ABCs of Child Psychiatry

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Why “Just” is Such a Dangerous Word in Mental Health

Chalking up behavior as being due JUST to one's personality doesn’t make sense

Since this is my first blog on Psychology Today, I just wanted to thank those of you for your interest and invite you to return or subscribe for lots more related to all things child mental health.  You can read my bio and the description of the blog to learn more.  I am also certainly open to topic suggestions, questions, and feedback. 

Let’s get right into it…..

How many times have you heard a psychiatric diagnosis questioned based on the possibility that the behaviors are JUST something else.  You all know the drill: “C’mon doc, are you sure this ADHD thing isn’t a fancy label for kids who are JUST (insert lazy, bad, spoiled, etc.)?” Another common one is “Can’t a kid JUST be sad without being called depressed?”

There is a very legitimate question in there for sure, but it is not the one most people are asking.  Indeed, mental health professionals are called upon every day to try and make a call as to whether particular behaviors fall beyond developmental expectations and are thus deserving of a diagnosis.  The problem, though, lies with the alternative and specifically in the assumptions behind that word:  JUST.  The implications are that if a set of behaviors are a JUST then the following must also be true.

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a)    Their origin differs from the cause of “real” symptoms and aren’t particularly interesting

b)    Nothing can be done about it

c)    We can and should be blaming the child, parents, or both rather than framing the issue as a something to do with brain function

All of these assumptions are likely wrong, although much more research is needed to address them more fully.  For now, however, there is overwhelming evidence that nearly everything we assess in child mental health (mood, attention span, aggression, autistic traits) exists, at least on the surface, as a quantitative continuum rather than in binary yes/no disease form.  As such, making a diagnosis of ADHD is a bit like officially calling somebody “tall” or “smart.”  What is much less well understood, however, is whether or not the mechanisms that underlie JUST traits or personality are shared, but perhaps amplified, when it comes to full-fledged disorders, or whether there may be lurking more discrete etiologies for at least some of those with the more extreme behaviors that qualify for a diagnosis. 

In the meantime, the word JUST simply doesn’t make sense from either a clinical or neuroscience perspective.  It may on the surface seem like we are being less stigmatizing by avoiding more clinical sounding terms, but at the end of the day it might be just the opposite.  Meeting criteria for ADHD does not mean that a child is incapable of controlling his or her actions, and being JUST shy doesn’t mean these anxious feelings around people are going to last forever. Child behavior at all levels is complex, derived from a large array of mutually interacting genetic and environmental factors, and amenable to change with the proper approach.

Does this make sense, or am I JUST being difficult?

David Rettew, M.D., is a child psychiatrist at the University of Vermont and author of Child Temperament: New Thinking about the Boundary between Traits and Illness.

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