Ep 228: Are We Over-Pathologizing Normal Boy Behavior? with Dr Michael Milobsky

In part two of my conversation with Dr. Michael Milobsky, we talk about boys — and why so much normal boy behavior is increasingly being labeled as a problem. We discuss redshirting, kindergarten expectations, ADHD concerns, school environments that may not fit many boys well, and how to tell the difference between a child who is truly struggling and one who is simply developing normally. This is an important conversation for parents and educators about self-esteem, school readiness, and creating spaces where boys can thrive.

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Transcript

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Welcome back to your child is normal. I'm your host. Dr Jessica Hochman, so this is part two of my conversation with pediatrician. Dr Michael malowski, if you missed part one, I definitely recommend going back and taking a listen. So in today's conversation, we're talking about boys and specifically something I've been thinking about a lot lately, and that's whether we as a society are over pathologizing normal boy behavior. I talk to so many parents of boys who are told that their child is too active, too impulsive, too disruptive, or just not fitting the school environment the way that they're supposed to but sometimes the bigger question I ask myself is whether the environment is developmentally appropriate in the first place. So today we talk about how to think about the difference between a child who truly needs extra support, and a child who simply may be developing normally, I think this is such an important conversation, especially for parents who have felt worried or discouraged by the messages they're getting about their sons. Now I first found your account. One of the posts that I really liked was you talked about how you're an advocate for boys and kindergarten, and you advocate for red shirting boys. I really like this because I do feel like something that I've been thinking about a lot recently is the over pathologizing of boys. That's something that we share in common. And so I just wanted to ask you more about that. Tell me what are your thoughts on boys, and are we expecting too much of them today? So this came out of and I'm sure you and your dad experienced this. I am constantly being booked appointments with tearful moms of boys who are two and three and four and five years old, who are being told by a preschool that your boy is disruptive. There is something wrong with him. He needs to be evaluated. He needs a diagnosis. And I would even say six and seven and eight exactly for all that. And these are, almost without fail, children I've been seeing since birth, children who I have, like all of us, we all do intensive developmental surveillance, and there is not a single thing about any of these boys, maybe not zero. I mean, there's definitely some kids that have had issues, but that's a separate I'm not talking about those kids, but those kids we've identified already most of the time, but there's nothing wrong or abnormal with this child. What is being imposed on them is an unreasonable expectation and and a lack of recognition that boy and girl development are very, very different. That is a biologic reality that I'm not sure why that has become politicized, or why that has become taboo or lost in some way that's somehow negative, to acknowledge that boys and girls have different areas of strength and develop different skills at different paces, because they are genetically divergent in that way, and then, and then, taking that normal behavior around that boys almost invariably exhibit, which is a little more aggression, a higher activity level and drive, not the same language and communication schools and abilities, not the same self regulation as girls have at the same age. And once again, this is a generalization, but it's mostly true. Of course, there's individuals that cross over and that's not the point, and then pathologizing it and saying, because these behaviors we no longer find acceptable, your child now has a diagnosis, and it's up to you to get that diagnosis and label them and get them help, because in this space, it's wrong, and that has been to me, a psychotically common and increasingly oppressive issue. I'm not sure exactly when it started. I had three boys in the 90s and did not experience this when they were in those spaces. There was a certain recognition that boys are like this and girls are different at times, and honoring it and recognizing it and providing the right outlets and the right conditions and setting boys up for success. But now it's quite the opposite. Where do you think it's coming from? Because I have a couple of ideas, actually. You know, we talked about this with with the great Michael McLeod, and I actually had a conversation about this too. A lot of it seemed to start with the No Child Left Behind Act, when then schools were being held to these metrics and test based standards, and that this pressure, that schools had to meet these things to get funding, and that teachers had to start teaching two tests at an earlier and