath to tell children, “Don’t work so hard.”

If change is going to come, it should come from students, in the classroom.

As individuals, students have no choice but to compete. But together, there’s no telling what kind of power they could exercise. They face an age-old collective action problem, but they are smart. Schools can’t run without students, and the economy can’t run without schools; their work matters, and they can withdraw it.

Unions aren’t just good for wage workers. Students can use collective bargaining, too. The idea of organizing student labor when even auto factory workers are having trouble holding onto their unions may sound outlandish, but young people have been at the forefront of conflicts over police brutality, immigrant rights and sexual violence. In terms of politics, they are as tightly clustered as just about any demographic in America. They are an important social force in this country, one we need right now.

It’s in students’ shared interest to seek later start times for the school day to combat the epidemic of insufficient sleep among high schoolers. It’s in their shared interest to improve their mental health by reducing competition. They could start by demanding an end to class rank or a cap on the number of Advanced Placement courses each student can take per year. It’s in their shared interest to make life easier and lower the stakes of childhood in general. Only young people, united, can improve their working conditions and end the academic arms race.

Six Ways to Give the Gift of Generosity to Children and Teenagers

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Cissie Bonini, who represented EatSF, a nonprofit that gives food vouchers to low-income residents, spoke at Brandeis School of San Francisco. Students there pool their money in what is essentially a mini-foundation. CreditJason Henry for The New York Times

This is not a guilt trip. Pile the presents to the sky, by all means.

Trump-hating grown-ups may want to throw every last gift-budget dollar into the Planned Parenthood bucket. If that’s your thing, do it.

But let this column be an additional seasonal reminder that generosity is a trait that nearly all of us share and hope to imprint on the children and teenagers in our orbit. So if you’re so inclined, commit yourself to doing at least one thing before the end of the year to bring the gift of giving to young people.

Here are six ideas to get you started:

FAMILY HISTORY Why be generous? It’s a perfectly reasonable question for an innocent kindergartner or oppositional teenager to ask.

One of the best reasons is to honor your own family’s history of having been helped, as I’ve written before. Every family has one, if you stop to think about it.

Mine includes receiving financial aid at two schools over the course of a decade, a mother who survived premenopausal breast cancer thanks to some excellent medical care, and grandparents on my wife’s side who survived the Holocaust and were welcomed to the United States.

So tell your family history to your children, grandchildren, nieces or students. Update it each year with new examples of others who helped you out along the way. Kids love hearing these stories, and it helps them understand why you feel moved to support the causes you do.

YOUR CHARITABLE PIE One of the most meaningful family conversations I can recall resulted from explaining to our older daughter how we divide our charitable budget. To my wife and me, the list of organizations was a pretty good inventory of the things we cared about most.

But was there anything missing, we wondered? There was, according to our 8-year-old, who made the case for donating to a scholarship fund at her camp.

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Students at the Brandeis School of San Francisco listening to Ms. Bonini on Wednesday. Charities pitch to the students to request a share of their funding. CreditJason Henry for The New York Times

You don’t have to lead with the total dollar amounts or disclose them at all. Instead, drop 100 beans on the table, divide them into piles and then label each pile, noting that for every $100 you give away, this is how you divide it up.

Still, you should be prepared for possible questions about how much you give, which may lead inevitably to ones about how much you make and how much you have. Not all children have the financial knowledge to make sense of the answers or the discretion to keep the numbers to themselves, but by the time they’re in their late teenage years, they are often ready.

FINDING A CAUSE Not every family, let alone every child, has a burning desire to help in some particular area. Annie Hernandez, the executive director of the Frieda C. Fox Family Foundation, suggested the possibility of a tour.

Call your local community foundation (the local entities that help collect and redirect charitable dollars), ask to speak with a program officer, disclose your budget and see if that person is willing to take you to see organizations and neighborhoods where assistance would be helpful.

No, this is not poverty tourism or akin to favela tours; you’re seeking out an expert precisely to avoid any insensitivity and to try to establish a lasting relationship. And even if the person you speak with can’t help you in person, he or she may be able to send you to other local organizations that are compatible with your general areas of interest.

SCHOOL-BASED FUNDS The best school-based giving program I’ve ever encountered is the yearlong effort that the seventh graders take on at the Brandeis School of San Francisco.

Rather than give one another token bar and bat mitzvah gifts, the students and their families at the Jewish kindergarten-through-eighth-grade day school take the money they would have spent, toss it into a giant pile and let the children give it away. With additional fund-raising, the total can sometimes exceed $30,000. Essentially, it’s a mini-foundation that opens in the fall and closes the following summer, featuring grown-ups representing charities who visit the school regularly to request a share through pitches to the students.

As part of the school’s Judaic Studies curriculum, students pair off, establish an area of interest, find three local organizations that help in that area and then present one of them to classmates for further evaluation. Criteria for the culling include the importance of the problem, proof of the organization’s effectiveness and how big of an impact the students’ gift could make given the size of the organization.

Each one is ripe material for extended conversation, which is exactly the point. Students can change their minds about their allocation votes at least once before the day comes to dole out as much as $5,000 per group. “Every year at the culminating event, there are parents crying,” said Jody Bloom, who teaches the Judaic Studies class. “It’s a lot of the reason that they send their kids to the school in the first place.”

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Students at Brandeis, a Jewish school, save the money they would normally spend on bar and bat mitzvah gifts and instead give to charity. With additional fund-raising, the total can sometimes exceed $30,000 in a year. CreditJason Henry for The New York Times

GIVING CIRCLES Many schools are not equipped to support curriculums that feature actual dollars, but nothing is stopping parents from establishing something like it outside the classroom. Mandy Kao, a mother of three in Houston and a real estate entrepreneur, had herself participated in a charitable giving circle, where a group of people pool resources to make collective decisions about grant making, when she decided to start a circle for her three boys and other children a few years ago.

The group of Houston-area youths raise money through a Mother’s Day brunch and other activities and receive matching funds from an organization called Asian Americans/Pacific Islanders in Philanthropy.They’ve made grants to youth soccer programs that help refugees and to Big Brothers Big Sisters in an effort to try to encourage more Asian-Americans to serve as mentors.

In Manhattan, Sara Shapiro-Plevan, a consultant, is about to start a giving circle just for boys. She was plotting against the reality that by the time middle school rolls around, some children want nothing to do with members of the opposite sex, while others want everything to do with them. Either way, she figured, it would work better if it was just her sixth grader and his male friends. “It’s an easier way to have what might be a challenging conversation,” she said. “And to do something his mom was asking him to do.”

For many years, Jen Bokoff, a Brooklyn resident who works in philanthropy, has done a one-night-only circle with her family each Hanukkah. She and her relatives each bring $10, regardless of age, and then talk for a bit about an organization they favor. Everyone’s names go into a hat, someone picks and then that person’s organization gets all the money.

SHARING December can be a sad time for many adults, often because they feel diminished by the lavish holiday tales that flow through their social media feeds. Nevertheless, Ms. Hernandez is a big believer in talking about whatever giving we do, because it normalizes it as a regular holiday activity.

So how best for a family to share in a way that will not subtly shame some other adult having a more materialistic holiday?

Ms. Bokoff is the director of knowledge services at the Foundation Center, which helped build a resource-rich website for families and educators called youthgiving.org. In her world, the giving talk is often around donors’ treasure, time, talent and ties.

Treasure is the money. Time and talent are about volunteering, which children should certainly do too in their areas of interest.

As for the ties, that’s about your network — and for middle- and high-school-age children, their most powerful networks may be digital ones. “They can use those platforms to share causes they care about,” Ms. Bokoff said. “And if they do it, their friends are more likely to as well.”

When Tech Is a Problem Child

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CreditWesley Bedrosian

In the Broadway classic “The Music Man,” set in 1912, the con artist Harold Hill shows up in River City, Iowa, and attempts to persuade the otherwise contented townspeople that their youth are slipping into degradation. He singles out a billiard parlor, “the devil’s playground,” as the root.

“You got trouble,” he sings. “With a capital ‘T’ and that rhymes with ‘P’ and that stands for pool!”

These days, you don’t need goosed-up threats of nicotine stains and rebuckled knickerbockers to rouse the anxieties of parents. All you need is to broach the one subject that everyone views as Trouble.

By now, all parents know that technology poses at least some threat to children. Just last month, the American Academy of Pediatrics released a study that said while digital and social media can help early learning, they also come with a host of risks, including negative effects on sleep, attention and learning, along with higher incidence of obesity and depression. The group recommends that parents develop a Family Media Use Plan.

Fair enough, but what should be in such a plan? As the parent of adolescents, I want more than bromides. I want to know what other parents are actually doing that works.

For the last six weeks, I’ve circulated (on social media!) 20 questions covering topics like homework, passwords, bedtime and punishments. I received responses from more than 60 families, and though the survey was unscientific, the answers have already changed how we manage tech at my house.

FIRST PHONES The vast majority of parents who responded gave their children their first phones in sixth or seventh grade, with a few holding out until high school. But those devices aren’t always cutting edge. Parents opted for “dumb phones,” “flip phones” or “hand-me-down phones” from siblings or grown-ups. They also turn off features, including Wi-Fi, Siri, even internet access.

Other popular restrictions include: “Writing an expected behavior contract.” “No use of the internet on school days (except schoolwork).” “Screen time limited to 30 to 60 minutes per day during the week, unlimited on Saturday mornings.”

Another is a partial ban on group texting. “I was able to help my son feel better about not having this by allowing him to view group texts on the family iPad,” one parent said. “It helped him see how little value the group chatter has.”

Phones during friend visits are another issue: “Nothing more disappointing than seeing my children’s friends bring their devices to my home and have them focus on the devices to the exclusion of hanging out with my children.”

