A boy sits hunched over his computer playing a video game. His reactions are fast and his motivation high. His brain is working overtime, and he sits still for hours on end. He does not appear to have an attention deficit disorder, as his concentration is total. However, since kindergarten he has been on drugs such as Adderall, Ritalin, and Concerta. He has a friend across town who is equally intelligent and has not been medicated, but his parents and teachers are not happy. Even the girls in his class notice he pays little attention to homework, handing in a scrawled essay hastily written after midnight. In both cases, school bores them and they are unmotivated in the real world.
This is an increasingly common problem. Numerous parents have similar sounding stories. Their sons are intelligent, yet completely unmotivated to do school work: they enjoy reading three volumes of Lord of the Rings, yet are unable to concentrate in class. Many of the boys have decided that school isn’t for them. Some parents describe their sons as being well behaved at home, but disruptive in school. And others relate that their boys are lazy and unwilling to help at home or in the wider community. The parents have their own vague theories about why their boys are unmotivated, though none can pinpoint a firm cause. The volume of such problems reported by concerned parents has prompted Dr. Leonard Sax, a family doctor with a Ph.D. in psychology and an active researcher in childhood development, to investigate the growing malaise found in boys and young men. Dr. Sax identified a number of factors driving their growing apathy and lack of motivation, ranging from changes in schooling to the water we drink. However, in order to understand what is happening to boys, the story begins, implausibly, with fishes in Washington D.C., and alligators in Florida.
In 2006 a group of scientists began to examine fish in the Potomac River. They found the female fish to be entirely normal, but shockingly the reproductive organs of the male fish contained eggs. Intrigued by their findings, the scientists extended their search over a two-hundred-mile radius, finding that 80% of male fish had been feminized. Later laboratory results showed significant levels of endocrine disruptors present in the fish, which mimicked the actions of female growth hormones. The male fish were becoming female. This problem was not just limited to fish. Scientists studying alligators in central Florida reported that male alligators had also become feminized. Upon further investigation, the changing gender of Floridian alligators was also linked to a particular class of endocrine disruptors called phthalates.
In 1980 doctors in Puerto Rica noticed that girls aged as young as seven were going through puberty. The doctors found no evidence of hormones in meat or dairy causing the early onset of womanhood. A further study was made of Puerto Rican girls residing in the United States, but those girls were not subject to early onset puberty, and so racial and genetic factors were ruled out. Additional tests revealed that girls who underwent premature puberty had six times higher levels of phthalates in their blood. Over the course of the next two decades, American girls started to experience a similar trend: they too were undergoing puberty at a very young and unusual age. Clearly, something odd was occurring. Male fish and alligators were becoming feminized, while girls across the Americas were hitting puberty at a startling young age, and the link was an exposure to phthalates. Yet the question remained: where were the phthalates coming from? The link appeared to be bottled water.
The plastic used for almost all bottled water and other beverages is awash with phthalates from a compound called polyethylene terephthalate or PET. As plastic bottles warm up, phthalates are secreted. The hotter the temperature, or the more acidic the drink, the more phthalates are released. In the case of the central Floridian alligators, their habitat was on the watershed serving Disney World and Orlando, which meant millions of plastic drink bottles discarded by tourists in the hot weather were seeping phthalates into the water supply.
Bottled drinks are not the only source of phthalates. Researchers at the University of Cincinnati found phthalates were being introduced into young babies through the rigid plastic bottles and teats used for baby milk and pumped breast milk. In addition, pregnant women expose their unborn child to phthalates when drinking bottled mineral water—an act that is supposedly healthy. Research led by the Universities of Rochester, Iowa, and UCLA demonstrated that pregnant women exposed to phthalates were ten times more likely to give birth to a child with genital abnormalities. At this point, researchers knew that phthalates acted like female hormones, affecting the sexual development of children, but further laboratory tests found that phthalates specifically disrupted memory and motivation in young boys. A research team from Oxford University and Harvard found dramatic neurodevelopment and behavioral changes in young males exposed to phthalates; females were not affected in the same way. The female brain is immune to phthalates because girls are not reliant upon hormones for their drive. In contrast, boys require testosterone to achieve and be motivated. When boys are exposed to endocrine-disrupting hormones, their production of testosterone is altered, and with it their will to succeed. These same endocrine disruptors also blunt gender differences. When laboratory animals are exposed to the same amount of phthalates as drinking a Coke or similar beverage they stop engaging in rough-and-tumble play characteristic of males. When exposed to the amount of phthalates equivalent to a baby drinking from a bottle, the distinctive physical differences between the female and male brain are eradicated. And thanks to continuous research conducted over the last twenty years, there is now irrefutable evidence that the brains of boys and girls are different.