earlier age, and that is filtered down into kindergarten and now into the preschools to get kids more kindergarten ready, whatever that means, and that has a lot of that is totally antithetical to normal boy development. I think what's tricky for parents is sometimes they'll want accommodations in class, understandably. So they have, let's say, a seven year old boy who just can't sit still. He's got a lot of energy, and they want their child to be able to take breaks during class. Well, then the school asks them to get a 504 plan. The kid then needs a diagnosis, I know, and his diagnosis is. Male and it's boy, yeah, and I'm gonna say that. I know it's not right for everybody, but this might be a plug for Single gender education. At times, my boys were in all boys spaces, mostly for k1, two and three, and it was magnificent. They just recognized they had, these kids had to leave the class at regular intervals, and they structured the day and around that. And it wasn't considered abnormal. It wasn't considered an outlier. It was just the way things ran, and it was really positive. And there's a lot more research going on in this space, but some of it's being ignored. Stanford did a really good study in their center for his early child education in 2015 that showed that for all kids getting started in structured school settings later, resulted in a staggeringly less rate of kids being labeled as inattentive, being labeled as ADHD or being labeled as some kind of behavioral dysregulation. It's so interesting to me because my family, we went to Japan a few years ago, and they don't start school till the child's seven, and we're in this rush to start kids in school sooner. And that's what I wonder, because there's no cost for TK, where it's so much less expensive than keeping your kid in preschool. And I wonder if we're pushing our kids too soon before they're ready, and if financial reasons are playing a role in this we are, and people can't just afford to necessarily pay for preschool indefinitely while they're waiting, so they just end up having to put their kids in these spaces. And these spaces are now hyper structured, way more than they used to be, and many, many more girls, because of their developmental difference, are able to accept a much more formal, learning based environment naturally, and most boys are not. And I don't know why this is happening necessarily to the same thing, but the pressure on the teachers to regulate this and then label boys and get them out, or get them labeled somehow benefits them or the space. I don't understand it, but it's definitely going on absolutely no and I, I talk quite frequently to parents who are frustrated because their kids keep getting in trouble in school. And I understand it when they when they describe to me, Oh, my kid is, you know, just has a lot of energy. They can't sit down for too long. They want to get up. They want to they want to walk around the teacher gets frustrated. What should we do? And and I think about a lot. I'm fascinated by the way our school system is set up and that. And I believe that quite often our school system is not set up for these kids to thrive, and I'm fascinated by these schools that exist that allow for some creativity and some differing structure than what currently is available. So for example, there's this man named geever Tully. I highly encourage anyone to look up his school. He did a great TED talk on his school, but it's all about the kids are outside. They're constructing things. They're building things. They're using hammers, they're using saws, they're drilling and they love it. Boys School, honestly, and I wish that was that's not near the neighborhood where that's not near the neighborhood where I where I practice medicine, but I wish more schools like this were available for kids that would benefit and thrive in that environment. And listen, I know that we're all tired of of kind of throwing too much sunshine at nor at Norway. I mean, I think all of, I think a lot of Americans are tired of hearing about Norway, but once again, they have a model that we should be incorporating more for, like most of preschool, kindergarten age, they simply don't go inside. They the kids are just dressed to handle things, and they are just out, and it's way more free range. And they have a lot they've been doing this forever, and their mental health numbers and the way that they assess and behavior and development are all pretty impressive, and this this model, there's a lot of evidence that this is kind of a really good way to think about that phase of childhood, supervised, sort of educational spaces. There's a lot we can learn from them. Absolutely, yeah, and I'm, I'm curious, so Okay, so I agree with you. We're in agreement that there's a lot of normal kid behavior that's getting pathologized. But how do you distinguish between? Because there, there really are some kids that struggle in school and are having a tough time and do merit from a diagnosis of ADHD, or, you know, who really are, who really are struggling and having trouble. In the end, you know who are who are legitimately having trouble. How do you distinguish