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Behaviour Management

ADHD, ODD, ADD: Is labelling our children counter-productive?

One of my favourite thought-provoking articles I have read is a research paper by Nardone and Portelli titled When the diagnosis “invents” the illness. It is a fascinating take on the world we live in and how we classify mental disorders. It proposes a move away from the rigid categorisation of disorders and toward viewing problems as dysfunctional systems of perception and interaction.

Its implication for teaching children with social, emotional and behavioural difficulties would be a shift away from trying to fit children into a specific box such as ADHD, ADD, ODD, EBD etc which lead to predetermined strategies and instead focusing on a strategic approach where the problem is viewed on its own very specific merits and interventions are designed to help the student function better in their environment.

The paper makes a great case for this alternative way of thinking. It argues that a diagnosis has the potential to end up causing self-fulfilling prophecy and gives examples where this has been proven.

It gives one extreme example where a patient was admitted to the hospital as a manic depressive and was sedated with tranquillizers. The following day, she was to be moved to an alternative location but refused. The hospital insisted and the patient resisted. As they tried to forcibly move her, she became violent. She screamed. The doctor was called and a further series of injections were used to calm her as every time she woke, she became more violent.

This story may appear unpleasant but perhaps you may think “it was for her own good as she was manically depressed and they wanted to help her.” Your opinion may shift when you discover the police pulled over the ambulance when it was in transit to inform them that they had taken the wrong person. They had been injecting and sedating a “normal” person.

This story blew my mind. The nurses thought she was manically depressed so when she violently protested, they injected her as the diagnosis was there and the behaviour was interpreted as typical of the condition. How is this relevant to the classroom and students with social, emotional and behavioural difficulties? The story above is an extreme example but there are takeaways for us as teachers.

Let’s take for example a student with a diagnosis of attention deficit hyperactivity disorder (ADHD). A teacher who has a student with ADHD in their class may expect certain behaviours. They may expect the child to be disruptive, energetic, and inattentive and may treat them accordingly. The child – if they are aware of the diagnosis – may expect to perform these behaviours too. There is an element of diagnostic prophecy to the condition. 

With this diagnosis, common interventions include behaviour therapy and medication. To pose the question, what if the child has been wrongfully diagnosed and their behaviour was the result of something else and now they are being medicated?

Consider a child who is considered “normal” in your classroom. If a teacher is teaching a lesson and this child is inattentive and disruptive, the teacher might come to different conclusions. The teacher might consider their teaching. Was the child inattentive because the subject matter of the lesson was too difficult? Was the child disruptive because the methodology used was too boring and sedentary? The teacher may change the way they deliver future lessons to try to increase their engagement.

Is it possible that medically categorising our students at a young age might not be the correct way to go? Potentially. If a child with a diagnosis behaves a certain way, it can be accepted as part of their diagnosis. If a child without a diagnosis behaves a certain way, it may be more likely considered as communication.

I would not suggest throwing out all forms of diagnoses in schools, but I would be slower to label children in primary school and treat them a certain way because of their diagnosis. Thinking strategically (as discussed in previous articles) is a way to steer away from pigeon-holing our children and helping them to function more effectively in the classroom. The teacher can observe the problem behaviour specific to its characteristics and context and attempt to intervene to help the child function better in the classroom or wherever the problem may be. Having a diverse range of strategies, interventions and supports available is key to this way of thinking. 

I think this ideology is incredibly thought-provoking, how about you?