Daily Mail column by psych - overdiagnosis to excuse parents

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ASPartOfMe
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09 Feb 2018, 1:54 am

DR MIKE SHOOTER: Yes, some children suffer terribly. But I fear many parents want them to be labelled autistic... just to excuse their own failings

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One of my former trainees, now an experienced consultant child psychiatrist, shocked me with an admission recently: ‘You will never believe how things have changed,’ he said.

‘I’d say 75 per cent of the kids I see have either got ADHD or they are on the autistic spectrum.’

There was no doubt in his mind about this, but I saw things a different way. ‘Surely not,’ I told him. ‘What’s really going on is that you have chosen to diagnose them as that.’

Let me make one thing clear: I do not doubt the existence of autism spectrum disorder and ADHD (Attention Deficit Hyperactivity Disorder, to give it its full name). Actually, I am convinced we have underdiagnosed these hugely debilitating conditions in the past.

But, very often, the children I see with these diagnoses plainly have not got these conditions at all. Instead, they happen to be troublesome children reacting to awful situations in their families.
To put it bluntly, they are heartily sick of being tossed around on a sea of adult wishes. But, instead of being listened to, they get labelled with a disorder. These incorrect diagnoses are deeply damaging. Yet, I am one of the very few child specialists who are fighting against this trend.
So why is this chilling over-labelling of the nation’s children taking place? First and foremost, it is my view that some parents love a diagnosis. It lets them off the hook because it means their child’s behaviour is not their problem or their fault. They do not have to address their own role in their children’s unhappiness.

Secondly, a behavioural diagnosis on a child is seen by many as some kind of badge of honour. For example, a diagnosis of Asperger’s Syndrome — a condition on the higher functioning end of the autism spectrum that is often linked to super-cognitive function — is something you’ll find many parents boasting about.

A behavioural diagnosis on a child is seen by many as some kind of badge of honour
Dr Mike Shooter

The parents can talk about it in the pub as a recognisable condition they have seen and heard about on TV. This is a condition, they say, not a distressed child. ‘Oh, I’ve heard of that,’ their companions will inevitably say. ‘Perhaps our Johnny has that, too.’

In some cases boasting of these diagnoses can be a middle-class parent’s way of dodging responsibility for how their child has turned out. I won’t be popular for saying it, but a diagnosis can be a guaranteed way of reducing the stigma of their child’s awful and embarrassing behaviour among family, friends and teachers.

I have seen many genuine examples of children with autism, and salute the loving parents who work tirelessly to help their children.

For while the majority of my fellow child psychiatrists prefer to consult patients from behind the safety of a desk, a white coat and a stethoscope, I saw the vast majority of kids and families out in their communities, where I could learn how their lives work.

So how could he have ADHD? Could there be a much more straightforward explanation — not a medical one, but simply that the boy’s bad school behaviour was driven by stress at home, where his parents worked long hours in professional jobs?

My approach to the subject of over-diagnoses comes from my own deeply personal experience. I have long suffered from recurrent depression.

I know it is rooted in relationship troubles within my own family — largely from my emotionally distant father who so disapproved of my approach to life

Meanwhile, the vast majority of modern psychiatrists and doctors are forced to consider behavioural diagnoses such as ADHD and autism because it enables them to be seen to do something, and offer some resolution, and they can do it speedily from behind their desks.

Their working environment leaves no choice but to offer diagnoses because their jobs are measured in terms of data rather than human distress — as ‘client throughput’ and numbers of diagnoses — and the time they have to spend with ‘patients’ is so limited. As a society, we seem to have forgotten that children are by nature inconvenient, especially if they demand things, question things and are difficult in the school classroom

It is not a matter of chucking money at the current NHS system so that we have a slightly shorter waiting list for the psychiatrist at their desk. We have to create a very different service.

You can try to keep difficult behaviour at bay by wearing a white coat, but you won’t get far. Working with children and families has taught me that we are all vulnerable to acting out our fears and weaknesses. We need to address that as people, as a society, and as a health service.

It’s the human condition – and it does not need a medical label.


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MrsPeel
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09 Feb 2018, 6:16 pm

Read this straight after another post about the horrible situation for autistics in France, which sets this into perspective.
So, no. No, no, no, no.
Let's not go back to the psychoanalysis route and blame parents for the behaviour of their autistic kids.

The moral of this story is: if you think your child has autism, go to a psychologist or neurologist, not a psychiatrist.