My own favorite way to limit tech use: “Poor reception — the phones don’t always work.”

Asked to give other parents advice on when to give their children a phone, the consensus answer was: Wait as long as possible. Once you provide it, it’s very difficult to take back.

HOMEWORK Should children be allowed to communicate with friends while doing homework? Two-thirds of the parents say yes; one-third say no.

Among the comments by the Yeses were, “Only if they are in common areas of the house” or “Only with the door open (so we can monitor).” Another added, “Depends if they are working on a project together, which is difficult to enforce.”

The Nos said that homework is done independently, and that if kids need help, they should find a parent, or the parents contact a teacher.

Wider use of computers for homework also drew mixed reactions. Some parents are quite strict, limiting all technology “outside of a computer for spelling or Google docs.” “Only homework-related sites and no social media.” “Only certain educational sites are allowed. Wikipedia is completely discouraged. I strongly believe that actual books should be read for research purposes as opposed to ‘Googling’ everything.”

Others are more lax: “You have to let them use the tools they will need in their lifetime. Otherwise, let’s give them coal and a slate slab, like Lincoln.”

BEDTIME Researchers at King’s College London have found “strong and consistent association” between using devices at bedtime and inadequate sleep, poor sleep and increased sleepiness during daytime. Parents have gotten the message.

An overwhelming majority ban phones from bedrooms at bedtime. “Tech needs a bedtime, too, in our house, 30 mins before lights out.” “No technology one hour before bedtime.” “At 9 p.m. she brings her phone downstairs, where it stays until 7 a.m.” “Devices are supposed to be parked outside the kids’ bedrooms before they turn in for the night.”

Some parents make exceptions on weekends or as kids get older. A few have no restrictions at all, though one otherwise tech-friendly mom said: “No earbuds! Our carbon monoxide detector went off one night and he did not wake up because he was sleeping with earbuds in.”

At least one dad goes to the opposite extreme, turning off the Wi-Fi in the house at an appointed time each night. “Same rules, better enforcement,” he said.

Also popular is to require phones to be charged outside the bedroom. “Everyone in our house puts phones on a charging station in our kitchen before going to bed.” “Devices are charged in the kitchen. (I cook a lot and I can keep an eye on them, especially when the children are punished and still try to sneak off with them.)” “At bedtime, devices go in the bathroom for charging.”

One mother has no specific place, only not in the child’s room: “My husband and I simply ask where the phones are charging during our ‘audits of responsibility.’ If the children try to work around the rule, they know the device will be placed in ‘jail.’”

SOCIAL MEDIA Many parents restrict first-time phone users to a single social media platform. “Only Snapchat; no Instagram, Twitter, Facebook.” “Only Instagram, and I check it occasionally.” “One platform at a time.”

Regardless of the sites, most parents insist on knowing passwords and logins. “My rules, until he was 18, were that I get all the passwords to all accounts. I did spot check from time to time.” “I have ALL usernames and passwords, and if they change, she has to update my list. If I try to log on and cannot, I get the phone until it pleases me to give it back.”

Do parents actually monitor their children’s online behavior? Some do. “I read texts frequently.” “We are ‘friends’ or ‘following’ all of his social media accounts, so we see every post.” “I have asked to read texts when daughter was hiding device as I came into the room.” “I do random audits. We talk about digital citizenship and positive words.”

But others prefer to give their children freedom. “When they each began texting, I read random texts. And I asked about the ones I read. (‘I see you and friend are chatting about the Jets,’ or ‘I see you and friend are chatting about another child in class.’) That way they know I can read any text at any time, even though I don’t.” “They’re almost all very boring.”

PUNISHMENTS What happens if children violate the family rules? Is it actually possible to separate a digital native from a device for an extended period of time? Behold, skeptical ones: Many parents say yes.

“Yes when younger.” “Yes, she responds to it.” “YES!! It’s the ultimate motivator!” “Yes. Weeping and gnashing of teeth, and then they find other things to do.” “I have. He gets very angry initially but eventually he calms down. Last spring I implemented a 3 week digital cleanse. He was angry each day for 3 days but also became more pleasant.”

Another common way to get children to adhere to restrictions is to have them pay for overages. “We pay the fee but have her pay overages.” “We also cut data off.” “She now babysits family friends to earn more and has to learn basic budgeting.”

FAMILY TIME Perhaps the biggest complaint about technology is that it eats into family time. So what techniques have parents used to take back that time?

First, tech-free dining. “No devices for all meals.” “No phones at the table, and that’s not just at our house. Siblings, nieces, nephews and my mom’s home have the same rule. No one gripes about it, they just do it.” “No devices at meals. No earbuds in the car.”

Second, consider positive alternatives. “Doing things that make phones a burden. Playing a fast-moving game, hiking, attending concerts or performances.” “We watch movies together, have a fire in the yard or swim when it’s warm and have game night, only board games allowed. They used to complain, but have found favorite games and look forward to it now.”

“Do something constructive together. Make sure everyone (even mommy and daddy) get their hands dirty. We often will cook together and make some of the worst meals ever, but it’s O.K. because we did it together.”

Finally, when all else fails, many rely on the old parental standbys: threats, bribes and public humiliation. Threats: “Randomly I scream, ‘Take that phone out of your hand!’ It limits their use for the next five minutes.”

Bribes: “Parent-child date night. (Parents alternate taking one child out for a treat; fourth week is parents night out.)”

Public humiliation: “If a device is picked up during family time, we get to open texts, and my husband and I do dramatic text reading.”

Now that’s a technique even the parents of River City might embrace. These days, trouble may start with the phone, but the solution still begins at home.

The Moral Bucket List

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CreditRachel Levit. Photography by Tony Cenicola/The New York Times

ABOUT once a month I run across a person who radiates an inner light. These people can be in any walk of life. They seem deeply good. They listen well. They make you feel funny and valued. You often catch them looking after other people and as they do so their laugh is musical and their manner is infused with gratitude. They are not thinking about what wonderful work they are doing. They are not thinking about themselves at all.

When I meet such a person it brightens my whole day. But I confess I often have a sadder thought: It occurs to me that I’ve achieved a decent level of career success, but I have not achieved that. I have not achieved that generosity of spirit, or that depth of character.

A few years ago I realized that I wanted to be a bit more like those people. I realized that if I wanted to do that I was going to have to work harder to save my own soul. I was going to have to have the sort of moral adventures that produce that kind of goodness. I was going to have to be better at balancing my life.

It occurred to me that there were two sets of virtues, the résumé virtues and the eulogy virtues. The résumé virtues are the skills you bring to the marketplace. The eulogy virtues are the ones that are talked about at your funeral — whether you were kind, brave, honest or faithful. Were you capable of deep love?

We all know that the eulogy virtues are more important than the résumé ones. But our culture and our educational systems spend more time teaching the skills and strategies you need for career success than the qualities you need to radiate that sort of inner light. Many of us are clearer on how to build an external career than on how to build inner character.

But if you live for external achievement, years pass and the deepest parts of you go unexplored and unstructured. You lack a moral vocabulary. It is easy to slip into a self-satisfied moral mediocrity. You grade yourself on a forgiving curve. You figure as long as you are not obviously hurting anybody and people seem to like you, you must be O.K. But you live with an unconscious boredom, separated from the deepest meaning of life and the highest moral joys. Gradually, a humiliating gap opens between your actual self and your desired self, between you and those incandescent souls you sometimes meet.

So a few years ago I set out to discover how those deeply good people got that way. I didn’t know if I could follow their road to character (I’m a pundit, more or less paid to appear smarter and better than I really am). But I at least wanted to know what the road looked like.

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CreditRachel Levit. Photography by Tony Cenicola/The New York Times

I came to the conclusion that wonderful people are made, not born — that the people I admired had achieved an unfakeable inner virtue, built slowly from specific moral and spiritual accomplishments.

If we wanted to be gimmicky, we could say these accomplishments amounted to a moral bucket list, the experiences one should have on the way toward the richest possible inner life. Here, quickly, are some of them:

THE HUMILITY SHIFT We live in the culture of the Big Me. The meritocracy wants you to promote yourself. Social media wants you to broadcast a highlight reel of your life. Your parents and teachers were always telling you how wonderful you were.

But all the people I’ve ever deeply admired are profoundly honest about their own weaknesses. They have identified their core sin, whether it is selfishness, the desperate need for approval, cowardice, hardheartedness or whatever. They have traced how that core sin leads to the behavior that makes them feel ashamed. They have achieved a profound humility, which has best been defined as an intense self-awareness from a position of other-centeredness.

SELF-DEFEAT External success is achieved through competition with others. But character is built during the confrontation with your own weakness. Dwight Eisenhower, for example, realized early on that his core sin was his temper. He developed a moderate, cheerful exterior because he knew he needed to project optimism and confidence to lead. He did silly things to tame his anger. He took the names of the people he hated, wrote them down on slips of paper and tore them up and threw them in the garbage. Over a lifetime of self-confrontation, he developed a mature temperament. He made himself strong in his weakest places.

THE DEPENDENCY LEAP Many people give away the book “Oh, the Places You’ll Go!” as a graduation gift. This book suggests that life is an autonomous journey. We master certain skills and experience adventures and certain challenges on our way to individual success. This individualist worldview suggests that character is this little iron figure of willpower inside. But people on the road to character understand that no person can achieve self-mastery on his or her own. Individual will, reason and compassion are not strong enough to consistently defeat selfishness, pride and self-deception. We all need redemptive assistance from outside.

