Diagnosis of Psychopathologies in the Very Young

23rd November

A couple of articles about the increase in diagnosis of psychopathologies in the very young, i.e. 2 to 4 year olds such as Oppositional Defiance Disorder (ODD) and Attention Deficit Disorder (ADHD) triggered an LBC radio discussion to which I was invited to contribute. Essentially, the presenter Nick Ferrari, started with the question: “was it true that children of this age could have conditions of this kind?”

Giving a considered answer that did justice to the scope of this topic was a tall order. Psychologists, psychiatrists and many others in the fields of mental health, paediatric medicine, child development and child well-being in general have wrangled over and debated the merits and otherwise of giving young children with behavioural difficulties labels. In recent years the anti-labelling lobby has increased its volume. For example, Professor Sami Timimi, Consultant Child and Adolescent psychiatrist, has written and spoken extensively about the limitations of psychiatric diagnosis and its powerful and pervasive impact on mental health services, including structuring guidelines (such as NICE), research, administrative systems and care pathways. Recent British Psychological Society president, clinical psychologist Professor Peter Kinderman, has also added to the debate, calling for more account to be taken of wider social and circumstantial factors in mental health and well-being as well as individual biological factors.

Several years ago Dr Vivian Hill and colleagues of the British Psychological Society’s Division of Educational and Child Psychology and the Institute of Education carried out a survey ‘The medicalisation of childhood behaviour – a focus on ADHD’. The findings of this study were reported in the Guardian in December 2014 and highlighted the inappropriate use of medication in pre-school children and further highlighted the importance of contextual factors in making sense of children’s behaviour and in formulating appropriate interventions. In many ways the points I made in my five minute slot on LBC reflect these findings:

1. The behaviour of young children is their main means of communication

2. This communication is generally about their needs and more often than not those that are not being met as they want/need

3. By and large we can think about needs as relating to physical (including sensory), social, cognitive and emotional function. For example, a child who appears to be restless or over-active is often communicating their need to move, to be physically active and/or to be outside

4. The diagnosis of a ‘condition’ places all reasons for the problem in the child and whilst this may be partly the case it is rarely entirely the case as context and situation almost always play a part too

5. Following on from point 4; if we take the position of ‘fixing’ the child then the adults are much less likely to change their approach or to alter the child’s context and both of these, in my clinical experience, are essential

6. Every child and their context and situation is unique and multiple factors are at play. The all too frequent ‘one size fits all’ medication approach that follows from medical diagnosis can’t possibly address this.

In the radio interview I placed my cards on the table, including myself in the growing list of professionals who are hugely concerned about the early diagnosis of psychopathologies but as well as voicing concerns I tried to emphasise an alternative approach, which is to always view behaviour in context, both physical and social, to make sense of it over time and to support and value the work of skilled professional psychologists in using this approach where the level of need warrants their involvement. Yes, there are children who could be considered to have a clinical condition but it is not so much the diagnosis and the giving of a diagnostic label that matters as what comes after this, in other words, the ‘so what?’

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