Children are entirely powerless in the diagnostic process. Adults are the ones who interpret a child’s behavior, describe a child’s “problems,” and then relay these things to a physician or psychiatrist, who then renders their diagnosis pretty much exclusively on the basis of adult perceptions. But how do we know it’s the child who has the problem as opposed to the adult?

There’s an inherent tendency to blame the child in this adult-centric approach. Parents are under a lot of psychological pressure to A) Think of their children as exceptional, and B) Believe their own parenting to be perfect. So when problems arise, this creates a strong incentive (both consciously and subconsciously) to blame it on a diagnosable disorder in the child rather than considering the possibility that the way you parent children or what you expect from them needs to be adjusted.

“It’s true that you look for distress or impairment,” says Torrey Creed, a clinical child psychologist at the University of Pennsylvania. “But who’s distressed the parent or the child? Sometimes parents actually want something diagnosed but it doesn’t need to be. …In some cases, including those involving anxiety or mood disorders, it may not be the kids’ welfare but the parents’ that is in play. There’s a vanity component to parenting: who doesn’t want the prettiest, cleverest, most personable kid in the room? It’s hard to admit that maybe your baby is simply awkward.” (Kluger, 2010)

A child’s behavior is a product of their environment

Adult behavior and adult attitudes also play a role in creating the very behaviors the child exhibits, and it may be the behavior of adults (not the responses shown by the child) that is the true problem. In the child care industry I would see this happen all the time: the parents who have trouble handling a child are almost always either creating or largely contributing to the behavioral patterns that are then labeled as abnormal. Parents would sometimes come to us for advice, describing their children as difficult, disturbed, or unruly at home, and wanting to see if we could send them in the direction of a diagnosis. Yet we often knew these same children to be normal, well-behaved kids at school. Often times you could watch this change in behavioral patterns take place in real time when their parents came to pick them up. The calm, content child suddenly becomes irritable and mouthy just as soon as her anxious, obsessively demanding parent shows up and starts barking commands at her. Unfortunately, the parents never sees how calm and well-behaved her little girl can be in the right atmosphere. She only knows how the child behaves around her. The fact that parent-child interaction therapy is such a useful tool for treating psychological and behavioral disorders in children is testament to the fact that a child’s problems are commonly the result of parent-child dynamics, not some underlying disorder in the child.

Watching a few episodes of the television show Supernanny will illustrate this reality all too clearly. The show features some of the rowdiest, most ill-behaved, hyperactive children one could encounter. Yet something strange happens when Ms. Jo comes into the house. After the initial rebellion that all children will put up, the presence of a talented and competent caretaker completely alters their behavior. By the end of the week they are entirely different children, at least when she’s around. Sometimes the parents seem to learn and the situation improves. In many others, the household goes right back to its usual chaos once she leaves. Whatever the outcome, the show provides clear proof that caretaking can make all the difference in the world when it comes to a child’s behavior and temperament. Yet make no mistake about it: these are also precisely the types of kids and situations that commonly result in the child being placed on medication.

If you’re a parent reading this, none of these things are meant in a judgmental way. We’re not looking to assign blame, just ensure that children receive the type of help they need. Nor does it mean that there are never cases where a child becomes behaviorally disturbed when parents are doing everything right. Furthermore, this phenomenon also works in reverse: it may be that kids are fine at home, and it’s the teachers and school officials that are having trouble and pushing for a diagnosis.

Teachers can get lazy too, and some prefer a medicated child to the tough and arduous task of working through their own teaching inadequacies to control a youngster the right way. Teachers, too, sometimes have poor supervision and discipline skills. Case in point: One little girl, we’ll call her Mary, was a sweet and polite child who was perhaps a little slow compared to her peers, and like all children, sometimes got distracted or had her moments, but all in all, a very easy, normal child to work with. We had cared for her since she was a toddler, taught her throughout preschool and kindergarten, and lost touch after kindergarten when she started a cheaper after-school program offered at the elementary school. She was fine with us, she was fine in kindergarten, she was fine through first grade. Amidst her second grade school year, we received a call from her upset mother, asking us if we thought Mary needed to be placed on medication. Our answer: Hell no. It turns out her second grade teacher was struggling with Mary, and pushing hard for her to be put on behavioral medications. It’s a scenario I’ve witnessed numerous times throughout the years.

So both parents and teachers can end up pushing for a child to be medicated. Either way, it’s clear that perfectly normal children are being mislabeled because of adult difficulties. As Dr. Michael Fitzpatrick, a London physician, states, “the extension of these categories to include 20 to 30 percent of all children reflects a social trend of pathologizing and medicating children’s lives, which seems to reflect difficulties of parents and teachers in dealing with familiar problems of child development.” (Tanner, 2007)