People on this road see life as a process of commitment making. Character is defined by how deeply rooted you are. Have you developed deep connections that hold you up in times of challenge and push you toward the good? In the realm of the intellect, a person of character has achieved a settled philosophy about fundamental things. In the realm of emotion, she is embedded in a web of unconditional loves. In the realm of action, she is committed to tasks that can’t be completed in a single lifetime.

ENERGIZING LOVE Dorothy Day led a disorganized life when she was young: drinking, carousing, a suicide attempt or two, following her desires, unable to find direction. But the birth of her daughter changed her. She wrote of that birth, “If I had written the greatest book, composed the greatest symphony, painted the most beautiful painting or carved the most exquisite figure I could not have felt the more exalted creator than I did when they placed my child in my arms.”

That kind of love decenters the self. It reminds you that your true riches are in another. Most of all, this love electrifies. It puts you in a state of need and makes it delightful to serve what you love. Day’s love for her daughter spilled outward and upward. As she wrote, “No human creature could receive or contain so vast a flood of love and joy as I often felt after the birth of my child. With this came the need to worship, to adore.”

She made unshakable commitments in all directions. She became a Catholic, started a radical newspaper, opened settlement houses for the poor and lived among the poor, embracing shared poverty as a way to build community, to not only do good, but be good. This gift of love overcame, sometimes, the natural self-centeredness all of us feel.

THE CALL WITHIN THE CALL We all go into professions for many reasons: money, status, security. But some people have experiences that turn a career into a calling. These experiences quiet the self. All that matters is living up to the standard of excellence inherent in their craft.

Frances Perkins was a young woman who was an activist for progressive causes at the start of the 20th century. She was polite and a bit genteel. But one day she stumbled across the Triangle Shirtwaist factory fire, and watched dozens of garment workers hurl themselves to their deaths rather than be burned alive. That experience shamed her moral sense and purified her ambition. It was her call within a call.

After that, she turned herself into an instrument for the cause of workers’ rights. She was willing to work with anybody, compromise with anybody, push through hesitation. She even changed her appearance so she could become a more effective instrument for the movement. She became the first woman in a United States cabinet, under Franklin D. Roosevelt, and emerged as one of the great civic figures of the 20th century.

THE CONSCIENCE LEAP In most lives there’s a moment when people strip away all the branding and status symbols, all the prestige that goes with having gone to a certain school or been born into a certain family. They leap out beyond the utilitarian logic and crash through the barriers of their fears.

The novelist George Eliot (her real name was Mary Ann Evans) was a mess as a young woman, emotionally needy, falling for every man she met and being rejected. Finally, in her mid-30s she met a guy named George Lewes. Lewes was estranged from his wife, but legally he was married. If Eliot went with Lewes she would be labeled an adulterer by society. She’d lose her friends, be cut off by her family. It took her a week to decide, but she went with Lewes. “Light and easily broken ties are what I neither desire theoretically nor could live for practically. Women who are satisfied with such ties do not act as I have done,” she wrote.

She chose well. Her character stabilized. Her capacity for empathetic understanding expanded. She lived in a state of steady, devoted love with Lewes, the kind of second love that comes after a person is older, scarred a bit and enmeshed in responsibilities. He served her and helped her become one of the greatest novelists of any age. Together they turned neediness into constancy.

Commencement speakers are always telling young people to follow their passions. Be true to yourself. This is a vision of life that begins with self and ends with self. But people on the road to inner light do not find their vocations by asking, what do I want from life? They ask, what is life asking of me? How can I match my intrinsic talent with one of the world’s deep needs?

Their lives often follow a pattern of defeat, recognition, redemption. They have moments of pain and suffering. But they turn those moments into occasions of radical self-understanding — by keeping a journal or making art. As Paul Tillich put it, suffering introduces you to yourself and reminds you that you are not the person you thought you were.

The people on this road see the moments of suffering as pieces of a larger narrative. They are not really living for happiness, as it is conventionally defined. They see life as a moral drama and feel fulfilled only when they are enmeshed in a struggle on behalf of some ideal.

This is a philosophy for stumblers. The stumbler scuffs through life, a little off balance. But the stumbler faces her imperfect nature with unvarnished honesty, with the opposite of squeamishness. Recognizing her limitations, the stumbler at least has a serious foe to overcome and transcend. The stumbler has an outstretched arm, ready to receive and offer assistance. Her friends are there for deep conversation, comfort and advice.

External ambitions are never satisfied because there’s always something more to achieve. But the stumblers occasionally experience moments of joy. There’s joy in freely chosen obedience to organizations, ideas and people. There’s joy in mutual stumbling. There’s an aesthetic joy we feel when we see morally good action, when we run across someone who is quiet and humble and good, when we see that however old we are, there’s lots to do ahead.

The stumbler doesn’t build her life by being better than others, but by being better than she used to be. Unexpectedly, there are transcendent moments of deep tranquillity. For most of their lives their inner and outer ambitions are strong and in balance. But eventually, at moments of rare joy, career ambitions pause, the ego rests, the stumbler looks out at a picnic or dinner or a valley and is overwhelmed by a feeling of limitless gratitude, and an acceptance of the fact that life has treated her much better than she deserves.

Those are the people we want to be.

Far From My Tree

Motherlode - Adventures in Parenting


By SUE ROBINS

My eldest son is 20 years old, lives in a house crammed with seven scrabbly roommates, works part time in a restaurant kitchen, doesn’t drive, is a vegetarian, and has homemade tattoos etched into his thighs.

He’s firmly a musician – a drummer in a loud punk band, and he loves nothing more than to tour across North America, playing gigs in sketchy houses in Oakland, Calif., and south Chicago.

He appears to have only one pair of pants – dirty, black cutoff jeans, and his shirts are also of the ripped-off-arms variety. I’m not sure who has been ripping up all his clothes. Maybe there’s a wild dog living in his house.

I’m both proud of and horrified for my boy. His jaw is squarely set, and he’s acutely committed to what he wants to do. And that is to tour with his band in their black-panel van, crisscrossing borders, dodging death in dubious neighborhoods, sleeping on strangers’ couches, and eating vegetarian burritos.

As my children traveled through their teenage years, I emphasized to them: Find your passion and follow it. What I really meant was: Find your passion, but do it in the way I did it. That is, go to college first, get a liberal arts degree, meander through your 20s, and then supplement your undergraduate degree with graduate studies. All while wearing clean, intact clothing.

But what if, as Andrew Solomon so eloquently addresses in his masterpiece, “Far From the Tree,” your child ends up so very different from you? I read “Far From the Tree” because it speaks of children with disabilities (and my youngest son has Down syndrome), but I gained a deeper knowledge of all children who stray from their parents. If we face reality squarely, and give our children the space to be who they want to be, every single child should be different from his parents, and should be allowed and even encouraged to fall far from our trees.

My oldest boy does not show up to family events in his collared shirt and pressed pants. In fact, he rarely shows up at all. He doesn’t respond to calls from grandparents, although he will send thank you texts for birthday gifts, so he still has a sliver of decorum. He’s proudly anti-establishment, and my current lifestyle with my husband (and his stepfather) – living in the suburbs and driving a BMW – clearly disgusts him.

I watch my friends’ children embarking on their second year of college, most of them still living at home with their parents. They are clean-cut, unfailingly polite, sit quietly at dinner parties and patiently dole out answers to questions from adults. Inevitably, someone asks me, “What’s your son doing?” and then I feel a strange mix of pride and apology. “He’s living his life,” I say. “But what graduate program? What path is he taking?” “He’s not in a program,” I say. “He’s working and playing in a band.” They take a deep gulp of wine and look down at their expensive shoes.

I read a biography of Dave Grohl, the former drummer for Nirvana. In it, Mr. Grohl’s mother – a teacher herself – agreed to let him drop out of high school so he could tour with his band. She said that he was good at a lot of things, but school was not one of them. Clearly Mr. Grohl’s path did not include the traditional, go-to-college-get-a-job trajectory.

My son is teaching me that there isn’t just one way to live life. Yes, I wish he would go to college so he doesn’t live below the poverty line and reside in a house of squalor.

But that’s what I want for him. That’s not what he wants for himself. He is not the male version of me. He’s a musician, and the creative life means a guaranteed amount of struggle and heartache. Every time we meet for lunch, I tell him that I love him, and that I’m proud of him.

Even if my boy’s path never rises out of moshing in the basements of America, that’s got to be O.K., too. There are no conditions placed on unconditional love.

Girls’ Clothing: A Line Between Sweet and Skimpy

Here’s an interesting New York Times article about the “sexualization” of girls through popular clothing, and strategies parents can use to help their daughters dress modestly.  Thank goodness for a school uniform!

Anastasia Vasilakis
By BRUCE FEILER
Published: May 10, 2013

It first happened to me this spring. My daughters, who had just turned 8, came bounding into the room to show off new outfits they were wearing to an extended-family gathering. My eyes bulged. The dresses drooped provocatively off the shoulder and offered other peekaboos of their bodies. Sure, as a parent, I figured I would one day face clothing battles with my children. Politicians aren’t the only ones who draw red lines.

But so soon?

As a father, I find these conversations particularly challenging. On the one hand, I’ve internalized all the messages that I should not criticize my daughters’ bodies, compliment them merely for their looks, or in any way stifle their emerging sexuality. On the other hand, I don’t want them to leave the house dressed as pole dancers.

For years, I had what I thought was a sly way of handling this issue. Whenever my daughters modeled a new piece of clothing, I would say: “I don’t care what you wear. I care who you are.” But recently they’ve begun throwing my line back at me: “But I thought you didn’t care what we wear!”

Time to get some new lines.

