Falling Behind: How to talk with boys
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Hi there, it's Meghna here with a bonus episode in our special series, Falling Behind, The Miseducation of America's Boys. The series explored the many reasons why boys are trailing girls in academic achievement. Now, in this bonus episode, you're going to hear a powerful conversation we recorded in front of a live audience at WBUR's City Space Live Events venue.

The conversation is with Dr. Kevin Simon. He's an attending pediatric psychiatrist at Boston's Children's Hospital, assistant professor at Harvard Medical School, and Boston's first chief behavioral health officer.

And what he has to say, though, applies to boys across the country. Now, for those of you who heard the series, and I hope that's all of you, you might recall that Dr. Simon appeared in our episode about mental health. But we knew he had so much more experience and expertise to share than we could fit in that one episode. So we invited him back for this special live conversation, which we're calling Episode 6. ♪

How to talk with boys. Good morning, everybody. You ready to have a good day today? I'm Meghna Chakrabarty. This is an On Point special series.

falling behind the miseducation of America's boys. The ways that school doesn't work for lots of boys comes with a higher penalty. He calls it six cruel hours of our lives, you know, an acronym for school. The data will show that we're failing them desperately. It's a beautiful day in London.

If you have a teacher who tells you, like, you're really badly behaved and sends you all these messages that you're not going to do well, it turns out there's a little bit of a self-fulfilling prophecy there. What?

As a first grade teacher, relationships with the boys became a window into what I argue now is a need for the reimagining of Black boyhood. Just because your skin color think that you condone violence, because they see other Black children on the news condoning violence, killing, like,

It brings you down. One thing I do with my class is I always ask them if they can remember the time when they were first told that boys don't cry. And 100% of them can do it. Like as men, we're like in jail with our emotions. Like we can't let them out. It just sucks. The quote actually comes from Frederick Douglass. It's easier to build strong boys than rebuild broken men. Today's boys are tomorrow's men.

So the inspiration for this series came because in higher education, in college, there is a rapidly growing gap between attainment levels for women and for men. But we wanted to look upstream to see, well, what are the things we can identify that are contributing to that gap later? And so we had five episodes. The first one had to do with elementary education and whether boys, in fact, do

on average learn a little differently than girls the second episode was about behavior which we'll talk a lot about the third episode was how to better meet the needs of young black boys the fourth episode was about the lack of male teachers in schools and the fifth episode was about mental health in high schoolers so dr simon was in episode five

But your experience as a psychiatrist really crosses all of the things we talked about over that week. So could you start by telling us

a little bit about what kind of things you see and the stories that you hear in the young people that come into your your office on almost a daily basis yeah yeah so in terms of the young people that i see so i am a child and adolescent and addiction physician at boston children's and so i see and have trained in seeing literally infants all the way

through college. In terms of the patient population that I'm most engaged with right now, it's predominantly adolescents and that can anywhere be from let's just say 10, 11 on through what I call emerging adulthood, 18 to kind of 24. And so the young people that I see

oftentimes are coming not because they want to unfortunately but because somebody has recognized something's going on and that something that's going that's going on is classically in one of the domains of their life so an interpersonal challenge i.e.

parent, guardian, or in school. There's what we sometimes call a drop-off. They were doing, even if you were a C student, all of a sudden now you're a D student. Or if you were an A student, all of a sudden you're a C student. Or they've quit activities that they used to enjoy like basketball, but now they don't want to engage in it. And so when you start to see those patterns, undoubtedly something's happening and someone's recognized that. So then they end up seeing us in clinic.

So seeing you in clinic, and particularly for boys, let's keep our focus on them for a little longer, means that something else was going on earlier. Right. Right. And this is what I wanted to hear more from you about because we didn't actually have you in our second episode, but you have a lot of thoughts and experiences about, well, school being one of those main realms that you talked about. Yeah.

Are schools good at really understanding or interpreting the behavior of boys? Yes and no. More often, let me say, for those that show up not as is expected, no.

No, they don't do a good job. And so if you have someone that is a little bit brisk or just not engaging with some kind of enthusiasm that you're, as a teacher or the school official, wanting them to do, they're not really great at assessing, well, what's really going on? In part, in real time, and I'll speak to teachers. My dad was a public school teacher in New York for 20-plus years. In real time, you have 20-something students who

You don't have the actual time in real time when the disruption is happening to figure out what's going on. And so you pull that student out, but then maybe you suspend them. And unfortunately, we have data that says...

kids of color happen to be in school or out of school suspension at a higher rate than the general population. And so you can imagine if you're now plucked out of school or plucked out of class, well, that's actually not actually that helpful. In part, now you just isolated the individual that for whatever reason was engaging in some kind of way that seemed disruptive. And so by the time they do get to me,

happened today there's someone who is suspended for the next couple of weeks with schools literally at the end of the year so it's like okay well we just have 10 days 12 days that they're not going to be engaged so let's come up with a plan so that's that's some of what shows up and trying to figure out in real time how to help the young person but

Also communicate to the school. Hey, here's actually the full breath of the picture so schools they don't have in real time sometimes the The space yeah for sure the space the time the supports right and when I want to come back to that actually because it's a big part of this because we also learned that

in schools in which they've somehow managed to create that space, time and supports, and teachers can form stronger relationships.

