K: If your child is diagnosed with a mental illness; My child was given a diagnosis; What to do if your child is diagnosed with a psychiatric problem; Understanding a mental health diagnosis .
D: What to do if your child is diagnosed with a psychological or behavioral disorder
If Your Child Is Diagnosed With A Psychological or Behavioral Disorder
If your child was recently diagnosed with a mental health or behavioral disorder, chances are you’re a bit anxious or confused. It’s important that you approach the situation in the right state of mind and have an accurate understanding of precisely what it all means.
Remember this: Nothing about your child has changed. They are the same child today that they were a week ago before you received this diagnosis. If it feels like your world is collapsing, that’s a sign that you’re putting an enormous amount of psychological energy behind this idea. This is a bad thing, especially when it comes to something so abstract as a psychological or behavioral disorder. If a child was diagnosed with something real and tangible like cancer, that’s one thing. But a mental or behavioral disorder is merely a few words scribbled on a paper by a doctor to label symptoms that you already knew about. Try to think of it as such.
2. Understand the limitations of the diagnosis
If you haven’t already, read the information we provide on the problems with diagnosis, which will help you see this diagnosis in a more accurate light.
3. Remember, it’s a diagnosis, not a death sentence
Doctors are often wrong, and children often grow out of their symptoms. For example, two-thirds of all children who qualify for at-risk criteria for psychosis never develop it. (Jabr, 2012) A number of children diagnosed with autism will eventually outgrow their symptoms. (Wang, 1-22-2013) Same for ADHD and other disorders.
4. Address the symptoms, not the label
If you think about it, the whole process of getting a diagnosis is actually rather useless. While it may give adults a way to define and refer to a child, it doesn’t actually change anything, and it may even backfire, because it narrows the way in which adults look at things. The moment we do this, we start seeing the child’s behavior through a stereotyped filter. A world of walls and categories that teaches use to view them in a particular way. The diagnosis tells us what we should expect to see, and thus, what we expect of them. It tells us what to look for, and what to find. It’s sole purpose is to categorize and stereotype children for the mental health industry. Since children vary so much from one another even within the same diagnostic category, it doesn’t even necessarily give you an accurate road map to go by.
We don’t want you stereotyping children, and I’m sure you don’t want that either. So here’s what we want you to do: Disregard the diagnosis, and focus on the symptoms. Go ahead and research the condition if you’d like to, but realize that these conditions are only generalizations that mayor may not apply to your child. Use the diagnosis as a vague guideline only to address which problems concern you, but also look for off-label behavior and focus on the things you want to see.
Losing the Labels
When adults struggle in dealing with a child, especially if they’re not accustomed to struggling like this, (say a parent has other kids that don’t present the same type of problems, or a normally competent teacher struggles with a particular child), they begin looking for something that might explain these difficulties. This makes them all-too eager to latch onto any label that is given to explain a child’s behavior. The problem is that these labels can conceal more than they reveal, leading to a type of tunnel vision where adults lose track of a child’s individuality and instead start seeing them through the prism of this label. It can also throw adults off course, sending them down an errant path that later proves to be misguided.
Here’s how things usually work: A parent takes a child to see a doctor or child psychologist, looking for a diagnosis that might explain their child’s struggles. Often times they’re coerced into this move by school officials or other outside sources. “Parents come to my office pleading for any type of diagnosis of any ‘disability, ‘” says Dr. Daniel Zeidner, M.D., “because the school told them that their child needed extra help and the school would love to help them, but to gain funding for providing the extra help the school first needed to have the child diagnosed.” (Wall Street Journal, 3-15-2019, A16)
So they take a child to a specialist who asks about the child’s symptoms, and maybe (if they’re being more thorough. than most), he or she will conduct some sort of observational period and ask the child’s teachers for input. Based on this information, and guided by the doctor’s or teachers’ presumptions, the child is given a diagnosis that fits the behavior. Caregivers then accept this label as an established fact. Parents rush home to learn all they can about this particular diagnosis, and doctors and teachers put together a treatment plan. This might mean a particular type of medication or a particular type of behavioral therapy tailored for that particular disorder.
Unfortunately, there are many ways this process goes awry, and parents and teachers put way more faith in these labels than they should. These diagnostic determinations aren’t written in stone. They are more like slightly educated guesses than they are established facts.
The first thing you need to understand is that there’s a tremendous amount of overlap between these disorders. In order to make a diagnosis, the child must meet the criteria for a particular disorder by exhibiting some of its associated symptoms. This usually means they display at least 4 out of 7 or 3 out of 6 of the possible symptoms listed. But there are only so many different ways a child’s behavior can be abnormal, which means most psychological and behavioral disorders share many of the same common symptoms. Thus a child who scores high for a conduct disorder may also meet the criteria for ADHD, antisocial personality disorder, bipolar disorder, or callous & unemotional traits.
For example, one study found that 83.8% of youth scoring high for CU traits also had elevated symptoms of conduct problems. The overlap wasn’t as high going the other direction, but still 19.3% of kids with high levels of conduct problems also scored high on callous unemotional traits.
