Diagnostic Labels – when do they help?
I have been listening to the “Body Keeps the Score” book over the Christmas period and very much enjoying the insights and evidence from its author – Bessel Van Der Kolk. What is wonderful about current psychology books is that many are written by authors with extensive experience in their fields – in many cases going back 40-50 years.?
One of the chapters in the “Body Keeps the Score” book covers diagnosis and whether it benefits people who have experienced any form of trauma but especially those who have experienced significant and frequent trauma or Adverse Childhood Experiences. The conclusion of the author is that such diagnosis (for example labelling someone with borderline personality disorder, or ASD or ADHD) only benefits if it contribute to the individual’s understanding of themselves relative to their trauma experiences.?
This conclusion reminded me of a young person that attended an NMT Construction Skills course some years ago. I'll call him Liam.?He was a “looked after” child and he had been moved to Aylesbury for his own benefit because he had become “mixed up” with the wrong crowd in his hometown. He asked me to attend a meeting that was focused on his ADHD medication and what further medical support was to be provided (if any).? This was attended by his psychiatrist, care worker, support worker, youth justice worker, Liam and me.? He remarked at one point that he must be a real problem to need so many people to support him.? I then commented, perhaps they believe in you vs see you as a problem.? He looked at me with a puzzled look and said, “do you think that could be the case?”.? I suggested he asked the various people himself, and he is he did just that.? What did he find out? That each person supporting him was doing so because they genuinely believed in him and even though they felt they had reinforced this to him, until he asked the question himself, he had not taken this onboard, he thought he was a problem that needed to be controlled.?
During the meeting his ADHD medication was discussed, and it was agreed that he would continue to receive the same dose because his behaviour was less impulsive and variable.? I then asked a question, “has there been any thought as to how Liam can learn to manage, control, harness his natural behaviours, free from medication?”? The silence around the room gave me the answer.? But Liam showed a strong interest in wanting to do just that – learn how to live without medication.?
This experience taught me a lot, we are quick to label and in so doing believe that we both understand the problem (because we have labelled it) and have solved 90% of any issues that the problem causes.?For anyone to get support they need to be diagnosed with some form of condition or disorder, but the actual diagnosis is often a best guess at the time and given a specific context.? Bessel Van Der Kolk’s experience with the people he treated for trauma showed that they had received, on average, 6-7 different (and most often competing) diagnosis before they got referred to him?? And, why did they get referred to him? Because he had the tools, methods, approaches, techniques to actually help them with their day-to-day struggles – put simply he knew what to do.?
If we are to diagnose then we also need to enable the individual involved to fully understand what the label (diagnosis) means to them in their everyday life.? In my experience over the last ten years, this enabling to make sense does not happen.? The individual is left with one route – medication.?
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When I had more direct contact time with young people and their parents/carers it always interested me when they shared the label their son or daughter had been assigned.?The two most frequent labels were ADHD and ASD.? Yet, their interest in the label seemed to stop at the point of it being applied.?This did not apply to all cases, but it did in the majority and especially where the young person did NOT have an Education Health Care Plan (EHCP).? From my perspective the label did not seem to benefit the young person themselves, it may have given a part explanation for poor achievement throughout secondary education but little else.? The young person still needed to figure out how they could progress from their current position (often no achievement at all and limited perceived prospects) to earning their own living.???
That is why it is NMT’s mission to enable young people to progress towards earning their own living.?There is not higher initial purpose, earning one’s own living is the baseline achievement – not achievement at school.???
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Marketing Manager at New Meaning Training - passionate about improving outcomes for young people who didn't do well at school.
2 个月I am so split on this. The trend used to be that labels were harmful and would hold you back if one was applied. I also used to think that if a child is coping and progressing then what's the point or need for a label. In this new era of better understanding and more dialogue about neurodiversity, I have been inclined to change my mind and think that labels help to explain difference and provide insight that helps a child or young person to navigate the world with better tools. But then, there's still the issue of "what then?". I know of young people who wear their label(s) and see it as justification for not making progress. It's so difficult to know whether it is worth pursuing a diagnosis, especially when the young person has passed the point where they might get help through an EHCP. Jury is out. Some young people need labels and some don't. All need good self awareness and agency. Many need support. Everyone needs to be offered reasonable adjustment rather than judgement.