That benefits all the students no matter their gender, but boys seem to benefit the most because there's a question of how you use the word expected with behavior, but how the behavior of boys is just interpreted. Right, right. Yeah, so in reference to interpret, so I have a four-year-old. He had his well visit checked today.

And when KJ is running around, I see KJ as KJ and he's bubbly and he wants to engage people. And yes, he might rumble and tumble. That behavior at four, expected. Transition, at some point we're going to get to kindergarten. It's like, okay, KJ, it's good. But now you got to like sit for, let's just say 25 minutes. If that's not what you were normally doing on a day-to-day basis,

Then to, like, be put in that position, and it's like, okay, what are we doing? And if you're not really stimulating, oh, things will go left real quick, right? And when it goes left, is it that you're recognizing this kid needs more stimulation, more engagement, or is it he is not really...

fit out for our classroom right right and so that's what i hear a lot of times when i'm talking to school officials they say is it possible that we could engage him or her but him for for this context in a different way and sometimes educating parents about 504 plan well how do you get a 504 plan and this becomes the challenge you got to tell the parent hey take this letter

go to the principal's office or go to any person's office, hand this in. It's you requesting that my child get evaluated. Now the school generally has about 60 school days, sometimes 90 school days, but that's not 90 real days because it's a school week. It's five days. Don't count holidays. Don't count

Right. You can actually end up missing the entirety of the school year, depending on when you learned, wait, I could actually request this. Yeah. Right. And so you can see how gaps of time start to compile. And a parent might know something's off. I need some help. And yet the system is not set up to do it in an efficient manner. And we see this in the data. Parents of kids of color that have ASD.

When a parent recognizes it, and this is from a study, when the parent recognizes it and brings it to someone's attention, that point to the actual diagnosis is like three to four years. Can I pick up on that? Because it's a really sobering statistic that you gave. But you also emphasize, again, this is like for a child of color, that when the parent recognizes it,

Are we in a place where sticking with ASD in children of color, that it's being recognized less often by the other adults in their lives? Correct. And so there's a delay in me as a clinician saying what I hear from the mom, again, potentially an anxious person, I think he's okay. Let's check back in a year.

Well, that's a whole year that parents have to engage and the kid's not getting services for entire years. And so I meet people who are 14, 15, 16,

And bringing it to someone's attention that, oh, I think there's some other... Even the challenges that you came to me thinking that you had, yes, we have this diagnosis. I think that diagnosis is true. Hey, by the way, there's actually something else that I think has been going on for a long time. Bringing people's awareness to that is very challenging because they're like, I knew something was off. There's layers, there's compounding...

inequities that many families face. And I promise we'll come back to that too because it's a major issue in terms of, again, then the diverging paths that boys and particularly young boys of color are sometimes taking or put on. But I also just want to get back to, again, this expectation, this behavior expectation, right? Because in cases where there's truly some diagnosable challenge that the child needs help with,

That's a major category. But what about in cases where, again, the system, school systems, and I have a 10-year-old boy, and we're very lucky because we live in a great town and great school system. But the expectations that are put on what a teacher needs to accomplish in a school day for a kindergartner doesn't really comport with boy behavior. And I'm just wondering if...

Here's a case where you think that perhaps there's a lot of young boys that wouldn't end up in your office if earlier on just minor changes were made to the time they got to run around during the day. Yeah, yeah. So...

a lot of the training that I have received is actually to figure out who not to do things to. Yeah. Yeah. Because there are some people who come and it's like, hey, Dr. Simon, I want Adderall. It's like, well, actually, there's some other things that we could try, right? And so to that point of the individual where the behavior is actually not

clinically like deviant clinically bad it is, you know, perhaps the young person that seems to have like a little bit of bravado and They're not engaging the right way could the bravado potentially actually be lack of confidence and so you have to actually give that kid space to yes have the bravado and then say but I can help you and

and slow down in terms of let's do the math, right? You hear this oftentimes. I'm not good at math. I wasn't good at math. What did my mom do? She made me meet this guy, Jack, Wednesdays, and I would lament going to... And I'm looking at the clock, how much longer? But my mom recognized, no, you can get good at math, Kevin. Yeah. Right? She didn't accept the fact that I kept saying, I don't like it. I don't like it. I don't like it. It was like,