The issue of appropriate clothing for girls has been the subject of increasing academic and popular scrutiny, fed by skimpy panties printed with “wink wink” or skinny leggings that say “cute butt sweat pants.” In 2007, Walmart bowed to parental pressure and pulled pairs of pink girls’ underwear off its shelves because they were printed with the words “Who needs credit cards …” on the front and “When you’ve got Santa” on the back.

Sarah K. Murnen, a professor of psychology at Kenyon College, said parents today face greater challenges than those in the past because girls’ clothing has become more sexualized. “Some people say it’s due to an increased pornification of culture,” Professor Murnen said, “where the easy availability of pornography on the Internet has made its way into styles and popular culture.” She cited thong underwear, push-up bras and leather miniskirts for first to fifth graders as examples.

In a 2011 study, Professor Murnen evaluated 5,666 items of girls’ clothing on 15 popular Web sites to determine whether they were “childlike,” “sexualizing” or “adultlike.” She found that 29.4 percent of items were judged to have “sexualizing characteristics,” including more than half of dresses and two-thirds of swimsuits. In a separate study of girls’ magazines, she found that the percentage of provocative clothing had more than doubled since 1971.

Professor Murnen said that this trend was particularly alarming because her research indicates that when adults look at girls dressed in sexualized clothing, they take them less seriously. “Teachers are looking at these girls and assuming they aren’t intelligent,” she said.

Joyce McFadden, a psychoanalyst and the author of “Your Daughter’s Bedroom,” said girls today are unprepared to withstand sophisticated efforts by corporations that prey on girls’ desire to be popular. “As parents, we’re so afraid to talk honestly with our daughters about their sexuality that we end up leaving them out in the cold,” she said.

The American Psychological Association grew so alarmed with the objectification of girls in popular culture that in 2005 it set up a task forceSharon Lamb, a psychologist at the University of Massachusetts, Boston, and a member of the task force, said her hope was that their two reports “would bring attention to marketers and media to be more reflective about the kinds of girls they were presenting.”

Unfortunately, she said, the reports added pressure on parents to be more vigilant. “I don’t think it’s parents’ fault that they are ‘allowing their kids to walk around like this,’ ” she said. “There’s so much being done through peer culture that it’s a real struggle for parents not to be meanies and come across as antisexuality.”

So what is a worried parent to say? I suggested five possible retorts from girls and asked for guidance.

“EVERYBODY DOES IT.” “Ooh, that’s a rough one,” Ms. McFadden said, “because it’s the precursor to ‘Well, Johnny is freebasing’ or ‘So-and-so gets to stay out until 4 in the morning.’ You have to say, ‘Well, in our family we do things differently.’ ” The critical step, she said, is for parents to make sure they are on the same page before approaching their children. “You’re going to have to compromise on some pieces of clothing,” she said. “I had to give in on push-up bras with my daughter. But don’t let these items take over her wardrobe.”

“IT’S THE ONLY THING THEY SELL.” Ms. Lamb, co-author of “Packaging Girlhood,” said children who make that observation have a point. “Still, you have to state your values,” she said. “You have to say: ‘I don’t want to see you and your friends buying into these marketers’ schemes to sell teenage stuff to younger and younger kids. It’s like “Invasion of the Body Snatchers.” The marketers are the body snatchers, and I’m going to fight them.’ ”

“YOU’RE SUCH A SQUARE.”Professor Murnen agreed that parents need to embrace their old-fashioned standards. “I’m not a conservative person,” she said. “But when it came to my daughter, I told her I hope she developed a wonderful body image and a healthy sexuality but that I didn’t think that’s what sexy clothes were doing.” Professor Murnen said she even adjusted her own fashion choices. “I personally like attractive clothing,” she said, “but I’m careful not to wear clothing with sexualizing characteristics, because I do feel like I need to be a role model for my students.”

“MOM WEARS THESE THINGS, WHY NOT ME?”Ms. McFadden said it’s fair to point out to girls that as they get older, they will have more freedom to make their own decisions. “Our generation of parents are such sissies when it comes to setting boundaries,” she said. “Parents concede to their children’s whims to make their children happy, but those children don’t grow up to be happy, because they have no internal compass. These limits are what make healthy, happy adults possible.”

“FINE, BUT I’M JUST GOING TO CHANGE WHEN I GET TO SCHOOL.” Ms. Lamb said her response to girls who threaten to peel off layers once they leave the house would be to redirect the conversation. “I would say, ‘I’m not interested in controlling what you wear,’ ” she said. “ ‘I’m interested in getting you thinking about what it means to be an attractive person.’ ” She said she often tells her teenage students that the species would die out if boys only wanted to have sex with girls who looked like Victoria’s Secret models. “We’re built to be attracted to people with different looks, with different personalities, with different talents, senses of humor and lots of wonderful things,” she said.

As for us, the night my daughters first flashed their approaching tweendom, my wife quickly heeded the message. Shawls were procured, and those once-revealing dresses soon became more age appropriate. With a little hunting, my wife and daughters located some Web site that sold attractive clothes with more modest, yet trendy-enough slogans: “I Love Music” and “Bee-You-Tiful” with a bumblebee.

Still, we had been warned. The big battles are yet to come. Ms. McFadden said we should stay strong. “You have to remember,” she said, “you’re raising a person who’s going to live a whole life. Just because one episode doesn’t go well doesn’t mean an accumulation of similar messages won’t somehow trickle down. You just have to be brave, let them have the freedom they deserve, but still set guidelines that represent your family’s values.”

A version of this article appeared in print on May 12, 2013, on page ST2 of the New York edition with the headline: A Line Between Sweet and Skimpy.

ADHD – Diagnosing the Wrong Deficit

An opinion piece from The New York Times

Shannon Freshwater

IN the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently. But one thing was unusual. His symptoms had started only two years earlier, when he was 31.

Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.

The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.

Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?

For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.

We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.

A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.

One study, published in 2004 in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 control subjects.

A 2006 study in the journal Pediatrics showed something similar, from the perspective of a surgery clinic. This study included 105 children between ages 5 and 12. Seventy-eight of them were scheduled to have their tonsils removed because they had problems breathing in their sleep, while 27 children scheduled for other operations served as a control group. Researchers measured the participants’ sleep patterns and tested for hyperactivity and inattentiveness, consistent with standard protocols for validating an A.D.H.D. diagnosis.

Of the 78 children getting the tonsillectomies, 28 percent were found to have A.D.H.D., compared with only 7 percent of the control group.

Even more stunning was what the study’s authors found a year after the surgeries, when they followed up with the children. A full half of the original A.D.H.D. group who received tonsillectomies — 11 of 22 children — no longer met the criteria for the condition. In other words, what had appeared to be A.D.H.D. had been resolved by treating a sleeping problem.

But it’s also possible that A.D.H.D.-like symptoms can persist even after a sleeping problem is resolved. Consider a long-term study of more than 11,000 children in Britain published last year, also in Pediatrics. Mothers were asked about symptoms of sleep-disordered breathing in their infants when they were 6 months old. Then, when the children were 4 and 7 years old, the mothers completed a behavioral questionnaire to gauge their children’s levels of inattention, hyperactivity, anxiety, depression and problems with peers, conduct and social skills.

The study found that children who suffered from sleep-disordered breathing in infancy were more likely to have behavioral difficulties later in life — they were 20 to 60 percent more likely to have behavioral problems at age 4, and 40 to 100 percent more likely to have such problems at age 7. Interestingly, these problems occurred even if the disordered breathing had abated, implying that an infant breathing problem might cause some kind of potentially irreversible neurological injury.

CLEARLY there is more going on in the nocturnal lives of our children than any of us have realized. Typically, we see and diagnose only their downstream, daytime symptoms.

There has been less research into sleep and A.D.H.D. outside of childhood. But a team from Massachusetts General Hospital found, in one of the only studies of its kind, that sleep dysfunction in adults with A.D.H.D. closely mimics the sleep dysfunction in children with A.D.H.D.

There is also some promising research being done on sleep in adults, relating to focus, memory and cognitive performance. A study published in February in the journal Nature Neuroscience found that the amount of delta sleep in seniors correlates with performance on memory tests. And a study published three years ago in Sleep found that while subjects who were deprived of sleep didn’t necessarily report feeling sleepier, their cognitive performance declined in proportion to their sleep deprivation and continued to worsen over five nights of sleep restriction.

As it happens, “moves about excessively during sleep” was once listed as a symptom of attention-deficit disorder in the Diagnostic and Statistical Manual of Mental Disorders. That version of the manual, published in 1980, was the first to name the disorder. When the term A.D.H.D., reflecting the addition of hyperactivity, appeared in 1987, the diagnostic criteria no longer included trouble sleeping. The authors said there was not enough evidence to support keeping it in.

But what if doctors, before diagnosing A.D.H.D. in their patients, did have to find evidence of a sleep disorder? Psychiatric researchers typically don’t have access to the equipment or expertise needed to evaluate sleep issues. It’s tricky to ask patients to keep sleep logs or to send them for expensive overnight sleep studies, which can involve complicated equipment like surface electrodes to measure brain and muscle activity; abdominal belts to record breathing; “pulse oximeters” to measure blood oxygen levels; even snore microphones. (And getting a sleep study approved by an insurance company is by no means guaranteed.) As it stands, A.D.H.D. can be diagnosed with only an office interview.

Sometimes my patients have resisted my referrals for sleep testing, since everything they have read (often through direct-to-consumer marketing by drug companies) identifies A.D.H.D. as the culprit. People don’t like to hear that they may have a different, stranger-sounding problem that can’t be fixed with a pill — though this often changes once patients see the results of their sleep studies.

