Emotion regulation is a real and important construct, but understanding a child’s functioning requires much more information than the term dysregulated can provide. To understand how children regulate their emotions, we need to understand how they experience them, and emotional experiences vary along several dimensions.

The first is valence. Is the emotion positive or negative? Excitement, joy, and anticipation can be just as tricky as anger, sadness, and fear. A child who can’t wait for her birthday party might have as much trouble in school as a child who is disappointed about a canceled playdate.

The second is energy. How much energy accompanies the emotion? Some emotions are accompanied by high levels of physiological and behavioral energy, while others are accompanied by relatively low levels. Two children can experience similar emotions but look very different in this regard. One child who is upset fidgets, paces, and talks constantly, whereas another becomes inhibited, quiet, and frozen.

The third is intensity. How strong is the emotional experience? Some children experience emotions with high intensity whereas others are relatively muted. Two children can both get angry when their parents tell them to turn off the TV, but one might become furious while the other simply has mild irritation.

The fourth is duration. How long does the emotional experience last? Emotions unfold over time, and they eventually return to baseline. Some children become extremely emotional but recover quickly; others remain emotional for hours. One child cries when she loses a soccer game but happily goes to the playground with her friends five minutes later. Another remains upset for the rest of the afternoon.

The fifth is expression. How does the emotion manifest, where is it directed? Internalizing emotional expressions direct inward and include ruminating, avoiding, and shutting down. Externalizing emotional expressions direct outward and include yelling, crying, and throwing things. We tend to notice externalizing behaviors because they can be disruptive, but internalizing can be just as impairing to a child. A child may scream and throw his pencil if he gets a bad grade on a test, whereas another, afraid of sounding stupid, may sit quietly, experiencing just as much distress.

When we describe an emotional experience, we also need to think about whether it is appropriate and adaptive. Three factors are particularly important here: age, context, and goals.

When we think about age, we think about whether the emotional experience is developmentally appropriate. Self-control develops throughout childhood and adolescence, so we don’t expect young children to express emotions with the sophistication of older children and adults. A two-year-old who has a tantrum on the floor looks very different from a fifteen-year-old who does the same thing.

When we think about context, we assess whether the emotional response makes sense. The same response can be appropriate in one context and disproportionate in another. Extreme, prolonged sadness after losing a beloved pet looks very different from extreme, prolonged sadness after staining a shirt.

When we think about goals, we determine whether the emotional response is in service of or interfering with what the child wants or needs to do. We shouldn’t try to achieve a constant state of calm or to eliminate unpleasant emotions. Instead, it’s to manage emotions flexibly and deliberately. Anxiety can be adaptive for a kid the night before a test if it motivates them to study; conversely, it can be maladaptive if it interferes with learning, sleeping, or otherwise doing the things they need to do.

So, to sum things up, we need to be precise in our descriptions and thoughtful in our interpretations.

These issues are not specific to conversations about dysregulation. Vague psychological terminology–”therapy speak”--is disrupting lots of conversations about parenting, mental health, and education. Jargony terms like dysregulated, overstimulated, and triggered have become part of everyday language. In theory, greater familiarity with psychological concepts should improve our understanding, but in reality, popular usage seems to strip these terms of their specificity and render them meaningless. The conversations become circular: The child is screaming because he’s dysregulated, and we know he’s dysregulated because he’s screaming. We haven’t explained anything; we’ve simply renamed what’s happening.

Also, calling a child dysregulated or something else pulled from psychobabble implies that something is wrong, but we haven’t had a chance to establish that there’s pathology in the first place. Not every intense, unpleasant emotion needs to be regulated away, and not every child who struggles to manage an emotion is disordered.

Back to Wendy: I wasn’t intending to challenge her understanding of her child. I was just asking her to help me understand him. When she uses the word dysregulated, she obscures information and implies pathology–she doesn’t effectively communicate what Paul is experiencing, and it’s difficult to determine whether what’s happening is inappropriate or impairing. So instead of using clinical terminology, I need parents to tell me clearly and concretely what they see, what their kids do and experience. Descriptions provide helpful information about a child; dysregulated provides nothing.

oh man

It’s pub day in the UK!

One thing that keeps coming to mind is how we use anxiety to justify extra time on tests. My issue isn’t the core premise. Anxiety can truly impair performance on timed tasks. Instead, it’s that we’ve conflated accommodating anxiety with treating it, and in the process, we’ve inadvertently redefined anxiety as a permanently disabling condition.

To illustrate what I mean, let me tell you about Nina. Nina was diagnosed with anxiety in fifth grade. At the time, her anxiety was debilitating enough to interfere with her ability to take tests under standard conditions, and per the recommendation of a neuropsychologist, her school granted time and a half. The recommendation was reasonable and sound.

I met Nina five years later when she needed updated documentation for the ACT. In the intervening time, she had received psychotherapy and taken anxiety-reducing medication. She’d matured and developed coping skills. By the start of high school, she no longer needed meds, she saw a therapist only as needed, and her anxiety was manageable. Yet she still received—and claimed to need—extra time on tests. It was interesting: All signs suggested that her anxiety was well controlled, yet she was still being accommodated for an anxiety-related disability. Nobody bothered to revisit it because she’d always had it, and she assumed she’d always need it.

Again, my issue isn’t with Nina’s diagnosis or the clinician’s original recommendation. Severe anxiety disorders can interfere with attention, working memory, information retrieval, and processing speed, and they can cause genuine functional impairment. For some students, like Nina, extra time is necessary to make sure anxiety doesn’t prevent equal access to their education.

But, unlike some disabilities, anxiety is often highly responsive to treatment. Evidence-based psychotherapy and medication can reduce symptoms and improve functioning. Many anxiety disorders also change with development, so a child like Nina who is impaired at ten may very well not be at fifteen.

So when anxiety is substantially interfering with academic performance, absolutely provide extra time. It’s a reasonable accommodation. But it shouldn’t blindly follow a student for the rest of their academic career. When anxiety is disabling enough to warrant accommodations, those accommodations should be paired with treatment, serving as a bridge that mitigates the effects of the anxiety while treatment works to eliminate it. That means granting extra time for a limited period, maybe six months, and then reexamining it. After treatment, schools can look at symptoms, functional impairment, and treatment response to decide whether extra time is still necessary. If the impairment persists, keep the accommodation and continue to monitor it. If it improves, consider reducing or removing it. (Importantly, both treatment and assessment need to be accessible. Parents shouldn’t have to shell out thousands of dollars for private services.)

But we should not grant anxiety-related accommodations indefinitely. When we do, we communicate that anxiety is a fixed limitation that must always be worked around rather than a condition that can improve. And we risk undermining confidence in accommodations for students who truly need them. Accommodations are an important disability-rights protection, so we must ensure that they remain tied to documented functional needs.

It’s been a while since I posted a video, but I love this one!

My book goes on sale in the UK, Australia, and New Zealand this week!

Some of the comments, however, questioned why I sounded so critical of private schools specifically. I get it: Much ink has been spilled about wealthy public school families securing academic accommodations for their kids in order to give them a leg up, so this is clearly not just a private school issue. But I do believe Nate’s story exemplifies a widespread and underreported problem in how testing accommodations are granted at private schools, which leads to real inequities that go far beyond what prior conversations have covered.

To explain more thoroughly, I thought I’d write a follow-up post to provide some context here: how testing accommodations work in public schools, and what changes when a private school is the one granting them.

How the System is Supposed to Work

To understand what’s going wrong, it helps to understand how testing accommodations are generally granted at public schools, which serve the majority of American students, including a disproportionate share of students with disabilities and with limited financial resources.

Public schools are required by federal law to provide every student with a free and appropriate education in the least restrictive possible environment. That requirement includes providing appropriate accommodations for students with disabilities.

Two federal laws govern this process. The Individuals with Disabilities Education Act (IDEA) covers students whose disabilities require specialized instruction and related services. To qualify, a student must fall under one of thirteen defined disability categories, the disability must adversely affect educational performance, and the student must need special education services to access their education.

Section 504 of the Rehabilitation Act casts a broader net, covering any student with a physical or mental impairment that substantially limits participation in a major life activity. In the case of testing accommodations, we can reasonably assume that activity is school.

The problem is both laws are somewhat ambiguous. In IDEA, thresholds for what counts as a “disability,” an “adverse effect,” and a “need” aren’t clearly defined. Likewise, in Section 504, what “substantially limits participation” can be interpreted subjectively.

Since these legal standards are a bit slippery, schools use several methods to determine whether a student qualifies for a disability designation. The three most common are the discrepancy model, the Patterns of Strengths and Weaknesses approach, and Response to Intervention.

The discrepancy model—historically the most common—looks for a significant gap between a student’s IQ and their academic skills. The idea is that a student who is clearly intellectually capable but performing below expectations may have a learning disorder. The problem, however, is that the underlying assumption—that a gap between IQ and achievement signals a learning disability—has been largely discredited by subsequent research. Instead, kids across the IQ spectrum—low, average, and high IQ—can be either strong or weak learners. And, alarmingly, since IQ tests are culturally biased, this model tends to underidentify students from certain marginalized groups who have artificially low IQs, and they fail to be linked to appropriate services.

