Diagnosing problems away


Joanne Jacobs has a link to this NY Times article about the freewheeling approach being taken to making psychiatric diagnoses in children:

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.

The confusion is due in part to the patchwork nature of the health care system, experts say. Child psychiatrists are in desperately short supply, and family doctors, pediatricians, psychologists and social workers, each with their own biases, routinely hand out diagnoses.

But there are also deep uncertainties in the field itself. Psychiatrists have no blood tests or brain scans to diagnose mental disorders. They have to make judgments, based on interviews and checklists of symptoms. And unlike most adults, young children are often unable or unwilling to talk about their symptoms, leaving doctors to rely on observation and information from parents and teachers.

Joanne says, “Parents will accept a diagnosis they think is wrong if it gets their kid special help at school.” In the absence of sound medical and scientific practice, and in a culture where many parents want simply to dismiss behavioral problems rather than deal with them, this pragmatic approach — diagnose my kid so s/he can get special treatment — is awfully appealing, and for all the wrong reasons.

During grad school, I worked as a tutor at a privately-run learning center and specialized in kids that had ben diagnosed with learning disabilities. Of the dozens of kids I worked with, all of whom had been professionally diagnosed with some disorder, exactly one of those kids actually had something pathological going on. I would have to physically restrain the kid at times to keep him from looking out the window or walking off.

By contrast, I had a conference with a parent there who started the conference by telling me that her son was “learning disabled in math”. I countered by saying, “Oh, I’m sorry. I’m here to help your child work through that.” And the parent actually looked disappointed, as if recovering from a learning disability was something she’d prefer not to have happen to her kid.

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