Blog: Does My Child Have a Disorder?

Does My Child Have a Disorder?
The drive to name the problem can compound the problem
By Claudia M. Gold, MD
Our current health care and education systems put diagnosis front and center. The focus, both for parent and clinician, is on the “what” rather than the “why”.  This drive to name the problem leaves us with an inaccurate and potentially harmful choice between “normal” and “disorder.” In contrast, when we protect time for listening with curiosity, we can learn how a child’s behavior, from his perspective, might make sense.
An example
“What’s wrong with my child?” the mother of 4-year-old Michael asked, as she sat down in my office. Like many parents, she seemed to be at war with herself, hoping that I might tell her “nothing,” yet at the same time seeking validation of her deep and longstanding struggle to be a good parent.  Michael had been referred for “an ADHD evaluation” by his pediatrician and preschool teacher.   Usually I meet first with both parents, but his mother Angela came alone. I opened up the visit with an invitation to tell me her story.
Michael had been a challenging child from birth, intense and difficult to soothe. Angela had struggled with postpartum depression. When Michael turned two and began in a developmentally appropriate way to say no, Angela found herself full of rage. She told me how typical behaviors such as resisting a bath would precipitate an extreme reaction from her, resorting sometimes to harshly grabbing Michael by the shoulders and shaking him. She felt terrible shame about her behavior. Her voice trembling, she wept in the safety of my office as she let herself experience the grief around her troubled relationship with her son.
When I saw Michael and his mother together the next week, Angela joyfully reported at the start of the visit that, while mealtime had been a primary battleground, Michael had eaten an entire spaghetti dinner by himself. The whole tone in the household had shifted dramatically, as Angela, feeling some relief from her debilitating feelings of guilt and shame by sharing them with me, began to enjoy her son for the first time in years. 
In turn, once Michael connected with his mother in more positive ways, he reconnected with his own natural appetite. As we worked together in the coming months, the behaviors that Angela and his teachers had been attributing to ADHD began to subside. The relationship between mother and son took a different direction.
What happened that allowed the situation to transform?  By listening for the “why” rather than jumping to the question of whether he did or did not “have ADHD” we could appreciate Michael’s behavior as a form of communication within the context of their relationship. Clearly, they were both struggling, and the situation was far from “normal.” Yet Michael’s behavior represented not a disorder, but rather an effort to communicate his distress. He was attempting to find a way to connect with his mother.
The Silenced Child
As I describe in my new book The Silenced Child, the specter of an “ADHD evaluation” conveys a level of certainty that is not consistent with contemporary developmental science. While the constellation of behaviors we call “ADHD” has some known genetic components, there is not a gene for ADHD.
The rapidly growing field of epigenetics shows us that when we can change the environment to decrease the level of stress, as depicted in this vignette by “simply” listening, we have the opportunity to change not only behavior, but gene expression, and so structure and function of the brain.
Michael’s history of “difficult” behavior in infancy suggests that his challenges might have a genetic component. But when we can change the environment, particularly in the early years as the brain is making hundreds of connections per second, we have the opportunity to put development on a healthy path. An abundance of contemporary research in neuroscience, psychoanalysis, and developmental psychology tells us that being curious about the meaning of behavior, rather than simply naming and eliminating it, promotes growth and healing.
Forces in our culture can get in the way of listening for meaning.  The pressure to diagnose in order to “get services” is one such force. As this example demonstrates, the listening itself is the “service” that is needed.  For young children and families, both reassurance and diagnosis of a psychiatric disorder may represent forms of not listening. In contrast, when we alot time for listening with curiosity, free from pressure to either reassure or diagnose, we allow parents to connect with their natural expertise and help get development back on track.
Claudia M. Gold, MD is a pediatrician and writer. She has practiced general and behavioral pediatrics for over 25 years, and currently specializes in early childhood mental health. She is the author of The Silenced Child: From Labels, Medication and Quick-Fix Solutions to Listening, Growth and Lifelong Resilience (Da Capo 2016,) Keeping Your Child in Mind: Overcoming Defiance, Tantrums and Other Everyday Behavior Problems by Seeing the World through Your Child’s Eyes, (Da Capo 2011,) and forthcoming The Developmental Science of Early Childhood: Clinical Applications of Infant Mental Health Concepts from Infancy through Adolescence (Norton, February 2017) She is on the faculty of William James College, University of Massachusetts Infant-Parent Mental Health Program, the Berkshire Psychoanalytic Institute and the Austen Riggs Center. She writes regularly for Psychology Today and her own blog, Child in Mind.