To diagnose or not diagnose our children; that is the question

Yesterday, the New York Times published an article about diagnosing preschool depression, also known as "early-onset depression." The article cites statistics such as 1 to 3 percent of children between 2 and 5 have depression.

There are many who would react to this concept with outrage, and indeed a diagnosis of any kind of a young child is up for debate; mood swings, tantrums, and oppositional behavior are all developmentally appropriate for this age, and should not be pathologized. Some would argue that the influence of the pharmacological industry and a decreasing tolerance for the natural range of personality and behavior has led to an over-diagnosing (and over-medicating) of children.

That said, talk to an adult who has suffered from lifelong depression and many of them will tell you that they struggled with feelings of depression for as long as they can remember. And what DO we call it when a 4 year old child seems to display little joy in life, regardless of the parents' efforts to help him or her?

Diagnosing children in general is a relatively new phenomenon. For example, it has only been for the past 20 years that the field of psychiatry has acknowledged that adolescents can become depressed, something which is now accepted by most. This is part of why there has been what appears to be an "explosion" of diagnosing children - it may not be that we are inappropriately over-diagnosing, but instead that we are diagnosing appropriately for the first time. It wasn't until the 1900's that there were child labor laws and not until the 1960's that child abuse laws were passed. Until recently, children were not acknowledged as legitimate people, with their own thoughts, feelings, and experiences. For example, they weren't even talked to when someone in their life died; people would say things like "he is to young to understand" or "she doesn't really know what's going on."

Accurately diagnosing children and appropriately treating them, then, is a controversial job and takes a very specific skill. In some cases, for example, the symptoms of ADHD can look similar to Bipolar disorder in children. Currently there is debate about whether or not Aspergers is simply a subset of Autism, another diagnosis that has increased a great deal in frequency. However, controversy not withstanding, while there is a myth that children are being overdiagnosed and medicated in high numbers, in reality the 3 to 7 percent of school-age children who meet the criteria for ADHD are diagnosed accurately more often then not. Indeed, research indicates that between 5 and 10 percent of children aged 6 to 15 have a learning disability, and approximately half of those children go undiagnosed. The impact of this lack of diagnosis (and appropriate educational intervention) is tremendous, dramatically affecting an individual's self-esteem and chance of success.

Overdiagnosing and overpathologizeing a child can cause tremendous harm to that child, on the level of their self-esteem, the way they are viewed and treated by others, the way they see themselves, and even on their development and physiology. Often early traumatic experiences can manifest later as behavior problems and if a professional is too eager to reach a solution, what the child truly needs can be missed.

That said, we also know that early intervention can make a tremendous difference in the life of a child and into adulthood. If a young child suffers from depression, anxiety, attentional or learning differences, autism, or any number of disorders, finding out at an early age, and giving that child the help they need, can make the difference between a life of needless suffering and one where they develop to their fullest potential. In some cases, early intervention can even minimize or prevent a lifelong condition.

It is crucial, then, that we do not shy away from problems that a child may be manifesting, or brush-off parents who express fears and concerns. On the one hand, we clearly do not want to become a culture where we don't have tolerance for the wonderful range and diversity of personality and character-types that children present. On the other hand, we don't want to miss the opportunity to make the difference in the life of a child, where acknowledging a problem and intervening to help them can give them a chance at happiness.

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