Most doctors who treat children have become worried about increasing childhood mental health and developmental diagnoses. The causes are probably many but blaming an increase in the stresses of modern life should not accepted without question. We may be inadvertently training our children to fail in coping with everyday life.

Today, many parents present upon the recommendation of the school, claiming their child needs support, with the parents asked to ‘get a diagnosis’. Needing support is a euphemism, meaning the child has either behavioural or academic problems, or both, and the school’s attempts at control and/or remediation have been unsuccessful.

Dr David Roberts, Paediatrician

Dr David Roberts, Paediatrician

The school’s funding is performance based, KPIs are affected, and its resources threatened. Having a medical cause shifts responsibility for the solution from education to health. The school can claim to be discharging its responsibilities and, in ‘getting a diagnosis’, the school receives more education system funding.

Remediation of academic problems is the core business of teachers not doctors, although some conditions such as Inattentive ADHD can play a part. Referrals from teachers usually do not detail what’s wrong, what’s been tried, and why it hasn’t worked. Teachers also seem unmindful of how seriously most parents view a trial of medication.

School-led action

Management of behavioural problems is the core business of psychologists, not doctors. However, Hyperactive ADHD can be implicated. Paediatricians are called upon to make judgements and, as such, we operate in a space which intersects with other professionals, who may align themselves with the school’s agenda. The schools are a referral source.

A second problem stems from poor education sector policy settings. Positive Behaviour Support (PBS) is the behavioural system now mandated in WA public and private schools, the disability and child protection sectors.

As an offshoot of Applied Behavioural Analysis (ABA), the technique which has revolutionised autism treatment, PBS’s origins were sound. However, it has always been a part of the Non-Aversive Movement, which prohibits the use of aversive consequences (i.e. punishment) in behaviour management.

Thus, PBS’s principal tools are limited to rewards and antecedent manipulations (eliminating behavioural triggers).The literature of Behaviourism characterises PBS as a fad not a science. This is what has introduced a filter through which research findings and effective treatment alternatives must pass, and whereby it references ‘current thinking’ as its authority.

Teachers are prohibited from using aversive methods (ie punishments), which can be just as effective, less resource intensive and quicker in effect. The teacher’s time, energy and focus are being wasted, to the detriment of the whole class, including the misbehaving child. The classroom is disrupted further because well-behaved children see the misbehaving child not punished but rewarded for bad behaviour, and they copy that behaviour in the hope of receiving the same reward; called vicarious reinforcement.

Another influence causing over-diagnosis of mental health problems in childhood is our readiness to invoke threats to attachment as a cause of behavioural problems. Attachment Theory is a valid construct, but an attachment disorder requires erosion of, not merely the threat to, the child’s confidence in the security of attachment

Attachment Theory holds that threats must accumulate to become clinically significant. Risk rarely comes in single packages, and adversity is normal. The protective Resilience System appears to have sufficient redundancy to sustain good development in all children, not just those resilient by nature. Resilient children do not appear to possess unique qualities. In the face of a threat, a resilience response sets up (and doesn’t exclude) the opportunity for success.

Competence in early childhood is most dependent on secure attachment, and self-regulation. The association between self-regulation and authoritative parenting is very strong.

The work of Dianna Baumrind in the 1960s overturned the originally Freudian view that the child interprets the imposition of boundaries as a withdrawal of love and acceptance. Baumrind proposed that it is incorrect to interpret parenting along a single continuum from democratic to authoritarian.

Rather, parenting style is better described along two continua: responsiveness and demandingness. According to Baumrind authoritative parents are responsive to their child’s emotional needs, while simultaneously holding high (age-appropriate) expectations of their child’s behaviour.

The behavioural or academic problems children now present with reflect their psycho-social context as much as their individual natures. The process of assessment should consider both.

Key messages

  • Funding policy encourages labelling of children
  • Behavioural policy is PC not science-based
  • Children are by nature resilient

References available on request.

Questions? Contact the editor.

Author competing interests: nil relevant disclosures.

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