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To diagnose or not to diagnose?

A report funded by the NIMH has been issued by Erik Parents and Josephine Johnston at the The Hastings Center. This report examines several long-running debates about pediatric mood and behavior difficulties in children. This report, the product of an interdisciplinary gathering of psychiatrists, educators, parent advocates, social scientists and bioethicists, considers the following questions: Why are these diagnoses so controversial? Why do some people feel that children are over-medicated, while others are concerned about under-treatment? As different cultures have different rates of treatment with psychotropic medications, how much of what we see in the United States is driven by context — by individual, familial, or societal values?

One area of focus in the report has to do with the difficulty inherent in reaching definitive diagnoses when evaluating children with behavioral and emotional challenges. The authors write, “What we’ve learned is that diagnoses don’t have clear boundaries — what counts as healthy and unhealthy anxiety or healthy and unhealthy aggression, for example, is not written in nature. Human beings living and working in particular places and times define them. This leads to inevitable disagreements about whether a cluster of moods and behaviors is best understood as disordered, about how exactly to describe some symptoms, and about whether or which particular diagnosis is warranted.”

This confusion about diagnosis is exactly why we believe that a more informative route to figuring out how best to help families does not center around diagnosis, but rather, on a very clear and specific understanding of what skill deficits a child/family is struggling with and what unsolved problems consistently lead to difficulty. As we often say, it is your explanation of why challenging behavior is happening not a particular diagnosis that is most effective in guiding your intervention!