My Thoughts on Childhood Diagnoses

Apr 14, 2010

Children seem to have acquired laundry lists of labels, names and diagnoses as the Mental Health Community has infused itself into mainstream in the last few decades. On one hand, this means more effective awareness, management and problem solving at earlier times in the child’s life. On the other, it means addressing the physical, emotional and social ramifications that are inextricably connected to the diagnosis.


There is an unfortunate trend in the Medical Arena to have pediatricians diagnosing mental health issues. While there are absolutely links between the physical and mental healths of our kids, I believe it has become far too common to hear parents report that their children have ADHD or Asperger’s solely based on the professional opinion of their doctor.

Mental Health diagnoses should be accurately assessed and evaluated by someone with a background in Psychology or Social Science. There is a plethora of official assessments to give appropriate results that are much more sound than someone’s opinion. I have had so many parents tell me that they were given a diagnosis within several minutes of meeting with their pediatrician, and they questioned whether the doctor could truly have known that was exclusively the problem and how much credibility the diagnosis had.

Further, there are many diagnostic symptoms and criteria that can also solely be behavioral problems. I can’t tell you the number of children with whom I worked who supposedly had diagnoses that were no longer relevant after addressing the social and emotional concerns. Bottom line – look at therapy before you pursue getting your child assessed, and make sure the assessment is done by a person trained to do so.


I see this as an issue on two levels. First, when kids are struggling with something, they know it. They don’t know how to fix it or why it is difficult, but children have an innate sense of something being amiss if it is. So, if a child actually needs a diagnosis (think biological, chemical or physiological imbalance), by all means, it can be a relief to know and understand what is going on.

However, I once had a professor in my undergraduate work that told me mental health issues (specifically ADHD in children) largely goes underdiagnosed and overdiagnosed. While that may seem confusing, the clarification is that the children who truly warrant a disgnosis often do not receive one, but kids who do not need one, do.

The danger there is that once a diagnosis has been made, it goes on a permanent mental health, medical and academic record. That one declaration can follow your child for all of their formative years. Other kids often know and can be very cruel. Teachers can accommodate too much or not enough. Kids can use it as a crutch and milk it. All around, it can be nightmarish. Bottom line – Kids will sometimes feel better knowing why they are having a hard time, but it can also be traumatic to be labeled with a “problem”, too.


Again, a two-fold component. First, if a child has a diagnosis that is less common (Asperger’s, OCD, PDD, ODD, etc.), they will likely need an outlet for normalizing their issues. This requires finding groups, meetings, chatrooms, whatever so that they meet and interact with other kids that are going through the same things and understand the unique concerns.

However, diagnoses can also isolate children, if they feel negatively about the problem. Many childhood disorders by their very nature separate kids with anxiety, fear, depression, and the like. It will be a challenge to help them feel connected to their peers, even in the midst of their differences. Bottom line – Children will need special time and opportunity to deal with their peers regarding their issues. Help them practice explaining their problems so it becomes easier to do, and discuss things that you struggle with, too, so they can watch how you cope.

To give you a few last thoughts, I think it is important to address the issue of psychopharmacological medications for children. This would include any medications that cross the blood-brain barrier and affect mood, thinking or behavior. It is far too common for kids to be on medication for behavior in recent years, often being prescribed in conjunction with other medications. I know there are certain children who absolutely MUST be on medication, but this should be the minority, not the norm. I strongly encourage you to go down every other road first, and consider medication the last resort, not an easy fix.

Also, if your child is demonstrating problematic or maladaptive behaviors, do not ignore the harmful effects of low self-esteem. Low self-worth can create devastating consequences, which can mirror diagnostic criteria for many diagnoses. Determine if your child is struggling with their self-concept, and address that first.

Children rarely need to be formally diagnosed, officially labeled, or prescribed medicine. In all of the children with whom I worked in my practice, there was only one who actually ended up meeting criteria for an actual diagnosis after therapy. One, out of more than one hundred. Guard against the ever-increasing practice of diagnosing, but rather check other spectrums for happiness and health!