In contrast, the Patterns of Strengths and Weaknesses approach looks at the overall profile of a student’s cognitive and academic skills, identifying relative strengths and weaknesses that are consistent with particular learning disabilities. This is where comprehensive neuropsychological evaluations tend to play the largest role, as they provide detailed data on the specific cognitive processes underlying a student’s academic performance. However, cognitive strengths and weaknesses are transdiagnostic and nonspecific, so this model has not borne out as a reliable way of identifying kids with disabilities in school.

Finally, Response to Intervention, or RTI, takes a different approach altogether, providing increasingly intensive tiers of instructional support to all struggling students and monitoring their progress. Students who don’t respond adequately to evidence-based intervention at multiple tiers may then be identified for special education evaluation and support. RTI is generally considered more proactive and reliable than the other models, though it requires schools to have robust, well-implemented tiered support systems, and not all do.

Different states permit different combinations of these methods, and school districts vary considerably in how rigorously they implement them. This variability means that wealthy districts with more resources tend to identify more students and provide more services, and wealthy parents are more likely to have the knowledge and advocacy skills to navigate the process effectively. None of this is a secret. It has been documented and discussed extensively.

But all this discourse is failing to acknowledge that all of that variability, all of that slipperiness, still exists within a system with guardrails: the documentation, notification, and due process requirements I described in The Free Press. Private schools have none of them.

A Different World

Private schools that do not receive federal funding are not subject to IDEA or Section 504. They have no legal obligation to identify students with disabilities, no requirement to provide a free appropriate education, and no mandate to offer any particular accommodations to any particular student. Many private schools–to their credit–are honest about this: They do not have the resources or expertise to educate students who need special education services, and those students should look elsewhere.

But the flip side of having no legal obligations is having no legal constraints. Private schools can modify testing conditions whenever and however they want, for any student, for any reason. No disability designation is required. They can give extra time to everyone, or to no one, or to whichever students they think might benefit.

What this looks like in practice varies enormously. Some private schools have adopted policies that mirror the standards of Section 504, requiring documentation of a disability before granting accommodations. A notable number do not. Many private schools in and around New York City, where I practice, operate more or less like Nate’s school: They will grant extended time based on a recommendation from a private neuropsychologist, selected and paid for by the family.

When we think about these policies, it’s worth considering what neuropsychological evaluations are and aren’t good at.

A comprehensive neuropsychological evaluation can be an extraordinarily useful clinical tool. It can provide detailed data on a student’s cognitive and academic functioning across many domains. It can provide a rich, integrated picture of a student’s abilities. It can compare a student’s functioning to that of a large sample of same-aged peers and, in doing so, it can distinguish between garden variety difficulties and genuine deficits, between age-appropriate struggles and disorders.

What neuropsychological evaluations are not particularly good at—and what they are not designed to do—is function as gatekeepers for disability accommodations. Neuropsychologists are clinicians, not school administrators or lawyers. Their job is to understand a student’s functioning and recommend whatever treatment plan might help that student succeed. And extra time on tests is genuinely helpful for most students, not just students with disabilities. When kids sit down to take a test, they are being asked to demonstrate mastery of recently learned material that has not yet become automatic. Working through problems takes time and effort. Time pressure adds stress, and stress degrades performance. Allow more time, and most kids do better.

As I noted in The Free Press, it’s rare to find a neuropsychologist who doesn’t recommend extra time. That’s not because most of our patients have disabilities, but because most of our patients are students, and students tend to benefit from more time. But when private schools interpret our recommendations as determinations, many, many students without disabilities end up receiving what most of the world considers disability accommodations.

That’s how we end up with numbers like the ones I cited from the United Kingdom, where students at private schools receive testing accommodations at rates roughly 50% higher than their state school peers. We don’t collect comparable data here in the United States because private schools aren’t required to report it, but there is no reason to believe what is happening in American schools is any different.

The Stakes

From here, inequities compound. High-stakes tests—like the SAT and ACT—grant testing accommodations largely on the basis of documented school history. A student who has been receiving extended time throughout grade school has the track record to support that accommodation on standardized tests. A student who has not does not.

So as students approach the most consequential academic tests of their educational careers, students from wealthy private schools—who, on average, arrive at college admissions with significant advantages in terms of resources and preparation—are also disproportionately taking high-stakes tests under more favorable testing conditions. Students from public schools, who had to clear a much higher bar to receive any accommodation at all, are not.

Where the Blame Actually Belongs

In The Free Press, I argued that, rather than blaming parents, we should ask why private schools set up a system that is so easy to game in the first place. Of course, when a system presents an available loophole, parents who are paying attention and have the resources will pursue it. It’s not admirable, exactly, but it is human and natural and predictable.

Private schools have no legal obligation to follow the frameworks that govern public schools, but they do have an ethical one. If private schools are genuinely committed to the values of fairness and integrity that appear in virtually every one of their mission statements, this is a place to demonstrate it. They should adopt the same standards for granting testing accommodations that govern public schools, with documented disabilities, clear policies, and consistent procedures.

Accommodations are a civil rights protection, designed to ensure that students with disabilities do not face discrimination. As I wrote in The Free Press, when they become something you can purchase, the students who lose are the ones who were never in a position to buy them in the first place.

Thank you to everyone who has been so supportive of my book launch! I hope you all enjoy Actually, You’re Fine!

Putting aside the question of guilt for a moment, the case has sparked a lot of conversations among parents (mostly mothers!) who are wondering how we raise sons who respect women. But just as many conversations are about how we raise sons (and daughters) who can speak up when friends behave badly and who can defend those who are vulnerable.

The truth is that being an “upstander,” as my daughter’s kindergarten teacher liked to put it, is very hard. Speaking out against group dynamics is extremely difficult for most people, and especially for teenagers and young adults. It’s easier to diffuse and deny responsibility than to be the one who breaks ranks. Even a kid with the strongest moral compass may struggle to call out bad behavior from friends because the desire to belong can easily outweigh one’s conscience.

On some level, this is developmentally appropriate and expected. By adolescence, sensitivity to social reward peaks, but self-regulation and inhibitory control may not fully come online until years later. So teens are likely to take risks, especially when peers are watching, and even when they know better. When good choices conflict with group acceptance, acceptance often wins. And not only are they socializing without adults present, but they also care less about our opinions than they do about their friends’. Even if we were in the room, they might still seek approval from their peers over us.

Which brings me back to the question so many of us have been asking: How do we raise people who can speak up to friends who are behaving badly? How do we keep our kids from becoming bystanders in horrifying situations like the one at Cornell?

I’m not sure I have a good answer. I don’t know if it’s really possible to raise a child who can confidently resist group dynamics. Maybe our best shot is to steer them away from groups that behave badly in the first place. You can’t be a bystander if you don’t ever enter the proverbial room.

And I think our best window for that is in early childhood. When our kids are little, we control their social lives. We control the playdates, the carpools, the after-school activities, and the families with whom we spend time. We engineer our children’s friendships.

Of course, how kids behave when they’re young doesn’t perfectly predict how they’ll behave when they’re older. Friendships shift as kids grow up and move through school, and who they hang out with in elementary school may not be exactly who they hang out with in high school. But, as my mom likes to say, leopards don’t change their spots. Nice, lowkey kids usually stay nice, lowkey kids, and families with values we support tend to raise kids with values we support. Even if the correlation isn’t perfect, it’s a pretty strong positive.

So let’s engineer high-quality friendships. Let’s push our kids toward kind, inclusive nerds. Let’s avoid trying to engineer coolness. And let’s definitely avoid teaching our kids that acceptance, power, and popularity are the top prizes, because those are exactly the sorts of priorities that will lead them into dangerous situations.

In my practice, I talk with families a lot about deterministic views of parenting, I caution against mother blaming, and I’m critical of how much pressure we put on ourselves to make sure our kids turn out well. Usually, I think these narratives are overhyped. In truth, we can’t shape our kids into exactly who we want them to be. (If only it were that easy!) We’re but one piece of a much larger puzzle. An important piece, yes, but there are so many other people who influence our kids. So let’s do our best while they’re little and our influence is greatest to ensure the quality of the other pieces. That way, even as our kids get older and our influence fades, they’ll still be surrounded by people who bring out the best in them.

TODAY IS PUB DAY! From the bottom of my heart, thank you to everyone who supported Actually, You’re Fine. Please read and share with your friends. I cannot wait to hear what you think. Xoxoxo

Lucy’s spelling was just as bad. Her writing was incomprehensible; the words were hardly phonological approximations of correct spellings, and there was no rhyme or reason to the letters she was using. Most of the time, she seemed to be guessing.

Lucy, for her part, was a shy, nervous child. She said she hated school. It was boring, she was stupid, and she couldn’t do what the other kids were able to do.

Unsurprisingly, when we conducted a neuropsychological evaluation, Lucy’s academic skills measured well below average. Her intellectual abilities were totally solid, though, and when I observed her in the classroom, it was clear she was receiving high-quality instruction, so I felt confident diagnosing her with a Specific Learning Disorder in Reading.

I explained to Lucy’s parents that she struggled with manipulating the sounds of language and linking those sounds to letter symbols, so dyslexia was an appropriate term to describe her disorder. Her parents were understandably upset; the word dyslexia seemed to imply that life would be extremely hard for their child. I tried to reassure them that the disorder was actually highly treatable, and that with the right interventions, Lucy would absolutely learn how to read.

