If it only were as simple as ADHD

The probability that your child will be diagnosed with a particular mental illness has as much to do with trends in the mental health field and the “lens” of the doctor than it does with the symptoms that you may be describing to the doctor or therapist.

When I worked on an inpatient psychiatric unit that worked with severely mentally ill children, we had a running joke with regard to the diagnoses that the children received because it varied so much depending upon which of our psychiatrists saw the child. We had the psychiatrist who diagnosed almost every child with ADHD, and another who saw almost every child as having latent Bipolar Disorder. Needless to say, my confidence in the accuracy of the diagnoses I saw with these children lowered each day that I encountered yet another diagnostic flip-flop between each doctor.

It was also unfortunate for the kids who may have benefitted from  either diagnosis if it were possible to know definitively it was accurate. But how were we to know? The standard response from the psychiatrists was to try the medication and see if it helps. The theory was that if the medication helped, we could deduce through reverse engineering that they must have had the diagnosis for which the medication is commonly prescribed.

I’d hardly call that a scientific approach. A majority of the population would positively respond to Ritalin. We’d focus better, complete more tasks, complete tasks that we had been delaying for years, and our concentration would make it appear to an outside observer that we were calmer. Does this mean that we all have ADHD and don’t know it? Of course not.

Understanding the mind and the complexity of human experience requires an organic, whole process. When the mental field divided diagnoses into five hundred different parts in an attempt to mirror the structure of the medical field it advanced itself in the sense that certain diagnoses could be teased out and understood in more powerful ways. This helps the patient’s medication management in particular so that the right class of medication is attempted with regard to the particular diagnosis.

However, when the field fractured into five hundred little pieces it also set itself back a hundred years. A child who has attentional issues is having these symptoms potentially for several reasons, some of which would benefit from understanding and psychotherapy. Many, many children who are struggling with family issues (parental discord, e.g.) express that in the form of symptoms commonly referred to as ADHD. Many children that are depressed begin acting out in ways also confused with ADHD, and the problem is that if we only medicate this child, and never inquire deeper, how will the origin of this child’s symptoms ever be fully understood and resolved?

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