REVIEW: What to Do for the 15-20% of Children Who Need a Little Extra Help


The Orchid and the Dandelion: Why Some Children Struggle and How All Can Thrive by W. Thomas Boyce, M.D. (Knopf)

By Charlie Gofen

The best child development books offer lucid guidance that is informed by research, inspired by compassion, and presented with lyrical prose. Selma Fraiberg’s The Magic Years and T. Berry Brazelton’s Touchpoints come to mind. I’ve also been a longtime fan of Michael Thompson’s insights about boys and Madeline Levine’s wisdom on troubled teenagers from privileged backgrounds.

Pediatrician-researcher Tom Boyce joins this select group with The Orchid and the Dandelion, a beautifully written book that highlights some of the most fundamental differences among children and suggests ways that parents, teachers, and caregivers can help our most sensitive kids develop and lead happy and productive lives.

The core concept of Boyce’s book is that while most children are dandelions (rugged and able to thrive almost anywhere), roughly 15-20% of children are orchids (more fragile and needing special nurturing and care). Orchid children display a high level of sensitivity to their environments – Boyce describes them as “psychologically unprotected” and notes that they may be afraid of new situations and find the world at times “a frightening and overwhelming place.” If they don’t receive the right support, they may struggle and “devolve into lives of disorder and despair.” The twist, though, is that when provided a healthy environment and strong support, orchids can blossom into something extraordinary.

“Like their namesake flowers,” he writes, “they are both endowed and burdened with an exquisite sensitivity to the inhabited, living world, and, also like the orchid, have both frailties that can threaten their existence and health, as well as hidden capacities for lives of beauty, honesty, and notable achievement.”

In the investment world, we talk about “high beta” stocks, which may do quite well (much better than the overall market) in a robust environment, but which may perform much worse than the market in weak conditions. The range of outcomes of orchid children mirrors these investments – they come with both a high level of risk and a high potential reward.

Studies show that 15-20% of children experience more than half of all the physical and psychological illnesses found within a population of children over time. What’s more, this concentration among the “afflicted few” persists into adulthood.

Boyce recognized that identifying which children were most likely to fall into this group, and why, was not only vital for a clinician caring for individual children but vital from a broader public health perspective.

He and his colleagues found inventive ways to test the relative sensitivity of children in a lab setting, measuring how they responded to a variety of cognitive, emotional, and even mild physical stressors. (In one study, young children watch eagerly as hot chocolate is prepared for them, but just before they are to receive the treat, a fire alarm goes off. Just reading about that experiment elevated my heart rate.)

Boyce writes with the composed expertise of a doctor and researcher, but his book is also deeply personal. His sister suffered from physical and psychological maladies from an early age and, although brilliant, had a troubled life. Her struggles drove his desire to understand the huge divergences in the development of children, including the question of how children born into the same family can have such different life paths.

One of the elements of his approach that is so appealing is that he shuts down negative moral judgment about children who appear less strong and resilient than their peers, showing how the differential susceptibility of orchid children isn’t a matter of character or will. Some combination of inherited traits and environmental factors make certain children more sensitive than others. Their heightened “stress response” isn’t within their control.

The children who are shown to be the most at-risk are those with the genetic predisposition of an orchid who are then exposed to adversity, often in the form of family chaos, poor parenting, poverty, or a dangerous neighborhood. Because of orchids’ heightened sensitivity to their environment, these stressors are likely to impair their mental and physical health and raise the odds that they develop chronic diseases and face other problems later in life. (By contrast, orchids in nurturing, supportive settings enjoy some of the best health outcomes of any children, demonstrating again that orchid children have both exceptionally positive and exceptionally negative outcomes.)

Among the strategies Boyce recommends for parents of orchid children are giving them stability and reliable routines and affirming their “true, tenderhearted, and creative self” with a lot of attentiveness, support, and love. “Though orchids may sometimes appear weak or inconsequential within the buzzing, feverish activity of family life,” he writes, “they always have an array of gifts and potencies of great significance and advantage. Parents can uncover and reveal those gifts in their interactions with their children, in the ways they refer to and describe their children, and in the trust they place in each of their children’s individual competencies.”

He also discusses the crucial role of primary school teachers, who can help orchid children thrive by resisting exclusionary social behavior in their classrooms and by offering public support for kids low on the social hierarchy, perhaps by celebrating their artistic or intellectual gifts.

Authors of popular books on child psychology and development like to throw in some neuroscience, and Boyce doesn’t disappoint, offering a primer on the prefrontal cortex, autonomic nervous system, and cortisol levels.  Happily, I found his science lesson accessible, relevant, and brief. He avoids 50-page digressions on the evolutionary significance of the amygdala.

He does spend some time on the nature-nurture debate, addressing why some people but not others exhibit certain traits. He concludes that we can rarely isolate genes and environment from one another. Individuals may be genetically predisposed to certain psychological or personality disorders, but these traits may not emerge without precipitating environmental factors such as exposure to great stress. There is a growing understanding of the complex interplay of genes and environment. Boyce describes recent advances in the field of epigenetics showing that life experiences such as trauma can control how and when certain genes are expressed.

One certainty is that no two people ever have an identical genetic makeup and life experience. Even within a single household, Boyce notes, children usually turn out unalike in temperament. “(T)o my recollection, there has not been a single instance in all those years of caring for kids and young families in which a parent said of a second child, `Oh, this one’s just like the last one.’” There are too many variables, ranging from birth order to the different parenting responses to each child. Siblings each experience their parents and their childhood uniquely, internalizing events differently and being shaped behaviorally and “epigenetically” into unique individuals.

As caveats to his clear-cut categorization, Boyce shows that there is great diversity within the orchid and dandelion groups, that the orchid-dandelion construct is really a continuum rather than a dichotomy, and that there is way too much chaos and unpredictability in life to forecast an outcome for any individual child based on this labeling.

In the end, we do our best as parents and caregivers, and then we hope for good fortune. Boyce writes: “Garrison Keillor once quipped that a parent’s life is eighteen years of ceaseless prayer. It is an observation that errs only in its promise of an eighteen-year end.”


Charlie Gofen is an investment counselor in Chicago who has taught high school and been a newspaper reporter.