I gave them a referral for a good Orton-Gillingham tutor named Dana, recommended some school supports and accommodations, and told them to bring Lucy back for a reassessment in three years unless something meaningful changed before then.

Sure enough, I didn’t hear from them again until Lucy was ten, when her parents dutifully brought her back for a reevaluation. Now a fifth grader, Lucy came into my office looking much more confident in her skills. She had developed a stronger self-concept, especially as a learner.

Lucy’s parents also reported that she had come a very long way. Sure, she still wasn’t among the top students in her class. She was resistant to doing her homework and never seemed to want to read for fun. But she could keep her head afloat, and her grades were solid.

Her parents attributed the improvement to effective interventions, and specifically to Dana, who they said was life-changing. About a year earlier, Dana had stopped the formal reading instruction she’d been doing, but she and Lucy had built such a nice relationship that Lucy wasn’t willing to let her go, so they shifted to informal homework help. Her parents called it glorified babysitting, but they were glad to keep Dana on the payroll so long as Lucy was happy and learning.

On formal testing, Lucy’s academic skills were just as her parents described: average. Her reading and writing skills measured around the 37th percentile. Not incredible, but definitely okay. Near the bottom of the average range, but still well within normal limits.

In my diagnostic formulation, I told Lucy’s parents that, since her reading skills were now at grade level, she no longer met criteria for a learning disorder. I removed the label from my evaluation and from her superbills. Her parents were surprised. They thought dyslexia was a forever thing.

I directed their attention to the diagnostic criteria in the DSM, which hinge on academic skills that are below average for grade level. Lucy’s skills weren’t below average anymore, so the diagnosis no longer fit.

It’s a common misconception that diagnostic labels are permanent descriptors. In reality, they describe how a person is functioning at a given moment in time. They are mere snapshots. Yes, neurodevelopmental disorders cause chronic impairment for many people, and no, those problems don’t disappear overnight. But people are always growing and developing and learning, and skills are responsive to intervention. So our diagnostic labels are appropriately fluid. Something that fits at one point in time may not fit at another.

This is exactly how we want it to be. A major purpose of diagnosis is to link a person to interventions, and, ideally, we want those interventions to work so well that the diagnostic label stops being relevant.

Lucy was a perfect example of this process in action. Reading may always be hard for her. It will probably always be a relatively slow, effortful process, and it’s conceivable she may never enjoy it. At the same time, the interventions taught her to read. She can do it. Her academic performance is at the expected level. She’s no longer disordered.

Let’s all keep this in mind when we talk about diagnoses. The last thing I want is for labels to be growth-limiting, and for people to think a label means there’s a ceiling on what they can accomplish. On the contrary, a label should provide a roadmap for meaningful support, intervention, and growth.

T-minus one week until AYF!

New Yorkers, I’d love to see you at the book launch!

Amy told me Miles had been a temperamental baby and an active, stubborn toddler, so in some ways none of this was new. But things had really gone downhill over the past three years. She first noticed a real problem when he started kindergarten. She received weekly calls from the teacher who reported that Miles was disruptive in class, and she got wind that a few parents of Miles’s classmates were encouraging their kids to stay away from him on the playground. Now he was in third grade, and it was all really getting out of hand.

As I do in most intakes, I asked Amy what she had already tried, and what had and hadn't worked.

Everything, she said. She'd read the books, listened to the podcasts, and followed every parenting Instagram account that anyone recommended to her. Along the way, she'd attempted gentle parenting, French parenting, jellyfish parenting, conscious parenting, and probably a few more I've never heard of. None of it worked.

I must admit that my gut reaction was ungenerous.  I judged her pretty harshly. She had been dealing with this for at least three years and was only now looking for professional support? We could have addressed this ages ago with real, expert-provided care and maybe nipped it in the bud. Instead she had tried to handle it on her own, armed with advice from influencers and quacks, while the problem grew and metastasized.

So I told her about Parent Management Training, an evidence-based therapeutic approach that I thought could really help. PMT teaches parents concrete skills, like how to give clear commands, how to praise the behaviors you want to see more of, and how to use tools like planned ignoring and time-outs, all with the goal of reducing children’s disruptive behavior. I gave her the contact information for a few clinicians I know and trust who offer it, and I told her to call me back if she had any trouble getting an appointment.

The recommendation seemed so obvious that I was honestly shocked no one had made it before. Then she told me someone had.

In fact, she had tried several times over the years to get into PMT. Her pediatrician had suggested it. So had a friend of hers who's an occupational therapist. She even called two of the clinicians on the list I'd just given her. The problem was usually money: insanely high session fees combined with out-of-network mental health coverage that was basically nonexistent. And on the rare occasions when the fees were manageable, the waitlist was months, sometimes years, long.

No wonder she turned to Instagram.

I left the intake feeling pretty humbled. Amy had done exactly what we tell parents to do. She asked her pediatrician, she listened to people she trusted, and she made the calls. Every time, she hit a wall.

Our mental health system is broken. If you're super rich, you can get good care on a reasonable timeline. Everyone else ends up on a waitlist that never seems to move.

Those of us in the field feel frustrated about parents getting their information from dubious sources online. But we are operating in a system where care is inaccessible to most families, and then we act surprised when they go looking for help wherever they can find it. A parent watching their kid struggle is not going to sit quietly for two years waiting for a call back. They're going to pick up their phone and start scrolling. What other choice do they really have?

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My thoughts about the piece are not totally coherent and are mostly framed as questions rather than answers, but I’m going to try my best to group them into three main themes.

Some context, for those who don't know me personally: I'm a firm believer in the social and cultural benefits of public education. Despite being in the fortunate position of being financially able to send my kids to private school, I chose public school so they could get those benefits. At the same time, I'm also fortunate to have made the very conscious, very expensive choice to buy an apartment in one of the city’s wealthiest neighborhoods so that I could send my children to one of the highest-performing zoned schools. So like Hannah-Jones, I'm a staunch supporter of public education, but unlike Hannah-Jones, I have admittedly been a welcome recipient of the myriad benefits of residential segregation.

Now that that's out of the way…

Theme 1: The Importance of Progress Monitoring 

Hannah-Jones points to a lack of insight into her daughter’s learning as a core issue with her schooling. One example she provides is that her daughter, Najya, never had homework. Since Najya did little, if any, work at home, Hannah-Jones had few opportunities to see work samples and monitor her daughter's academic progress. 

It’s true that academic outcomes tend to be better when parents are active and involved, and parents can’t be active and involved when they don’t know what’s going on in the classroom. That's why it seems so crazy to me that we're moving not only to eliminate homework, but also to eliminate standardized testing. Standardized testing offers one of the only uniform, normed ways to monitor progress. As a parent, I don't actually know how my kids are doing relative to their grade-level peers unless I see standardized test scores. Qualitative and subjective data, like teacher narratives and report card grades, are helpful, but they are much harder to interpret; standardized test results give me a far clearer and more objective picture of how they are doing than really anything else. 

I appreciate the criticisms of standardized testing. That said, Hannah-Jones alludes to rampant and extreme grade inflation, so standardized tests are essential for maintaining clear, high, measurable standards, and for making sure kids are progressing through their education knowing what we expect them to know. Testing has to start early because one grade builds on the last, and you can't build a house on a shaky foundation; as Hannah-Jones points out, early knowledge gaps persist and widen over time. Best to identify them and intervene right away.

Theme 2: The Importance of Good Teachers

Yes, progress monitoring at home is essential for a productive home-school partnership. But many parents, for various reasons, are unable to adequately support academic progress at home. High-quality teachers are essential for closing the gap in what parents can (and cannot) provide. Reduced ratios, teacher training, and after-school tutoring can help identify struggling students and catch them up before lagging skills turn into real academic problems that are difficult to overcome.

Therefore, we should think of teachers as the ultimate school resource. We always talk about improving under-resourced schools in terms of devoting more resources, as if the core problem is that we're not spending enough. But the truth is we spend a tremendous amount per pupil already, with more taxpayer money going to vulnerable students. The problem is that we're spending it inefficiently and misdirecting resources toward things that don't really move the needle. If we're serious about closing achievement gaps, teacher quality (i.e. recruiting, training, and retention) seems like exactly where resources should go.

Theme 3: The Importancce of School Culture

School culture is essential for student success, and part of that culture is an engaged, involved parent community. Hannah-Jones writes that, as someone with high socioeconomic status, she felt an obligation to improve the culture of a high-poverty school when most of the other parents in the community lacked the ability to contribute productively to it. 

Admittedly, I often have a cynical attitude when I talk about the role of parents in schools. When I enrolled my daughter at PS6, I filled out a form requesting friends that I hoped would be in her class, but I joked that I had no expectation that my requests would be honored, and I preferred it that way. I work with a lot of parents who send their kids to private schools whose perception is that there's a pay-to-play system in which the wealthiest families get the best treatment. I don't want that experience. I don't want schools catering to any one student or being especially responsive to any one parent. Teachers and administrators should know what they're doing and be captains of the ship, with uniform treatment for every kid in the building no matter how pushy the parents.

