I have never been comfortable labeling children.
Labeling a child (or anyone for that matter) always seems so reductionist to me, as if the label could tell the whole story.
As a society, though, we have become increasingly comfortable and casual with their use. Not a week goes by where I don’t hear, “He’s ADD” or, “My kid is dyslexic,” or “Well, she’s Asperger’s.” (Those are just some of the common ones; there are many more.)
I understand that getting “the diagnosis” or the label can be comforting on some level, but there are many factors beyond the label that need to be considered when trying to understand a child.
Let’s look at Maria, an 8 year old I saw recently. Recently seen by a neurologist who pronounced she had ADHD after about a 20 minute assessment, the mom took that diagnosis seriously (as she should) and thought to herself, “Well, that’s that. We finally understand what’s going on with Maria.” She presumed that starting her on the medication prescribed would fix the problem.
Well, not too long after that, Maria started to feel overwhelmed in class describing symptoms of nervousness during tests and whenever the teacher asked the kids to write. When it came to homework, she was quite avoidant, arguing a lot with her parents about getting it done. Math word problems resulted in particular resistance from Maria.
When I tested Maria, she came across as a sweet style child who appeared pretty anxious, particularly with tasks that involved evaluating, considering and problem solving – in other words, tasks in which straightforward answers were not readily apparent. With reading, she showed almost no ability to answer comprehension questions that involved inferences, that is, “reading between the lines,” or answering questions that were not explicitly stated in the text.
About 70% of the kids are pretty self-managing. They read pretty well. They hand in their homework and are reasonably flexible in terms of their personality style. That is, they are on a nice smooth road.
With 30% or so it’s a different story. For them, school is an ongoing struggle (starting in first grade). Frustration tolerance is not a top quality of theirs. It almost goes without saying that their attention skills are variable (at best) and they don’t read, spell or write very well. Homework is a continual battlefront. They sometimes annoy other people in ways they are not aware.
This latter category of kids are on the rough road.
“Rough road” is not a special education category or a psychiatric disorder, but almost all of the kids classified in special education or given diagnostic labels by medical doctors are kids who are on a rough road.
Maria is one of the 30%. Just calling her “ADHD” doesn’t do justice to the totality of what she is experiencing. Next week we will talk about how to approach her.
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