Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder
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A veteran clinical psychologist exposes why doctors, teachers, and parents incorrectly diagnose healthy American children with serious psychiatric conditions.
In recent years there has been an alarming rise in the number of American children and youth assigned a mental health diagnosis. Current data from the Centers for Disease Control reveal a 41 percent increase in rates of ADHD diagnoses over the past decade and a forty-fold spike in bipolar disorder diagnoses. Similarly, diagnoses of autism spectrum disorder, once considered, has increased by 78 percent since 2002.
Dr. Enrico Gnaulati, a clinical psychologist specializing in childhood and adolescent therapy and assessment, has witnessed firsthand the push to diagnose these disorders in youngsters. Drawing both on his own clinical experience and on cutting-edge research, with Back to Normal he has written the definitive account of why our kids are being dramatically overdiagnosed—and how parents and professionals can distinguish between true psychiatric disorders and normal childhood reactions to stressful life situations.
Gnaulati begins with the complex web of factors that have led to our current crisis. These include questionable education and training practices that cloud mental health professionals’ ability to distinguish normal from abnormal behavior in children, monetary incentives favoring prescriptions, check-list diagnosing, and high-stakes testing in schools. We’ve also developed an increasingly casual attitude about labeling kids and putting them on psychiatric drugs.
So how do we differentiate between a child with, say, Asperger’s syndrome and a child who is simply introverted, brainy, and single-minded? As Gnaulati notes, many of the symptoms associated with these disorders are similar to everyday childhood behaviors. In the second half of the book Gnaulati tells detailed stories of wrongly diagnosed kids, providing parents and others with information about the developmental, temperamental, and environmentally driven symptoms that to a casual or untrained eye can mimic a psychiatric disorder. These stories also reveal how nonmedical interventions, whether in the therapist’s office or through changes made at home, can help children.
Back to Normal reminds us of the normalcy of children’s seemingly abnormal behavior. It will give parents of struggling children hope, perspective, and direction. And it will make everyone who deals with children question the changes in our society that have contributed to the astonishing increase in childhood psychiatric diagnoses.
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are we to make of this? Is there a form of “pediatric bipolar disorder” that is not a lifelong condition, but is still quite disabling when it takes hold in mid to late adolescence? This was the conclusion of these scholars. Other experts have formed an entirely new diagnosis for these preteens and teens—temper dysregulation disorder. This new DSM-5 diagnosis is thought to apply to those who have attacks of rage several times a week. The intensity of the rage has to be in excess of what one would
excessive enthusiasm, perhaps? There happen to be very few longitudinal studies of ADHD children from which to draw inferences. However, those that do exist point to ADHD being outgrown in high numbers. One such data set shows 95 percent of people who had ADHD as kids self-report not having it by ages nineteen to twenty-five.6 When parent reports are utilized, instead of those by young adults, the figure slips to 66 percent. This finding was yielded by none other than Dr. Russell Barkley, one of
Kentucky, and Tennessee—it doesn’t necessarily mean that he or she’s in the ADHD red zone. It could mean that the kid is simply academically disaffected. Reenter Marco, the sixth-grade client of mine with good looks and swagger. If only Marco’s litany of complaints about school was new to me: “Why study all those dead guys?”; “I’m not planning on going to Cal Tech, so why do I have to memorize the periodic tables?”; “Where is knowing algebra going to get me in life?”; “I don’t see why I have to
say that when explosive conflict erupts between teens and their parents, it may speak less to mental illness on the part of any family member and more to the stress that everybody is under. PERFECT EMOTIONAL STORMS Brandon’s Rages Brandon is one of those boys with chiseled good looks, poise, and a melodic voice that makes you think of Harry Potter. When I started therapy with him, he was two months shy of his eighteenth birthday. Life with his mother had become, in his words, “a living