The Raphael Remedy

Diagnosing Kids

by | May 13, 2015 | Counseling

Have you ever bought a new car? You start looking around and researching models until you find “the one”- the perfect car, the one that has everything you’ve been dreaming about- a unique beauty. Once you’ve decided and start getting excited a curious thing happens…you suddenly start seeing them everywhere. Whereas a month ago no one seemed to have been driving “your car”, now everyone seems to be in on your secret and they’re all over the road.

A similar phenomenon happens in psychology.

When studying a particular disorder, suddenly it seems that everyone seems to have it. I remember taking Abnormal Psychology and slumping down in my chair as the professor described various disorders that sounded just like me. I was convinced that I might possibly have a form of schizophrenia called hebephrenia that, among other things, was characterized by uncontrollable laughter. I did tend to laugh a lot…could that be me?!

When it comes to diagnosing patients for psychological disorders, it can be a tricky business. For most psychological and emotional “disorders”, there are no blood tests that can give a definitive diagnosis. Clinicians use various assessment tools (some better than others) but in large part they rely on observation and anecdotal evidence to make determinations to fit clients into specific diagnostic categories. Naturally some things are easier to diagnose than others. Treatment modalities can vary widely, but nailing the right diagnosis is important in order to know how best to proceed.

When dealing with children we need to be especially careful. The wrong diagnosis and subsequent treatment can follow them for life, sometimes with tragic results. Today we seem to witness an explosion of childhood disorders that used to be quite uncommon. ADD and ADHD, in particular, are diagnosed and medicated at alarming rates. Some studies indicate 9% of American children are diagnosed with ADD and ADHD, with the majority of those kids being boys. Most of them are prescribed stimulant medications, such as Ritalin or Adderall, for which, if we’re honest, no one really knows what the long terms effects will be. It’s a huge experiment on the most vulnerable of subjects.

I’ve had clients tell me they took their child to an “expert on ADHD” and after “testing” were told the child had ADD or ADHD and was prescribed medication…often after only one meeting with the doctor. Now since there is no actual blood test, that test would be subjective and, perhaps biased toward that diagnosis. After all, if they are “experts” on a particular disorder, they may see it everywhere, just like my Toyota Avalon. Many of the doctors prescribing these medications are family practitioners and neurologists with little or no training in psychology and therefore can’t explore the psychosocial issues that may be involved and need to be addressed.

There’s a big push these days to simply assume kids with such symptoms were “born that way” and therefore, like diabetics, need medication to correct their condition. The problem with that assumption is that it doesn’t make scientific sense. Genetics simply don’t work that way. It takes centuries for genes to mutate to such a degree that a substantial portion of the human family will be affected. Curiously, in other countries, the diagnosis rate is dramatically lower. In France, only .5% of children receive this diagnosis and subsequent drug treatment. So are American kids that defective, or are there other explanations?

Now let me be clear, there are many kids today who exhibit symptoms of ADD and ADHD, and for some, medication can be helpful. The problem though is that there may be many other explanations for some “symptoms,” some of which are normal childhood behaviors being interpreted through a jaundiced eye by clinicians and school psychologists who “see it everywhere” and who believe these kids were simply “born that way.” Too little time is taken to look at and address other possibilities like diet and food allergies, and psychosocial causes that may be in play. Family problems, trauma, grief, divorce and sometimes just the plain boredom of a more gifted child not being challenged in his class can be fueling these behaviors and need to be considered and addressed. Medications, with their long list of side effects and unknown long-term effects should be a last resort, but for too many clinicians, is the first one.

Pharmaceutical companies are “marketing” the diagnosis to an unsuspecting public with reckless abandon. Frequently school officials put pressure on parents to “do the right thing” for their child by medicating them. Several years ago an acquaintance called me about her high school aged son. She didn’t know what to do as the school was pressuring her and her husband to get her son on medication since he wasn’t doing well in math. They contended that he had ADD and the medication could help him focus better. As we talked she indicated that he had no trouble in other subjects and there were no attention or behavior problems at home. The math teacher went as far as to tell her son that he really needed medication but that his parents didn’t want to give it to him! I helped her write a letter to get them to back off and she refused the medication. It seemed in that particularcase that over zealous teachers and school officials had a vested interest in maintaining their top rating and, perhaps with some good intention, were taking things too far without considering other explanations (like not everyone likes math!), or other possible consequences.

The point is this…when diagnosing children, common sense should prevail over “prevailing wisdom.” Making a good diagnosis takes many factors into account and requires more than a cursory meeting. It is often a “gut call” and the role of the Holy Spirit is indispensable. Choosing a Catholic therapist who is not only a qualified clinician but also a person of prayer is an excellent starting point. Listen to your own inner voice and pray for God’s lead.

Remember, God loves your child even more than you do and has a plan for his or her life. Sometimes these challenges are part of the overall strategy and the good He will bring of them is yet to be revealed. Trust Him.

Allison Ricciardi, LMHC
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