Beyond my day job, I have a personal interest in A.D.H.D. and sleep disorders. Beginning in college and for nearly a decade, I struggled with profound cognitive lethargy and difficulty focusing, a daily nap habit and weekend sleep addiction. I got through my medical school exams only by the grace of good memorization skills and the fact that ephedra was still a legal supplement.

I was misdiagnosed with various maladies, including A.D.H.D. Then I underwent two sleep studies and, finally, was found to have an atypical form of narcolepsy. This was a shock to me, because I had never fallen asleep while eating or talking. But, it turned out, over 40 percent of my night was spent in REM sleep — or “dreaming sleep,” which normally occurs only intermittently throughout the night — while just 5 percent was spent in delta sleep, the rejuvenating kind. I was sleeping 8 to 10 hours a night, but I still had a profound delta sleep deficit.

It took some trial and error, but with the proper treatment, my cognitive problems came to an end. Today I eat well and respect my unique sleep needs instead of trying to suppress them. I also take two medications: a stimulant for narcolepsy and, at bedtime, an S.N.R.I. (or serotonin-norepinephrine reuptake inhibitor) antidepressant — an off-label treatment that curtails REM sleep and helps increase delta sleep. Now I wake up without an alarm, and my daytime focus is remarkably improved. My recovery has been amazing (though my wife would argue that weekend mornings are still tough — she picks up the slack with our two kids).

Attention-deficit problems are far from the only reasons to take our lack of quality sleep seriously. Laboratory animals die when they are deprived of delta sleep. Chronic delta sleep deficits in humans are implicated in many diseases, including depression, heart disease, hypertension, obesity, chronic pain, diabetes and cancer, not to mention thousands of fatigue-related car accidents each year.

Sleep disorders are so prevalent that every internist, pediatrician and psychiatrist should routinely screen for them. And we need far more research into this issue. Every year billions of dollars are poured into researching cancer, depression and heart disease, but how much money goes into sleep?

The National Institutes of Health will spend only $240 million on sleep research this year. One of the problems is that the research establishment exists as mini-fiefdoms — money given to one sector, like cardiology or psychiatry, rarely makes it into another, like sleep medicine, even if they are intimately connected.

But we can’t wait any longer to pay attention to the connection between delta sleep and A.D.H.D. If you’re not already convinced, consider the drug clonidine. It started life as a hypertension treatment, but has been approved by the Food and Drug Administration to treat A.D.H.D. Studies show that when it is taken only at bedtime, symptoms improve during the day. For psychiatrists, it is one of these “oh-we-don’t-know-how-it-works” drugs. But here is a little-known fact about clonidine: it can be a potent delta sleep enhancer.

Vatsal G. Thakkar is a clinical assistant professor of psychiatry at the N.Y.U. School of Medicine.

A version of this op-ed appeared in print on April 28, 2013, on page SR1 of the New York edition with the headline: Diagnosing The Wrong Deficit.

Minimalist Parenting, ‘Manimalist’ Style

The New York Times

By ANDY HINDS

My wife is leaving for a conference tomorrow. The next five days will be the longest stretch of time I’ve spent taking care of our twin, almost-4-year-old daughters without any backup.

If you’re picturing my wife typing out lists of instructions for the care and feeding of our children, drilling me on the days and times of all their activities, and stocking the freezer with elaborate meals to sustain them through her absence, you’re thinking about a different family. I do the bulk of the child care in our home, and I like to keep it so simple that even if I screwed it up, no one would really notice. To say that my stripped-down parenting style is because of my gender would be an oversimplification. But after reading a new book about improving the quality of family life by dialing down parental intensity, I’m inclined to think that it does play a role.

I’ve been a stay-at-home (mostly) dad since my wife went back to work when the girls were 4 months old. In the first year, I read a few books about child development, sleep training and parenting styles, but as the girls grew up happy and healthy, and as I got the hang of things, I stopped reading. Nowadays, I stick to parenting blogs and articles that celebrate the unleashing of a child’s imagination by providing plenty of unstructured playtime, and roll my eyes at photo spreads of extravagant parties and toys and the humblebrags of parents who are exhausted and stressed from shuttling their children to various “enrichment” activities.

Despite my dwindling interest in parenting manuals, I couldn’t resist a new release with a title that I felt encapsulated my child-rearing philosophy. Like most people, I enjoy reading books that support my own beliefs, and that’s why I stayed up late to greedily devour “Minimalist Parenting” by Christine Koh and Asha Dornfest, frequently nodding in agreement and exclaiming “Exactly!” to my dog (who seemed indifferent to the whole business). There’s nothing like being told that you’re doing it right.

The theoretical foundation of “Minimalist Parenting” is what I would refer to as “my way”:

Living a joyous life that’s in line with your values (instead of some manufactured version of “successful” modern parenthood) will give your kids room to grow into the strong, unique people they are meant to be. More important, this way of being will provide a model that shows your kids how to trust their instincts as they move toward independence and adulthood.

There is quite a bit of preaching (to the choir, in my case) the gospel of rejecting the shame, guilt and stress that many parents develop in trying to provide the latest and “best” of everything for their children. What’s more important than keeping up with parenting trends, Ms. Koh and Ms. Dornfest argue, is to “edit” or “minimalize” your schedule, adjust your expectations, roll with the punches, and create space in your family’s life for joy and fun.

For me, this book was not merely a gratifying confirmation of my own parenting instincts. In addition to the philosophical content, “Minimalist Parenting” offers a wealth of practical suggestions on how to achieve (or approach, anyway) this state of enlightened parenting. They don’t sugarcoat it either: there is work involved.

As disappointed as I was to learn that I couldn’t just cruise through the rest of my tenure as a father by being laid-back and scoffing at those who over-parent, I eventually found comfort in reading some of the tips on how to get the work done so there’s more time for fun. There are scores of strategies laid out in the book, covering everything from family finances, to clutter mitigation and birthday parties, but it was their advice on lunchboxes and leftovers that proved balm to my soul: my girls’ wonderful preschool provides all their food on the two days a week they spend there, but soon they’ll be big, brown-bagging kindergardeners, and I needed to hear that the new task could fit into our old routines.

While reading “Minimalist Parenting,” I (perhaps subconsciously) appreciated that it used inclusive language when addressing or referring to its audience. I’m so used to “Mom” being the default term for the primary caregiver that I hardly notice it anymore. It was refreshing to note that Ms. Koh and Ms. Dornfest mostly use the words “parent” and “partner” instead of “Mom” and “husband” when discussing family dynamics. Nonetheless, when they described the binds that parents get themselves and their children into when they try to be “perfect,” I didn’t picture any of my dad friends.

Through blogging and simply being a mostly stay-at-home dad, I am in contact with lots of fathers (and mothers) who are very involved in their children’s care. I do know a number of overzealous dads and free-range moms, but they are in the minority. I thought of my dad friends while reading the chapters that Ms. Koh and Ms. Dornfest dedicate to simplifying mealtimes and celebrations. “Simplified” is just the way most of us roll.

A quick meal of raw vegetables, pasta, simply cooked meats or other protein? Done. Don’t worry about themed holiday classroom celebrations? Never been a problem. Simplified birthdays? Last year, for my girls, I planned atransportation-themed birthday adventure. We took the trolley downtown (San Diego, that is), hopped on a ferry to the town of Coronado, ate lunch, rode around in a pedal-powered surrey, and then ferried and trolleyed back home, stopping for cupcakes on the way. The expense was negligible compared to a party, the planning took about half an hour, the children had a blast, and Mom and Dad were happy and relaxed. Just the kind of thing you might read about in “Minimalist Parenting.”

In the final chapter of the book, “YOU, Minimalist You!,” the gender neutrality dissolved. Suddenly, “motherhood” replaced “parenthood” as in, “there are real cultural associations between motherhood and martyrdom,” and the chapter went on to offer advice on topics like yoga pants and makeup. I don’t need that advice, but its appearance underlined the way the book read like a cheering section for me and my “manimalist” style but probably reads as the advice it’s intended to be for others.

Men are socialized toward minimalist parenting (and nearly everything else). Women are more likely to struggle to shed the burdens of the “cultural associations” that compel them to pursue unattainable parenting standards. “Minimalist Parenting” is a pushback against parenting expectations for women and maybe a push toward the more relaxed standards that exist for men. And to me, as far as gender roles are concerned, movement toward the middle is progress.

Exercise May Protect Children From Stress

NY Times Article

By JAN HOFFMAN
Hélène Desplechi/Getty Images

Physically active children generally report happier moods and fewer symptoms of depression than children who are less active. Now researchers may have found a reason: by one measure, exercise seems to help children cope with stress.

Finnish researchers had 258 children wear accelerometers on their wrists for at least four days that registered the quality and quantity of their physical activity. Their parents used cotton swabs to take saliva samples at various times throughout a single day, which the researchers used to assess levels of cortisol, a hormone typically induced by physical or mental stress.

There was no difference in the cortisol levels at home between children who were active and those who were less active. But when the researchers gave the children a standard psychosocial stress test at a clinic involving arithmetic and storytelling challenges, they found that those who had not engaged in physical activity had raised cortisol levels. The children who had moderate or vigorous physical activity showed relatively no rise in cortisol levels.

Those results indicate a more positive physiological response to stress by children who were more active, the researchers said in a study that was published this week in The Journal of Clinical Endocrinology and Metabolism. The children who were least active had the highest levels.

“This study shows that children who are more active throughout their day have a better hormonal response to an acute stressful situation,” said Disa Hatfield, an assistant professor of kinesiology at the University of Rhode Island, who was not involved in the study.

Dr. Hatfield noted that the study did not control for sugar intake, which has also been associated with higher levels of cortisol. And as the researchers themselves noted, the wrist-born accelerometers could not accurately measure certain activities like bicycling or swimming.

