Absurdly mild mental "illness", USA cultural thing?

In My Humble Opinion
21

Schizoid PD can develop as a result of Asperger’s, so it is not outside of the realm of possibility that I have both. And really, when I hear people describe their experience with Asperger’s, I do think of myself. A whole lot more than I’m willing to admit. So I’m not going to say I’m not deluding myself sometimes. I very well could be.

But I will say this: I got my diagnosis while getting help with depression. I guess one could argue that if there had been “early intervention” during my childhood, I wouldn’t have become a depressed young adult, and I’d have a more “normal” life now. But I can easily imagine how having that label so early in my life would have given me an excuse not to do all the things I have done (going to college and graduate school, leaping out of helicopters, moving across the country, etc.). Sometimes you live up to the label you are given, for good and for bad. People who are labeled “smart” act “smart”. People who are labeled “lazy” act “lazy”. Maybe monstro would have fulfilled all the prophesies and predictions embedded in the word “schizoid” if it had been given to her in adolescence rather than in her 30s. Maybe now that she has that label, she isn’t as “free” as she’d be without it. Who knows?

When I was in grad school, I went to the school’s health clinic because my clumsiness was concerning me. I was tired of bumping into file cabinets (the bruises were getting crazy) and I was just curious if there was something that could be done to help me. The doctor who examined me gave me a routine exam and afterwards told me she thought I had mild cerebral palsy. I was all WTF!? Then I told her there’s no way that could be true. Could she not see how ginormous my calves were? They had gotten that way because I had just finished biking up and down the entire island of Manhattan the previous weekend. In her notes she wrote, “Patient has managed to adapt surprisingly well despite her limitations…” After I read that, I was like, “If I’m adapting so well, then I don’t really need to find out what’s wrong with me, right?” And I still don’t know the answer to this question. But I do think there’s something to be said for not knowing what your limitations are.

As I said, if the kid is having emotional difficulties, the mother should by all means get him some help. But who she describes sounds like an eccentric kid with introverted qualities, entering a time in his development that is difficult for every kid. There’s not enough information in her post to merit concern that he’s even at risk for developing anything. Let alone to diagnose him as autistic.

22

It wasn’t.

23

Inner Stickler, apologies. Miscommunication!

Monstro, of course nobody can diagnose anybody over the internet, but the details in the mother’s post strongly suggest Asperger’s Syndrome to me. There is a lot of anxiety about labels, but they do serve an important purpose, which is to get necessary services. This boy sounds extremely high functioning in all areas except social. A diagnosis could help his parents get him into a free social skills group.

24

And that’s what grates, I guess. Socially inept children are plentiful. It bothers me that because some of them have a suite of traits that arbitrarily qualify them as “special-needs”, they are suddenly eligible for rapid-response Rescue 911 treatment. But the ones who don’t fulfill any DSM-IV diagnosis, your typical “goofy” or “dorky” kid, are not eligible for any special help. They end up showing up on a therapist’s doorstep in the 20s or 30s with suicide marks on their arms. But it’s too late for free Rescue 911 for them. At that point, they better have good insurance. Or just suck it up.

That probably sounds more whiny and sour-grapey than I intend. But it still underscores my displeasure with all the “labeling”. A system that ties special services and resources to labels incentivizes labeling, deservedly or not. How could you not have overdiagnosis under such circumstances? If people care about socialization so much, why not target kids who exhibit marked socially ineptness, rather than those who have varying degrees of socially ineptness and also happen to meet other criteria that similarly may or may not be hampering their lives? I’m all for helping people who exhibit actual problems. I’m less for labeling people just because they “fit a profile.”

25

When I was about 13 or 14 in the early 80s, I was a shy underachiever. My parents had divorced when I was 12. I wasn’t getting great grades.

The school sent me for some sort of testing involving a school division psychologist.

The psychologist labelled me as having a “learning disorder”.

My mother latched on to this crutch. I wasn’t underachieving, I had a learning disorder.

Over the years, this became my mother’s mantra when it came to my educational and career development. I achieved whatever I achieved despite my “disability”.

From time to time, I voiced a displeasure at this label. I countered that I was an awkward and lazy teenager with all of his mental faculties in order. To which I was patted on the arm and told it was ok.

Through my post-secondary education and graduation from university, my mother thought I was doing remarkably well for someone with a learning disorder.

Time and life went on.

When I was 35, I was working in a middle management position with aspirations of advancing in the industry. Grandma died and the family fully gathered together for the first time in years. As one does, my life and career were topics of discussion between me and my seldom seen aunts and uncles, some of whom are well connected individuals in a similar industry to my own. My mother was part of one such conversation. She proudly chimed in that I’d done quite well despite my learning disorder.

I was horrified. So much for the idea of networking with potentially great allies. My mother had unintentionally put a stop to that.

I stewed on this for a couple of days and then called my mother and tore a strip off of her. The message was that if she must view me as having limited learning potential, she was to keep it to herself. I sternly insisted that I did not agree with it; that I felt she had inadvertently sabotaged a networking discussion and that I was not going to let a 30 year old primary school 2 day assessment define me in any way. I got my point across that day, but it hurt me and my mother to have to have that conversation. I don’t know if mom still sees me as her learning disabled son, but she won’t be discussing it out loud anymore.

Labels are dangerous things. They may innocently become self-fulfilling prophecies and crutches excusing one from achieving or behaving in a responsible and accountable manner. The idea that one might be going through a childhood or adolescent stage may be just that - something that will be outgrown in time.

Don’t do this to your kid.

26

The US Constitution guarantees every American the right to their own personal disability. I forget which amendment says that. But clearly, all disorders are of equal import.

27

I completely agree that the system incentivizes labeling and leads to overdiagnosis. The problem with targeting “social ineptness” rather than “kids with autism” for intervention is: how do you define “social ineptness” and where is the line? We already have a system in place for diagnosis of autism and the acceptable treatments for it.

What you’re suggesting is actually very interesting because it corresponds with a new trend in special education called RTI (Response to Intervention). RTI consists of multiple education tiers based on normative criteria. The first tier is general education. If a child isn’t meeting his grade-level norms in reading for example, he might be moved to the second tier, where he would receive small group intervention. If he doesn’t respond to that treatment, he would be moved to the third tier, where he would receive more intensive, individualized intervention. RTI avoids using labels such as “dyslexia,” and rather places students according to the level of intervention needed to have them work at grade level. RTI can also be used for behavior interventions, and doesn’t focus on labels such as “emotionally disturbed.”

This would be interesting to implement for social skills, but there are so many things you need in place first. You need criteria for what are acceptable, grade-appropriate social skills. You need to create goals for the student according to those standardized criteria, which would probably entail an IEP. You need (and this is the biggest step) to get the whole school district on board with the RTI framework. Frankly, it would be easier and faster just to take the kid to a psychologist, get an Asperger’s diagnose, and place him in a social skills group once a week.

28

Isn’t there a condition called something like “Defiant Child Syndrome”?
This is what used to be called "juvenile delinquint?.The psychiatric industry thrives on identifying new syndromes, illnesses, etc.
Is a whiney brat mentally ill, or just a whiney brat?

29

As with a lot of people in these sorts of threads, you agree that helping kids that suffer from these sorts of issues is likely a good thing. But you want to use your own criteria rather than the criteria being used by the hypothetical school or doctors’ office in question. I also question the difference that you seem to be drawing between “exhibiting actual problems” and “fitting a profile.” Most of the items in the profiles for diagnosable syndromes are, in fact, actual problems. A kid that likes to play on his own a lot: Fine. A kid that only ever plays on his own and has demonstrated that he is completely incapable of playing with other kids, and who is additionally incapable of even participating in group activities in the classroom because his social functioning is so low: Not fine. And yet in that kid’s case, you will still have well-meaning people saying that he is “just being a boy” and doesn’t need special coddling or treatment, even when his school performance is clearly suffering and at age 8 he still cannot even tell you the names of any of the other children in his class, some of whom he has known since preschool.

Yeah, that second kid in this hypothetical scenario is my kid. And the therapies and assistance he got from his school after his supposedly ridiculous and unnecessary diagnosis have helped turn him into a child that is able to actually function and succeed in the classroom.