That said, four years later, we are dealing with the class-size debacle that I wrote about last week. I told my sister-in-law Jane–who knows my thoughts and opinions on schools well–that I was disappointed with our administrators because I believed that they failed to communicate with parents. I felt they should have been more proactive about presenting us with a clear, concrete plan for how they'd use space and staff to support our children despite the unusually large classes. Jane pushed back: Did I really think the school owed parents that level of detail and proactivity in their communication? I said yes. We're important stakeholders, and our engagement is a key part of school culture, which is itself a key part of school quality.

So how do I reconcile these two seemingly contradictory views: that schools shouldn't be so responsive to parents, but also that they should be responsive to parents? I don't know the answer. Maybe it’s that schools shouldn't favor certain parents, but they should be highly responsive, equally, to all of them. I appreciate it’s a hard needle to thread.

Another complicating factor is that my kids attend a school where parents are easy to engage. We have the time, the savvy, and the money to be effective partners. Those resources–financial and otherwise–aren't available equally at every school. So how do you partner with all families equitably when some appear to have relatively less to give the school in return?

If I'm being honest (pessimistic?), I usually say schools are largely a reflection of the socioeconomic status of the families who send their kids there. The research bears this out: Socioeconomic status is a better predictor of student outcomes than almost anything else we measure. But I don't think that lets us off the hook. Quite the opposite, in fact. Schools represent our best opportunity to equalize opportunities, rather than simply mirror opportunities, for the students they serve. Let’s invest intelligently in them.

T-minus three weeks to AYF!

1. Strong Topic Sentences

Rule: Open each paragraph with the main point. Don’t build up to it. Lead with it, then support it with evidence.

Why it matters: Readers, including supervisors, reviewers, and patients, often skim. A reader who only reads topic sentences should still get the argument or clinical picture. Burying the main point mid-paragraph forces the reader to reconstruct your reasoning, which is difficult and annoying.

Example (clinical):

• Weak: “On a task requiring the patient to hold information in mind while manipulating it, she scored in the 9th percentile. She also struggled on a similar spatial span task. Together, these results suggest...”

• Strong: “The patient demonstrated a significant weakness in working memory, scoring in the 9th percentile on a task requiring her to hold and manipulate information.”

Example (academic):

• Weak: “Several studies from the 1990s used small samples. Later replications found inconsistent effects. Taken together...”

• Strong: “Evidence for this effect has been inconsistent across the literature, in part because early studies relied on small samples.”

2. Vague “This”

Rule: Never start a sentence with “This” unless it’s immediately followed by a noun that tells the reader what “this” refers to.

Why it matters: An unanchored “this” forces the reader to guess whether you mean the previous finding, the previous method, or the whole paragraph. In writing used for diagnosis, treatment planning, or scholarly argument, that ambiguity can lead to misinterpretation.

Example (clinical):

• Vague: “The patient scored below average on measures of processing speed. This is consistent with reports of slow task completion.”

• Clear: “The patient scored below average on measures of processing speed. This slower processing speed is consistent with reports of slow task completion.”

Example (academic):

• Vague: “The intervention group showed greater gains than controls. This suggests the mechanism is domain-general.”

• Clear: “The intervention group showed greater gains than controls. This pattern of gains suggests the mechanism is domain-general.”

3. Incomplete Comparisons

Rule: If you use a comparative word (more, less, better, worse, higher, lower), state explicitly what the comparison is relative to.

Why it matters: “More distractible” or “a stronger effect” begs the question: more or stronger than what? Without the anchor, the comparison can’t be evaluated or verified against a baseline, a norm, or another condition.

Example (clinical):

• Incomplete: “The patient was more anxious during the interview.”

• Complete: “The patient was more anxious during the interview than is typical for someone her age, as reflected in frequent requests for reassurance.”

Example (academic):

• Incomplete: “This treatment produced better outcomes.”

• Complete: “This treatment produced better outcomes than the waitlist control condition.”

4. Passive Voice

Rule: Default to active voice. Name the actor—the patient, the clinician, the researcher—as the subject of the sentence.

Why it matters: Passive constructions can obscure who did what, and that ambiguity matters both clinically (did the patient refuse the task, or did the examiner discontinue it?) and in research writing (did the authors control for a variable, or did it simply “get controlled for”?). Active voice is also more direct and easier to read.

Example (clinical):

• Passive: “The task was discontinued after three consecutive failures were observed.”

• Active: “The examiner discontinued the task after the patient failed three consecutive items.”

Example (academic):

• Passive: “It was found that reaction times were slower under load.”

• Active: “We found that reaction times were slower under load.”

5. “First/Second/Third,” Not “Firstly/Secondly/Thirdly”

Rule: Use first, second, third (etc.) as sequencing words. Avoid the “-ly” forms.

Why it matters: “Firstly/secondly/thirdly” is dated and adds syllables without adding meaning. Modern style guides favor the plain forms for concision. Plus, is “fourthly” a word? “Seventhly”?

Example:

• Avoid: “Firstly, participants completed a baseline measure. Secondly, they underwent the intervention.”

• Prefer: “First, participants completed a baseline measure. Second, they underwent the intervention.”

6. Anthropomorphizing Studies

Rule: Studies don’t “show” or “believe” anything. Attribute claims to results, findings, or the authors: “results suggest,” “findings indicate,” “the authors argue.”

Why it matters: This is a precision issue as much as a style one. A study is a method, not a mind. “Studies show X causes Y” overstates certainty; “findings suggest an association between X and Y” accurately represents what the data can support.

Example:

• Avoid: “Studies show that early intervention improves outcomes.”

• Prefer: “Findings suggest that early intervention is associated with improved outcomes.”

7. “Girl/Boy” or “Woman/Man,” Not “Female/Male” (as Nouns)

Rule: Use “girl,” “boy,” “woman,” or “man” (or “patient,” “participant,” “client”) when referring to a person. Reserve “female” and “male” as adjectives, not as standalone nouns for a person.

Why it matters: Using “female” or “male” as a noun (”the female was uncooperative during testing,” “twelve males were recruited”) is clinically and academically distancing if not downright dehumanizing—it reads as though describing a specimen rather than a person. This convention holds in both clinical notes and research manuscripts.

Example:

• Avoid: “The female was administered the interview.”

• Prefer: “The patient was administered the interview.” (or, once introduced, use her name.)

• Avoid: “Twelve males and fourteen females participated.”

• Prefer: “Twelve men and fourteen women participated.” (or “boys/girls,” as age-appropriate)

8. “Emotion, Behavior, Attention Regulation,” Not “Emotional, Behavioral, Attentional (Regulation)”

Rule: When describing regulation, use the noun form of the modifier—“emotion regulation,” “behavior regulation,” “attention regulation”—rather than the adjective form.

Why it matters: “Emotion regulation” is the established term in the clinical and developmental literature. We regulate emotions, not emotionals. Same reasoning extends for behavior and attention.

Example:

• Imprecise: “The patient demonstrated difficulty with emotional regulation and behavioral regulation.”

• Precise: “The patient demonstrated difficulty with emotion regulation and behavior regulation.”

9. “Every Day” vs. “Everyday”

Rule: “Every day” (two words) is an adverbial phrase meaning “each day.” “Everyday” (one word) is an adjective meaning “ordinary” or “routine.” Watch out for other similar pairs (e.g., “work out” vs. “workout”).

Why it matters: This small error undermines credibility in formal writing.

Example:

• Incorrect: “She reported struggling with everyday transitions between tasks.”

• Correct (frequency): “She reported struggling with transitions every day.”

• Correct (routine/ordinary): “She reported struggling with everyday transitions, such as moving from one meeting to the next.”

10. Reflexive Pronouns in Place of Object Pronouns

Rule: Don’t use “myself,” “himself,” “herself,” etc. as a substitute for “me,” “him,” “her” when there’s no antecedent in the same clause for the reflexive to refer back to.

Why it matters: “Please direct questions to myself” is grammatically incorrect and reads as a failed attempt to sound formal. Plus, it’s an oddly narcissistic sentence construction; how many times do we need to refer to ourselves?

Example:

• Incorrect: “The results were reviewed by the supervisor and myself.”

• Correct: “The results were reviewed by the supervisor and me.” (or, better, switch to active voice: “My supervisor and I reviewed the results.”)

11. Misused Conditional Tense

Rule: Don’t use “would” to report a single, specific, observed event. Reserve “would” for genuinely habitual or hypothetical behavior, and use simple past tense for what was actually observed or reported.

Why it matters: “She would become frustrated and stop the task” (describing one specific session) implies a hypothetical rather than something directly observed, which subtly weakens the evidentiary weight of the statement. Overuse of “would” across a document can make documented, repeated events sound speculative rather than established.

Example (clinical):

• Misused: “When presented with a difficult item, the patient would become frustrated and push the materials away.”

• Correct (single observed instance): “When presented with a difficult item, the patient became frustrated and pushed the materials away.”

• Correct (genuinely habitual, per history): “According to his mother, he would often refuse homework when he felt overwhelmed.”

Example (academic):

• Misused: “Participants in the high-load condition would show slower response times.”

• Correct: “Participants in the high-load condition showed slower response times.”

