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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Children: Are We Too Quick To Suspect Mental Illness?

Allan Schwartz, LCSW, Ph.D. Updated: Sep 16th 2011

Children: Are We Too Quick To Suspect Mental Illness?Children: Are We Too Quick To Suspect Mental Illness?

Several of my readers have protested about what they see as a tendency to label children as having mental disorders when these kids are merely being the individuals that they are. Now there is evidence that this may be true, as expressed by the British Psychological Society.

It's been reported that children who seem shy in school, or quiet, or sad, or who talk back, are at risk of being diagnosed with depression, social anxiety disorder, oppositional defiant disorder, attention deficit disorder or any of a wide variety of mental health problems. What often follows these diagnoses are powerful prescription medications such as Ritalin, Prozac or others. These children can also be placed in special education programs.

The driving concern that fuels this trend is the broader definition of mental illness in the new DSM V (Diagnostic and Statistical Manual) that is not yet published. Given the new diagnostic criteria and additional behaviors listed as indicative of mental illness in the DSM V, there is the danger that too many children could be viewed as having mental disorders when it is not necessary.

Experts report that what is of primary importantance for most children is that they be given support and help when they appear to be going through a difficult time. A child who looks sad is not necessarily depressed, but may be in need of someone to talk with.

Many parents contact me with questions about their children's behavior. They worry about autism, learning disorders, dyslexia and hyperactivity. When a parent expresses worry that their two-year-old may be hyperactive, you know that something has gone wrong. I was recently approached by a grandmother who was concerned that her two and a half-year-old grandson's nursery school teacher had referred him for evaluation because of aggressive behavior. She explained that the child was very bright and could already read on a first grade level. He was much taller than all the other children in his class, and was often mistaken for a five-year-old. His aggression took the form of pushing other children out of the seats he wanted to sit in. Does this strike a chord? No matter how large or how smart he was, the child was only two and a half-years-old! His behavior was typical of toddlers. The evaluation showed no signs of any mental disorder and in fact commented on his advanced intellectual development. This may simply have been a case of adults "forgetting" how young he really was.

Readers also complain that mental disorders and their diagnoses seem to be like fashion fads. Once, ADHD was a fad. Now, some have complained that Reactive Attachment Disorder is the new fad. Reactive Attachment Disorder (RAD) is a complex psychiatric illness that can affect young children. It is characterized by serious problems in emotional attachments to others.

While many of these complaints are valid, it would be a tragic mistake to overlook children who truly do fall under these diagnostic categories. For example, some well meaning people state that ADHD is over diagnosed and is not real. This type of attitude can result in failure to get the needed help for those children who do suffer from the disorder. ADHD is very real and unbelievably painful and challenging for parents, teachers and children. Some disorders may appear to be faddish, but are very real none the less. They are serious and are not to be trifled with. As the saying goes, "Don't throw out the baby with the bath water."

I want to strongly emphasize the fact that it is not my intention to criticize parents, teachers or mental health professionals. Everyone has the best interests of children in mind. Worried parents, teachers and other professionals may, at times, be overly zealous in looking at a child's behavior. If this happens, it's out of genuine concern for the child.

If you have any doubts about your child, consult your physician who can make the appropriate referral if it's deemed necessary. If teachers are expressing concern, they should be taken seriously and not dismissed. Again, consult your physician and, if necessary, get a referral to a child psychiatrist or child psychologist.

Your comments and questions are welcome.

Allan N. Schwartz

 

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    Excellent Article - Cathy - Sep 16th 2011

    This says in a technical way what I have been saying for years.  In the 60's, with 30 to 35 kids in a classroom, we had children with all sorts of behaviors that I feel would have been diagnosed as, well, probably most the fad of the year with the others what was fashionable within the past few years.  I had a cousin who in grade school could not stand to be cooped up so escaped and went home but later joined the Air Force and became a plumber with success.  My mother-in-law told me that my older son, now 35, was hyperactive and needed medication.  I just ignored it because he was so interested in everything and bright.  My younger son with Down syndrome, from the beginning with pre-school they wanted him medicated to sit still.  He was functioning at the 24 month level and they had toys and puzzles lining the walls so he just got up and played with them rather than sit and be bored.  Seemed smart to me.  Every year they complained.  One teacher was belting him in his seat until I saw the belt!  We took him to a psychiatrist and after talking with us and watching our son gently examine several items at his level, the psychiatrist said that he was just interested in his surroundings.  The teacher and higher staff even blamed me saying "Well, he probably got this from watching you be busy all the time."  I asked the psychiatrist if I were making him hyperactive by example and he said "You are showing him that people have things they have to do."  So, no medication and once he was homeschooled and when he was in my presence, he was calm.  Actually, I am described as calm also.  So, we come to this current town and one lady tells me that her teenage son as Asperger's syndrome but she also tells me what the problems are:  he gets in fights with the teacher (verbal), he won't get up in the morning and is late for school and his grades aren't good and even though he is interested in construction, the family wants him to go to college to get a 4 year degree and she mentioned that every night when she was on the computer that it made him angry because he wanted her to pay attention to him or maybe play a board game.   I tried to explain that some of this was a teenage behavior but..........Another woman that was walking with me told me her son was diagnosed with Bi-Polar.  She said he had broken 3 of her cell phones when he was angry.  Then admits that she is always texting more than she probably should be and he wanted her to pay attention to him.  He also keeps stealing her cigarettes but, she admits, he throws them away because he is afraid she will get cancer like a dear relative just died from.  She was diagnosed with Bi-Polar at the same time he was.  I just saw so much room for improvement and felt some other strategies should have been looked at before giving a diagnosis the way they did.  Oh, and another woman just entered our lives and her son has Asperger's.  I know almost no one here but if seems they all have a diagnosis of a mental health issue.  Now, being a mother of a son with Down syndrome, seeing children in the schools and working with some of them, I know these mental health issues do exist and are serious business.  Funny thing is though, parents of those children actually turn the world upside down trying to avoid a diagnosis of a mental health condition.  It does take away from those with the conditions not only just because "Yeah, everyone has that." but in the funding of special services especially with all the budget cuts.  I just think they need to look at trying all other possible strategies before moving on to why and a diagnosis. I actually got a book on mental health for people with Down syndrome and I diagnosed my son, my self, my husband and the dog as having almost everything in the book!  You really need someone highly qualified to make these diagnosis.  We are all not met to be the same and "normal" has a very wide range when it comes to human beings whether the school thinks so or not!  I was shy, extremely shy in public when I was in school and now, no one believes it at all and they just laugh!

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