Honey, you can like it. You can do well. And so the teachers also, because my mom's a strong advocate, and I told you my dad was a teacher, they knew how to communicate to teachers in schools and say, don't let him...

play you. He can do this. Right? They knew how to engage. And so that's the other challenge, right? I'm asking both the school system to recognize and shift, but I'm also sometimes asking parents to shift in how they communicate to the school. Because the reality is, if I come with a view of heat,

it's very unlikely that I'm going to receive the warmth that I actually need, right? There's like an African proverb, the sun will burn down the village for the warmth that he wants, right? So we have to slow folks down. And so when I communicate to school systems, I'm like, I think there's another way that we can engage him. And oftentimes they'll actually change that engagement style. And then they'll think, oh, that medicine must be working.

and i haven't actually prescribed anything it's it's you've engaged him differently and you recognize oh he can be more responsive and it's like yeah he actually can but it's still to get there it requires advocacy coming from somewhere undoubtedly the parents that i meet that they have the spreadsheets they they

go to the PTA plus meetings. They're the ones that get their kids the things that their kids are and should be afforded. It's unfortunate that there are other sets of families where the agency to be the advocate...

is not just it's not just there in part because sometimes they've been bludgeoned and beaten down so much by trying to get to the right person and people just keep kind of pushing them along pushing them along pushing them along and so it is challenging for families that have young people who are of color young people who just

aren't responding the way that the system supposedly wants them to respond. So tell me more about this. For black boys, again, I'm really focused on this expectation question because so much seems to stem from that.

Are there a different set of expectations for what normal behavior is for young black boys? Yeah, and you know, unfortunate stereotypes have like strings of truth, right? And so you see a person like myself when I'm 14 years old, I'm on the taller end, right? Oh man, you must be good at basketball.

Well, I happen to myself like basketball, so yes, I played a lot. But I had other friends who were just as tall as me, could care less about basketball, could care less about being an athlete. And yet people keep pushing that idea on them, and maybe that person wants to write something.

or do something else, but people have this expectation of, "Oh, why aren't you wanting to do this?" "Just because I don't like it." And so when that then shows up in school, at church, and the person is not engaging the right way, yeah, they can be seen as, "Oh, don't hang out with him."

don't be social with him. And the reality is everyone should be afforded the opportunity to be whomever they want to be. Well, let me put a finer point on it, actually, if I could. Because it reminded me of a story that you told us once.

let's say there's a kindergarten right and you know boys and girls and there's one boy who's not a child of color who's just like having a bad day having trouble sitting still and throws a book same thing exact same behavior from a from a black boy yeah um there is evidence there's data to show that i mean you actually presented this data to us that at kindergarten

the ramifications for the exact same behavior. Right.

for that five-year-old black boy are very different. Yeah, so unfortunately, kids of color tend to be quote-unquote adultified, right? So this person is chronologically the same age, yet I'm engaging and seeing them differently, and I have this expectation that they should be able to do things that maybe a seven-year-old should do. And the adultification that happens generally is about four years, right? So you're looking at a seven-year-old, but you're really thinking of them as a 13-year-old, right? It

It happens all too often. When that does happen, and so the same behavior, someone, blonde hair, blue eyes, you know, taps their teacher. The teacher sees the person for the little kid that he is and says, oh, Johnny, let's not do that, Johnny. Same kid, now, dark hair, brown eyes, browner skin. Same tap.

oh my gosh he assaulted me and we see that same behavior but how did i respond to what the behavior was and we unfortunately have published data that kids of color can do the same exact behaviors the framing by the behavior is one of punitive nature and so what ends up happening young people

unfortunately on a trajectory sometimes for juvenile justice when it could be that if we just engage them differently framed it differently and actually just framed it as this is just a five-year-old kid yeah the outcomes could be drastically different and yes we do see it unfortunately even at the kindergarten age language is so critically important and

We use the same words, but they mean so many different things in different contexts. I'm a child psychiatrist. I see young people that come to the emergency room. A psychiatric crisis for me is somebody is actively wanting to harm themselves or harm someone else or just in so much distress, they cannot function out in community. That's a crisis for me, clinically. A crisis for a teacher is...

He threw this cup against the wall. Someone come help him. And EMS is going to come and say, what's the crisis? Well, he threw a cup against the wall. I got 20 kids to engage. He needs to get out of here, right? Gets to me. Hey, what's going on? I talked to the parent. Hey, what's going on? Okay, so, okay, what really happened? I got frustrated. I didn't know something. He said, okay, did you throw the cup?