12. Comma Splices

Rule: Don’t join two independent clauses with only a comma. Use a period, a semicolon, or a coordinating conjunction (and, but, so, etc.).

Why it matters: Comma splices are a basic grammatical error that can also create ambiguity in dense professional writing about where one idea ends and the next begins.

Example:

• Splice: “The intervention was brief, the effects persisted at follow-up.”

• Corrected: “The intervention was brief, but the effects persisted at follow-up.”

• Corrected: “The intervention was brief. The effects persisted at follow-up.”

13. Call People by Their Names, Not Generic Role Labels

Rule: Once a person has been introduced, refer to them by name (or a specific role, e.g., “Dr. Alvarez, the referring physician”) rather than defaulting to generic labels like “the parent,” “the patient,” “the teacher,” or “the author” throughout the document.

Why it matters: Writing reads as more precise and more person-centered when it names the actual people involved.

Example (clinical):

• Generic: “The mother reported sleep difficulties. The teacher noted similar concerns about fatigue.”

• Specific: “Mrs. Chen reported sleep difficulties. His teacher, Mr. Patel, noted similar concerns about fatigue.”

Example (academic):

• Generic: “The author argues that the effect is overstated.”

• Specific: “Kahneman argues that the effect is overstated.”

14. “More” vs. “Most”

Rule: Use “more” when comparing two things; use “most” when comparing three or more (superlative).

Why it matters: In writing that compares multiple domains, conditions, or studies, mixing these up misrepresents how many things are actually being compared.

Example:

• Incorrect (only two conditions compared): “Of the two conditions tested, the high-load condition was the most impaired.”

• Correct: “Of the two conditions tested, the high-load condition was the more impaired.”

• Correct (three or more): “Of the four conditions tested, the high-load condition was the most impaired.”

This document was prepared with AI assistance. I consider it live and will continue to edit it as I see fit. Students, please check back often!

No school year starts without some kind of scandal, and this year at PS6 it’s about my daughter’s class size. Enrollment and DOE funding converged in a way that put 32 kids in every second grade classroom.

Parents are, to put it mildly, irate. Of course big classes aren’t unusual in New York City schools, but 32 far exceeds the roughly 25 kids per class we’re used to, and it is way more than what the state’s new class size mandate allows.1 I get why people are concerned. They worry about how their kid will learn in a classroom that’s loud and crowded, and they don’t trust that the teacher will be able to give the students personalized attention.

At the same time, I think the panic is overhyped. PS6 has so many resources that most schools don’t, and the principal has developed a strong plan to support the kids. Here’s how I’m thinking about it.

Some backstory: In 2022, Governor Kathy Hochul signed the Class Size Reduction Law, capping New York City public school classes at 20 kids in grades K–3, 23 in grades 4–8, and 25 in high school. Initially, full compliance was expected in the 2027-28 school year, but that quickly proved unrealistic (more on that soon), and the deadline was pushed to 2029-30.

The class size mandate followed years of advocacy by the UFT, who argued, reasonably, that smaller classes support both teaching and learning. The Education Law Center called the mandate a long-overdue step toward the “sound basic education” promised by the state constitution.

However, when the state passed the mandate, they didn’t say how to pay for it. In order to meet the caps citywide, the DOE needed to hire over 10,000 teachers and build hundreds of new classrooms. By 2025, the city had spent $137 million, which may sound like a lot, but it was really only enough for about 1,300 teachers. Few schools received enough funding to create new classrooms, and many actually saw their budgets shrink. Even the UFT, the mandate’s biggest champion, admitted that the law’s future depended on staffing, space, and money that the school system didn’t have.

That shortfall launched many heated discussions about trade-offs, and it became clear that enforcing compliance would result in unintended program cuts. Which, like, duh. Why is this a surprise? Resources are always finite, so we need to think about how to get the biggest bang for our buck. Unfortunately, the evidence for small classes is less compelling than many assume.

To be fair, smaller classes do help. Teachers can better differentiate instruction, manage the classroom, and get to know each kid. But benefits have to be weighed against what they cost, and a recent-ish high-quality literature review suggested that class size effects, while real, are modest and expensive, so class size reduction efforts should be targeted at disadvantaged schools rather than applied as a rule everywhere.

Also, teacher quality is far more important for student achievement than class size is. And, though nobody has done a direct comparison, it seems logical that a low student-to-teacher ratio would provide many of the same benefits as a small class, for way less money. So, rather than adding classes, we could spend money on teacher training and hiring additional staff who can pull small groups within the spaces we already have. PS6 is already doing basically that. We have amazing teachers and low ratios. Between the head teachers, the paraprofessionals on staff, and the associate teachers funded by our PTA, my daughter has five warm, skilled adults in her classroom this year.

And finally, though it’s tempting to storm the superintendent’s office and lobby our state assembly members, this is (thank goodness) not going to be a particularly compelling political cause. The truth is we are so fortunate, and the DOE has bigger fish to fry. Let’s remember that, no matter our class sizes, PS6 is a high-performing school in a wealthy neighborhood. Even when the DOE shortchanges us on funding, we have in spades the things that predict outcomes more than almost anything else: high socioeconomic status and lots of social capital.

So, as I continue to watch our grade WhatsApp chat, I want everyone to take a deep breath and remember: we already have amazing teachers, we have one of the lowest student-teacher ratios of any public school in the city (besting even many private schools!), and our kids have every advantage a high-SES zip code provides. As key stakeholders, we want funding to go where it will get the biggest return on investment, and that is (bites tongue, knocks wood) not reducing class sizes at PS6.

Instead of a video, I’d like to share the information about my book launch! Please join me on October 13 at the JCC!

When school began, James struggled mightily: he couldn't follow the rhythms of the school day, couldn't sit still for long stretches, couldn’t manage transitions, and couldn't handle conflicts with his classmates. His teacher wondered if it was ADHD.

At the same time, she also noticed James was young for his grade, smaller than his classmates, and just exhausted all the time. When she thought about his relative age along with his recent move, she considered that maybe it wasn't ADHD at all. Maybe he was just developmentally behind his classmates, or maybe he was reacting to a big life transition. But, unfortunately, if it wasn't ADHD, her ability to get James real support at school would be limited. A late birthday and a new apartment don't get you an IEP.

Cases like James’s are what come to mind when I think about the recent headline-making Channel 4 documentary, The Great ADHD Myth. The central question the documentary seeks to answer is whether ADHD is a "real" neurodevelopmental disorder or a social construct. Admittedly, I haven’t watched it, but it sounds like a pretty boring premise. Not only is this an old, worn out question, but also, it's not actually answerable when framed as an either/or. ADHD is both a neurodevelopmental disorder and a social construct at the same time, just like basically every other diagnosis in the DSM.

A mental health disorder is defined by impairment in functioning, and since humans are social creatures, that functioning invariably is in social contexts. By definition, when you have psychopathology, there's a mismatch between how someone feels, thinks, or behaves and what their environment expects or allows. That mismatch is the social construct part. Why the mismatch happens in the first place might be biological or not. But how much of the problem is biologically-based has nothing to do with how real the problem is.

With ADHD specifically, someone has impairments in attention and executive functioning severe enough that they can't function well in their daily lives. The source of those impairments could be inherent to the person or to the environment. Most likely, though, it's both.

In reality, plenty of kids are young for their grade, or dealing with something hard at home, and still hold it together fine. Something about James's particular combination of factors meant he couldn't function in his environment in a way that a lot of other kids can. Maybe there was a brain-based issue. Maybe there was a life issue. Maybe, probably, it was a combination of the two. But it’s the fact that he had impaired functioning, not the specific cause of it, that qualifies him for a diagnosis like ADHD in the first place. And it seems crazy to assume that, since there were social factors contributing to James’s attention and executive functioning deficits, those deficits were not real or worthy of support. Of course they were.

A kid struggling because of overactivation in the default mode network is struggling just as much as a kid struggling because of reduced volume in the prefrontal cortex, who is struggling just as much as a kid in a classroom with expectations designed for kids who are more mature than him, who is struggling just as much as a kid trying to function while his stressed-out parents find a more affordable home. The fact that a disorder has a social dimension doesn't make it any less of a disorder. 

So, I’m begging, can we stop asking these tired, either/or questions? ADHD, like basically all psychopathology, is multifactorial. All the factors are real, and all of them deserve our attention and care.

Enjoy!

I hate to be the one to break up the party, but healthy sleep habits need to start now. (Not the week before school. Now!) I have so many teenagers in my practice who push back, arguing that they need these last few weeks to sleep a lot, as if sleep is money in the bank that they can withdraw later when they're running short. It isn't, and that's not how this works.

It’s a common misconception that a kid can sleep from 2 to 10 am for the rest of August and then just shift everything earlier after Labor Day. But, unfortunately, that’s not how it goes. Sure, the total hours matter, but the consistency matters almost as much. Eight hours a night is a great target for most teenagers, but it needs to be roughly the same eight hours, night after night, for many of the benefits to kick in. So kids need to start moving their sleep well in advance, easing toward something closer to the 11-to-7-ish schedule they'll actually be on in the fall.