between what's normal childhood behavior and what is something that's worth looking into more? So I think the issue is that there's a lot of, I'm going to say, except for the most extreme cases, like kids who might have autism or. Or a really major neurodevelopmental disability, there's a lot of overlap between that stuff and normal development for a very long time. So one is recognizing, you know, that the overlap is large. And I think most of us, you know, a lot of developmental specialists talk about about somewhere in second and third grade used to be closer to fourth grade, but I think it's now more into third grade, where that really starts to diverge, like self regulation, and those kind of skills, really, for most boys, are becoming a lot more accessible and start to be able to show up in a more consistent way. And then if and then kids, all kids who are not able to really start to do that, start to be declare themselves more at that age, understanding that the difference between home and school. A lot of these kids, the parents, are like, at home, I don't see this. This is just, I'm only hearing this from the teachers in that setting. That's also kind of a red flag that this is being hyper pathologized in one space, and then this, if it's if these issues are global, that's a much, also more of an indicator that, hey, this might be an issue that does need more of an evaluation, more of a red flag, and not just, not just setting specific Yes, Yes. And I agree with you, and I think certain characteristics that come to mind sometimes parents don't feel safe at home with their kids when their kids are you know, kids can't act in dangerous ways. That always perks my ears big time. And then also, I would say, their own self esteem when they're having trouble making friends, when they're not feeling good about themselves, when their self talk is not is not healthy, not positive. I always that that makes me want to pay more attention to that kid and get them some help. Sure, for sure, so, but just a normal boy that's got a lot of energy that just needs to get outside more, and maybe talks a lot and is a little impulsive. Exactly that's that's like, once again, there's so much overlap that I think giving kit, giving time for these things to declare themselves, recognizing there's normalcy been looking for. Once again, the bigger red flags, the hyper negativity, the the rejection, sensitivity, kind of picture where kids can't tolerate any kind of correction, or or or any without experiencing a massive emotional wound. Those, those that definitely put your kids outside the normal spectrum of development. And I, I love how you said, you know, kindergarten. You said, kindergarten readiness, whatever that is. Can you tell me more about that? Like the your I love your thoughts on red shirting and why that is, why that is something we should give more thought into. So I think kindergarten readiness in most minds for parents, has been shaped by what the kindergarten spaces have these, I think, very rigid and test based expectations, which are not, I think, developmentally realistic. I look at kindergarten readiness is that, can your child participate in the social part of kindergarten happily and easily? They can relate well to their peers. They know what other kids want from them. They can easily interpret what the teachers want from them. And that and that, that is 99% of it. I'm not so concerned from a kindergarten reading standpoint, whether they have all their math skills in order or other reading skills in order. That's way less important to me when I think tie their shoes, when no one has a lot of kids, don't use laces anymore, exactly, exactly. So I look at those things as far as kindergarten readiness, and even in that place, delaying entry into those formal spaces, you just and once again, there's a difference between boys and girls here, but there is much more space and time to develop confidence and competence and then, and then feeling really positive and getting positive reinforcement from the teachers, and Not being overly labeled. And when, when boys enter beyond six, that's way more likely to happen, and it's and it's way more likely to be positive in it that they carry that with them forward, when they're constantly being corrected and labeled and criticized right away for things that, for a lot of time are just developmentally normal, that leaves a mark that also they carry forward. Yes, and I agree there's a huge difference between, let's say a four year old boy and a five year old boy, tremendous. And a five, right? Yeah, and so on and so forth and that. And I keep and it continues. And you just touched upon this a little bit, but in terms of the harm and over labeling, what do you think that potentially is doing to the youth, male of our generation? I think it's hyper pathologizing them. It's giving them it's really creating a feel, a sense around school and education that is very negative. I would refer people to Richard Reeves book of boys and men. Nine, which is very well sourced and detailed, which talks about how the educational numbers in this country between boys and girls are diverging