A protest resounds in many schools: “Please stop stigmatizing children with so many diagnoses! That only serves to medicalize and sell more medicines.” It is a protest expressed by some parents, indeed, but also by some educators.
In just a few years, the prevalence of attention deficit hyperactivity disorder (ADHD), dyslexia or the high-performance autism spectrum, among other neurodevelopmental disorders, has increased. And a quite logical question arises: are we pathologizing normality? Are we victims of a mercantilist strategy?
A big step for equal opportunities
The answer is no. There will always be misdiagnoses or misdiagnoses, but overall we are seeing a big step forward. Perhaps the best way to perceive it is to see what happens when we deny the evidence!
Take this real case as an example. Kindergarten boy, three years old. A special education teacher perceives behavior of social inhibition: she does not look into the eyes, she does not play symbolic games, she does not point her finger at toys… The teacher believes that she may have an autistic disorder, but the rest of her colleagues do not consent to a specialized evaluation . “He is too young to carry that stigma,” she says.
Result: loss of time to develop effective educational strategies with scientific evidence. It is also a missed opportunity to request a support professional for the next course, help to which that child was entitled.
This case raises another no less reflection: a teacher trained in learning disorders may be capable of suspecting this and other problems. We can leave the definitive diagnosis to the pediatrician or the clinical psychologist, but perhaps over the years that professor has a very good semiological perspective (especially if he educates her) and less experienced colleagues should pay attention to him.
Teachers can perform a very important task, since an early diagnosis improves the prognosis and social inclusion of almost all those affected. The plasticity of the brain has some “windows” of age that we must take advantage of.
This case has the virtue of indicating the answer to the question with which we began the article: it is not that there are more children with ADHD, dyslexia or autism, simply now we pay more attention to them and we know how to diagnose it more rigorously.
Fortunately, society has advanced and is advancing towards a more understanding attitude towards diversity, be it in ways of living, sexual inclinations or neurodiversity.
This approach should also be a public policy concern. Neurodevelopmental disorders should be taken into account with specific educational plans, since they can represent between 11% and 15% of the student body.
A full life
Does the person who diagnoses stigmatize? A simple answer could be: stigmatize those who do not know the relativity of a diagnosis and see the negative part without seeing the positive.
Consider the case of dyslexia, which is generally accompanied by compensating strengths. They are intelligent children who also have a remarkable ability to orient themselves in space. Many overcome the problem with strategies of their own making.
This disorder has not only not deprived them of a fulfilling life, but has enhanced metacognition strategies that will serve them for other challenges. But a percentage will not be able to overcome it with their own strategies: for these, it will be key to be diagnosed and supported. And unfortunately, here comes the social class bias and the type of family the child has.
It is a mistake to think that a diagnosis defines a person. We don’t diagnose for that: we do it to define what is general and generalizable that happens in a person. Therefore, a diagnosis is always a reduction and simplification necessary to activate therapeutic plans or social assistance. But it is always necessary to apply clinical guidelines and protocols taking into account the patient’s environment and their characteristics.
In conclusion: a good educator, a good pediatrician, a good family doctor, nurse, psychologist or social worker share the same goal, to lay the foundations for a full life for each person. Knowing neurodiversity in depth offers each child –and perhaps, in the future, each adult– the possibility of re-educating capacities to better adapt to their environment, to their interpersonal relationships and, thus, reduce inequality of opportunities.
Vicente Morales Hidalgo, pediatrician and member of the Grup de Disorders de l’Aprenentatge of the Societat Catalana de Pediatria, has collaborated in the preparation of this article.