The Self Fulfilling Prophecy of Childhood Mental Health Diagnosis
This morning I let my two dogs out to play in the yard, and Marty, my West Highland Terrier mix, ran out of the door and over to a mud puddle, where he dug a hole in which he preceded to roll. I was irritated by his behavior, as there was now a muddy mess, which I would have to clean up. I can understand, however, that his behavior was instinctual and within his doggy nature.
As humans we learn manners, codes of behavior, morals, ethics, and the "right procedure" (Perls, 1973), primarily through education rather than through our inherited instincts and animal intuition. Our exploration of the environment is interrupted and cut-short during childhood as we are taught to mature and function according to socio-developmental norms and expectations. Although we must grow to understand not to harm ourselves, nor others, and to live within social limits, there seems to be an emphasis on education over instinct and intuition with regards to how our children engage with their environment. When these expected norms are not achieved parents, teachers, and therapists begin to worry that there may be a problem with the child and often contain their own resultant anxieties by isolating, labeling, and diagnosing a disorder.
The Department of Health and Human Services reports that 1 in 5 children (20%) may have a diagnosable mental disorder. According to the Centers for Disease Control 9.5% of children have Attention Deficit Disorder with Oppositional Defiant Disorder as a common co-occurring diagnosis, 1% of all children have an Autism Spectrum Disorder (such as Asperger's Syndrome) and according to Dr. Joseph Biederman, Chief of the Clinical and Research Programs in Pediatric Psychopharmacology at the Massachusetts General Hospital, 1 in 4 children have Bipolar Disorder. It seems that these disorders have become the childhood mental health diagnoses de jour (not to mention that the bulk of Dr. Biederman's research funding comes from 15 pharmaceutical companies). I do not mean to be dismissive about mental health disorders; however, these are startling statistics and I must beg the question: are these disorders really becoming more prevalent and chronic, or are we as adults using these labels as containment for our own worries, blind spots, and concerns about our children?
Daniel Stern, M.D. writes in his book, The Interpersonal World of the Infant, that infants and adults exist within two different, parallel systems of perceptions, cognition, affectivity, and memory, for encountering and making sense of their environment. I would argue that throughout the course of development, children's systems remain separate and parallel, while interacting with the adult's system. What is most important is the dynamic that is created through this interaction. Children with experiences of consistent, responsive, predictable, and available adults, are more able to attach and form healthy relationships in the future, engendering feelings of self-efficacy as the child learns that they have control over the social environment. By externalizing or separating the child's behavior from the child, often through a diagnosis, we may be blinding ourselves from our children's signals, ignoring that for which they require a consistent response. Consequently, they may end up learning that their needs and behaviors do not have an effect on the behaviors of others and they do not learn to expect that their needs will be met in the environment. Parents are often unable to respond promptly and consistently when their own blind spots and trigger areas are evoked by their child's behaviors, which is where the labeling or diagnosing seems to serve a purpose - i.e. no child of mine would behave in this manner it must be the ADHD.
As discussed by Philip Bromberg, the primary influence that parents have over their children comes from showing them who they are through attuned interaction as opposed to telling the child what or who they are. By relating to the child as though he or she is in some way disordered we may be ignoring other aspects of them, disconfirming the relational existence of those aspects of the child's self and resulting in a developmental trauma. Hence, the label becomes a self-fulfilling prophecy. Looking at childhood difficulties though a holistic lens we become more aware of the rapidity of development and the interrelationships among social and cognitive systems, in which problems created in one area may spill over to affect development in other areas (Campbell, 2002). Children are under an incredible amount of pressure to be healthy and "normal," and to develop faster or in the same way as their parents. Too often there is a cracking under pressure as the child's unique and individual needs are misunderstood, disregarded, and replaced with a diagnosis. No diagnostic label, however, can be used to explain the needs of your child, and it's these needs that are truly important.
Thank You! - Will's Mom - Sep 1st 2011
Thank you so much for this insightful article. As a mom of a child who has been "pigeoned holed" by the school system since his first day of K5 in 2008, I struggle with giving him medication just so he can be "managed" in the classroom. He is bright, funny and intelligent, and ALL boy - but stiffled by a system that is more concerned about work sheets and test scores than his social development. Any suggestions on how to answer him every morning when he takes his meds and asks me, "now what are these pills for again?"