Look, I get it. The last few weeks of summer are a hard time to be regimented about anything. Camp is over. Kids are enjoying some downtime, hanging around, and maybe fall sports tryouts are coming up, or maybe there's a family trip shoehorned in, but for the most part, a lot of us don't have much going on. Still, it helps to keep some kind of rhythm to the day. Set aside some time for physical activity, do something with friends outside of the house, and maybe even get to that summer homework you’ve been avoiding since June. And, while we’re at it, this is also a perfect moment to get screens out of bedrooms! 

I'm not saying we flip a switch tomorrow and suddenly it's lights-out at 10 and up at 6. There's some wiggle room. But sleep hygiene doesn't happen overnight. You can't manufacture it the night before school starts. So start easing into the fall schedule now. It'll be a much smaller shock to the system in September.

Great opportunity to see Hadestown if you haven’t already!

For the record, Eleanor is doing fine in math. Her report cards look good, and her Acadience screeners look even better. She’s happy to play math games at home. She’s eager to get ahead on learning her times tables. Her teacher isn’t remotely concerned.

She also has a jam-packed after-school schedule complete with piano, religious school, chorus, tennis, run club, and ice skating. She doesn’t want to add anything, but she’s not willing to drop anything either. One could reasonably argue that she’s over-scheduled already.

So while there’s no actual problem, I have spent actual time and energy wondering whether I should go solve one.

I call this a borrowed problem. Borrowed problems are issues that have very little to do with our own kids and experiences, and instead, we pick them up from the people around us. Someone else’s kid is doing more math, so maybe mine isn’t doing enough. Someone else’s kid is comfortable being put to bed by a babysitter, so maybe mine should be too. Someone else’s kid reads chapter books, or goes to sleepaway camp, or eats sushi, or whatever, and suddenly something that wasn’t bothering us at all starts to make us feel like we’re screwing up.

In fairness, other parents generally make perfectly good decisions. I bet RSM is great, and plenty of kids love it. But it’s a mistake to assume that if something is right for someone else’s kid, it must be right for ours, too.

So before I take action or make a change, I’ve been going back to the four questions I wrote about earlier. (1) Is this actually a problem? (2) Whose problem is it? And then only if the answer to both of those is yes, (3) Who has the power to fix it? And (4) What's the smallest possible intervention that might help?

With RSM, I didn’t get past question two. Eleanor is, thankfully, perfectly good at math, and she is happy with her after-school schedule. So what am I actually solving here? Fine, some kids go to RSM, but that’s not Eleanor’s problem; it’s a borrowed one.

Parenting is full of this garbage. We know way too much about how everyone else is raising their kids: what enrichment they’re doing, what reading level they’re on, which camps, which sports, which therapies. It’s too easy to interpret “different” as “wrong.”

But, honestly, there’s no such thing as the correct way to raise a child. There’s no correct way to make them independent, or athletic, or social, or academic, or adventurous, or organized, or whatever.

Of course some differences need attention if and when they really do get in the way of a kid’s life. But before we start fixing and optimizing and intervening, ask yourself whether what you’re looking at would even register as a problem if you had no idea what was going on with anyone else.

If the answer is no, there’s no reason to borrow the problem.

Omg

I’m not a betting woman, but if I were, I’d wager that you don’t really need either of those. (At least not yet!) Here’s why:

Most mental health struggles in kids are part of typical development. Not pathology. We’ve talked about this before: sleep problems, sibling fights, disorganization at school, picky eating, oppositionality... you name it. These are all unsavory, challenging, normal, and expected parts of childhood. It’s a mistake to medicalize these things and to reach for a clinical intervention every time something feels hard.

First of all, there’s an opportunity cost to everything. A full neuropsych and months of therapy require a lot of time and money, and these resources are often better spent on something else, like playdates and after-school activities.

But beyond the cost, clinical interventions can be stigmatizing. They can shape how a kid sees themselves. Despite our best intentions, kids may implicitly pick up the message that they are broken, something is wrong with them, and they need to be fixed.

So instead of jumping to the full eval or the weekly treatment model, I want a third option. Something closer to mental health primary care.

What I’m envisioning is the smallest possible intervention. Usually this would look like short-term troubleshooting with a licensed clinician who has specific training and can look at the situation from a distance, with some objectivity, and think creatively about how to solve it. I’m talking five sessions or fewer, on an as-needed basis, with solutions-focused work. Check in, see how it’s going, and stop when it’s no longer needed. In terms of how psychology is organized, this would fall under counseling rather than clinical services.

And this kind of work should usually involve the caregivers, not the kid. Kids don’t have full agency over their environments. They can’t enact change the way adults can. If I go see my own therapist and she tells me to adjust something in my life, I’m a fully grown adult, so I can try to do what she says. Kids can’t in the same way, for reasons that are both logistical and developmental. Their lives are run by the adults around them—namely parents and teachers—so those are the people who need to be doing the problem-solving.

Let me give you an example of what this could look like.

Adam was starting kindergarten, and the beginning of the year was rough. He was oppositional at school: arguing with teachers and refusing to participate in classroom activities. The school tried a behavior plan, but it didn’t work. His parents kept getting phone calls from teachers, and nobody seemed to know how to help.

Adam’s mom called me asking if I’d consider seeing Adam for therapy. Instead, I told her to connect me with the teacher and the school psychologist, and together, we set up a meeting. I asked them to show me the behavior plan. It needed real work: the behaviors it meant to address weren’t described objectively, so there was a lot of room for interpretation, which almost certainly meant that implementation was inconsistent and ineffective.

I reworked the plan and sent it back to the school, and suggested a few ways home and school could communicate better. I checked in a couple more times with the parents and the school over the next few weeks, and by Christmas, things had settled.

That’s it. That was the whole intervention. Leaner than a typical therapy model; more consultation than treatment. Plus, we avoided the neuropsych entirely. And it worked.

This is not to say that a full neuropsych and weekly therapy are never appropriate. Of course they are, in some cases. For instance, had Adam’s behavior continued to limit his participation in school, perhaps a neuropsych would have elucidated a cognitive impairment that was getting in the way of his academic success. Maybe a more regular, formal CBT approach would have been necessary to get the level of improvement everyone was hoping for. Who knows?

These just shouldn’t be our first-line treatment options. In the situations where you feel like you need to do something—you don’t feel comfortable with a wait-and-see approach—but a full eval and months of weekly therapy seem like overkill, see if you can find a mental health professional who is able to start with a relatively short-term, light-touch intervention, and up the intensity only when necessary.

There are already well-established models for this sort of approach in other fields. In medicine, we see a primary care doctor before going to a specialist. In education, we try informal interventions before special education services. It’s time the mental health fields caught up and embraced a multi-tiered model of our own.

For more like this, pre-order my book!

I made Eleanor watch this the other night and she thought it was boring.

Dara wanted to know if something was wrong with Jack. Anxiety? A sleep disorder? And once she knew what was causing the problem, she wanted to fix it.

I asked what they’d already tried. Nothing, she said; they’d just been making late plans.

Then I asked what would happen if they left while Jack was still awake. Dara said that they didn’t know. Jack got so upset even talking about doing something different that they’d stopped bringing it up. And besides, he fell asleep easily this way. He seemed happy. And, if she was being completely honest, she and Brett liked this part of the day with him, too.

So I asked, “What’s the problem, then? If he’s sleeping well, and he’s happy, and you’re happy, why are you trying to change something? Is putting Jack to bed stopping you from doing things you want to do?”

“No,” Dara said. Their friends teased them a little about eating dinner so late, but mostly people didn’t mind.

“Is there something coming up?” I asked. “A wedding, a work event, anything in particular that will actually require you to leave before bedtime?” No. Nothing they could think of.

I told them what they were describing sounded pretty normal. Plenty of little kids want to be tucked in by a parent. Plenty of parents like being the one to do it. It wasn’t getting in anyone’s way. Yes, Dara and Brett got teased sometimes. And yes, they stood in contrast to their friends who were able to leave their houses earlier with kids wide awake. But not every family runs the same way, and kids want different things from different people at different times. What works in one house doesn’t necessarily work in another. This isn’t pathological. Jack didn’t meet criteria for anything. He didn’t need a treatment plan. He needed his mom to tuck him in. It sounded like they’d all talked themselves into a problem that didn’t need solving.

I see this all the time. Somewhere along the way we stopped letting childhood wackiness just be childhood wackiness. Big feelings. Fighting with a sibling. Shyness. Picky eating. Not wanting to sleep away from home. Wanting a parent at bedtime. None of this is fun, but all of it is common. Normal, even.

So before calling a professional asking how to fix something, I want parents first to ask themselves four questions:

1. Is this actually a problem?

2. If it is a problem, whose problem is it?

3. Who has the power to change it?

4. What’s the smallest intervention that might help?

When Dara and I walked through these questions, she realized she didn’t have a problem. Maybe her friends did, and they were teasing her about something that Jack was “supposed” to do. But her family was okay. The smallest intervention was to just leave it alone, and Dara and Brett would reframe the situation in their minds.

Ultimately, nothing really changed. Dara and Brett still put Jack to bed. They still hand him off to Jill fast asleep and rush to their 8:30 dinners. The only thing that shifted was how they thought about it.

That’s sometimes the most powerful thing I can offer. Not a strategy. Not a diagnosis. Just permission to stop solving a problem that was never really a problem in the first place.