The brains of boys and girls are not the same. Since the early 1990s twelve distinguished neuroscientists at the National Institute of Mental Health have conducted MRI brain scans of young children, watching their development. They observed different developmental trajectories between girls and boys. The parietal gray matter of the brain, which integrates information from different senses, develops two years faster in girls, whereas the temporal gray matter, responsible for spatial perception, develops slightly faster in boys. But it is the occipital gray matter, the visual cortex, which displays the greatest difference. Girls aged six to ten show rapid development of the visual cortex, which then shrinks slightly after the age of fourteen. For boys, the visual cortex does not grow at such a rapid pace until after the age of fourteen. Due to this different trajectory, the language area of the brain of a five-year-old boy looks like that of a three-and-a-half-year-old girl. To put it another way, when it comes to understanding language, the average five-year-old boy is eighteen months behind his female counterpart. If one were to teach a three-and-a-half-year-old girl to read, write, and sit still it would be a frustrating experience. Trying to teach a five-year-old boy is similar. Generally, he’s simply not ready, he just wants to play games and explore the world. When he’s put in a classroom, told not to move, told to keep quiet, and the focus is on academic work, then he finds it hard to sit still. He’s not necessarily being naughty, he just wants to move and act out the natural inquisitiveness of young boys. He’s not helped either by the type of work that is set for him. From almost his first day at school he is hammered with phonetic drills in a bid to teach him to read. He eventually learns the mechanics of reading, but there is no deep love for literature, nor does he learn the intrinsic appeal of a story. By the fourth grade his literacy results might be good, because he has memorized the drills, but we now know that twelfth grade boys are doing worse than their predecessors. Since 1980 approximately 90% of teenage boys have stopped reading in their spare time, and the phonetic drills of their earlier life are at least partly responsible.
Boys are further disadvantaged as kindergarten is a very different place from thirty years ago. In the United Kingdom and the United States, boys and girls start full-time schooling at the age of four, and the emphasis is no longer on drawing, painting, singing, and play. At that age, a boy has a zest for life, he wants to explore the world around him, then suddenly he is confined to a table and chair, and taught how to read and write, before his brain is ready. He fidgets, he’s bored, he doesn’t understand, and more importantly he is unable to pay attention. His teachers notice his lack of attention and his unwillingness to follow instructions, soon he gets labelled as hyperactive, an educational psychologist assesses him, and he is diagnosed with Attention Deficit Hyperactive Disorder or ADHD. Medication soon follows. Since 1987 the number of American children taking drugs for ADHD has increased thirtyfold. More than one-third of these children are taking not one medication but three or four, in a bid to calm them. However, contrary to some opinion, ADHD may always have been with us, and not been invented by the drug companies. The official handbook for diagnosing all psychiatric diseases is the Diagnostic and Statistical Manual of Mental Disorders. The diagnostic criteria for ADHD includes: a reluctance to engage in tasks that require sustained mental effort; difficulty in sustaining attention; and, failing to give close attention to detail. According to these criteria, even Tom Sawyer and Huckleberry Finn had ADHD. It is not a diagnostic criterion that exclusively applies to boys of our own time. The key difference is that boys of Tom Sawyer’s generation could play, explore, and engage in physical activity, they were not confined to a classroom from a very young age, nor were they medicated to keep them there.
Yet parents and teachers of children with ADHD do report impressive results when their boys are medicated. Attention improves, as do test results and the ability to sit still, but this improvement does not mean a medical condition is present. For many years, physicians thought the positive response to ADHD medication confirmed their diagnosis. This changed in 2006 when Professor John Gabreili of M.I.T. showed that ADHD medication improves the attention and performance of all children, even if there is nothing medically wrong with them. In effect, the drug is stimulating the brain; it is not necessarily fixing a condition. So what’s the harm? If a child can’t sit still, nor concentrate, why not give them some pharmaceutical help to boost their school performance? According to Professor William Carlezon of Harvard University this might not be the wisest idea. His team found that ADHD medication damages the nucleus accumbens in the developing brain leading to a loss of drive in adulthood. This was confirmed by research at Brown University, University of Michigan, University of Pittsburgh, South Carolina, and universities in Holland, Sweden, and Italy, which found that this damage to the nucleus accumbens is permanent, even when low doses are given for a short period of time. If a boy’s nucleus accumbens is damaged it dramatically affects his motivation. For instance, he may feel hungry but he just won’t be bothered to do anything about it. Further research at Tufts Medical School and UCLA revealed that the smaller the nucleus accumbens the more apathy and the bigger the decrease in motivation, even when not depressed. However, prescription medications are not the only things that detrimentally affect the nucleus accumbens of the developing brain. So far we have observed in a linear fashion how endocrine disruptors in plastics upset the hormonal balance of young boys, how the neurodevelopment of boys is different to that of girls, how early schooling is not always suited to boys leading to medication for ADHD, and how this medication can lead to changes and loss of drive associated with the nucleus accumbens area of the brain. As boys move into their teenage years they face an additional challenge which also compromises their motivation, attention, and the nucleus accumbens area of their brain. That challenge is video games.