(Baskin-Sommers et al., 2015) Another study found anywhere from 12% to 51% of youth diagnosed with conduct disorder will also meet the criteria for callous & unemotional traits. (Kahn et al., 2012) When it comes to oppositional defiant disorder (ODD), it’s estimated that 14% of youth have comorbid (coexisting) ADHD, 14% comorbid anxiety disorder, and 9% comorbid depressive disorder. (Angold, Costello & Erkanli, 1999)
Speaking of the diagnostic problems when it comes to bipolar disorder, Dr. Ronald Fieve says “It is difficult to diagnose children or teens with Bipolar II because the signs and symptoms may coexist with a host of other psychiatric problems, including anxiety disorders, conduct disorder, attention-deficit / hyperactivity disorder, oppositional defiant disorder, and others listed in the DSM-IV for children.” (Fieve, 2006, pp. 219-20)
I can’t help but chuckle when I read passages like this. It’s basically an admission that these labels have little factual basis, but are merely different types of artificial constructs a practitioner has decided should apply to a particular child. Since all behavioral problems manifest themselves in similar ways, and since each diagnosis shares many overlapping symptoms that are common to all children with behavioral issues, then each diagnosis is merely an exercise to pin a label on a child according to their own particular hunches.
As Stephen Scott states, “comorbidity is the rule rather than the exception in clinical referrals.” (2012, p. 19) In other words, most children referred for behavioral problems show traits that could get them diagnosed with any number of disorders. If a child’s symptoms could fit within 6 or 8 different diagnoses, then the one a doctor picks is not necessarily the one that most accurately describes your child’s issues.
Also understand that a child who has been diagnosed with 3 different disorders is not necessarily 3-times as disturbed as a child who was only diagnosed with one, as many people would presume. It just means that there’s more overlap in the symptoms they display.
ADD, ADHD, oppositional defiant disorder, conduct disorder, bipolar disorder, autism, callous and unemotional traits–all these are merely different theories invented to try and explain why a child behaves differently from their peers. Some of these labels may have more basis in reality than others, yet THEY ALL lack any sort of definitive biological marker that could definitively prove their existence. Rather, they’re boundaries we’ve erected around different types of traits to try and group similar children together, prone as we humans are to categorizing and stereotyping the world around us. And just like the stereotypes we apply to other humans, these labels quickly get us into trouble when we believe in them more than we should.
Dr. Ronald Fieve describes one girl, Brienna, who was overactive from the age of two. “Her parents became exhausted trying to keep up with her,” he writes, “and it seemed that the only time she was still was during sleep. Brienna was highly irritable, lashing out at family and friends, and she had a tough time in preschool and kindergarten, where teachers often gave her time out for screaming or hitting other children. Twice administrators asked Brienna to leave a private school where she was enrolled. By the time she started first grade, she had already seen a number of child psychologists.”
Her teachers recommended Brienna be given ADHD medication, and her parents complied. Dr. Fieve, however, believes the child as was not ADHD but actually had early onset bipolar disorder. While the two can manifest in many of the same symptoms, they are treated in two very different ways.
“Many times, teachers will tell parents during a conference that they suspect ADHD in a student,” Fieve says. “The parents then rush to the pediatrician upon the teacher’s diagnosis and return with a large supply of Ritalin or other stimulant medication. A non-medical member of the teaching staff then gives the child the stimulant each day, and no one is aware that the powerful medication may exacerbate symptoms of childhood bipolar disorder. This can result in the Bipolar II child becoming extremely active, volatile, angry, and out of control.” (Fieve, 2006, pp. 213- 214)
He goes on to write that “By the time she was 9, Brienna was taking three medications: The Ritalin to treat the ADHD and remain alert during the daytime hours, a sleeping pill at night, and an antidepressant to boost her depressed mood. …By the age of 10, Brienna was hospitalized for depression, and she remained in counseling after she was released.” (ibid, p. 214)
Dr. Fieve believes this child actually had bipolar disorder, and says her symptoms improved once given treatment for it. Perhaps he’s right. Other clinicians, however, complain about precisely the opposite: they say that other childhood behavioral problems are being misdiagnosed as bipolar disorder. (Liebenluft, 2011) When you have kids with a set of shared symptoms and vaguely defined behavioral disorders, you end up with a situation where no one can say with any certainty what is truly going on. Yet everyone rushes to claim a child for whatever disorder they specialize in and are trained to see.
Stress and PTSD can also cause behavioral changes that mimic ADHD and other childhood mental disorders. But mislabeling a child who is dealing with traumatic stress as having a behavioral disorder obviously misses the root of the problem.
Another pitfall is that once a label is applied to a child, it becomes a self-fulfilling prophecy. Caregivers look for certain behavior; they expect to find certain behavior. Worse still, all too commonly the label becomes a limitator – something that justifies a child’s lagging behind. So rather than trying different approaches or pushing a child to improve, the label becomes an excuse for mediocrity. “This child simply cannot do any better,” they tell themselves, or “No matter what I do, his (fill in the diagnosis) will get in the way.”
So. . .
Your child is a unique, one of a kind person. Do not let the labels define them. If a diagnosis helps check a box for schools or other professionals, great. But it really doesn’t tell you anything about a child you didn’t already know just by working with them.
Never assume a given diagnosis is accurate. Continue to challenge these assumptions, especially if you’re not seeing any improvements. Many families spend years heading down a dead-end path because they take the first diagnoses and run with it, assuming it to be fact. It is not. It is an educated guess that mayor may not be accurate.
Don’t let the label become a self-fulfilling prophecy. Continue to challenge a child and hold them to the same high expectations you do their peers. Kids follow your focus, so if you start to treat them as inherently disabled, you’re bound to be proven right.