EBD Blog

Children receive diverse psychiatric diagnoses of Emotional and Behavioral Disorders that leave parents and the children bewildered, according to a story entitled “What’s Wrong With a Child? Psychiatrists Often Disagree” by Benedict Carey, in the New York (NY, US) Times. Mr. Carey recounts multiple examples of children who have been characterized as having bipolar disorder, attention deficit disorder, oppositional-defiant disorder, pervasive developmental disorder, depression and anxiety.

At a time when increasing numbers of children are being treated for psychiatric problems, naming those problems remains more an art than a science. Doctors often disagree about what is wrong.

A child’s problems are now routinely given two or more diagnoses at the same time, like attention deficit and bipolar disorders. And parents of disruptive children in particular — those who once might have been called delinquents, or simply “problem children” — say they hear an alphabet soup of labels that seem to change as often as a child’s shoe size.

In my opinion, this is a pretty predictable consequence of approaching these problems as something that should be handled by medical practices, when many of them would be better managed by environmental manipulations. We need to identify the specific needs of the children and design methods for teaching them how to do things. If the problem is “argues with adults,” we should analyze the conditions under which the behavior occurs—the antecedents and the consequences of arguing—and either modify those events or teach the child a self-management strategy (or both). If the problem is fidgeting (is that really a problem?), we need to determine what fidgeting does for the child and address that function; I suspect that most children can learn non-fidgets activities and, when we make them more rewarding than fidgeting, the salience of the problem will be reduced greatly.

What happens too often, in my view, is that we go through a checklist of “symptoms” looking for a secret, hidden pattern that represents an underlying disorder. We’re still trying to do Freud here. What we actually get, of course, is a cluster problems. Evidence may show that these problems do, in fact, cluster together, but such clustering doesn’t necessarily indicate that they reflect an underlying organic base for the individual problems.

I also recognize that providers of mental health care for children must use a diagnostic system so that costs of providing services can be charged to insurance companies. Just because someone has to pay for therapy doesn’t mean that therapy has to be medications nor that we should ignore simple and practical means of addressing problems.

Link to Mr. Carey’s article (free subscription may be required).