Neuroscientists know that the nucleus accumbens operates in tandem with the dorsolateral prefrontal cortex. The nucleus accumbens is responsible for channeling drive and motivation; the dorsolateral prefrontal cortex provides the target and context for that drive. Both areas need to be working correctly for a person to be properly motivated. Recent brain imaging of boys aged seven to fourteen found that playing video games skews this system. The images showed blood flow being diverted from the dorsolateral prefrontal context to the nucleus accumbens. The result of this change in blood flow means a gain in reward and achievement, but no contextualization, nor connection to the real world, and a reduction in drive and motivation for other areas of life. In this scenario, the nucleus accumbens is stimulated by video games in much the same way that crack cocaine affects the same area, a stimulus acknowledged even by ardent gamers. In other words, video games stimulate the brain in much the same way as ADHD medication, which partly explains why boys who are not attentive at school can sit for hours playing a multiplayer game.
There is still some controversy over video games. Some academics, scientists, and philanthropists hold the position that video games aid learning and inspire children, but the evidence does not support this position. Professor Craig Anderson of Iowa State University, a leading researcher in the field, compares the controversies over video games to those surrounding the harms of smoking in the 1960s. Eventually, the weight of evidence against video games will become too strong, and he cites studies that show the link between video games and antisocial behavior is as strong as the link between second-hand cigarette smoke and cancer. The antisocial effects of video games were revealed in a recent study by Yale University researchers. Their work uncovered clear and unambiguous data that showed boys who play video games have a more violent self-image and more violent behavior. They also found increased cardiovascular arousal and decreases in helping behavior. In fact, earlier studies have underestimated the deleterious effects of video games: they are more toxic than violent television, as the person playing is actively perpetrating the act, he is not just passively observing. Yet with the average boy spending thirteen hours per week on video games, and serious gamers spending considerably more time, is it possible there might be some cognitive benefit? To date, the only measurable cognitive enhancement derived from video games is an improvement in reaction times by 0.02 seconds. However, other studies over the last seven years have shown a correlation between playing video games and poor academic performance. This is not surprising as real life demands different skills to the cognitive and visual-motor skills of pushing buttons. Girls, at least, notice the problematic nature of video games. While girl gamers are not unknown, girls generally spend little time on games. In interviews they complain of boys as being unmotivated, silly, boring, disgusting, and wasting time. Some actively refuse to associate with gamers. And college administrators report a trend of college age men who have no interest in meeting anyone; they just wish to stay in their room. Little wonder when playing video games rewires the brain in a manner similar to crack cocaine.
There is, however, still hope. Some parents, educational psychologists, and pediatricians have found that delaying the start of schooling until a boy is six or seven years old is advantageous. At that age he’s ready to learn, and he’s less likely to decide school isn’t for him. By his teenage years he’s more likely to be a higher achiever than those boys who start school at the age of four. In some Scandinavian and continental European countries, children routinely start school at the age of six, and by their late teenage years are regularly outperforming children of other countries in international tests. They are also less likely to be medicated. Single-sex schooling also helps boys to enjoy their education. In co-educational schools, boys who relish art, literature, and creative writing are often reluctant to excel in these subjects as they are often in the minority. This leads to name-calling and teasing, often with innuendos concerning their sexuality. In a single-sex school, boys find other like-minded friends, and teachers who know how to teach boys, leading to a blossoming of their academic life, followed by increased attention and motivation.
Sports and team competition also play an important role. Many boys thrive on competition. They want the opportunity to experience the thrill of victory and the anguish of defeat. Such team competition engages and socializes boys, teaching them to value something above themselves, in the process subordinating their ego. A boy might not care about his own personal grade or the prize, but he often cares deeply about the competition. Therefore, boys will often respond well to any challenge in which there are winners and losers, and that the outcome is in doubt, meaning anybody might conceivably lose. This real-world competition helps boys to stay away from the video games. Parents can also make other positive choices by limiting exposure to endocrine-disrupting chemicals found in plastics. The alternative is to let boys continue as they are sitting alone in their bedrooms driving virtual cars or killing virtual people. Unable to succeed at school or in the real world, these boys become men devoid of ambition, their brains rewired, their hormones feminized, and their body heavily medicated; they are unable to contribute to their community, family, or nation, little use to themselves or anyone else.