Diagnoses as Descriptions of Behavior
An interview with Craig Weiner
Posted Jan 02, 2017
Welcome to Childhood Made Crazy, an interview series that takes a critical look at the current “mental disorders of childhood” model. This series is comprised of interviews with practitioners, parents, and other children’s advocates as well as pieces that investigate fundamental questions in the mental health field. Visit the following page to learn more about the series, to see which interviews are coming, and to learn about the topics under discussion:
Dr. Craig B. Wiener is a licensed Psychologist based in Worcester, Massachusetts where he specializes in the treatment of children, adolescents and families.
Dr. Craig B. Wiener is the author of three books on Attention Deficit Hyperactivity Disorder (ADHD). His first two books: Attention Deficit Hyperactivity Disorder as a Learned Behavioral Pattern: A Return to Psychology (2007), and Attention Deficit Hyperactivity Disorder as a Learned Behavioral Pattern: A Less Medicinal More Self-reliant Collaborative Intervention (2007) are written for professionals. His third book, Parenting Your Child with ADHD: A No-Nonsense Guide for Nurturing Self-reliance and Cooperation (2012) is directed at parents.
EM: How would you suggest a parent think about being told that his or her child meets the criteria for a mental disorder or a mental illness diagnosis?
CW: I tell the parents that mental "illness" diagnosis means that the child is "doing" a set of atypical behaviors more often and with greater intensity than others do. Children do not "have" the category name. The name is a description of behavior not an explanation of behavior, and there might be a variety of ways to account for why a child might qualify for the criteria of a mental health disorder.
EM: How would you suggest a parent think about being told that his or her child ought to go on one or more than one psychiatric medication for his or her diagnosed mental disorder or mental illness?
CW: The decision to medicate a child is between the parent and child’s doctor. Medication will very likely produce welcomed short-term changes in the child’s behavior. If the child’s problems are so severe that it is imperative to seek quick relief, medication might be the preferred treatment option, and perhaps it will be easier to teach the child better ways to cope when she is in a medicated state. And maybe some of the improvements that you get from medicinal treatments will continue, if you decide to reduce and eventually eliminate the medications down the road. Just be aware that medicinal treatment has potential risks and shortcomings.
I also indicate to parents that prescribers will assure you that psychiatric medicines are powerful yet harmless, but how much of any medication is entirely safe? Side effects could worsen over time, and biological and psychological changes can become difficult to reverse the longer a drug remains in the body. Medicinal treatment can take away the urgency of a problem. Urgency is what drives people to work hard and change, and lack of urgency can lessen desire to seek counseling. You may end up relying solely on the medications.
And what if the medications stop working? When children are older, it is not as easy for them to change their habits and routines. Keeping a child on long-term medicinal treatment can also mean higher dosages and multiple drugs as time passes. The child may need more medication as she grows, and there is a possibility that her body will build up a tolerance to the drug as well.
Sadly, the potential for side effects increases with the amount and number of drugs needed to achieve the desired effects. Medicinal therapy also may create the belief that medication is necessary for success, when in fact there might be other ways to resolve problems. Individuals may learn to seek psychiatric drugs as a primary way to make improvements in their lives and never explore whether they might resolve their problems in a different way.
It is also difficult to stop medicinal treatment once it has begun (even when supervised by a physician). Stopping medication means your child has to adjust psychologically and biologically to not having a chemical boost in her body. Unwanted behaviors will occur as soon as you withdraw the medication. While you may think that the worsening means that the "illness" is returning, it could be "drug withdrawal" is creating the problem.
But most important, while medicinal therapy is certainly a reasonable treatment option when the benefits clearly outweigh the harm, the long-term advantages of all psychiatric medications have not been outstanding. There is the likelihood that the progress will be short-lived. Relying solely on medications may be ill advised in the end even though the drugs can take away problems relatively quickly.
EM: What if a parent currently has a child in treatment for a mental disorder? How should he or she monitor the treatment regimen and/or communicate with mental health professionals involved?
CW: It is important for the parent to monitor the treatment’s positive effects as well as the adverse effects. It is also important for the parents to gauge whether the child is showing improvement in cooperation and autonomy rather than simply being subdued.
If the child is on psychiatric medications, it is imperative that parents inquire about plans to withdraw the child from the medication. For most people, it is better to reduce the length of time on medication even if the medication has helped to produce a short-term easing of the problem.
EM: What if a parent has a child who is taking psychiatric drugs and the child appears to be having adverse effects to those drugs or whose situation appears to worsening? What would you suggest the parent do?
CW: I would recommend that the parent talk with the prescriber and discuss their concerns about the drugs effect on their child. I would let the parent know that psychiatric medication creates serious disturbances within a person's brain. The child’s brain might go through a series of compensatory adaptations in order to maintain chemical equilibrium. I would emphasize that the continued use of any psychiatric drug can create substantial and long lasting changes within a person's body. These concerns are imperative to discuss with the prescriber before continuing on medication or adding new medications to rectify a drugs failure to produce adequate results.
CW: Instead of understanding the child’s difficulties as a “chemical imbalance, which is what most traditional interventions presume, the parent might understand the child’s behavior as the child’s way to cope. Parents might observe and identify possible ways day-to-day functioning reinforces the child's problematic behavior. Parents might then alter the sequence of events that are unwittingly perpetuating the unwanted patterns of behavior.
Second, parents might use less coercion and less reliance on external cues or directives when helping the child meet socio-cultural expectations; this helps to develop autonomy and independence.
Third, parents might incorporate the child’s viewpoint as regularly as possible; this approach fosters amicable ways to resolve problems related to their child’s integration with others. The act of identifying which behaviors parents want their child to change, as well as those that the child wants the parent to change, is vital. Often the key is to identify emotional “triggers”: those unresolved problems, fears, and “old bruises” that a situation ignites.
Fourth, parents can set firmer limits on the extent to which they will accommodate during troublesome responding, and thus require the child to meet them halfway.
Fifth, parents can role model the behaviors they want their child to imitate.
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