incredibly fast. The rate of high school graduation, the number of college degrees and the entrance into graduate school for women versus men, are going like this. And of course, you know, you could argue, well, it's just correcting for the patriarchy when and yeah, there is, there is some of that. But there a bigger question is that educational spaces are becoming less tolerant, less sensitive and less friendly towards males and boy normal boy tendencies at a very early age and is creating, I think, a lot of negative feelings around education and educational success that carry all the way through. And we're seeing boys just leave the educational system way more than girls. It's so interesting, like I talked to my husband, who's who's who did well in school eventually, but he says he could care less about school till about 10th grade. Correct for that, he was a terrible student. Didn't do homework, just played basketball like yourself. I'm sure I didn't care about school until 10th grade. Didn't even really register as something to to focus on. And so many more girls just naturally do that. They get a lot of positive reinforcement for it. They they're naturally good at it way more than boys are at a younger age. So just have to. And I think acknowledging that, understanding that yes, is really important for for the health of for the health of our kids, exactly, and the message boys get is becoming increasingly negative, so it's being reflected in how that looks at the end points of the educational system. So if maybe, just maybe that you just answered my question, but if you could recommend changing anything about how we're raising boys and the culture of how we're raising our boys, what would it be? I think it's, I think it's a recognition that of developmental differences and creating friendly spaces at the earliest points of entry in the educational system, preschool and kindergarten, that honors that and accommodates that, not in a not in a negative way, but, you know, in a way that just sets them up for success and positive engagement with those spaces earlier. Thank you. Thank you that that definitely resonates with me. So I really, really value that you're speaking out about this. I think, I think a lot of parents with young boys and teenage you know that that have boys that fit into this space will really appreciate hearing that perspective. I mean, I hear when I started posting about this, the amount of DMS I get from parents about boys, and a lot of them said, Honestly, I never believed this until I had kids. I thought it was all the patriarchy, and I thought it was I thought it was toxic masculine propaganda. And now I now I see that it's true. Why should they feel bad about themselves for something that's completely normal? And honestly, that's what I think makes so many different wonderful people eventually, as grown ups, I always think about, I have a cousin who was a very rambunctious young boy, and now he's the captain of our he's the captain of of he's a fireman, and he's a captain. And I am so grateful that there are people like him that exist on this planet, because I would be a terrible fireman. I'm not brave. Me too. Actually, you know, I It's wonderful that the world, you know, the world takes all types to make it go around. So absolutely, I think we have to look at, look at the fact that there are different children, different personality traits, and appreciate them for it, and provide them with an environment where they can thrive. Agree, and I think that the system has to be altered to accept that and honor that. But right now, the system is hyper focused on on metrics and test scores that mostly lean towards the natural abilities of girls at a younger age. Yeah, and I, what I worry is, like you said, I'm such a believer in self esteem and the good it can do for a child, and as they grow up to be an adult, you know, a high functioning adult in society, and if we make them feel bad for something that they really don't need to feel bad about, I just, I think we're doing we're not it's not in their interest, and we're not keeping them healthy. Agreed, agreed. And so the books I refer people to. One is the if you're raising sons, the wonder of boys was a great resource, especially with younger kids. Two was decoding boys by Karen Anderson, which was an amazing resource around adolescence. And third is of boys and men, which really talks about the entire systematic sort of approach to boys, which is damaging. I'm thinking, after this podcast ends, I'm gonna, I'm gonna give you a list of people that should be on your podcast. Karen Anderson included. Yeah, she's amazing. I absolutely Hold on If you I might realize my computer is failing to just plug in real quick so I don't go black on you. No problem. No problem. Can you choose? Okay, all right, I'm good. There we go. Oh, sorry. I'm just going to end with my first patient here. So I'm just going to enter that charge back. Gonna, if it's okay with the I just do I stop it to go home for showers. I know that's why I said it to you, because I know you, you know Fridays is like, I just hang around the house and do this kind of stuff. So I