My patient Zach was an objectively awesome tenth grader. He was academically talented and motivated, with a mix of A’s and A-minuses in accelerated classes. He was a starter on the varsity basketball team. He did Math Olympiad. He even played the French horn in the school band, though he admitted that was mostly for his college application and to get out of an art history requirement that had a reputation for being pretty onerous.
He started preparing for the ACT in April of his sophomore year, hoping to get it over with the following fall. His tutor charged $800 an hour, with a minimum of two-hour sessions, twice a week. Within weeks, he was in my office complaining that there was no way he was going to do well. He couldn’t get the pacing right and never finished all the questions in the allowed time. Mind you, he was consistently getting 34s on his practice tests. A perfect score on the ACT is 36. It’s an exceptionally rare score. And Zach was very close to it. But Zach wanted to go to the University of Pennsylvania, and he said that a 34 still wasn’t good enough. Zach was already in the top percentile of test takers nationally, and he still felt like a failure.
I am a clinical neuropsychologist. I offer psychotherapy and cognitive remediation to children with learning disorders and related developmental disorders. Zach came to see me because he wanted me to write him a letter saying he needed testing accommodations. Maybe with time-and-a-half he’d get the perfect score he really needed.
STUDENTS DIVIDED OVER UNIVERSITY OF MICHIGAN HIDING FIRST-SEMESTER GRADES FOR 2027 FRESHMEN
When nothing is enough, when excellence is the minimum acceptable, we fall short. And when we fall short, we reach for labels and accommodations and services to close the gap. Of course, sometimes children have real disorders and disabilities, and labels and supports are crucial. But in other cases, the struggles are healthy, normal parts of development, and medicalizing them backfires. The supposed quick fixes may seem helpful in the moment, but more often than not, they make kids even more miserable.
How we learn to live by the numbers
Zach isn’t alone in his anxiety about scores and percentiles. We’re all socialized to care about measurements, and we think about how our data compare to everyone else’s. From day one, pediatricians measure our kids’ height, weight, and even head circumference, and tell us where those numbers fall relative to same-age peers. I remember my son’s first checkup. I was so excited to hear that my chunky little guy was in the 95th percentile for both height and weight.
It’s only a matter of time before our obsession with toddler head circumference turns into an obsession with teenage ACT scores. We get emotionally attached to these numbers. We give them more importance than they deserve, and we read them more negatively than we should. I talk to parents all the time who are worried about a score in the 37th percentile. In reality, the 37th percentile is solidly average.
More isn’t better
What I usually explain to parents is that in most domains, more isn’t better. The average range is wide, and it’s the middle that’s often optimal.
Take attention. With too little, we have trouble in school. With too much, we become hypervigilant about tiny, insignificant details and lose the forest for the trees. Anxiety works the same way. Too much and you can’t leave the house; too little and you’re reckless, walking into oncoming traffic. We want to land somewhere near the healthy middle.
Most scores are also imperfect descriptors of what we can do. We try hard to measure and quantify our traits and abilities, but those measurements are snapshots in time. How we do in a given domain today isn’t necessarily a good predictor of how we’ll do tomorrow, since we’re constantly learning, developing, and growing. Also, there’s always measurement error. Scores are estimates, not absolutes. And, finally, the best predictors of success are things like perseverance, creativity, and people skills, which usually can’t be measured at all.
The squeeze from both ends
But we’re human, and we feel the squeeze from both ends. If our kids are struggling, we see a disorder, and like Zach, we look for a diagnosis and accommodations. If our kids excel, we worry they’re perfectionistic, people-pleasing or anxious. We can’t win. The messy middle, where most healthy development actually happens, seems to have disappeared.
And this tendency to pathologize everything is making our kids miserable.
Nothing is free
We bring in interventions and services to fix the problem, thinking, “What’s the harm? It can’t hurt.” But there’s an opportunity cost to everything. Every minute and every dollar spent on some kind of therapy is a minute and a dollar not spent on soccer practice, day camp, playdates, or regular old homework. The choice isn’t between an intervention and doing nothing. It’s between an intervention and doing something else with that time and money, something that might bring our kid joy and enrichment (and might even build the perseverance, creativity, and people skills I mentioned earlier).
Working against their mental health
We mobilize all these supports to protect our kids’ mental health, but we might actually be working against it.
Start with depression. Depression is characterized by helplessness and an external locus of control, the feeling that we aren’t in charge of our own destinies. Diagnostic labels locate problems in the brain, outside of kids’ control. And when outcomes seem to hinge on rankings and status and paid accommodations, effort stops feeling like it matters.
Anxiety is similar. Anxiety is maintained by avoidance, and the best treatment involves exposure to the feared thing. When we provide an accommodation that lets our kid avoid whatever seems hard, it brings short-term relief. But we deprive them of the opportunity to learn how to cope. They don’t internalize the message that they can do hard things, and the anxiety grows. We accommodate to relieve the pressure, but the accommodation actually keeps the stress going.
I WORRY LESS ABOUT SCREENS THAN ABOUT THE CHALLENGES TODAY’S TEENS NEVER FACE
We get swept up, too
Of course, we want the best for our kids. I’m not saying we’re hurting them on purpose. We get swept up in the same pressure they do. And how could we not? There’s so much mom guilt. We’re constantly told that every little decision we make on our kids’ behalf matters, and we’re trying to navigate an impossible landscape, bombarded with conflicting information. It’s hard to separate what’s valuable from what isn’t, especially with a robust influencer economy that literally profits from our feelings of inadequacy. In that context, a diagnosis makes sense. It partly absolves us, and it offers a clear fix.
So what do we do instead?
If the diagnosis isn’t the solution, what is?
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We need to reframe “average” as good and talk about rankings differently. We need to broaden what counts as success. We can actively work against helplessness by giving kids real control and crediting their effort and hard work. We can reduce their anxiety by supporting them through hard things instead of constantly removing obstacles. And we have to be honest with ourselves about the difference between support and enabling.
Most important, we should trust our instincts. When there’s a real problem, it’s usually obvious. In that case, seek help. When there isn’t, take a deep breath. Support your kid informally. The struggle will pass, and most likely, it will be a blip on the radar, eventually not mattering nearly as much as we think.
Zach will probably get into a really good college whether he gets a 34 or a 33 or a 35. And he’ll probably be a happy, successful human regardless of where he goes to college.
Development is resilient. Let’s be resilient, too.
Author’s note: The character in this opinion article is a composite and/or fictionalized.