PARENTS

The Overpathologizing Of Child Behaviour (Or Why The DSM Isn't Always Helpful)

What works for one might not work for others.

09/08/2017 16:02 EDT | Updated 09/08/2017 16:54 EDT
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When I was kid, the school complained that I was too fidgety and had trouble paying attention to the teacher. It was 1970 and I was given the diagnosis "Ants in her in pants."

About the same time, my left-handed brother was having his hand thwacked with a ruler repeatedly for holding the pencil in his left hand. Writing was a behaviour that was only to be done with the right hand.

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Yes, a lot has changed since then. Being a lefty is no longer a childhood abnormality that requires a treatment; corporal punishment is out; and a whole lot more kids are now being pathologized and medicated for so-called "abnormal behaviour" or misbehaving. The way society conceptualizes and treats children's behaviours can be trendy, but it's up to us as parents (with the help of our doctors) to figure out what's truly best for our kids.

Being a lefty is no longer a childhood abnormality that requires a treatment; corporal punishment is out; and a whole lot more kids are now being pathologized and medicated for so-called "abnormal behaviour" or misbehaving.

Currently, we are in a time in history when the medical model of understanding mental illness has taken precedent. If you are outside the vary narrow box of what's deemed to be acceptable or so-called "normal" you are labelled "abnormal."

Further, a proper label must be attached to your mental illness so that you can qualify for help from your school board or insurance provider. Medications are covered by health plans, but therapy sessions are either limited or not included at all.

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Children's symptoms must meet a certain diagnostic criteria, as laid out in the DSM, or the Diagnostic Statistical Manual. Most parents have no idea of just how political the world of diagnosing a person has become in recent years because of changes to the last few editions of the DSM.

Here are some red flags that something has gone amiss:

  • The first edition of the DSM was published in 1952 with 129 pages and 106 diagnoses. The DSM-5 is now 950 pages of roughly 350 diagnoses.
  • Temper tantrums now meet the criteria for Disruptive Mood Dysregulation.
  • Grief now meets the criteria for major depression.
  • Infants can be diagnosed with bi-polar disorder.
  • There has been a 35-fold increase in children classified as being disabled by mental disorders between 1987 and 2007. Numbers have been increasing since.
  • Allen Frances, the chair of the DSM-5 task force, stepped down and publicly criticized the unethical involvement of the drug companies in the process and warned of a hyperinflation in diagnosis, which has proven to be true.

So, yes, both big pharma and a new DSM that has made the pigeon hole for being normal so small, means that nearly all of us meet the criteria for some mental illness and qualify to be treated, largely pharmaceutically. But there are more factors, too.

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We want to diagnose people. We prefer to tell people we are a parent with generalized anxiety disorder rather than call ourselves a "worry wart." Now we can blame our biology for our shortcomings. The poor behaviour of our children is because of limitations in their impulse control, not our parenting skills.

There is yet another factor to consider when we look at the recent spike in the rates of diagnosis of our children, namely, advances in technology. Now that we can take pictures of the brain, we are more apt to accept that some structural deficiency or neuronal wiring mishap is to blame for children's behaviour.

Now that we can take pictures of the brain, we are more apt to accept that some structural deficiency or neuronal wiring mishap is to blame for children's behaviour.

While imaging does provide information, scans are not proof of causation. What we do know is that the brain structures change experience, but experience also shapes the brain. The brain of a child grows and develops until about age 25. We have lots of time to shape the brain in healthy ways through needed experiences.

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So instead of getting too impressed by the difference in serotonin levels in the brains of depressed teens compared to non-depressed teens, why not ponder why research shows that talk therapy (and talk therapy in combination with drugs) is as effective in overcoming depression than antidepressants? (Although other studies say the benefits of talk therapy are overrated.) Talk therapy changes the anatomy and functioning of our brain.

However, it's important to note that some people do require medication for depression and other mental illnesses, so it's best to talk to your or your child's physician about all the options and do what's best for you and your child.

It's important to note that some people do require medication for depression and other mental illnesses, so it's best to talk to your or your child's physician about all the options.

Lastly, the hyperinflation of diagnoses of children can also be accounted for by the change in our society and family structures.

Most families are over-scheduled and stressed; the pressures to perform in school are stronger; social media has ironically led to social isolation and more feelings of loneliness and depression; and culture has placed values on wealth and fame instead of values that lead to authentic happiness.

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Human beings are very complex, and there is no one diagnosis or treatment that suits everyone. But it's worth looking at alternative ways to diagnose and "treat" our kids — and ourselves. One option is Martin Seligman's positive psychology — a movement that de-emphasizes the DSM and its biological focus, and focuses on a positive philosophy of human behaviour that is a strength-based approach.

Rather than focus on dysfunction and treatment, positive psychology embraces and celebrates our uniqueness, and examines how we can become happier and more fulfilled. The focus is on improving functioning through improved relationships and living by character strengths and values.

As we said previously, no one method works for everyone, but when it comes to our kids, it's good to know all the options.

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