Mandy, a first-time mother, was relieved when the developmental pediatrician explained that there was an explanation for her young son’s rocking and spinning, lack of eye contact, the limited and repetitive speech, and other behaviors. The doctor explained that Mandy’s son met the diagnostic criteria for autism spectrum disorder, and they discussed the interventions that are commonly helpful to children who are on the autism spectrum. Mandy realized that the relief she felt came from not only finally understanding the reasons for her son’s developmental differences, but also from knowing that other parents had paved the way, so Mandy had some idea of what to expect and how to help her son.
A diagnosis can bring clarity to seemingly random, disconnected symptoms so that the most effective treatment can be found. The value of having an answer that “connects the dots” can be immeasurable, and in the case of some serious physical and mental disorders, life-saving. In these situations, a diagnosis shines light and hope into the darkness. The cancer patient begins chemotherapy and prepares for surgery. The person with clinical depression is prescribed an anti-depressant medication and begins weekly counseling.
Even while diagnoses are increasingly framed as reflecting differences more than deficits or defects, there is no escaping that the very premise of the diagnostic approach is rooted in pathology. Someone who drinks alcohol to the point of this behavior negatively impacting his or her life is viewed as having the disease of alcoholism. Someone who subjectively reports feeling tired and achy all the time is said to have fibromyalgia. A child who has become defiant and difficult is quickly labeled with Oppositional Defiant Disorder, and the child who seems distracted, disinterested and struggles to say seated for the entire day of school is, of course, labeled with Attention Deficit Hyperactive Disorder.
Because diagnoses tend to define what is wrong or atypical, people historically have approached the news of a diagnosis with sober acceptance. This is the man who is told he won’t be allowed to drive anymore because his EEG shows a pattern of seizures that suggest a diagnosis of epilepsy. This is the woman in her early 40s who wants to get pregnant but finds out she is already in menopause. The diagnosis helps her understand the way she has been feeling and her various symptoms, but she doesn’t consider the diagnosis to be good news.
It was only in recent history that people began to metaphorically run toward diagnoses as if they were medals they have won or military ribbons they collect and wear on their chests. Websites that allow users to input their symptoms so that they can figure out the most likely diagnosis are now more popular than ever before. None embrace this trend more than modern-day parents. As a child-centered play therapist, I interact daily with these parents, and I empathize with them. They want to understand why their child is having daily tantrums, has difficulty with school, or seems to be so angry all the time. Many, if not most, of the children I work with have previously been diagnosed with one or more disorders and/or syndromes. There is no shortage of clinicians who will provide the comfort and absolution provided by a diagnosis.
Within this societal context, how does one know whether or not a child’s diagnosis is doing more harm than good? In making this determination, look out for the following three red flags:
- The child uses the diagnosis as an excuse or crutch. Children who genuinely struggle with disorganization and distractibility may need guidance when learning to clean their rooms or maintain their school notebooks, but it’s a red flag when children reference their challenges as a way to avoid or get out of the things they don’t want to do or which do not come easily (ie. “Mom, you know I have ADHD; I shouldn’t have to clean and organize my room.”)
- Family members seem to view all behaviors through the lens of the given diagnosis (or multiple diagnoses). It is not uncommon for parents to say to me things like, “Our son is really defiant and angry; he has Oppositional Defiant Disorder, so we’re just doing the best we can to manage that. It’s really hard.” Then they ask, “Do you know how to treat ODD?” After talking with these parents further, I discover that they are considering divorce and frequently argue in front of their child. The family has moved multiple times, and the grandmother, who used to took care of their son during the day, passed away last year. Even when a child has a legitimate diagnosis, his or her behavior cannot be fully understood without some consideration of life experiences and environmental factors. It’s not about blame; it’s about trying to understand the lived experience of a child in a way that acknowledges the respective roles of both nature and nurture.
- The diagnostic label gets top billing. Every child, every person, is a unique individual. Diagnoses can help bring clarity and can point the way to potential solutions (for instance, someone who has a sensory processing disorder might learn of a clothing company that makes “soft” and seamless clothes that can be better tolerated by a hypervigilant nervous system), but a person should never be over-shadowed by his or her diagnosis, accurate or not. My own daughter met the diagnostic criteria for autism spectrum disorder when she was a child, but she could never be reduced to this simple label. She is also an artist and nature lover with a quirky, fresh sense of humor, and so much more. When parents speak more about a child’s diagnosis than they do about who that child is as a person, it’s a red flag that the diagnosis is more harmful than helpful.
When a child is given a diagnosis, the next step is often medication. Medical practitioners know very little about the long-term outcomes associated with many of the medications that are widely prescribed to children, beginning sometimes at the ages of 2 and 3 years old. If such dramatic measures can be avoided by stepping back a bit from our society’s recent obsession with labels and diagnoses, wouldn’t that be a good thing? If a child can be helped without labeling him or her in a way that suggests there is something broken or damaged within the child, wouldn’t this be better overall for the child? Children can manifest certain behaviors for a wide variety of reasons—even when there is an accurate diagnosis that explains some aspects of the child. Take the whole child into account, and make sure your child’s diagnosis is helping more than it is hurting.