Yeah, I threw that damn cup. I said, okay. And I'm accepting of it. I'm like, okay. But I'm one-on-one with him. Yeah. I say, all right, I don't, I think, you know, cooler heads, there's been time now. I don't think you really need to be on an inpatient unit. I think we should, you know, discharge you back home where you should be. Right? The school's like, what?

that doctor doesn't know what that he's talking about because the crisis for them is completely different than crisis for me, right? But we're using the same word crisis. So that also happens very regularly. And it's one of the things that we're trying to do because we recognize the language that emergency services using, the language that schools are using, the language that clinicians are using, same words, but very different meanings. But in that example, we went from

little kid being frustrated and throwing a cup to calling EMS. Certainly there's a space in between those two to do other things. Correct. And so that's where some of our interventions come in, right? So how do I help the school remember you have a social worker? How to help the school remember we now have a school behavioral health system, right? Because you got teachers like my old dad who's been doing things the same way for as long as he's been engaging.

And I'm sure there are new things that pop up every year for teachers. And now this is just one new thing. But how do I help them recognize, oh, but this one new thing could be really, really helpful. Yeah. When potentially many new things have suggested to be helpful. And didn't. And didn't pan out. Yeah. Right. And so I don't ever fault individuals that are in systems or trying to change systems as to the true challenge of actually shifting behavior.

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You know, it's so clear that, again, we'll keep our focus on boys. Like boys of color, they suffer this double whammy, right? There's the adultification, which due to those different set of expectations can lead them like to an academic off-ramp very quickly. And then, as you said earlier...

that when there is a need for some kind of actual diagnosis so they could get appropriate help, oftentimes families have to fight for that. Yeah, yeah. And what I was going to ask is, it occurred to me that there's yet another layer here. In your example when you said you're talking to this kid one-on-one,

You know, I think I've heard it 10,000 times in my life when someone's looking for a therapist, like, you know, me or female friends I have, they're like, I'm more comfortable speaking with a woman. Or a man might say the same thing. It's utterly reasonable to have a person of color say, well, I'd actually be more comfortable speaking to a therapist who looks like me. Yeah. Right?

You may be one of the few in all of Greater Boston who... Yeah, yeah. So this exact point also comes up. So for those of you who are here, you should take a photo. There are not many black child psychiatrists. But the truth is, I... Colleagues. Kev, I got a kid for you. I automatically know who the kid is for me. And yet, I'm one person. Yeah.

And so we should be able to, yes, have some racial concordance, but that's impossible because there just aren't enough providers of color. And yet I also have to be able to understand and be open to all cultures,

And so not every patient of mine is black. I have Indian patients. I have patients of different religions. How do I show up and how do I engage and be curious about who that person is? And when I don't know something, legitimately say, "Help me understand." Yeah. Right? And even when someone is racially concordant, we might have completely different cultures. I happen to be Haitian American. That does not mean that for every Haitian American,

that I am the person that they should engage with, right? - Yeah. - So we sometimes don't allow the nuances to be present. And so if somebody who I see, their family sent me a card for Diwali. - Diwali, yeah. - Yes, yes. I had no clue what this was. And I said, "Hey, explain this holiday to me," right?

I've gone to Shabbat, not because I'm Jewish, but I just want to understand, wait, what is this? You don't talk about work on Fridays after out? Like, I loved it. I'm trying to be curious. And when we engage with providers of all kind of color, it is that kind of empathetic curiosity that you need because the truth of that is not everyone's going to be able to have the dynamic of male to male. Yeah.

Can I ask you to follow up to that, though? Because I totally get what you mean, right? Like a truly thoughtful, effective psychiatrist is going to be able to find concordance with whomever they're talking to.

But to be blunt, I mean, America being what it is and black families having justifiable reason not to trust various systems because they haven't been believed by previous practitioners or by other officials in the system. And there's a lot of evidence for that, that they have to work harder just to be believed. I mean, even for something as simple as like,

pain measurement, right? That like black patients are just not believed they're in as much pain as they are. Where am I going with this? Ah, yes. America being what it is, I would totally understand it why a young black boy would be looking at, say, a white provider and being like, I don't trust you. Yeah, no, so... So what can that provider do? Yes, so...

Given who I am and what I look like, I see a therapist. However, again, given who I am and what I look like, I know all the other black therapists. So my therapist is not black, right? But I make sure that the person that I engage with, I understood their background, I understood their training. And even when we were engaging, gave them grace to say, oh, you can ask things about race. And we probably are going to talk about racism.