don't have to amazing, amazing. Okay, this has been so wonderful. I'm so I can't tell you how appreciative I am to know about a pediatrician like to know about a pediatrician like you out there to see that you are on the social media space. So thank you for all you do. If it's okay, I thought I would end with just a few lightning round questions, end of the interview. Love it. Okay. The first one is, if you were not a pediatrician, what would you be? Stand up comedian? A stand up comedian, SNL. That's definitely the part of my personality that I would be really, really leaning into. Yeah, for sure, I'd be doing open mics and trying to get on stage. Not too late. No, it's never too late. I have a solid five minutes. I think I could throw in there to an open mic. I just have to work up the courage to do it. Fantastic. Do you have a favorite comedian? Oh, I have a whole list. What is one thing that you wish parents could relax about? College admissions, academic metrics and grades, and if I'm getting it right all the time, those are the 3e scooters, yay or nay. Oh, dumbs down. Too many. I've seen too many devastating head injuries that just didn't need to happen. Okay, now, just to ask more on this, but it follows Jonathan heights theory of getting them outside more Absolutely. And once again, let me give him a scooter that doesn't have a motor. Like, that's fine, but the E scooter, they're way overpowered for the developmental level of the people who they're being sold to. That's the problem. There's just a myth that, yes, all right, favorite TV show, or what's, what's the TV show you're watching right now and enjoying the pits, because I'll tell you why. When I was in medical school, I started third year medical school the same year that er came out, and Dr Carter, which was Noah wise character, was also starting his third year of med school. So I went through medical school with Dr Carter, and now we're both middle aged Jewish physicians. And so I'm watching the pit I feel very in a linear way, connected to his whole TV doctor arc. I even wear the same watch. So yes, it's very, very connected to it. What's the most misunderstood trait about boys, self regulation and emotional reactivity that just are different and show up differently at a younger age than girls. Favorite sports team, the University of Pennsylvania, Quaker basketball team, still, and tell everybody, what was your role on that team? Oh, I played, I played basketball for the UPenn for my college years. I was division one college basketball player, and I played overseas. I played for the US Maccabi team. And I can't generate an emotional connection to any other sports team. I just It doesn't matter. It's still there. So I just it's hard. They're not exactly a high end television draw. You have to fight. You have to really work hard to find their games. But that's it, and I can attest, I saw video footage of him actually dunking. Very impressive. Yeah, that that, that is long gone, but at least I have video proof that it happened. Amazing. Okay, last one, what as a grandparent? What does it taught you about parenting? Has, or I should say, has, has. Being a grandparent taught you anything new about parents? Yeah, you know it when you're a grandparent, when I become a grandparent, is you have no other role. You're not in. You're not in charge or responsible for making sure that they have the right sleep schedule and making sure that they are getting the most wholesome food at every meal, like like parents do, your whole role is to just do make them love you. And it doesn't matter how you do that, you just generate constant affection and positivity and warmth. And maybe we should be doing more of that as parents too, not to the not to the complete disregard of boundaries that we do as grandparents, because I'll admit that we do. That, but maybe there's we could leak a little more of grandparenting into parenting. Amen, that's very beautiful. I like that a lot. Those are great words of wisdom. Now tell everybody. Where can they find you? Sure? My Instagram is at peds at The Meadows, P, E, D, S, peds, like pediatrics peds at The Meadows. The Tiktok account is Dr Mike M the YouTube account is Dr Michael malowski, the podcast is, your kids will be fine. And I really appreciate on your social media account how authentic you are, how real you are. You are talking to you right now. You're just as you are on social media that's hard to find. Yeah, it's you know that I was told that in order to connect with people and get your message out, you have to be willing to show up as who you are and authentic and not and not filter that or be guarded. It's not exactly easy, but it's it does allow more of what you have to say to get out. So no, I appreciate that I learned from you. I noticed that you do that, and I think it's actually it's inspiring. Thank you. Thank you. Jessica, well, thank you for what you thank you for what you do. It's been a pleasure to talk to you and learn from you, and I hope you continue to grow. It's been a joy watching you grow, and I only wish you continued success. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask dr, Jessica.