These threads tend to be filled with suppositions and misinformation that are nowhere near based on facts. People seem to assume that a diagnosis of Asperger’s syndrome involves nothing more than a parent saying, “You know, my kid seems to be a bit of a loner.” In our case, it was two years of evaluations done by his teachers, principal, special ed instructor, primary care pediatrician, pediatric psychologist, with a small amount of input from his dad and me. And the symptoms were significantly more than just “he likes to play on his own.”

As for the argument that “if you label a child he will never have any incentive to succeed!” Well, I disagree with that even just on its face, but would additionally point out that for some kids, if you don’t label them, they will never have the ability to succeed.

Sometimes I feel that there is an element of vindictiveness or… I don’t know, jealousy? in people who criticize diagnosis of children’s problems like this. It’s like, “Hey, I had problems when I was a kid and I just dealt with it and nobody helped me! So where do kids today get off thinking they deserve all this help for their problems?”

Anyway, this topic hits a bit close to home for me, for obvious reasons.

30

I don’t know how I would define social ineptness. The mother doesn’t describe it either. She just says the boy doesn’t have friends. But he also doesn’t seemed bothered by this. He likes being different, she says.

I also notice that she doesn’t say he is teased or bullied. Or that he is overly talkative or self-absorbed or a discipline problem. These would be hallmarks of social ineptness just as much, if not more, than lack of friends. Either they are there and she innocently forgot to mention them, or they don’t and she is doing some selective perceiving.

A definition of social ineptness, IMHO, should have a component of dissatisfaction or personal unhappiness to it. It may surprise people, but some introverts actually like not having friends or complicated lives. This makes them abnormal, no doubt, but does this make them disordered? Pathological? Would these people even be helped by social skills training?

After re-reading that mother’s description, I’m thinking her son fits more of schizoid character than an AS profile. I openly admit to being biased about that, with no apologies! Of course, I doubt if she knows about SPD, she’d be as eager to run that up the flag pole with a doctor. No doubt for the reason you just laid out, Pyper. Her kid wouldn’t be eligible for special services with that diagnosis. Even though schizoid children are vulnerable to all the things that AS kids are and then some, one group is “special” but the other group is not. Anyone who argues this is fair is smoking crack.

31

You may be thinking of Oppositional Defiant Disorder. Conduct Disorder more fits with juvenile delinquent, since illegal activities are a necessary part of the definition.

32

Hey, if a kid is obviously suffering, MsWhatsit, I really do not have a problem with getting him EVERY SINGLE THING IN THE WORLD to help him not suffer. I hope you believe me when I say this. I like you a lot, and I would hate to think I’m now your enemy or something.

I just disagree that labels are the things that should make getting help easier. I don’t think parents should have to send their kids to specialists to get them the services that they need. I don’t think people should have to examine behaviors under a microscope (does he have a tic? or is that hand thingy he does a stim? is she just quiet? or does she have a language disorder? does he just really like Sesame Street? or is he obsessed with Sesame Street?) to be able to answer the fundamental question, “DOES THIS KID NEED HELP?”

The kid in the OP’s link may or may not need help. The mother apparently thinks so, and she’s in the best position to answer the question. I obviously don’t think there’s enough information to think, “OMG! GET THAT BABY SOME HELP!” But like you, I am also biased. If the kid doesn’t seem disturbed that he doesn’t have friends, I don’t see why everyone else should be freaked out about it. If he did seem bothered about it or if the mother saw that he had a blindspot about how his behavior was affecting other people, of course I’d say he should get help.

I’m obviously not anti-label, because in my second post I recommended the mother take the kid to a doctor to see if he should be “labeled” as depressed or anxious. I’m not anti-label, but I am anti-“giving labels more importance than they deserve”. The thing about being labeled with AS is that this highly functional, pretty normal-sounding little boy will be lumped in with kids who are more severely handicapped and in more need of special services than he is. What does this do to him? What does this do to the kids who need special services but can’t get them because they don’t hit all the magical criteria? Why should people have to get pinned with a label to get some help? That’s fucked up. I don’t care what anyone thinks.

