I groaned when I read an article about a new disorder that would lump picky eating with bulimia and anorexia as another type of eating disorder. That's ridiculous. Picky eating is not a disorder. It is a preference, a way a child adapts to his family and the availability of the food he prefers to eat. I'm not saying that kids aren't very difficult to feed, nor that there are foods that they hate (I've always hated oatmeal) but to call this a disorder takes responsibility for the behaviour away from the child and the parent. Why do we insist on pathologizing what are normal aspects of our children's behaviour?
I travel a great deal around the world as part of my research on resilience and have seen too many children surviving on very little food to believe for a moment that a child who insists she will only eat white pasta and jam sandwiches is anything more than indulged. Even if she has hypersensitivity to taste sensations, the fact is that she won't starve if she is provided healthy alternatives and no dessert for a week. Guaranteed. Children may not like to eat what doesn't taste good, but this is a preference, not a disorder that needs a mental health intervention.
Here's a simple suggestion: If you have a picky eater try removing all the sweets and junk food from your home and making available in the fridge a few healthy meals that can be reheated anytime your child is hungry. When the whining gets real bad, think of children fleeing war who are abandoned in refugee camps, and you'll quickly realize that your child may be expressing a preference, but it is us parents who are creating the environment around a child that turns those preferences into a disorder. Kids eat what their bodies need, but only when they don't have the choice to pack themselves full of empty calories that are addictive and tasty (high in salt, sugar and fat).
I'm sorry if I sound less than sympathetic about this latest disorder. It's just that I meet lots of children who have real problems and need the resources of mental health professionals. Making the common and everyday struggles we confront as parents into a diagnosable disorder doesn't serve our long-term need to provide all children with the support they require to thrive.
Here's a few other questionable disorders:
Conduct disorder: What exactly does it mean for a child to be badly behaved and challenging rules? At what point is a defiant child just asserting himself and requiring structure and consequences, and at what point does it signal something more serious? In my experience, conduct disorder is a label we professionals lay on children who are annoying us adults. It adds absolutely nothing to treatment. It tells us nothing about why the child is "misbehaving". All it does is blame the child (implying the problem is the child's rather than the lack of appropriate structure around the child) or help convince insurers to pay for visits to a parenting coach.
Personality Disorders in Children: For a while now parents and professionals have been trying to convince me that some of the children I see clinically have Borderline Personality Disorder (a failure to sustain consistent attachments with others) or Narcissistic Personality Disorder (self-centeredness that can evoke violent reactions when one's self-esteem is threatened). While some of these labels might make sense when used to describe patterns of adult behaviour, they can cause big problems when used to label children. Aren't all children narcissistic, self-centred and selfish, at times? Our role as parents is, I think, to model empathy and philanthropy. Not to indulge our children with endless gifts, excuses for why they aren't responsible for their failures, or cushioning them from every threat to their self-esteem.
It's the same for Borderline Personality Disorder. A child with BPD is supposed to exhibit a lack of ability to maintain consistent relationships with others. At one moment those who are ‘borderline' hate us for trying to help them, the next moment they love us. Hmm, sounds pretty normal for most 2-year-olds, and 12-year-olds. How did something so normal become grounds for a disorder in children when their emotional development is still ongoing? To drop a label like that on a child can do long-term damage.
Attenditon Deficit Hyperactivity Disorder (ADHD) is an organic neurological condition that affects a small, small, percentage of children. They are easily distracted. Their lack of concentration can cause them lots of problems at school. This is a problem. But why do as many as 5% of children carry this diagnosis, and why more boys than girls? And why do some cultures use the diagnosis more than others? What I often see in my clinical practice is a desire by educators and parents to ensure that children sit down and conform to classrooms that haven't changed in a hundred years despite all that we know about children's developmental needs (sitting in little desks for hours is not what we were designed to be doing). I say, first show me a different type of classroom, and then I'll be convinced that the hyperactive tyke who can't focus on his reading and climbing the walls has a genuine disorder. But before that happens, let's be sure that what we're seeing isn't a disordered environment rather than a disordered child.
I‘ve work with many children with severe disorders who suffer the debilitating conditions that come with multiple personal challenges (like learning problems, poverty, family violence, and physical illness). My compassion for these children and their families is without limits. However, I worry that when we label something as benign and normal as picky eating a "disorder" we lose sight of our power as parents to structure our children's worlds in ways that will help them succeed. Instead we give them an excuse for behaving badly. As a family therapist, I don't think it's fair to my clients to label them disordered when the problems they experience are more about their struggle to meet the expectations of others.