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Six Problems with Psychiatric Diagnosis for Children

Having differences is not the same as having a disease.

Diagnosing children with psychiatric disorders is even more problematic and potentially harmful than diagnosing adults. Here are some of the reasons why.

There is no consensus in the medical community about what behaviors constitute a particular "disorder." One psychiatrist might diagnosis a child with ADHD, another might say that the same child has oppositional defiant disorder (ODD) and a third doctor may diagnosis this child with bipolar disorder. In 2008, an article in the New York Times Magazine chronicled the story of a little boy who was diagnosed over the course of time first with ODD, then ADHD and finally with bipolar disorder. By the time he was nine, this unfortunate child had taken the anti-psychotic Risperdal, two stimulant drugs for ADHD, followed by Depakote, Lamictal, Abilify and Lithium. None of these powerful and potentially toxic psychotropic drugs helped this child, and in the end his parents sent him to residential treatment on the recommendation of a psychiatrist. Unfortunately, this story is repeated every day in the lives of more than 7 million children in the United States who are drugged far more than their counterparts in other developed countries.

Developmental delays are often "medicalized" and framed as psychiatric disorders. Not all children grow and develop at the same rate. Some children learn to read at five, some at six and some even later. But today's frantic parents seek out diagnoses and medication for a child who may simply be a late bloomer. Instead of jumping to a psychiatric diagnosis, parents might well find that speech therapy, social skills classes, behavioral therapy, family therapy and/or tutoring can more safely help a child meet the challeneges of developmental milestones.

Psychiatric diagnoses contained in the Diagnostic and Statistical Manual of Mental Disorders are not classified by causes like genuine medical diseases. DSM disorders are based on subjective opinion rather than objective research. They are decided by committees of doctors (many of whom have financial ties with the drug industry which profits mightily from these disorders), and the disorders come and go with the times. ADD, for example, was included in the DSM III, but does not appear in the DSM IV, which contains only ADHD. Homosexuality was for many decades considered a "mental disorder" and included in the DSM until the 1980's. It is no longer classified as such in the DSM IV. Aspergers Syndrome, which is currently a DSM diagnosis, will disappear from the next edition of the manual. These shifting and changing diagnoses are more like what narrative therapists call socially constructed "stories" than like real medical problems. What is considered normal and what is considered a "mental disorder" depends on the current attitudes of a society, not on scientific evidence.

Psychiatric diagnoses have been expanded to include normal childhood behaviors because adult behavior standards are being imposed on children. There is a world of difference between what is normal behavior in a child and what is normal behavior in an adult. Temper tantrums and swift changes of mood, for example, are not considered normal in adults, but they are business as usual for a child. Huckleberry Finn, whose boyish antics included playing hooky from school, telling lies, breaking the law, and consorting with strangers, was beloved by many generations of boys. He was considered to be naughty, adventurous, mischievous and more than a little cheeky. Today, judged by the standards of the DSM IV, Huckleberry Finn would be diagnosed as psychotic.

Psychiatric diagnoses such as ADHD bring hidden benefits to a child's family, teachers, and school. In some states, a child diagnosed with ADHD is granted significant financial aid for college based on his "disability." A child with a serious diagnosis such as bipolar disorder may be eligible for disability benefits which go to his parents. Because psychotropic drugs sedate children, they become easier to manage in overcrowded classrooms, which makes psychiatric diagnosis and medication of children beneficial to stressed-out teachers. Schools, too, profit from psychiatric diagnoses, since they receive more money for children with psychiatric "disabilities."

Perhaps worst of all, a child who has been labeled with a psychiatric diagnosis grows up believing that there is something wrong with her, that she is somehow "abnormal." Hours spent in a psychiatrist's office take a toll on a child's self-esteem. The child believes that she must take medication to behave and feel like a normal child. Because of the way labels are used--for example, "My son is ADHD" or "My daughter is OCD"--the child may well come to believe that the problem is a permanent attribute, rather than an issue of situational stress.

Psychiatric labeling and medicating have tragically become the mainstream way of dealing with difficult, michievous and overly imaginative children in our pill-popping culture. On the positive side, growing numbers of parents, distressed by emerging research about the side effects of psychotropic medications, are seeking alternatives to psychiatric diagnosis for their children. Parents are beginning to realize that a child having differences in learning style and/or behavior is not the same as having a disease. And many psychiatrists are becoming alarmed as well. Allen Francis, M.D., the lead editor of the current DSM-4, has been outspoken in his concern that the next edition of the DSM will cast its nets too widely to encopass normal childhood behaviors and feelings.

© Marilyn Wedge 2011

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