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No Child Left Undiagnosed

Parts of this article are taken directly from an article of the same name published by Allen Frances, M.D. Dr. Frances is the author of Saving Normal and a professor emeritus of Duke University School of Medicine’s department of psychiatry.  He was also the chair of the Diagnostic and Statistical Manual of Mental Disorders-IV task force.

It is a topic so important and so relevant that I wanted to share it with as many people as possible. Childhood touches all of us in some way. Whether you have children of your own or have nieces, nephews or cousins, everyone knows a child. There are many who work with children in some way, shape or form. This article eloquently describes the phenomenon of overdiagnosing and turning childhood behavior into a disease.

From my background and standpoint, I see children diagnosed all the time who are behaving in predictable and normal ways given their circumstances. Bad or disruptive behavior in relation to inconsistent discipline, anxiety and attention problems in response to family upheaval and depression due to the same. Choosing to medicate these and label the child with a disorder follows them the rest of their lives, especially if that label indicates mental illness. The child who believes he or she is mentally ill feels differently about themselves than the child who is told they are having a normal reaction to what is going on in their lives and that it can be worked on.

Dr. Frances starts by saying:

” Unless we soon come to our senses, the United States may indeed become a dystopia of overdiagnosed mental illness, starting with early childhood.  Already one in five adults takes psychotropic medication on a daily basis; one in four of us has qualified for a psychiatric diagnosis in the last year; and half of us will have been diagnosed with a mental disorder at some point in our lifetime.”

“The statistics for children and teenagers are even more alarming: A recent study found that by age 21, 81 percent of American kids could be labeled with a mental disorder-if they are evaluated often enough and with sufficient diagnostic ardor.”

In the past 20 years, the rate of attention deficit hyperactivity disorder (ADHD) diagnoses has tripled-11 percent of all kids in this country now have a diagnosis of ADHD and 6 percent are on daily medication for it. This is particularly extreme among teenage boys-one in five diagnosed, one in 10 medicated. Diagnoses of developmental disorders and childhood bipolar disorder have increased 40-fold over the same time period.

Dr. Frances states that we are turning childhood into a disease.

He attributes it to “wild and unwarranted diagnoses of normal childhood behavior”. He quotes a study conducted of 1 million Canadian children where the best predictor of an eventual diagnosis of ADHD was a child’s birthday-the youngest boy in the class was almost twice as likely as the oldest to be diagnosed. What boils down to perfectly normal or appropriate developmental immaturity is being labeled as a mental disorder and treated with unnecessary, expensive and potentially harmful pills.

The short-term side effects of ADHD medication can include anxiety, insomnia, reduced appetite, weight loss, stunted growth and increased blood pressure. But no one really knows the long-term impact on development of these medications. The medications for mood disorders such as bipolar disorder also come with the potential for heavy side effects including breast development in boys, lethargy, interfering with learning and weight gain.

ADHD can be a helpful diagnosis when made carefully, for the 3 percent of children whose impairment-abnormal levels of hyperactivity, impulsivity, and difficulty focusing attention is significant enough to require treatment. ADHD can be a harmful diagnosis, however, when applied carelessly to normal active kids who will likely fare better if left alone and taught appropriate self-regulation. I would also like to take this a step further and also apply it to those children suffering from emotional difficulties due to circumstances beyond their control.

Dr. Frances further attributes the problem to the drug industry, stating that the “pharmaceutical industry has played a role in this epidemic. In 1997, its lobbying brought it permission to advertise directly to consumers, a practice allowed only in the United States and New Zealand.”

He states that the results of this are a sector delivering $10 billion in annual sales and thousands of children taking medication they probably don’t need. Thirty percent of college kids and ten percent of high school students now reportedly use ADHD drugs for recreation or classroom performance enhancement, buying them on campus through illegal means. The drugs are readily available due to what Dr. Frances calls careless prescribing.

The article’s closing statement on this topic is that “In any rational world, we would do our best to restrict ADHD diagnosis and to use medication only as a last resort when other interventions have failed and impairment remains substantial.”

I don’t think that anyone disagrees that parents with difficult children need help dealing with disruptive behavior. This is a topic that gets many riled up, feeling they are being blamed for their children’s problems. There is no blame to attribute here, the point is doing what is best for the child. Many well meaning parents go from doctor to doctor to try and get help. Unfortunately they will eventually find the doctor who will diagnosis something, almost making it a relief to the parents to finally have a name or a reason for the child’s behavior problems.

We are not born with a parenting manual and those who have experienced less than ideal childhoods or come from dysfunctional families often make many unintentional parenting mistakes. Sometimes they don’t have realistic expectations for children’s development. Sometimes they are being urged by teachers or others to get the child medicated. Sometimes the very way that they communicate with the child causes anxiety or depression that manifests itself as bad behavior. Dysfunctional thought patterns often interfere with our ability to assess situations accurately and find true answers to problems in our life.

Until all other possible reasons for bad behavior or learning problems in a child have been examined, I believe it is a mistake to label and medicate. The possible consequences to the child, both emotional and physical, are too great.

My advice to parents when seeking help for their child is to look first for emotional problems such as anxiety and depression stemming from issues at home or school. The symptoms of these can look just like ADHD. Second, rule out inconsistency on your part or your spouses that may lead to confusion, anger and rebellion. This is often seen in divorce situations or where one parent disciplines differently from the other.

If you feel that you may have dysfunctional thought patterns that interfere with your child’s wellbeing or your ability to parent effectively, come to and utilize our free resource:

How to Break Free from 12 Dysfunctional Thought Patterns … and a handy chart to help you track your progress

If you would like Dr. Sherman to speak to your parenting group, organization or school, please contact her at


Photo by martha_chapa95