I know everyone knows of a kid who is severely handicapped and who actually fits the AS profile very well. I don’t deny the realness of AS or autism, and I am on record defending all kinds of neurological weirdness on this board. But this thread isn’t about kids who are obviously handicapped. It’s about a straight-A student who is doing well in band class and shows no signs of personal unwellness. Why doesn’t such a case deserve scrutiny? Seems to me people who actually have a dog in this fight would advocate skepticism, if only to keep resources directed at kids who need them the most.

Sorry for the rambly, but I personally do not like being accused of being insensitive to something that I’m actually sensitive about.

33

There are also limited resources. Start with the kids that have obvious problems. A little socially inept and has trouble focusing in class some of the time is a world of difference from limited speech, unable to focus on a school task without 1:1 therapist directing them, reading several years behind their peers, unable to write letters, obviously unable to be in a mainstream class, etc. (My daughter fits the later with additional challenges.)

Someone like the Mom in the OP. She reads the signs of Aspergers checklist, and is worried about little Johnny. There’s enough in her post to suggest she does get a formal test done and see if and where he might fall on the spectrum. If nothing else to rule it out and get a comfort level that her child is at least neuro-typical.

34

Some people are jerks, some people are not jerks. What does that prove?

35

As a teacher, I am so conflicted on this stuff. In no particular order:

  1. Sometimes labels can be really helpful. Understanding what is going on can guide you in how best to deal with it: as MR diagnosis have gone down and autism diagnosis have increased, it seems quite possible that for years we were lumping autistic children of normal intelligence in with MR kids and they certainly weren’t best served there.

  2. But some labels are really meaningless, such as “learning disability”. A learning disability is a demonstrated gap of 30 IQ points in a specific area. It suggests nothing about why or how that gap exists. So a kid who is a genius at everything but math, where he is merely average, has a disability and needs special help, but a kid with an IQ of 85, who is “slow” across the board isn’t entitled to anything.

3.5) But some kids really do have learning disabilities and can learn ten times more effectively if the traditional school structure is shifted a bit–and why shouldn’t it be? It’s all arbitrary anyway.

  1. Autistic kids can often thrive with the right support, so identifying and supporting them early is essential.

  2. But I swear to fucking god, there exists a sort of parent who has a weird need to have a special needs child and they positively lust after the ASD diagnosis. It fits some deep need they have to be a martyr, to keep their child more dependent than others, and to be utterly blameless about the results of their parenting. But if they can’t get ASD/Asperger’s. they will cheerfully haul their kids from doctor to doctor until they get something. It’s like some weird meta-tiger mom thing: the only acceptable alternative to a perfect kid is a tragic victim kid. When people hear about all these kids doctor shopping to get extra time on the ACT they think it’s basic corruption, but in my experience it’s worse than that: it’s like “I can’t believe Johnny’s only in the 89% percentile. He must have something wrong with him! Doctor shop until we find someone to confirm it!”. It’d be healthier for the kids if it were naked corruption.

  3. There’s also more garden-variety abuse of the system,but less than people think.

So I dunno. We need special ed services. We help a lot of kids that would have ended up living in a basement as a non-functional weird uncle in generations past. But it’s not a perfect system by any means, and it creates its own problems.

36

Dude, if someone needs counseling, see one, and the therapist will know how to play the game. The reason that “adjustment disorder” is such a common diagnosis is that it’s basically completely innocuous (as in, it’s not something that the insurance company will generally use against you later), it’s very broad (it can cover grieving, stress from work, stress from any interpersonal conflict, and basically any life situation that you are having trouble “adjusting” to, which could mean virtually anything) and is very commonly used as the catch-all for “well, I have to give the insurance company a diagnosis so I can bill them, even if I haven’t talked to them long enough to figure it out, even if it’s not meaningful to what the client actually needs, which is between me and the client anyway.” Officially I had a diagnosis of adjustment disorder, which was true if not particularly precise. My course of treatment was tailored for the diagnoses we didn’t discuss with the insurance company as well, however. If someone needs counseling because they’re not fitting in at school – well, they’re having trouble adjusting to the school environment, yeah? (I think the use of adjustment disorder as a catch-all has been discussed on the boards before, too.)