Michael F. Bergeron, a professor of pediatrics at the University of South Dakota and executive director of the National Youth Sports Health and Safety Institute, cautioned that chronic levels of cortisol might be a better measurement of a child’s propensity toward stress, rather than the single-day measurements taken in the new study.

“A single response to a single stressor may be what the body needs to do, and that’s not necessarily a bad thing,” he said.

Although elementary schools in the last decade have generally been supportive of physical education, only 29 percent of high school students meet the national guideline of 60 minutes a day, said Russell R. Pate, a professor of exercise science at the University of South Carolina, who has worked on national studies of fitness levels in students.

“It’s not a huge surprise that kids who are encouraged to be more active would be more relaxed,” he said.

In a school, a child who gets more activity on a daily basis, Dr. Hatfield said, will respond better to everyday stressors like tests and social challenges. “The study suggests the physiological reason: it may be because their hormonal response is different,” she said.

Drowned in a Stream of Prescriptions – for ADHD

Drowned in a Stream of Prescriptions

The New York Times

Before his addiction, Richard Fee was a popular college class president and aspiring medical student. “You keep giving Adderall to my son, you’re going to kill him,” said Rick Fee, Richard’s father, to one of his son’s doctors.
By 
Published: February 2, 2013 500 Comments

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”

“…when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”

Richard’s first experience with A.D.H.D. pills, like so many others’, had come in college. Friends said he was a typical undergraduate user — when he needed to finish a paper or cram for exams, one Adderall capsule would jolt him with focus and purpose for six to eight hours, repeat as necessary.

So many fellow students had prescriptions or stashes to share, friends of Richard recalled in interviews, that guessing where he got his was futile. He was popular enough on campus — he was sophomore class president and played first base on the baseball team — that they doubted he even had to pay the typical $5 or $10 per pill.

“He would just procrastinate, wait till the last minute and then take a pill to study for tests,” said Ryan Sykes, a friend. “It got to the point where he’d say he couldn’t get anything done if he didn’t have the Adderall.”

Various studies have estimated that 8 percent to 35 percent of college students take stimulant pills to enhance school performance. Few students realize that giving or accepting even one Adderall pill from a friend with a prescription is a federal crime. Adderall and its stimulant siblings are classified by the Drug Enforcement Administration as Schedule II drugs, in the same category as cocaine, because of their highly addictive properties.

“It’s incredibly nonchalant,” Chris Hewitt, a friend of Richard, said of students’ attitudes to the drug. “It’s: ‘Anyone have any Adderall? I want to study tonight,’ ” said Mr. Hewitt, now an elementary school teacher in Greensboro.

After graduating with honors in 2008 with a degree in biology, Richard planned to apply to medical schools and stayed in Greensboro to study for the entrance exams. He remembered how Adderall had helped him concentrate so well as an undergraduate, friends said, and he made an appointment at the nearby Triad Psychiatric and Counseling Center.

According to records obtained by Richard’s parents after his death, a nurse practitioner at Triad detailed his unremarkable medical and psychiatric history before recording his complaints about “organization, memory, attention to detail.” She characterized his speech as “clear,” his thought process “goal directed” and his concentration “attentive.”

Richard filled out an 18-question survey on which he rated various symptoms on a 0-to-3 scale. His total score of 29 led the nurse practitioner to make a diagnosis of “A.D.H.D., inattentive-type” — a type of A.D.H.D. without hyperactivity. She recommended Vyvanse, 30 milligrams a day, for three weeks.

Phone and fax requests to Triad officials for comment were not returned.

Some doctors worry that A.D.H.D. questionnaires, designed to assist and standardize the gathering of a patient’s symptoms, are being used as a shortcut to diagnosis. C. Keith Conners, a longtime child psychologist who developed a popular scale similar to the one used with Richard, said in an interview that scales like his “have reinforced this tendency for quick and dirty practice.”

Dr. Conners, an emeritus professor of psychiatry and behavioral sciences at Duke University Medical Center, emphasized that a detailed life history must be taken and other sources of information — such as a parent, teacher or friend — must be pursued to learn the nuances of a patient’s difficulties and to rule out other maladies before making a proper diagnosis of A.D.H.D. Other doctors interviewed said they would not prescribe medications on a patient’s first visit, specifically to deter the faking of symptoms.

According to his parents, Richard had no psychiatric history, or even suspicion of problems, through college. None of his dozen high school and college acquaintances interviewed for this article said he had ever shown or mentioned behaviors related to A.D.H.D. — certainly not the “losing things” and “difficulty awaiting turn” he reported on the Triad questionnaire — suggesting that he probably faked or at least exaggerated his symptoms to get his diagnosis.

That is neither uncommon nor difficult, said David Berry, a professor and researcher at the University of Kentucky. He is a co-author of a 2010 study that compared two groups of college students — those with diagnoses of A.D.H.D. and others who were asked to fake symptoms — to see whether standard symptom questionnaires could tell them apart. They were indistinguishable.

“With college students,” Dr. Berry said in an interview, “it’s clear that it doesn’t take much information for someone who wants to feign A.D.H.D. to do so.”

Richard Fee filled his prescription for Vyvanse within hours at a local Rite Aid. He returned to see the nurse three weeks later and reported excellent concentration: “reading books — read 10!” her notes indicate. She increased his dose to 50 milligrams a day. Three weeks later, after Richard left a message for her asking for the dose to go up to 60, which is on the high end of normal adult doses, she wrote on his chart, “Okay rewrite.”

Richard filled that prescription later that afternoon. It was his third month’s worth of medication in 43 days.

“The patient is a 23-year-old Caucasian male who presents for refill of vyvanse — recently started on this while in NC b/c of lack of motivation/ loss of drive. Has moved here and wants refill”

Dr. Robert M. Woodard

Notes on Richard Fee

Nov. 11, 2009

Richard scored too low on the MCAT in 2009 to qualify for a top medical school. Although he had started taking Vyvanse for its jolts of focus and purpose, their side effects began to take hold. His sleep patterns increasingly scrambled and his mood darkening, he moved back in with his parents in Virginia Beach and sought a local physician to renew his prescriptions.

A friend recommended a family physician, Dr. Robert M. Woodard. Dr. Woodard heard Richard describe how well Vyvanse was working for his A.D.H.D., made a diagnosis of “other malaise and fatigue” and renewed his prescription for one month. He suggested that Richard thereafter see a trained psychiatrist at Dominion Psychiatric Associates — only a five-minute walk from the Fees’ house.

With eight psychiatrists and almost 20 therapists on staff, Dominion Psychiatric is one of the better-known practices in Virginia Beach, residents said. One of its better-known doctors is Dr. Waldo M. Ellison, a practicing psychiatrist since 1974.

In interviews, some patients and parents of patients of Dr. Ellison’s described him as very quick to identify A.D.H.D. and prescribe medication for it. Sandy Paxson of nearby Norfolk said she took her 15-year-old son to see Dr. Ellison for anxiety in 2008; within a few minutes, Mrs. Paxson recalled, Dr. Ellison said her son had A.D.H.D. and prescribed him Adderall.

“My son said: ‘I love the way this makes me feel. It helps me focus for school, but it’s not getting rid of my anxiety, and that’s what I need,’ ” Mrs. Paxson recalled. “So we went back to Dr. Ellison and told him that it wasn’t working properly, what else could he give us, and he basically told me that I was wrong. He basically told me that I was incorrect.”

Dr. Ellison met with Richard in his office for the first time on Feb. 5, 2010. He took a medical history, heard Richard’s complaints regarding concentration, noted how he was drumming his fingers and made a diagnosis of A.D.H.D. with “moderate symptoms or difficulty functioning.” Dominion Psychiatric records of that visit do not mention the use of any A.D.H.D. symptom questionnaire to identify particular areas of difficulty or strategies for treatment.

As the 47-minute session ended, Dr. Ellison prescribed a common starting dose of Adderall: 30 milligrams daily for 21 days. Eight days later, while Richard still had 13 pills remaining, his prescription was renewed for 30 more days at 50 milligrams.

Through the remainder of 2010, in appointments with Dr. Ellison that usually lasted under five minutes, Richard returned for refills of Adderall. Records indicate that he received only what was consistently coded as “pharmacologic management” — the official term for quick appraisals of medication effects — and none of the more conventional talk-based therapy that experts generally consider an important component of A.D.H.D. treatment.

His Adderall prescriptions were always for the fast-acting variety, rather than the extended-release formula that is less prone to abuse.

“PATIENT DOING WELL WITH THE MEDICATION, IS CALM, FOCUSED AND ON TASK, AND WILL RETURN TO OFFICE IN 3 MONTHS”

Dr. Waldo M. Ellison

Notes on Richard Fee

Dec. 11, 2010

Regardless of what he might have told his doctor, Richard Fee was anything but well or calm during his first year back home, his father said.

Blowing through a month’s worth of Adderall in a few weeks, Richard stayed up all night reading and scribbling in notebooks, occasionally climbing out of his bedroom window and on to the roof to converse with the moon and stars. When the pills ran out, he would sleep for 48 hours straight and not leave his room for 72. He got so hot during the day that he walked around the house with ice packs around his neck — and in frigid weather, he would cool off by jumping into the 52-degree backyard pool.

As Richard lost a series of jobs and tensions in the house ran higher — particularly when talk turned to his Adderall — Rick and Kathy Fee continued to research the side effects of A.D.H.D. medication. They learned that stimulants are exceptionally successful at mollifying the impulsivity and distractibility that characterize classic A.D.H.D., but that they can cause insomnia, increased blood pressure and elevated body temperature. Food and Drug Administration warnings on packaging also note “high potential for abuse,” as well as psychiatric side effects such as aggression, hallucinations and paranoia.