For more like this, pre-order my book, Actually, You’re Fine, wherever you get books!

Every movie should feature an Andrew Rannells music number

You’re confused, understandably. The tests confirmed attention and executive functioning problems, so doesn’t that mean she has ADHD?

I explain that’s not how the diagnosis works.

Our paper-and-pencil tests of attention and executive functioning aren’t diagnostic; they are descriptive. They attempt–albeit imperfectly–to isolate a single cognitive skill, and then they tell us how well a kid demonstrated that skill compared to others their age on one particular day in a quiet room with an adult giving them their full attention. It’s useful. Since executive functioning is multifactorial, it helps to pinpoint which specific aspect is giving a kid trouble, and we can tell if what we’re seeing is a real deficit or just normal kid challenges.

But as a predictor of diagnosis, our tests are weak. Attention and executive functioning problems aren’t specific to ADHD. Not even close! They show up in nearly every diagnosis we test for–anxiety, depression, learning disorders, autism, you name it. Trouble focusing and regulating are among the most common symptoms in all of psychology since so many different things can cause them.

That’s why ADHD gets diagnosed off a checklist instead. (I realize it seems unscientific and arbitrary, but I don’t make the rules!) To meet criteria for a diagnosis, you need six or more symptoms of inattention, six or more of hyperactivity, or both, showing up before age 12 and causing impairment in more than one setting. That impairment doesn’t have to show up in grades, though it often does: the classic image is one of a disorganized backpack, misplaced homework, misread directions, and ‘careless’ errors. But a kid can be getting straight A’s and still be impaired in school if the impairment is social, emotional, or behavioral in nature. Picture the kid who drives everyone crazy by blurting out answers. Or the kid who can’t lose a game without flipping over the entire board. Or the kid who can’t sit still at circle time.

But when we see nothing like that, which is what’s going on with your daughter, the ADHD label seems like a real stretch.

So you ask: Maybe she’s just good at masking? Or maybe the ADHD is just really mild? Both fair questions. As I’ve said before, kids with real ADHD generally can’t hide it so well that it’s completely imperceptible at school. And mild isn’t a vibe, it’s an actual clinical term–it means that the kid has few, if any, symptoms beyond the minimum required. Your daughter doesn’t have even the minimum required, so it’s not mild ADHD. It’s not ADHD.

But I want to be really clear: I believe you. Your daughter has genuine attention and executive functioning vulnerabilities, and what you’re seeing at home and what we’re detecting on testing is real. It’s just not ADHD. The good news, though, is that a full neuropsych doesn’t stop at attention and executive functioning. We look at those results alongside everything else–mood, learning, language, academics, and more–and, in that context, we can usually find our answers.

holy moly!

Since it’s a family device, the rules surrounding the iPad are up to my husband and me. (Mostly me!) In our house, we don’t really have strict or explicit “screen time” limits, but Eleanor generally understands that if there’s anything better to do—hang out with her brother, go to the playground, call her grandparents, even watch a movie on TV—I’m not letting her use the iPad, so she doesn’t bother asking.

The apps are ours to choose, too. I don’t think iPads are great teaching tools, but every so often I add an “educational” drawing or math game to the home screen, figuring that, while there are certainly better ways for Eleanor to practice drawing and math, at least these apps won’t be harmful, and Eleanor seems to be entertained for now. For a while she was watching YouTube videos of a girl and her mom unboxing toys, and one day Evan and I decided the videos were a little creepy and weird, but we were too lazy to monitor what she was watching, so we just deleted the app, no negotiation. And if Eleanor doesn’t like our decisions about the iPad, she is free to choose not to use it. That’s it!

Eleanor is seven. We’re at the very beginning of all this. But I think the general framework we have implemented is working and setting the stage for easier conversations later. The device—whatever it is, iPad, phone, laptop—will always belong to our family, on terms we set and can change whenever we want. Her expectations for agency and independence and privacy will be minimal if the device is effectively mine. And there will be no negotiation to have because it doesn’t belong to her, and it won’t until she can pay for it herself.

I think the main reason this seems to be effective is because nothing about technology and child development is simple, and it’s impossible to set up an allow-versus-restrict binary. I don’t buy that there’s some magic age when social media just becomes fine, but at the same time, screens aren’t going anywhere, and kids will find their way to them one way or another. Technology comes with real upsides and real downsides, and our job is to teach our kids how to use it well.

I want to be clear that I’m not sharing all this to tell anyone what to do. This is uncharted territory for all of us. It’s hard, and it’s personal, and what’s effective in one house might be a disaster in another. Plus, everything is constantly changing, so what works today might not tomorrow. So while this approach seems to be good right now for my family, I’m not claiming it’s the answer for everyone all the time. The best we can do is stay flexible and keep adjusting as we go, and I’ll share what’s held up so far in my house in case some version of it is useful in yours, too.

The only good part of the last season of Hacks

This post was one of a million I’ve seen recently. Neuromyths are everywhere in education right now: We constantly talk about “brain breaks,” “nervous system regulation,” and “learning styles” that supposedly map onto brain types. Educators try to frame teaching as a science rather than an art.

This tendency speaks volumes about what kinds of knowledge and expertise we’ve decided to trust. We rank explanations: Social explanations feel softer than biological ones, and harder explanations seem to carry more authority. When a finding from education has a brain image attached to it, it feels more proven and more real.

This is little more than philosophical prejudice. Explanations at the social or behavioral level are complete on their own terms, and they shouldn’t require biological confirmation to be considered valid. If we observe that children learn better when they feel safe and calm—and of course we have observed this repeatedly across decades with plenty of behavior data to back it up—that observation doesn’t become more true when we identify its neural correlates. Yet the brain scan is what’s being funded and published. And then it gets misinterpreted on Instagram by a well-meaning teacher who wants to prove that her work is important. Her many years of experience in the classroom and the careful social science research informing her teaching exist and are rigorous, but they don’t feel as hard as neuronal growth.

I think it’s worth asking why.

Education and child development more broadly have long been treated as intuitive rather than empirical. The knowledge these fields produce is frequently dismissed as simply anecdotal or common sense or just plain wrong. This is not incidental. These are fields that are majority-female in practice, and they deal with concerns that have traditionally been coded as feminine. Their primary methods do not look like hard science in the way that scanning a brain does, and so they are not treated as valid or legitimate.

This fits with a well-documented historical pattern: When women enter a professional field, its prestige tends to decline, and when men enter, or when the field adopts methods associated with traditionally masculine disciplines, prestige rises. Neuroscience, which remains dominated by men, follows this logic when it enters education. It doesn’t change what teachers do; it just changes who takes the work seriously. A finding about how children learn becomes more credible when paired with a picture of the prefrontal cortex, even if the teaching technique remains the same.

Notice, too, that the demand for harder scientific legitimization is not applied uniformly across fields. We don’t ask economists and engineers to justify their models. We only do this for women-dominated fields that we don’t really take seriously.

To be clear: this is not an argument that neuroscientists are sexist, or that neuroscience itself is the problem. Many neuroscientists are doing valuable work. But the relational and observational knowledge that teachers accumulate also gives them a genuine form of expertise that we should trust. Education has historically been women’s work, and thus, it has been undervalued and underpaid. Requiring biological confirmation before believing that teachers know what they are doing simply perpetuates this problem.

It is also worth noting, separately, that neuroscience often doesn’t deliver what we hope it will. I have already written extensively about methodological limitations in neuroimaging and the field’s replication crisis. But even when the neuroscience is solid, the pipeline from a lab to a classroom is long if it’s ever completed at all. Neuroimaging research typically does not change what teachers actually do. We already can figure out, from observation and experience and rigorous behavioral research, how children learn best. Neuroscience tends to do little more than confirm what we already can see with our own eyes.

And when biological explanations become the standard for what counts as real knowledge, other frameworks get crowded out. This is important because frameworks aren’t neutral. A brain-level explanation of a child’s academic struggles locates the problem inside the child. A social explanation locates the problem outside, in the broader environment where the child is required to learn. These framings point to different interventions, different responsibilities, and different politics. Neuroscientific framings tend to individualize or internalize structural problems. And the populations most affected by internal framings of their difficulties are often the populations whose social conditions and external environments most urgently need attention.

The demand for neuroscientific legitimacy is not a neutral scientific instinct. It reflects a judgment that runs along gendered lines about which kinds of knowledge are real, which methods count as evidence, and which people we trust to tell us the truth about our children.

<3

Here’s what the researchers actually did: Using brain imaging data from over a thousand children, they identified structural differences in brain networks that were associated with different clinical profiles and trajectories of ADHD. One of the networks they identified was associated with a profile characterized by emotion dysregulation, and people who fit that profile tended to have the worst outcomes over time.

That is a meaningful neuroimaging contribution. But they didn’t identify a brand new “subtype” of ADHD that includes emotion dysregulation. We have known for decades—clinically and empirically—that a substantial proportion of people with ADHD struggle with managing their emotions. Ask any parent of a child with ADHD or any professional who works with these kids. Emotion dysregulation is an extremely common and impairing feature of the disorder.

The fact that emotion dysregulation is commonly identified in people with ADHD makes a lot of sense. Emotion regulation is a core component of executive functioning, and ADHD, at its heart, is a disorder of executive functioning.

