December 6, 2023
December 6, 2023

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Problem Behavior in Children Is Not Always a Mental Disorder

Children are increasingly being given drugs by doctors to help teachers and parents cope with their troublesome behavior. Certain behaviors or actions by children, such as not sitting still, are being judged as evidence of mental disorders and used to justify an official diagnosis. This has led to an increase in diagno­ses of children with conditions such as atten­tion deficit hyperactivity disorder (ADHD) and drug treatment with stimulants, antipsychot­ics, and antidepressants.

The problem with giving children such di­agnoses is that it obscures other interpreta­tions of children and their behavior. It detracts from considerations of what is best, education­ally, for individual children. And it encourages a reliance on definitions of mental disorder to account for childhood normality or abnormal­ity. In a new book, Valerie Harwood and I have called this trend psychopathologization.

In the UK, around 5 percent of children of school age are said to have ADHD. The growth in mental disorder diagnoses seems to be a global phenomenon, with estimates of the worldwide prevalence of ADHD at 5.29 percent and an average in Europe of 4.6 per­cent. Figures are much higher in Australia (11.2 percent), America (11 percent) and Africa (8.5 percent).

In our research, we interviewed child mental health psychiatrists, education­al psychologists, teachers providing ad­ditional educational support, and youth work professionals in Australia, England, and Scotland. All voiced major concerns about increases in both the diagnoses and the prescriptions of drugs. Recent press de­bates, in The Conversation and elsewhere, about whether ADHD is “real” deflect from a more striking—and “real” —enthusiasm for labeling more and more children as mentally ill.

The risk of psychopathologization is great­est for particular ethnic groups and for chil­dren from disadvantaged backgrounds. In the UK, children and young people living in poor­er circumstances are four times more likely to be diagnosed with ADHD. Boys outnumber girls in diagnoses of ADHD by four to one, as is the case in most neuropsychiatric conditions. But there is a referral bias, where boys are more frequently referred than girls because of their aggressive behavior. This takes the ratio of boys to girls within mental health clinics or hospitals to between six and nine, to one. Girls are con­sidered more likely to exhibit the characteris­tics of the less prevalent attention deficit dis­order, which include sluggishness and anxiety. But because, by its nature, it does not involve hyperactivity, they may not be referred or may be misdiagnosed.

Catch and treat them young

There is great enthusiasm for resolving the mental health problems of very young children (or the risk of these) under the ru­bric of “intervention.” Some of these inter­ventions are even directed at unborn chil­dren, for example, by minimizing maternal stress and promoting healthy behavior by the mother during pregnancy.

The earliest times of life are key times of intervention for future healthy minds. The newborn, as well as the prenatal (or antenatal) periods, are viewed as times in a child’s life that hold the most potential for when mental health problems can be avoided, detected or corrected. This poten­tial decreases as age increases, on a down­ward sliding scale from the unborn, new­borns, infants, toddlers, and preschoolers. The “developing brains” of very young chil­dren are thus perceived as important in the prevention of mental problems.

For the child entering primary school, scru­tiny is intensified and directed at whether he or she will “fit” into school and be accommodated in its expectations and practices. For those chil­dren who cause concern, psychopathologiza­tion begins in earnest.

The acceptance that things have now been “set on course” generates a period where practices such as separation using different schools and classrooms, pharma­ceuticals, and behavioral management pro­grams for parents at home or for teachers within schools, swing into full-scale oper­ation.

Endangering others

At secondary school, a more somber tone emerges that reveals an acceptance that older children’s behavior disorders are unlikely to be resolved. The secondary-aged mentally abnormal youngster is seen as presenting danger and risk to the teach­ers and other students. The measures intro­duced at this stage are “palliative” and are aimed at controlling the young person’s condition and minimizing its impact. The purpose of this control and containment is to protect the security of others and of so­ciety at large.

In colleges and universities, psychopa­thology becomes linked to the troubled stu­dent with depression, and with a concern for the dangerous potential for potency and violence. Higher education establish­ments are seeking to learn from incidents such as the Virginia Tech massacre.

Diagnosing potency has become a regu­lar practice within institutions, together with drives to detect danger through “connecting the dots” and threat assessment. There is far less interest in those other forms of behavior disorder that received attention during earlier phases of schooling.

Are there alternatives?

Several of the professionals we inter­viewed described explicit efforts to resist diagnosing children with ADHD or other behavioral disorders and described three lines of resistance. These focused on the language used by teachers and parents. One interviewee, an educational psycholo­gist, said: “We’re trying to change the lan­guage and get people away from what they think is the bad child and helping people to understand that there’s a context here, the reason we’re getting the behavior might be this experience or that experience.”

Others tried to encourage teachers to look beyond the child’s difficulties to the family situation and to change the percep­tions of those families who came “looking for a prescription.” These professionals suc­ceeded in interrupting referrals for diagno­ses by showing teachers and parents better ways of understanding and responding to children’s behavioral problems.

Good teacher education could also help to reduce the numbers of diagnosed chil­dren. If teachers were helped to find chil­dren’s behavior less of a threat and more of an interesting challenge, with resourc­es and support to enable them to respond effectively, a diagnosis of disorder may be­come less attractive. It would require a form of teacher education that emphasiz­es meeting the needs of all children in the classroom and helps teachers to develop an enthusiasm for the diversity that the chil­dren bring.

D I S C LOSURE S TATEMENT

Julie Allan has received funding, relat­ing to this research, from the Academy of the Social Sciences in Australia. The Uni­versity of Birmingham provides funding as a Founding Partner of The Conversation.

Julie Allan is Professor of Equity and Inclusion at the University of Birmingham

By Julie Allan

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