2006 study in the journal Drug and Alcohol Dependence claimed that about 10 percent of adolescents and young adults who misused A.D.H.D. stimulants became addicted to them. Even proper, doctor-supervised use of the medications can trigger psychotic behavior or suicidal thoughts in about 1 in 400 patients, according to a 2006 study in The American Journal of Psychiatry. So while a vast majority of stimulant users will not experience psychosis — and a doctor may never encounter it in decades of careful practice — the sheer volume of prescriptions leads to thousands of cases every year, experts acknowledged.

When Mrs. Fee noticed Richard putting tape over his computer’s camera, he told her that people were spying on him. (He put tape on his fingers, too, to avoid leaving fingerprints.) He cut himself out of family pictures, talked to the television and became increasingly violent when agitated.

In late December, Mr. Fee drove to Dominion Psychiatric and asked to see Dr. Ellison, who explained that federal privacy laws forbade any discussion of an adult patient, even with the patient’s father. Mr. Fee said he had tried unsuccessfully to detail Richard’s bizarre behavior, assuming that Richard had not shared such details with his doctor.

“I can’t talk to you,” Mr. Fee recalled Dr. Ellison telling him. “I did this one time with another family, sat down and talked with them, and I ended up getting sued. I can’t talk with you unless your son comes with you.”

Mr. Fee said he had turned to leave but distinctly recalls warning Dr. Ellison, “You keep giving Adderall to my son, you’re going to kill him.”

Dr. Ellison declined repeated requests for comment on Richard Fee’s case. His office records, like those of other doctors involved, were obtained by Mr. Fee under Virginia and federal law, which allow the legal representative of a deceased patient to obtain medical records as if he were the patient himself.

As 2011 began, the Fees persuaded Richard to see a psychologist, Scott W. Sautter, whose records note Richard’s delusions, paranoia and “severe and pervasive mental disorder.” Dr. Sautter recommended that Adderall either be stopped or be paired with a sleep aid “if not medically contraindicated.”

Mr. Fee did not trust his son to share this report with Dr. Ellison, so he drove back to Dominion Psychiatric and, he recalled, was told by a receptionist that he could leave the information with her. Mr. Fee said he had demanded to put it in Dr. Ellison’s hands himself and threatened to break down his door in order to do so.

Mr. Fee said that Dr. Ellison had then come out, read the report and, appreciating the gravity of the situation, spoken with him about Richard for 45 minutes. They scheduled an appointment for the entire family.

“meeting with parents — concern with ‘metaphoric’ speaking that appears to be outside the realm of appropriated one to one conversation. Richard says he does it on purpose — to me some of it sounds like pre-psychotic thinking.”

Dr. Waldo M. Ellison

Notes on Richard Fee

Feb. 23, 2011

Dr. Ellison stopped Richard Fee’s prescription — he wrote “no Adderall for now” on his chart and the next day refused Richard’s phone request for more. Instead he prescribed Abilify and Seroquel, antipsychotics for schizophrenia that do not provide the bursts of focus and purpose that stimulants do. Richard became enraged, his parents recalled. He tried to back up over his father in the Dominion Psychiatric parking lot and threatened to burn the house down. At home, he took a baseball bat from the garage, smashed flower pots and screamed, “You’re taking my medicine!”

Richard disappeared for a few weeks. He returned to the house when he learned of his grandmother’s death, the Fees said.

The morning after the funeral, Richard walked down Potters Road to what became a nine-minute visit with Dr. Ellison. He left with two prescriptions: one for Abilify, and another for 50 milligrams a day of Adderall.

According to Mr. Fee, Richard later told him that he had lied to Dr. Ellison — he told the doctor he was feeling great, life was back on track and he had found a job in Greensboro that he would lose without Adderall. Dr. Ellison’s notes do not say why he agreed to start Adderall again.

Richard’s delusions and mood swings only got worse, his parents said. They would lock their bedroom door when they went to sleep because of his unpredictable rages. “We were scared of our own son,” Mr. Fee said. Richard would blow through his monthly prescriptions in 10 to 15 days and then go through hideous withdrawals. A friend said that he would occasionally get Richard some extra pills during the worst of it, but that “it wasn’t enough because he would take four or five at a time.”

One night during an argument, after Richard became particularly threatening and pushed him over a chair, Mr. Fee called the police. They arrested Richard for domestic violence. The episode persuaded Richard to see another local psychiatrist, Dr. Charles Parker.

Mrs. Fee said she attended Richard’s initial consultation on June 3 with Dr. Parker’s clinician, Renee Strelitz, and emphasized his abuse of Adderall. Richard “kept giving me dirty looks,” Mrs. Fee recalled. She said she had later left a detailed message on Ms. Strelitz’s voice mail, urging her and Dr. Parker not to prescribe stimulants under any circumstances when Richard came in the next day.

Dr. Parker met with Richard alone. The doctor noted depression, anxiety and suicidal ideas. He wrote “no meds” with a box around it — an indication, he explained later, that he was aware of the parents’ concerns regarding A.D.H.D. stimulants.

Dr. Parker wrote three 30-day prescriptions: Clonidine (a sleep aid), Venlafaxine (an antidepressant) and Adderall, 60 milligrams a day.

In an interview last November, Dr. Parker said he did not recall the details of Richard’s case but reviewed his notes and tried to recreate his mind-set during that appointment. He said he must have trusted Richard’s assertions that medication was not an issue, and must have figured that his parents were just philosophically anti-medication. Dr. Parker recalled that he had been reassured by Richard’s intelligent discussions of the ins and outs of stimulants and his desire to pursue medicine himself.

“He was smart and he was quick and he had A’s and B’s and wanted to go to medical school — and he had all the deportment of a guy that had the potential to do that,” Dr. Parker said. “He didn’t seem like he was a drug person at all, but rather a person that was misunderstood, really desirous of becoming a physician. He was very slick and smooth. He convinced me there was a benefit.”

Mrs. Fee was outraged. Over the next several days, she recalled, she repeatedly spoke with Ms. Strelitz over the phone to detail Richard’s continued abuse of the medication (she found nine pills gone after 48 hours) and hand-delivered Dr. Sautter’s appraisal of his recent psychosis. Dr. Parker confirmed that he had received this information.

Richard next saw Dr. Parker on June 27. Mrs. Fee drove him to the clinic and waited in the parking lot. Soon afterward, Richard returned and asked to head to the pharmacy to fill a prescription. Dr. Parker had raised his Adderall to 80 milligrams a day.

Dr. Parker recalled that the appointment had been a 15-minute “med check” that left little time for careful assessment of any Adderall addiction. Once again, Dr. Parker said, he must have believed Richard’s assertions that he needed additional medicine more than the family’s pleas that it be stopped.

“He was pitching me very well — I was asking him very specific questions, and he was very good at telling me the answers in a very specific way,” Dr. Parker recalled. He added later, “I do feel partially responsible for what happened to this kid.”

“Paranoid and psychotic … thinking that the computer is spying on him. He has also been receiving messages from stars at night and he is unable to be talked to in a reasonable fashion … The patient denies any mental health problems … fairly high risk for suicide.”

Dr. John Riedler

Admission note for Richard Fee

Virginia Beach Psychiatric Center

July 8, 2011

The 911 operator answered the call and heard a young man screaming on the other end. His parents would not give him his pills. With the man’s language scattered and increasingly threatening, the police were sent to the home of Rick and Kathy Fee.

The Fees told officers that Richard was addicted to Adderall, and that after he had received his most recent prescription, they allowed him to fill it through his mother’s insurance plan on the condition that they hold it and dispense it appropriately. Richard was now demanding his next day’s pills early.

Richard denied his addiction and threats. So the police, noting that Richard was an adult, instructed the Fees to give him the bottle. They said they would comply only if he left the house for good. Officers escorted Richard off the property.

A few hours later Richard called his parents, threatening to stab himself in the head with a knife. The police found him and took him to the Virginia Beach Psychiatric Center.

Described as “paranoid and psychotic” by the admitting physician, Dr. John Riedler, Richard spent one week in the hospital denying that he had any psychiatric or addiction issues. He was placed on two medications: Seroquel and the antidepressant Wellbutrin, no stimulants. In his discharge report, Dr. Riedler noted that Richard had stabilized but remained severely depressed and dependent on both amphetamines and marijuana, which he would smoke in part to counter the buzz of Adderall and the depression from withdrawal.

(Marijuana is known to increase the risk for schizophrenia, psychosis and memory problems, but Richard had smoked pot in high school and college with no such effects, several friends recalled. If that was the case, “in all likelihood the stimulants were the primary issue here,” said Dr. Wesley Boyd, a psychiatrist at Children’s Hospital Boston and Cambridge Health Alliance who specializes in adolescent substance abuse.)

Unwelcome at home after his discharge from the psychiatric hospital, Richard stayed in cheap motels for a few weeks. His Adderall prescription from Dr. Parker expired on July 26, leaving him eligible for a renewal. He phoned the office of Dr. Ellison, who had not seen him in four months.

“moved out of the house — doesn’t feel paranoid or delusional. Hasn’t been on meds for a while — working with a friend wiring houses rto 3 months — doesn’t feel he needs the abilify or seroquel for sleep.”

Dr. Waldo M. Ellison

Notes on Richard Fee

July 25, 2011

The 2:15 p.m. appointment went better than Richard could have hoped. He told Dr. Ellison that the pre-psychotic and metaphoric thinking back in March had receded, and that all that remained was his A.D.H.D. He said nothing of his visits to Dr. Parker, his recent prescriptions or his week in the psychiatric hospital.

