Day 8: Diagnosing children with mental health conditions (Part 3)
In the last two days, I have discussed the pros and cons of our current model of diagnosis. It appeared that both sides have rather strong arguments.
Are we overdiagnosing child mental health conditions?
There are increasing reports suggesting that children are overdiagnosed of attention deficit/hyperactivity disorder (ADHD), it almost looks like an ‘epidemic’ per se:
- Washington Post: https://www.washingtonpost.com/national/health-science/youngest-kids-in-class-are-more-likely-to-be-diagnosed-with-adhd-than-oldest-kids-study-finds/2018/11/28/c50ab11a-f331-11e8-bc79-68604ed88993_story.html?noredirect=on&utm_term=.1d975b4ca66b
- ABC News: https://www.abc.net.au/news/2018-10-15/overdiagnosis-target-of-new-medical-professional-alliance/10368266
- CNN: https://edition.cnn.com/2018/08/31/health/adhd-trends-study-partner/index.html
What are some causes of overdiagnosis?
a) Pharmaceutical companies
This idea neoliberalism and the market stroke me. In the paper, Esposito and Perez (2014) — Neoliberalism and the Commodification of Mental Health, they talked about how the neoliberalism plays a role in determining the norm.
Due to the “market rationality,” which means evaluating the merit of all actions according to what is deemed as valuable, acceptable, or desirable by “the market.” Essentially, it is better to be the ‘in group’ (i.e. the market)
than the ‘out group.’ Therefore, this encourages “people to adjust their
attitudes, habits, and behaviours to fit market demands is typically associated
with functional/rational behaviour.” Whenever one is not integrated, s/he
would be regarded as irrational idealism or even ‘mentally ill.’
No one ever blamed the society in creating such norms, instead they blame the individual, where then the society alienates them, therefore, the
individuals then alienate themselves.
At this point, pharmaceutical company jumps, noting that drugs are here to help patients to become more similar to the norm by ‘fixing them’ to perform norm-like behaviour.
This is a snap shot of this argument, which I will write further into in the future.
b) Forever changing diagnostic criteria
In the evolution of the DSM, from I to V, there has been introduction of new disorders and, also some reduction in threshold of existing disorders.
With mental health affecting a significant amount of population, a small change in the diagnostic manual can have a big influence on the population affected.
c) Funding and resource
In a world of scarce resource, how are people suffered from mental health conditions meant to receive supports? Also, raising a child is already very costly, how much would it cost to raise a child with some form of conditions?
Unfortunately, in the contemporary world, it is almost impossible to access funding and support without a diagnosis.
d) Humanistic factors
In relation to factor ( c ), overdiagnosing a child might be a natural humanistic respond. Since birth, our brains are not wired to deal with stress and sad experience. So even though it might challenge the integrity of the clinician, but realistically, if the support can leverage the suffering of the child, why not give them a hand? (No offence to any clinicians, this is just my opinion.)
Take away reflections
- Can you think of a time where you felt unease at giving a label to a child?
- What do you feel about children being labelled in order to seek help?
- What are your views on the contemporary society? How would you wish to change it?
