This September, my four year old son started preschool, and this October, he has stopped preschool. In fact, it ended up being quite a bad experience for everyone involved. Basically, it was a really bad fit between the environment and the child. However, I was really surprised by the response of some people. People have suggested I have my child evaluated, likely leading to a diagnosis, and I cannot believe how often we have been told by well-meaning people that he will likely have to go on medication. I have seen the way some people have changed how they look at him as a result of this experience.
As an OT, I wanted to do everything possible to improve the fit between the child and the environment. The child I saw in the classroom was not the one I was used to seeing at home, and I was shocked at how poorly things had gone. I wanted to try earplugs to reduce auditory defensiveness; I wanted to consult with a private practice pediatric OT; I wanted to try relaxation strategies; I wanted to look into modifying the way some classroom activities are done; I wanted to look into the possibility that hypoglycemia was contributing to the poor behaviour; and many more ideas. Yet I was not given the opportunity - instead I was given papers to fill out for further evaluation that would be looking for a diagnosis, if I wanted to go ahead with it.
It just seems like such a nice easy way for people to avoid having to address the real problems. A label of ADHD or ODD would make it easy to categorize him, and therefore decide that he really will be a "problem child" for basically the rest of his life. Then the teacher will "know" that the problem is with the child and not the environment. A diagnosis would let all of his future teachers know that he will be difficult for them. Given how people can change so much, four seems awfully young to be deciding that he will never be able to handle his anger well. Especially when I know the child and I know the improvements he has made with anger management in other environments.
However, as a health care worker, I have often valued finding out about diagnoses ahead of time. I see people in their homes, and I know I have gone to visit a client with a diagnosis only of depression, only to find out that the person is actively psychotic and has clear borderline personality traits. I definitely wished someone had let me know ahead of time. Also, with a diagnosis, it is easier to access resources to help a person, and to know what some of the common issues are with people with that diagnosis in order to be aware that they may occur. I have often seen with my clients that they feel their concerns are validated when they receive a diagnosis.
As a health care worker, I have also seen the negative impact a diagnosis can have. This seems to be the worst with borderline personality disorder. I used to work with a psychiatrist who did not give personality disorder diagnoses as he felt they were too stigmatizing. I once had a client who abused drugs and had a diagnosis of borderline personality disorder. I had taken her to one of her appointments with her doctor, and had felt the way he interacted with her had been inappropriate, but saw nothing specific to report him on. She later told me he had touched her inappropriately, and she made an official complaint to the College of Physicians and Surgeons. The College promptly sent her papers to sign so they could access her medical records. The same medical records that said she was a drug addict with borderline personality disorder. She did not have a hope of having anyone believe her. However, she was also the perfect target if a doctor wanted to get away with something, because who would believe her?
Diagnoses can be helpful in accessing services and supports, as well as with connecting with others with similar issues. The trouble with diagnoses, is that they do not tend to change and evolve as people change and evolve, and they also tend to make people focus on the negatives, instead of looking for the unique strengths that are inherent in everyone.
I have decided that four is too young to be seeking a lifelong label. However, that does not mean we will not be addressing the issues involved. We will just find environments other than preschool to practice in.