At 2:21 p.m., according to Dr. Ellison’s records, he prescribed Richard 30 days’ worth of Adderall at 50 milligrams a day. He also gave him prescriptions postdated for Aug. 23 and Sept. 21, presumably to allow him to get pills into late October without the need for follow-up appointments. (Virginia state law forbids the dispensation of 90 days of a controlled substance at one time, but does allow doctors to write two 30-day prescriptions in advance.)

Virginia is one of 43 states with a formal Prescription Drug Monitoring Program, an online database that lets doctors check a patient’s one-year prescription history, partly to see if he or she is getting medication elsewhere. Although pharmacies are required to enter all prescriptions for controlled substances into the system, Virginia law does not require doctors to consult it.

Dr. Ellison’s notes suggest that he did not check the program before issuing the three prescriptions to Richard, who filled the first within hours.

The next morning, during a scheduled appointment at Dr. Parker’s clinic, Ms. Strelitz wrote in her notes: “Richard is progressing. He reported staying off of the Adderall and on no meds currently. Focusing on staying healthy, eating well and exercising.”

About a week later, Richard called his father with more good news: a job he had found overseeing storm cleanup crews was going well. He was feeling much better.

But Mr. Fee noticed that the more calm and measured speech that Richard had regained during his hospital stay was gone. He jumped from one subject to the next, sounding anxious and rushed. When the call ended, Mr. Fee recalled, he went straight to his wife.

“Call your insurance company,” he said, “and find out if they’ve filled any prescriptions for Adderall.”

“spoke to father — richard was in VBPC [Virginia Beach Psychiatric Center] and OD on adderall — NO STIMULANTS — HE WAS ALSO SEEING DR. PARKER”

Dr. Waldo M. Ellison

Interoffice e-mail

Aug. 5, 2011

An insurance representative confirmed that Richard had filled a prescription for Adderall on July 25. Mr. Fee confronted Dr. Ellison in the Dominion Psychiatric parking lot.

Mr. Fee told him that Richard had been in the psychiatric hospital, had been suicidal and had been taking Adderall through June and July. Dr. Ellison confirmed that he had written not only another prescription but two others for later in August and September.

“He told me it was normal procedure and not 90 days at one time,” Mr. Fee recalled. “I flipped out on him: ‘You gave my son 90 days of Adderall? You’re going to kill him!’ ”

Mr. Fee said he and Dr. Ellison had discussed voiding the two outstanding scripts. Mr. Fee said he had been told that it was possible, but that should Richard need emergency medical attention, it could keep him from getting what would otherwise be proper care or medication. Mr. Fee confirmed that with a pharmacist and decided to drive to Richard’s apartment and try to persuade him to rip up the prescriptions.

“I know that you’ve got these other prescriptions to get pills,” Mr. Fee recalled telling Richard. “You’re doing so good. You’ve got a job. You’re working. Things with us are better. If you get them filled, I’m worried about what will happen.”

“You’re right,” Mr. Fee said Richard had replied. “I tore them up and threw them away.”

Mr. Fee spent two more hours with Richard making relative small talk — increasingly gnawed, he recalled later, by the sense that this was no ordinary conversation. As he looked at Richard he saw two images flickering on top of each other — the boy he had raised to love school and baseball, and the desperate addict he feared that boy had become.

Before he left, Mr. Fee made as loving a demand as he could muster.

“Please. Give them to me,” Mr. Fee said.

Richard looked his father dead in the eye.

“I destroyed them,” he said. “I don’t have them. Don’t worry.”

“Richard said that he has stopped Adderall and wants to work on continuing to progress.”

Renee Strelitz

Session notes

Sept. 13, 2011

Richard generally filled his prescriptions at a CVS on Laskin Road, less than three miles from his parents’ home. But on Aug. 23, he went to a different CVS about 11 miles away, closer to Norfolk and farther from the locations that his father might have called to alert them to the situation. For his Sept. 21 prescription he traveled even farther, into Norfolk, to get his pills.

On Oct. 3, Richard visited Dr. Ellison for an appointment lasting 17 minutes. The doctor prescribed two weeks of Strattera, a medication for A.D.H.D. that contains no amphetamines and, therefore, is neither a controlled substance nor particularly prone to abuse. His records make no mention of the Adderall prescription Richard filled on Sept. 21; they do note, however, “Father says that he is crazy and abusive of the Adderall — has made directives with regard to giving Richard anymore stimulants — bringing up charges — I explained this to Richard.”

Prescription records indicate that Richard did not fill the Strattera prescription before returning to Dr. Ellison’s office two weeks later to ask for more stimulants.

“Patient took only a few days of Strattera 40 mg — it calmed him but not focusing,” the doctor’s notes read. “I had told him not to look for much initially — He would like a list of MD who could rx adderall.”

Dr. Ellison never saw Richard again. Given his patterns of abuse, friends said, Richard probably took his last Adderall pill in early October. Because he abruptly stopped without the slow and delicate reduction of medication that is recommended to minimize major psychological risks, especially for instant-release stimulants, he crashed harder than ever.

Richard’s lifelong friend Ryan Sykes was one of the few people in contact with him during his final weeks. He said that despite Richard’s addiction to Adderall and the ease with which it could be obtained on college campuses nearby, he had never pursued it outside the doctors’ prescriptions.

“He had it in his mind that because it came from a doctor, it was O.K.,” Mr. Sykes recalled.

On Nov. 7, after arriving home from a weekend away, Mrs. Fee heard a message on the family answering machine from Richard, asking his parents to call him. She phoned back at 10 that night and left a message herself.

Not hearing back by the next afternoon, Mrs. Fee checked Richard’s cellphone records — he was on her plan — and saw no calls or texts. At 9 p.m. the Fees drove to Richard’s apartment in Norfolk to check on him. The lights were on; his car was in the driveway. He did not answer. Beginning to panic, Mr. Fee found the kitchen window ajar and climbed in through it.

He searched the apartment and found nothing amiss.

“He isn’t here,” Mr. Fee said he had told his wife.

“Oh, thank God,” she replied. “Maybe he’s walking on the beach or something.”

They got ready to leave before Mr. Fee stopped.

“Wait a minute,” he said. “I didn’t check the closet.”

“Spoke with Richard’s mother, Kathy Fee, today. She reported that Richard took his life last November. Family is devasted and having a difficult time. Offerred assistance for family.”

Renee Strelitz

Last page of Richard Fee file

June 21, 2012

Friends and former baseball teammates flocked to Richard Fee’s memorial service in Virginia Beach. Most remembered only the funny and gregarious guy they knew in high school and college; many knew absolutely nothing of his last two years. He left no note explaining his suicide.

At a gathering at the Fees’ house afterward, Mr. Fee told them about Richard’s addiction to Adderall. Many recalled how they, too, had blithely abused the drug in college — to cram, just as Richard had — and could not help but wonder if they had played the same game of Russian roulette.

“I guarantee you a good number of them had used it for studying — that shock was definitely there in that room,” said a Greensboro baseball teammate, Danny Michael, adding that he was among the few who had not. “It’s so prevalent and widely used. People had no idea it could be abused to the point of no return.”

Almost every one of more than 40 A.D.H.D. experts interviewed for this article said that worst-case scenarios like Richard Fee’s can occur with any medication — and that people who do have A.D.H.D., or parents of children with the disorder, should not be dissuaded from considering the proven benefits of stimulant medication when supervised by a responsible physician.

Other experts, however, cautioned that Richard Fee’s experience is instructive less in its ending than its evolution — that it underscores aspects of A.D.H.D. treatment that are mishandled every day with countless patients, many of them children.

“You don’t have everything that happened with this kid, but his experience is not that unusual,” said DeAnsin Parker, a clinical neuropsychologist in New York who specializes in young adults. “Diagnoses are made just this quickly, and medication is filled just this quickly. And the lack of therapy is really sad. Doctors are saying, ‘Just take the meds to see if they help,’ and if they help, ‘You must have A.D.H.D.’ ”

Dr. Parker added: “Stimulants will help anyone focus better. And a lot of young people like or value that feeling, especially those who are driven and have ambitions. We have to realize that these are potential addicts — drug addicts don’t look like they used to.”

Documentary screening and panel discussion on ADHD, “ADD and Loving It?!”

Listing, The Virginian-Pilot

Oct. 10, 2012

The Fees decided to go. The event was sponsored by the local chapter of Children and Adults with Attention Deficit Disorder (Chadd), the nation’s primary advocacy group for A.D.H.D. patients. They wanted to attend the question-and-answer session afterward with local doctors and community college officials.

The evening opened with the local Chadd coordinator thanking the drug company Shire — the manufacturer of several A.D.H.D. drugs, including Vyvanse and extended-release Adderall — for partly underwriting the event. An hourlong film directed and narrated by two men with A.D.H.D. closed by examining some “myths” about stimulant medications, with several doctors praising their efficacy and safety. One said they were “safer than aspirin,” while another added, “It’s O.K. — there’s nothing that’s going to happen.”

Sitting in the fourth row, Mr. Fee raised his hand to pose a question to the panel, which was moderated by Jeffrey Katz, a local clinical psychologist and a national board member of Chadd. “What are some of the drawbacks or some of the dangers of a misdiagnosis in somebody,” Mr. Fee asked, “and then the subsequent medication that goes along with that?”

Dr. Katz looked straight at the Fees as he answered, “Not much.”

Adding that “the medication itself is pretty innocuous,” Dr. Katz continued that someone without A.D.H.D. might feel more awake with stimulants but would not consider it “something that they need.”

“If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”

Mr. Fee slowly sat down, trembling. Mrs. Fee placed her hand on his knee as the panel continued.