But it is that you can likely help me in thinking about what I'm experiencing. In reference to the families that are looking for providers of color, and this is psychodynamic, important piece. I get parents who, kids 10, 13, visually we look similar. When I engage with them,

I actually have to be very cognizant about something that we call transference. Because I might be literally representing everything that their mother wants. And so when I'm engaging with you, you're resenting me. But you're not really resenting me. You're resenting your mom or whoever brought you to talk to this guy because this guy is supposed to help you. I have to be mindful of that in how I engage with the young person

to be aware of potentially when transference is happening. And then there's not just transference, there's counter-transference. I.e., I'm going to potentially see some young kids like myself, and that's not always great. Because I have to be mindful to help the person that needs help in real time, maybe not help my own potential traumas or my own history. And so this is the importance of having a therapist who goes to therapy. Because you want to understand

Even when this person is presenting to me, like I literally engage this very regularly. And parents will say, oh, wait, he talked to you. I say, yes. Like, oh, but he didn't talk to the other guy. That happened to potentially look like me. I was like, it's neither here nor there. But the person that I'm engaging, I recognize who I might be a representation of to him. And I'm not overplaying that. And so you don't got to call me that. You just call me a guy.

Right? Because when parents start to say or systems say, "Oh, but he's Dr. Simon." "No, no, no. Sit up." "No, no, ma'am. Don't." However he wants to engage right now, just allow him, afford him the room to engage. Because I have to let him know you can just be who you are. And I give space to that. And I don't tell them what to do. I'm walking with you. And I'm just posing questions about, "That's interesting."

So you suggest that you want to play football. Just help me understand, how does the vaping help that? Right? Not you shouldn't vape, which, yes, I want to say. But I'd say, well, just help me understand. Just in leaving that space for them to either answer it or sometimes to not even answer at all, but not press them about it because it's that space that then they start to think. Yeah. There's a sort of an undercurrent here about

all of us would benefit and our children would benefit so much if we could just slow things down a little bit.

Before I get to my next actual question, I just want to say for the record, I do want my children to grow up to be like Dr. Simon. So sorry, I fell into that trap there. Let me ask a couple of audience questions here. Coming back to boys specifically, someone wants to know, are there ways we are teaching boys to how to name and understand their emotions? Or are there ways that we could teach boys that? This seems to be a cultural issue and isn't necessarily supported by the larger culture.

Yeah, so whoever asked the question, one good question. Are there ways to help boys learn language? Because emotions, we all have them. We cannot turn them off. How I respond to my emotion, I do have some kind of control. So a few days ago, I'm engaging with a young person who's 17, their mom, and I asked the young person, hey, how's the engagement going? It's fine to me.

Okay, how do you think your mom is going to respond when I end up asking her that question? I don't know. No, no, okay. I hear you don't know, but you do know your mom. Do you think she's going to say it's fine? Well, nah. I said, okay, help me understand why. Well, she doesn't understand that my friends, they don't know how to plan. What do you mean? Which I understand that he's going to tell me about a scenario of

the friends don't know how to plan okay okay so yeah you know they they hit me up they told me out to go to friend's house and she didn't want me to go so okay what do you think your mom might need to feel more comfortable to let you to go i know you say i don't know i don't know how she's going to eventually tell you you can go so you should think about it eventually pull mom in and she says yes i don't trust the friends that he's with

So, oh, well, why not? They do things that I don't want him to do. Okay. So now, mind you, both of them have answered questions about other people. Right. So, okay. Well, what could you do in helping him? Could you overtly say, you know, I really want to know who you're with when you're coming home. I need a phone number of somebody. And for those that particularly engage in kind of behavior substances, I tell parents, you have to like drop your ego. Mm-hmm.

And you want your kid to, when they're going through any kind of crisis, call you. You don't want to get a call from someone else. But how do you create the space to let your kid feel comfortable calling you? We can't chastise them every time something bad does happen, right? So in terms of the question, which was, how do I help the young boys learn? I actually pulled up an emotional wheel because he got bristle at something that mom said. I said, oh, what's going on there?

Ain't nothing. No, something's there. And I said, he got caught with a vape and suspended, right? I said, okay. So yes, I see the visual anger. I suspect there might be a little bit of, and I'm literally saying it this kind of way to slow down, humiliation. Yeah.