Let me back up a little bit and explain what I mean.

Executive functioning is the set of higher-order cognitive processes that allows for self-regulation. Self-regulation has three distinct components:

1. Cognitive regulation involves managing attention and thinking: things like shifting focus when something changes, holding information in mind, and filtering out irrelevant distractions. This is the domain most people associate with ADHD since it encompasses inattention, poor focus, and mind wandering.

2. Behavior regulation is the ability to manage and modulate your actions: things like stopping yourself from blurting something out, waiting your turn, and not slamming a door when you’re frustrated. Kids who struggle here often look impulsive or oppositional.

3. Emotion regulation is the ability to modulate emotional responses so they are proportional to the situation. People who struggle with emotion regulation have trouble tolerating frustration without falling apart, recovering from disappointment, and not letting a bad mood derail an entire afternoon. They tend to have explosive reactions, experience prolonged distress over seemingly small things, and struggle to soothe themselves after getting upset.

All three parts of EF are compromised to varying degrees in people with ADHD. The neuroimaging study confirms this at the level of brain structure, which is valuable. And it confirms that emotion dysregulation puts people with ADHD at elevated risk for persistent problems over time, as well as for higher rates of comorbidities with other psychopathologies, which should raise red flags for everyone involved in treatment.

So I think the takeaway about this study is: Emotion dysregulation is a core, neurobiologically distinct feature of ADHD for a great many kids, and therefore, emotion dysregulation must be a main treatment target.

Therapists must work with kids with ADHD to help them recognize when an emotion is escalating, to tolerate frustration, to understand why they react the way they do, and to repair relationships after an outburst. These are all learnable skills, and therapy should build them with deliberate, supported practice.

Also, we should consider reframing how we discuss ADHD more generally. When we talk about it primarily as an attention disorder, we implicitly signal that the emotional dimensions of the diagnosis are secondary. They’re not. For many kids, they’re the part that does the most damage to friendships, family relationships, and self-concept over time.

So, ultimately, I’m glad this study is getting some press. But the moral of the story isn’t “there’s a new subtype”; it’s that the emotional dimension of ADHD is real. Research keeps pointing us toward a more comprehensive model of treatment, so it seems about time that we act on it.

I still haven’t seen Ragtime, but I loved Caissie Levy in this! So excited about her Tony!

Why these sorts of policies exist at independent schools is really beyond me. Independent schools are allowed to do more or less whatever they want when it comes to supporting their students, so why are they requiring families to get private evaluations? Teachers are with these kids every day. They can see who’s struggling, and presumably they can fairly judge when and how to help.

Also, anecdotally, it seems that the overwhelming majority of neuropsych reports recommend extra time on tests, regardless of whether the kid in question demonstrates a functional impairment in school. So, by making the neuropsych recommendation the sole criteria, disability accommodations are being granted to many, many kids in independent schools who don’t have disabilities.

Ultimately, my impression is that outsourcing the decision making to a private evaluator, who the family selected and is paying, isn’t making the accommodations process more rigorous. It’s just making it more shady and expensive. And this matters, for reasons that go well beyond any individual student or school.

Public schools—which educate the vast majority of students in this country, including a disproportionate share of students with disabilities and limited financial resources—operate under an entirely different framework. Under Section 504 and IDEA, getting an accommodation like extended time requires meeting a legal definition of disability and demonstrating actual functional impairment in the school setting. You can’t get it just because a clinician your parents hired put it in a report.

And a downstream consequence of these misaligned systems is unequal access to accommodations on tests like the SAT and ACT. Many standardized testing companies grant accommodations at least in part based on whether a kid has gotten them at school. If a student has a documented history of receiving extended time, they have a track record to support the accommodation, and it’s basically rubber stamped. If they have no such history, they have a much harder time getting it.

So what we end up with is a world where students from independent schools—who, on average, arrive at college admissions with significant advantages in terms of resources, tutoring, and preparation—are also disproportionately taking standardized tests with extended time. Meanwhile, public school students, who had to clear a much higher bar to receive any accommodation at all, are not.

We are not measuring the same thing. We are not looking at a level playing field. We are looking at a system in which the conditions of a high-stakes test vary based on family wealth and school type, and we pretend like it’s fair.

Independent schools have fewer legal obligations to students with disabilities than public schools do. That’s true, and there are good reasons for it. But fewer legal obligations doesn’t mean no ethical ones. In this particular instance, independent schools should be playing by the same rules as everyone else, not because the law requires it, but because the alternative is using disability rights infrastructure to give already-advantaged kids another leg up.

Accommodations are not a commodity. They’re a civil rights protection. So when they’re available for purchase, something has gone seriously wrong.

Love!!!

Lucy is a 10th grader at a competitive independent school. She’s doing okay: this year, she got mostly As and Bs and a C+ in advanced chemistry that she’s not happy about. She and her parents came to me because Lucy has been struggling with anxiety and noticed that she tends to run out of time on tests. She tried extended time on a few exams through informal arrangements with teachers, and she felt like she was finally able to show what she knew. The Joneses wanted me to do an evaluation to support a formal accommodation for time-and-a-half.

Testing showed average abilities across the board. Behavior rating scales and clinical interviews indicated significant anxiety, but even so, Lucy’s academic skills appeared appropriately developed even under timed conditions. Her academic fluency scores—like her grades—were solid. So while the data did support an anxiety diagnosis, they did not support functional impairment in academics. And, in the absence of a functional impairment, I didn’t think the extended time recommendation was appropriate.

I’ve seen cases like this almost every week for the past several years. The details change–sometimes it’s attention, sometimes it’s anxiety, sometimes it’s both–but the shape of my conversation with the family is pretty similar. And I want to walk you through it, because I think it gets at something important that we need to discuss honestly and openly.

At our feedback session, I deliver the news that, despite her anxiety, Lucy's academic skills look good and she doesn't need testing accommodations. Lucy and her parents push back hard, imploring me to change my mind; the school won't grant extra time unless I recommend it.1

So I ask Lucy to review, in her own words, what’s going on. She’s articulate about it. Time pressure stresses her out. She second-guesses herself. She knows the material but feels rushed, and that anxiety compounds. With more time, she feels calmer and performs better. She believes–and her parents believe–that standard time limits are getting in the way of her reaching her full potential.

Honestly, she’s probably right.

Research suggests that most students perform better when given more time on tests. This isn’t a Lucy problem. It’s an everyone problem. When kids sit down to take a test, they are being asked to demonstrate mastery of skills they have just recently learned. At that point, most of those skills aren’t yet automatic, and working through problems takes effort and time. Plus, time pressure introduces stress, and stress interferes with performance. When you remove the clock, kids tend to do better. So Lucy tried extended time and it helped. That is real. I’m not going to tell her she imagined it or that it doesn’t matter.

So I tell her I hear and trust what she is saying. But then I say something that tends to meaningfully shift the direction of the conversation.

“Even though I agree with everything you’ve told me, I don’t think you’re disabled.”

She looks at me like I’ve said something strange. No, of course I’m not.

“Let’s talk about that,” I say. “Because what you’re asking for is a disability accommodation.”

Families seeking testing accommodations must understand that academic accommodations like extended time aren’t a school support or a wellness intervention. They fall under disability rights legislation–specifically Section 504 of the Rehabilitation Act and IDEA–and exist to protect people with disabilities from discrimination and to ensure equal access to major life activities, including education.

Lucy is getting As and Bs. She’s completing her coursework. Her academic skills are nicely developed. She’s accessing school. According to my clinical judgement–and, in my understanding, the law–she does not have a disability. She has anxiety that is unpleasant and real and worth treating. She has a preference for modified testing conditions that is completely understandable, and a demonstrated experience of doing better under those conditions. But, since she is not disabled, she’s not entitled to extra time.

The Joneses push back hard. Of course they’re not arguing that Lucy is disabled. But she does better with more time, the accommodation helps her, and the school should want to support her. Plus, lots of kids without disabilities are already getting extra time, so if she doesn’t have it, she’s actually at a disadvantage.

At this point, I have to hold the line. Those things are all true—and I especially agree with their assessment of systems-level problems at Lucy’s school—but I still cannot recommend that she needs testing accommodations. The word “need,” in this context, means something specific: that without it, she cannot access her education. But the overwhelming evidence in front of us says she can.

I hope I don’t sound too judgey and unsympathetic, because the truth is, I genuinely believe Lucy is stressed, and she needs real treatment for her anxiety. I think she is attending a school where accommodations are abused. And I am a firm believer that the fairest solution for all kids would be for schools to rethink how they administer assessments. If a test isn’t measuring speed, why impose a time limit for anyone at all? But that’s a different conversation than the one about Lucy’s specific need for disability accommodations. And the last thing I want to do is to further damage the integrity of a system designed to protect people who genuinely cannot access school without support.

In the end, I referred the Joneses to a therapist who specializes in adolescent anxiety. I told Lucy that what she was experiencing was real and worth addressing. She left disappointed. Her parents left frustrated. It was as if I was refusing to give them the thing they had paid for.

That’s okay. Because, in my office, disability accommodations aren’t for sale.

So excited for this theater kid’s new album!