Through my work and in conversations with family and friends, I often hear things like “that’s my ADHD,” “that’s his ODD,” “that’s her autism” with a kind of throwing their arms in the air gesture. As though the diagnosis itself explains it all. Sometimes it can provide some explanation because it’s common of individuals with those diagnoses to have different types of behaviour problems, but sometimes this becomes a scapegoat and catch all explanation for the behaviour – to the individual; to parents and caregivers; to schools and staff; to physicians, and so on.
Psychiatric diagnosis (i.e., psychological disorder) labels are useful for a number of things. The most important reason for a diagnosis is to either get access to treatment and support or access to funding for treatment and support. A diagnosis also helps the individual or significant others in that person’s life to recognize there is a specific set of problems that help is needed for, and to possibly grant them a little lee-way. It also allows for some tolerance and acceptance. Sometimes though, the tolerance and acceptance takes over to such an extent that it becomes the reason the person does everything and it’s all accepted as though it comes along with the diagnosis and there’s nothing that can be done about it.
What is a psychiatric diagnosis really? It is a label that describes a set of behaviours that someone engages in (or lack thereof). It summarizes some things that an individual does or doesn’t do. The set of behaviours described usually falls under a specific category; i.e., disorder. This isn’t necessarily a prognosis or predictor of what the individual will become, how they will behave, or that it will be lifelong. For some it may be lifelong, but for many it may not and it doesn’t have to.
Back to the set of behaviours that make up a diagnosis. These can be considered behaviour problems, either of excess (too much) or deficit (not enough). Behaviour problems are common of individuals with a variety of psychological disorders yes, but guess what? They’re also super common in typically functioning kids, teens, and adults. Are you more likely to experience severe behaviour problems from kids with a psychiatric diagnosis? Probably. Does that mean that you have to accept those problems can’t be changed or are here to stay? The answer is no. Will you ever achieve perfection? Probably not – are any of us capable of perfect behaviour 365? (Not me!)
Behaviour problems are an inappropriate expression of something, most commonly some form of positive reinforcement (like attention whether good attention or bad attention, or access to something the person wants), or some form of escape (like getting away from someone or something they didn’t want to be around or getting out of doing something they didn’t want to do), and occasionally there may be a sensory component (e.g., I find this material on my shirt label really uncomforable, but I don’t have the language to express it, so I might resort to ripping my shirt off or hitting myself or others out of frustration). We call these functions of behaviour. The good news is that we have the technology to test for these types of functions, and when we have a good idea of the function, we can provide effective evidence-based strategies to treat it and turn it around.
Take home points: a disorder or diagnosis sums up a set of problem behaviours someone engages in, and help is available to treat those behaviours.