B19
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09 Feb 2018, 7:22 pm

That piece made me think about the obvious sense of personal affront that the Wrights so publicised - how dare a grandchild of theirs - theirs! - be on the spectrum, and all the damage they went on to do, which has ongoing effect. They chose to stigmatise a whole group of people, in order to assuage their own affront. The damage they managed to do is a major lesson in dehumanisation and disability, of which they made themselves leading proponents. And they were proud of doing so. It spoke - to me - more about them than their target population.



smudgedhorizon
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09 Feb 2018, 7:33 pm

I wish I had some sort of a clever remark to make, and I would if I knew what you're talking about. For now, just gonna thank ASPartOfMe for all the endeavors! You're educating me :D


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09 Feb 2018, 7:52 pm

The context is referencing Autism Speaks, founded by Suzanne (now deceased) Wright and her husband Bob Wright, who were affronted to find themselves grandparents of an AS grandchild. I can understand your confusion if you are unaware of the history and politics of Autism Speaks, and why a significant part of the Autism community have issues with that organisation, it's ethos, it's agenda, and terrible smear campaigns they have conducted over the years, like the "I Am Autism" video they sponsored (for a time) that was as hateful as this kind of thing can get.

Google can elaborate if you want to learn more about these issues.



ASPartOfMe
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09 Feb 2018, 7:56 pm

As I first started to read this I wanted to hate this person for bieng another person calling us lazy excuse makers but as I read this a few times I came to realize the he is saying on some levels some of what I have opined.

He specifically says autism is real. And that even though he thinks a lot of kids who are being diagnosed as Autistic are not autistic he is saying they have real problems through no fault of their own.

I have been writing against the push for very early diagnosing. I do not agree with him it is just the human condition, it should have a label maybe “helicopter parented stress disorder”


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09 Feb 2018, 8:11 pm

I hear you.

It was this part of that article that I 100% agree with:


It is not a matter of chucking money at the current NHS system so that we have a slightly shorter waiting list for the psychiatrist at their desk. We have to create a very different service.


Different parents react in different ways to the possibility of AS in a child. It depends a lot on their level of knowledge and level of ignorance. People can't be blamed for their ignorance unless it becomes a wilful ignorance. We were all ignorant re AS at some stage, even those of us on the spectrum.

What I object to most strongly is organisations and companies and specialities/professions and snake oil merchants that seek to exploit, manipulate and profit from that ignorance, and work to reinforce the stigmatisation so relentlessly. There's a lot about the "autism treatment professions" that isn't very professional it seems to me, not objective, not divorced from self interest, not well informed, and not interested in listening to, or learning from, AS people. We have a lot to teach them, when they become willing to learn, to listen, to see a much bigger picture than their narrow conceptualisations. Until that happens, AS people are a much exploited population; things will change as time goes by, though it's not clear at the moment whether the change is going to be for better or worse. It is time for fresh thinking, and that at least is what the article writer attempted to do.



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09 Feb 2018, 10:06 pm

I have no problem with the concept of a more holistic way of dealing with kids who have issues - involving their parents, teachers and so on. But denying children an autism diagnosis because of a feeling it is over-diagnosed, or because one has been trained in psychoanalysis, or because one can see the parental input into one's own depression, is more likely to do harm than good.

It is through having the diagnosis that both the child's and the parents' issues are able to be addressed, and without it, nobody is going to lift a finger to help any of them. Just as with depression, one has to be recognised as having a mood disorder before it can be addressed.

Yes, maybe the whole 'treatment' regime needs to be less about medicating the child and more about addressing their parental/environmental situation, and maybe the system is wrong in that sense. By all means, try to improve the treatment regime, but please don't deny the autism.



MrsPeel
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09 Feb 2018, 10:12 pm

This other thread illustrates the problem:

viewtopic.php?t=360102



Sofisol612
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10 Feb 2018, 8:03 am

I agree that the family and environmental factors should be considered when evaluating a child with difficult behaviors, and that medication should not be the only treatment for mental illnesses or neurological disorders. However, blaming the parents when there is no reason to suspect any kind of abuse towards the child is, in my opinion, completely wrong. Assessing children in natural settings could help get more accurate diagnoses, as the article claims. But I wouldn’t be so quick to dismiss most children with ASD and ADHD diagnoses as being “just human children whose parents want their failures to be excused”. Most actually diagnosed children have significant problems both at school and at home, and many parents hate to medicate their children, and they wouldn’t do it with the sole purpose of excusing embarrassing behavior.


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ASPartOfMe
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10 Feb 2018, 11:54 am

Sofisol612 wrote:
I agree that the family and environmental factors should be considered when evaluating a child with difficult behaviors, and that medication should not be the only treatment for mental illnesses or neurological disorders. However, blaming the parents when there is no reason to suspect any kind of abuse towards the child is, in my opinion, completely wrong. Assessing children in natural settings could help get more accurate diagnoses, as the article claims. But I wouldn’t be so quick to dismiss most children with ASD and ADHD diagnoses as being “just human children whose parents want their failures to be excused”. Most actually diagnosed children have significant problems both at school and at home, and many parents hate to medicate their children, and they wouldn’t do it with the sole purpose of excusing embarrassing behavior.