Right? Because you're trying to tell your mom you're doing something different. You're behaving differently. And here it is. This darn principal caught you. Okay. But let's not focus on the principal. There's a little bit of humiliation. And now you feel ridiculed because someone has to call your parent. Hey, he's not doing the right thing again. And how does your mom respond to you? Right? And literally, he's like, yeah. And she's like,

Why don't you tell me that? Like, well, because he doesn't have the language yet. So that's why we're working on it. Because to get from I'm angry to actually I felt belittled or I felt chastised or I felt overwhelmed. You have to be taught what the word is that matches the actual emotion. And oftentimes we allow folks to just have emotions and

but never slow down to say hey it looks like you were anxious or it looks like actually you were overwhelmed and sometimes in the moment when your kid's experiencing whatever set emotion it is that's not actually the time to be trying to give the lesson about what the emotion was right and so kids are friend my son my wife's probably not like my yesterday night i hear boom i run up the stairs my wife runs from the bedroom my son fell out the bed

Right? He's four. And she's like, that's why I told you the guardrails. Like, Brittany, he has to figure this out. Right? This is at like two in the morning. He's crying. Oh, my God. And that's not the time. KJ, come on. You got to sleep in that center of that bed. No, it is. Hey, it's OK. It's OK. It's OK. And he's crying and he's crying and he's crying. Today, when we put him to sleep, KJ, daddy doesn't want to run up the stairs. Right?

I'm giving space, one, to have the emotion that he's supposed to have, and then later come back, because undoubtedly, hopefully, he's not falling out of bed every night. But something else is going to always come back up that gives you an opportunity to engage your kid around the behavior or the emotion that they're having. And can you hold space to allow them to have it, process it for themselves, and then come back and say, hey, so the teacher,

She said, you stepped out of class again. What's that about? And if KJ, when he's in fifth, sixth, whatever grade, that's how I'm going to engage him. I'm not going to, come on, man, you got to sit down. No. What's going on? Yeah. From the perspective of a parent, though, this question was so good because it got me thinking, like, well, we can't just expect schools to do that teaching, right? Like, it has to start at home. Yeah.

When do caregivers get to feel their emotions? Yes. Yeah. No, no. So this is a great question. Caregivers should be allowed to have the frustration. And whether if you are married, hopefully you're able to have that frustration with your partner, not in front of the kid or even if it's actually in front of the kid. So you want to model actually having emotions and getting back to like regulation. Right. Yeah.

good friends, networks. Like it is possible if you're not married or you're single, you still have other people. And this is where it's important to engage with the parents of the children. So I'm framing as children here, children that your kids are in school with, right? Because you're not experiencing this by yourself. There are many, many other people who are like, wait, this is happening to you too? So in our clinic, we have a parent group.

Because we know it is isolating to feel like, how come he's X? Yeah. And you're not the only one. And it's so interesting how much learning happens socially. And so, yes, parents need to be social with each other to understand, okay, this is not that crazy. Yep. No, it's not. Some four-year-olds pee in their bed. It's not crazy. Right? Right.

But if you don't allow yourself the grace to actually have the space to figure it out with like-minded people, then you could just be in isolation. And unfortunately, I do meet a lot of people that don't have that space. And so sometimes they show up and they're very hot. But I give them the space to be hot because I get it. Like, he's not doing the right thing. And it's okay that he's not doing the right thing. That doesn't mean he's forever not going to be doing the right thing.

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Let me get to this other audience question that actually takes us back to schools. I think this is an interesting one. Should schools require neurological testing so that parents don't have to be the ones who are mindful of this potential symptoms? Yeah. So fortunately in our country, independent of current administrations and things, schools, so there is the American Disabilities Act and we do have IDEA as another acronym.

Where if a parent, and this is where the 504 plan that I referenced or IEP comes up. If you think there is something going on, you can actually say, hey, I think my child, I think my son needs an evaluation. And you literally, as a parent, you could write it on napkin. You hand it in. You have asserted your agency that,

your son should be able to receive a neuropsychological evaluation. So if your school receives public funding, you can get a neuropsychological, neuroeducational evaluation. If your school receives public funding. If you are in a school that does not receive public funding, that school has the capacity to do the things that it wants to do, not sometimes with the obligation that is federally mandated. So it's available, but do people know how to get it?

That's where sometimes public service campaigns are critically important There's no layer of nuance here the good chance that if you're a person that has some melanin hue in you The person that's providing the neuropsychological evaluation probably won't have melanin hue, right? Got to understand that it doesn't mean that they can't do a good job in doing the evaluation and coming up with the appropriate diagnosis if diagnosis are there but

There are challenges through and through in terms of behavioral health services that are critical. And so we are trying to create a pathway to get more people of color that are therapeutic mentors, neuropsychologists, school psychologists, child psychiatrists. Everything is needed, but it is possible. And so to that parent that is inquiring, I'm hopeful that

At least listening to this, you know, you can ask your school. And even if your school doesn't receive public funding, so I should add this nuance, you can still inquire. And hopefully that school does at least signal you where you could go to get that kind of service. By the way...

Idea is the individuals with disabilities Education Act. Thank you to the producer whoever thanks brilliant producers I have two more questions for you and then sadly we're gonna be out of time we talked about Specifically for families of color the difficulty when they're seeking Service or services or diagnosis of getting those I mean the example that you gave like years can go by it was particularly heartbreaking

But then on the flip side, are there situations in which a child comes in and probably could use a diagnosis and the family doesn't want it? Yeah. So there's a great paper by Andrea Spencer, a colleague of mine. This is when she was at Boston Medical Center. And it identifies six stages of parental engagement around treatment for ADHD. And I'm using this paper because it

identified 41 parents of color median salary was $20,000 and all the kids met criteria 3 to 17 all of them met criteria for ADHD and

qualitative survey i.e you're getting folks of color to say hey just help me understand what does it look like to get the diagnosis to start engaging in treatment she had in fact six stages that these parents identified right normalization of even believing what this person is telling me is true about my child right stigmatization and fear of course stigmatization and fear is is

appropriate in there. So these six stages don't happen in six sessions, don't happen in six visits, don't even happen in six months, right? But I have to be cognizant that, and then the reason we also use ADHD, the treatment is very effective, right? When you're below five, behavioral intervention. You're above five, medication like a stimulant is going to be recommended as the first line. You should still do the behavioral intervention, but if you're over

Stimulate first plus intervention. You're now telling me that a family of color, Haitian, parents who are not educated in this American system, who has a son, is eight and got a diagnosis. Somehow somebody helped them get to school to get the diagnosis. And they meet the provider and say, hey, it looks like Kevin has ADHD, attention deficit hyperactivity disorder, combined type.

So, okay. Oh, so this is why he's acting up. Sure, mom. This is why he's acting up. Okay. Now, one of our treatments happens to be a medication. You got to give it to him in the morning. I got to give my son a medication. Oh, slow down. Talk to me about this. Well, this medication will be helpful. It'll help him attend. It'll help him be focused. It'll help him be less distracted. Yeah. But I don't trust you guys. Mm-hmm.

Would I look like me or not? Could I represent all these guys? It's a pharmaceutical company, big pharma. Yet I'm the guy who's writing the paper that says, yes, I understand you're not going to agree. Yet I got to slow down and say, I get it. And I have to be able to communicate with them and create space. And I have patients like this who, Afro-Caribbean, and I don't just say, well, you don't want to engage with the treatment right now. Well, just find somebody else. I said it.

Let's keep meeting. Yeah. Because the symptoms are going to continue to persist. And they're like, all right, you referenced this medication before. And I said, yeah, okay. We'll start low dose. Either you're not going to, he's not going to recognize anything. And so that's actually not a bad thing. Because if you don't recognize anything from taking the medication, sometimes we're just trying to give you a nocebo dose just to say, hey, there's no bad reaction, right? Yeah. Okay. And now let's start titrating up a little bit.

We gotta have that nuance and that does not happen in 15 minutes. So it's fair that parents, let alone the child, young person I'm actively thinking about, 16 years old, comes, has anxiety, literally has anxiety. It's like, hey, I'm thinking, that's a talopram. This would probably help this kid. And yet, I know, he's like, don't just start telling me what my mom wants me to do. I don't know.

Hey, and mom's not in the room. I'm talking with them one-on-one. Let's just talk about this idea of taking it. What's the good? What's the bad? I'm engaging him to think out loud. Well, what is good? What is bad? And he was sweaty palms, sweaty palms. And he recognized something because he was trying to talk to a girl and his palms were sweaty. I mean, I can't be doing that, man. I'm like, yeah, you can't be right. And then it's like, Hey, let's do this.

Let's work our way up. We meet. We've been meeting, but two months later, man, I'm feeling so good. No sweaty palms? No, man, I got no sweaty palms. It's like, awesome, great, right? And now mom's like, what happened? Yeah, we were just talking. Because I hold his care to the chest because I'm supposed to. I don't want mom to feel like, oh, well, you see, I told you. No, no, we're working together. We're figuring it out.

I have so many more questions, but I only have time for one. Last one. And I'm going to seek your advice here. Because I was thinking of, we played that little bit of a trailer at the top of this conversation, and the last words in that trailer came from a...

researcher who quoted Frederick Douglass about, it's better, I'm paraphrasing obviously, it's better to help boys now because they will be tomorrow's men. So what can, I mean like every boy and man deserves to have this kind of, the support you're talking about, the richness of a complex and varied emotional life

We heard in our series so often how even boys at the youngest ages are already saying they don't feel like they can have that So what can we as family members teachers? Neighbors like do to help create a different world where all those things are possible for tomorrow's men. Yeah, no, so The quote is accurate

definitely easier to help people, young boys, become who you want them to be rather than, yes, trying to fix. And at the early age, the three, four, five, six, they're really experiencing everything for the first time. And it's so important to be able to give them that ability to experience it for the first time.

And when challenges come up, emotions, frustration come up, give them the space to have it, but do come back and actually talk about what they experienced. So, oh man, you didn't make the team. That sucks. It does suck. That sucks. All right, so let's make a plan for how we're going to get a little bit better. And that could be a chess team. That could be the ultimate Frisbee team. It could be basketball.

But yeah, it's okay for him to lament for a little bit that they didn't make the team. Don't just try to rush them out of that sense. I'm scared about something. So validate. Yeah, it's reasonable to be scared. What if you don't do well on the SAT? What if you don't get into the school that you want to go to? Giving them the space to think about it. Yeah.

Well, Dr. Simon, as always, it's been so edifying and a pleasure to speak with you. Thank you for coming back. And thank you for also taking part in this conversation within the WBUR Festival. Thank you. Happy birthday to WBUR.

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Support for this podcast comes from It's Revolutionary, a podcast from Massachusetts 250. Listen on for the story of one drag king's self-expression, pride, and transformation in Northampton, Massachusetts. ♪

You're listening to It's Revolutionary, a podcast celebrating 250 years since the shot heard around the world was fired right here in Massachusetts. I'm Jay Feinstein. From revolution to revolution, we're exploring the people and places in Massachusetts that shape America.

Today we found ourselves in Northampton, Massachusetts, home of some pretty rad rainbow crosswalks. They're nothing small. They're pretty, it's a pretty chunky, very obvious rainbow. That's Ross, better known as the drag king Victor Evangelica. I

I carry the spirit of Victor everywhere I go. He spreads the good word. I met up with him at the Cafe T-Roots on Main Street, the city's main drag, to talk about how Northampton might be revolutionary as an oasis of queer life. I want to make sure they know that they can bother us for food. Of course, after we ordered some delicious food. Oh, thank you so much.

Oh, that looks so yummy. And he said revolutionary doesn't even begin to describe Northampton. You know, this is a place where Sojourner Truth lived, Frederick Douglass visited. There is a long history of people who have been critical to our understandings of the human experience and people's struggles that have found refuge in this area. ♪

Revolutionary War veteran Daniel Shays, best known for Shays' Rebellion, lived around this area too. And today, Northampton continues to be an oasis for artists, queer people, and anyone who might not have somewhere else to go. You know, it's a very zany population here, I'm very proud to say.

It's a place he feels he can really be himself. The queer joy and honestly like self-expression that I can have here is something that I genuinely feel it's some of the best in the world. This is like one of the best places in our world to be queer and I

I think about that and I think about the struggles I still face and sometimes it's disheartening. But it's also, it brings me so much joy that there is such a resilient group of people around here who are very friendly, you know, want to help you. If you talk to somebody about confusing parking meters in this area, somebody's going to help you out. If you talk to somebody about where's this thing or that that's a local, they're probably going to know where to point you and what's the best place to eat.

And he's right, it was Victor's suggestion that brought me to T-Roots in the first place. But I was also in town to see Victor perform, where he dressed up in a costume made of wires and chains and Super Nintendo cartridges. One of the parts of the big reveal is I take off this, like, inhibiting jacket made out of wires, and I shed these things, and I'm able to move more freely throughout this number, and...

show people that act of transformation and freeing yourself from that kind of personal bind you might have. I mean, it just sounds like it gives you a level of joy. I'm just watching the smile on your face as you describe the character. Yeah, I kind of do a lot of 80s riffs that are nostalgic for me, just based off of what my parents were into a lot growing up. And that's really what makes me

feel the most at home I feel and is the easiest for me to fit into. It's a lot of fun. So that night, we joined an eclectic crowd in an arcade called The Quarters to see some drag.

Before the show, we caught up with a few audience members. Yeah, what are you hoping to see tonight? Craziness, fun, queer love, joy, you know, that kind of thing. Most of the time, there's usually a drag show happening somewhere. So whether it's like here, a couple towns over, there's usually like some place to go to see it. I just love drag as an expression of...

Like individuality and what people can do with their craft and their skills. It's fun to see how creative people get with it. I mean, the way people do their makeup and what they wear, it's amazing to see people just go up there and just be their authentic selves. And being authentic is what it's all about, says Victor. The best drag that people see is truly reflective of people who know themselves and...

reflective of people who are so proud of the person that they are that they're able to go on stage and serve a fantasy.

And he sees drag like that and art like that all over the Northampton area. I think when you get people who can live as their authentic selves as an area, you get better art. You get people who are doing things for real. And I'm, you know, I really do think about it all the time. Like, I don't think there's anywhere else I could have lived my lived experience and do what I do besides Massachusetts. I've turned you back. I love you!

It's Revolutionary is a podcast from MA250. For more stories, check out massachusetts250.org or wbur.org slash ma250. ♪