Also, the Mom in that Asperger’s thread could have been describing me as a kid. All being “smart but slow” meant was that my intelligence was more geared toward the visual/spacial and verbal/linguistic forms of intelligence, and less so towards math and numbers (but I’m willing to bet she’s not noticing these distinctions). I guess being smart and shy and expressing interests and imagination that are not exact conforming copies to the popular kids is now considered a defect by adults, too. Good gravy. It was bad enough when it was just the kids who thought “different is bad.” Does no one grow up anymore? Oh no… he’s really great at being a musician!!one1eleventy

Side note – The trend of self-diagnosing complex neurological conditions drives me up the wall. If someone asserts “I have undiagnosed Aspergers” I don’t believe them. If it’s really affecting your life, why on earth wouldn’t you talk to someone qualified to diagnose it?

37

Sorry monstro, I didn’t mean to be accusatory. I’m just talking on the Internet here, there’s no hard feelings. :slight_smile:

On topic, I will agree entirely that there is likely a lot of overdiagnosis going on out there, and I’ve run into the weird “my kid DEFINITELY HAS TO HAVE SOMETHING WRONG WITH HIM DAMMIT” people that Manda JO described also.

As far as labeling goes, I guess I share some of your concerns but not to the same extent. I have barely mentioned to my kid that he has this thing called “Asperger’s Syndrome.” He knows that he gets certain accommodations at school that not every kid gets, but on the other hand there are a lot of kids there that get accommodations that he doesn’t get (speech services or “occupational therapy” which is what they call fine/large motor assistance, etc.) so it isn’t like he feels he’s some kind of ostracized child with this big blinking label on his head separating him from everyone else. At least in our district, schools have changed a lot since I was a kid and getting services of one sort or another doesn’t seem to carry nearly as much stigma as it used to.

As far as not needing to send kids to specialists to get them needed services, unfortunately I think that’s a necessary evil of a system in which there are limited resources available. It would be great if there were enough teachers, aides, special ed instructors, school psychologists, etc., so that every kid could get assistance for any level of problem. But there aren’t, so we have to prioritize, and the way we do it is by saying, okay, we’re going to provide services for kids that have a diagnosable problem. Is that the best way? Maybe not. But I don’t think it’s the worst way either.

38

I guess it comes down to how much one believes that diagnosis and treatment is based on research that results in a better outcome for the child or not.

Yes you will find individuals who didnt do better. Yes there will be people over-diagnosing their child or selves. Yes some conditions are less serious than others.

But all of these are true of pretty much any medical issue. And yes there are conditions that turn out to be mistreated or not treated as well as they could have been. And sometimes conditions are identified that are not supported by future research.

The OP at the end of the day makes no case that I can see.

Otara

39

Yeah, when I first heard about Oppositional Defiant Disorder, my first thought was ‘so it’s brattiness, but with an excuse’. But my husband works with kids and has had one with ODD, and he says it’s not the same thing. This kid genuinely couldn’t help going against absolutely everything he was asked to do, everything the group was doing, etc.

This is one of the problems: most of these disorders are, or at least present as, magnified versions of normal behaviour. A certain amount of brattiness is within normal parameters and can be dealt with by normal child-raising; multiply it by a thousand and you’ve got a disorder that your average parent just isn’t equipped to cope with. But, because the behaviours are the same in type if not in magnitude, it’s very easy for people (including me) either to dismiss the disorder as silly pathologisation of normal variations, or to get silly and pathologise normal variations.

40

:slight_smile:

No hard feelings either.

Re overdiagnosis, I remember wondering in another thread how one could possibly distinguish overdiagnosis from a real epidemic. I think it was the last “ADD isn’t real” thread. People kept saying how there are too many people with ADD, as if there’s a quota for how many people with ADD are born every year. Like we can never go over some pre-determined limit.

I have no idea if ASD is overdiagnosed. I know no one in real life that has been diagnosed with it, so it doesn’t seem like that many people have it to me. I just hear about it all the time. Especially on NPR. And maybe there is some irrational hatin’ going on when I hear people like that “Asperger’s in love” couple, capitalizing on problems it did not seem they even suffered from. It’s like, “How dare they call themselves ‘special’ when they are faring better than lots of people who aren’t ‘special’?” But their specialness or lack thereof is not my problem, so it doesn’t matter.