He is not saying the parents are physically or verbally abusing them. If he does think that he needs to report them to authorities. Labeling sometimes does make people think about what can not be done instead of what can be, I see it on this forum all the time. I sense he against current trends of the the helicoptor, selfie, show off my kid on the net parent generation and if that is the case I agree with him. The extreme early disgnosis push is wrong, it does not take into account kids NT and autistic alike mature and that toddler traits are similar to autistic ones.

We pathologize normal human variation too much.

I would be rich if I got paid every time a parent came here in a panic their kid might be autistic because they missed a few markers, did not look at them when spoken too as much as they thought they should. Most of the time they end up saying the kid seems happy, then what is the problem?

There are obvious cases and children in real distress, we are not talking about that.


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10 Feb 2018, 12:23 pm

Because there is no way a child could have a condition and also be unhappy due to external circumstances. Its got to be either a disorder or bad/lacking/neglectful parenting of some kind...certainly not a mix of both. :roll: I don't doubt misdiagnoses can happen and a child unhappy due to their situation could be misdiagnosed having a disorder. But on the other side of that if its just decided that the kids problem is their parents and/or home situation then it might be overlooked that they maybe do have an underlying issue as well.

Like I remember for a while my mom agreed to babysit this kid after school for a while, and he did not behave very well at all. I think it is very likely he had some kind of a disorder, but also his parents seemed like total push overs and like they refused to set any boundaries or even talk to their kid about his behavior...just excused it all due to his 'disorder'. So I'd say in that case it was a case of a real underlying issue, and parents who couldn't be bothered to address it and help provide some structure for him, just left him endlessly frustrated and acting out.


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13 Feb 2018, 1:57 am

From what I gather Dr. Shooter is a prominent psychiatrist and his opinion is getting a lot of publicity in the UK. A rebuttle from an Autism parent was published in the Independent.
According to a celebrity psychiatrist, autism is a 'badge of honour' for some parents. In a way, he's right

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ne thing I’ve sadly come to learn is that while not everyone understands my beautiful, blue-eyed boy’s condition, some people add to the social misconceptions that shamefully still exist around ASD. But it usually comes from an online troll or someone from an older generation who enjoys peddling the myth that autism “didn’t exist” in their day and is merely an excuse from parents who can’t control their kids. It doesn’t usually come in the form of comments from a distinguished child psychiatrist like Dr Mike Shooter, who has worked with young people for more than 40 years.

And yet today I found myself shouting at the television today while he gave what I consider to be an inflammatory and offensive interview on This Morning. In several recent interviews to publicise his new book, he has claimed that autism is not only “vastly over-diagnosed” but also a convenient way out for parents who refuse to accept the responsibility of their child’s behaviour – and I have watched on in jaw-dropping horror.

Amazingly, however, there is one line that I agree with him on – although it’s in an entirely different context from the one that he intended. Rory’s autism is a “badge of honour” for me, but not because it’s a label I can peddle out time and again to explain or excuse his behaviour.

In fact, not just my husband Geoff and I, but also our daughter Immy, our extended families and our wonderful friends all embrace Rory’s autism. None of us would change a single hair on his head because to do so would be to alter who my son is, and at just four years old he is a truly remarkable and incredibly brave human being who brings joy and laughter into everyone lucky enough to know him.

I celebrate my little boy’s ASD because it’s quite simply an integral part of him – but ask me if I’d like to make life a little easier for him, and of course the answer would be yes.

Since Rory’s diagnosis, I have learned the hard way that you have to fight tooth and nail for the help and support your child is entitled to. Almost a year on from beginning the process to get his EHCP (educational health care plan) in place, and six months on from starting to try to navigate the journey to find the right school setting for him, I know only too well how bloody tough the day-to-day life of being the parent of a child with additional needs really is.

Simply getting a diagnosis of autism for a child can prove ridiculously difficult, and I speak as someone who has fortunately spent the past two decades asking awkward questions for a living as part of my job as a journalist.

I’ve come across numerous parents who have spent years fighting to get a diagnosis, and copious tales of children who can’t get one because of reasons such as they are “coping OK” at school – despite clear evidence to the contrary.

Yes, more young people may now be diagnosed with ASD, but this is only because awareness in society is growing and not because “troublesome children” are being wrongly labelled when in fact the cause is “awful situations” in their home life.

I’d encourage Dr Shooter to walk for a day in the shoes of a parent of a child with autism, and then reflect on some of his theories. Views like his do nothing to reduce the social stigma that can still surround spectrum conditions in this country


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“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman