• There's no doubt that modern life presents immense challenges for children, and rates of mental distress in young people seem to reflect this

  • But, asks psychotherapist Louis Weinstock, are diagnoses are always helpful?

  • If you need support for your child, you can contact a therapist here

Back in 2010, I ran a therapeutic school for kids with complex trauma. Sam was one of our most brilliant and most challenging students. Bright-eyed and freckle-faced, when he first arrived at the school aged 13 he bounded straight up to me and gave me a high-five before running past me up the stairs drumming his hands against the walls and singing out loud. He was funny, loving, cheeky as hell, and full of energy. Sam had been diagnosed with ADHD when he was younger and had been heavily medicated for many years. Because of his wild energy, he had been kicked out of every other school. We were the last chance saloon.

One day, I was reading through his case notes and discovered something that shocked me. Sam had been given his diagnosis of ADHD after neighbours found him crawling on the roof of his house. He was just three years old. Unfortunately, nobody picked up at that time that Sam’s dad was a violent drug dealer and his mum was a chronic alcoholic. In truth, Sam’s wild energy was a deeply intelligent, resilient response to a horrible situation. If you grew up in that environment, you too would find it hard to sit still and concentrate. You too would want to crawl onto the roof. But the ADHD diagnosis and the medication covered up the intelligence of his symptoms.

Sam grew up thinking there was something deeply wrong with him.

Imagine going to the dentist with toothache from an infected root and, instead of doing a root canal surgery, the dentist gives you some painkillers and sends you on your not-so-merry way. This is how most child mental health problems are treated today. We focus almost exclusively on surface-level, quick fixes for children’s minds instead of getting to the root of the problem.

Our children’s mental health has been getting consistently worse for the past decade: since 2010, there have been substantial increases in rates of adolescent depression, anxiety, self-harm, and suicide, not just in the UK, but around the world. Instead of questioning the root causes of this crisis, we are handing out labels and pills like candy. In the past five years, there has been a 40 per cent rise in antidepressants prescribed for children in the UK, while in the US, one in ten children are now diagnosed with ADHD and the number of children taking Ritalin (a powerful amphetamine-like drug) is growing all over the world. Autism diagnoses are on the rise too: in the US in 2009, 1 in 91 children had autism. By 2017, the rates of autism had risen to 1 in 40 children. If these rates continue, then by 2041, 1 in 10 children will have autism.

This does not mean that all diagnoses are bad. Nor does it mean that taking medication for mental health problems is bad. A diagnosis can help a parent or child feel less shame and open the door for extra support and funding. And psychiatric medication can help someone to get through a difficult time. But the story behind this approach says that mental health problems are primarily a function of faulty brain chemistry. This is what Sam grew up to believe. This story says the ‘madness’ is to be found within the individual child, excluding the possibility that the ‘madness’ may be better diagnosed in the world the child is born into. With this story, could we be gaslighting a whole generation of kids?

I have recently worked with a number of families where the school has suggested their child has ADHD and needs to get assessed. I ask the family if the symptoms change in different environments. They tell me that the symptoms disappear outside the school environment. This is not surprising to me. We know for example that ADHD and Autism are more commonly diagnosed in urban environments where we live separate from the seasons and cycles of nature, and ADHD diagnoses are about two times higher in the most deprived areas. In a 2019 US study, a 20-minute walk in a park improved children’s ADHD symptoms as effectively as taking a dose of prescription stimulant medication. 

So has the child got a faulty brain, or is that particular environment not right for them? This is a hugely important question for parents to grapple with. If your child gets a diagnosis, that label usually sticks with them for life. And they may well end up taking powerful psychoactive medications, for life. 

The spread of mental health labels has been exacerbated by social media. On Tik-Tok, #adhd hashtag stands at over 30 billion views. Millions of young people are seeing videos like this that encourage them to label themselves. In 2021, doctors at Great Ormond St Hospital had to release a statement about the rise in children seeking a diagnosis of Tourette's after watching Tiktok videos: “These sites appear to have exploded in popularity; for example, the site TikTok #tourettes has 2.5 billion views, having approximately doubled in viewing in the last month (January–February 2021). Some teenage girls report increased consumption of such videos prior to symptom onset, while others have posted videos and information about their movements and sounds on social media sites. They report that they gain peer support, recognition and a sense of belonging from this exposure. This attention and support may be inadvertently reinforcing and maintaining symptoms.”

Unlike chicken pox or a broken leg, you can’t see mental illness. This doesn’t mean mental illness isn’t real. It does mean that there is a greater level of subjectivity both in how we interpret our inner signals and how the world around us conditions us to interpret those signals. Imagine you are a young person who hates school and your parents have just been through a messy separation. You feel sad, really sad. And then you watch a Tiktok video that tells you  about the ‘Five Signs You Have Depression’. This information lands direct into your nervous system, and you then carry this awareness with you like an oversensitive smoke alarm going off every time you have a thought or a feeling that isn’t happy or ‘normal’..

So, what can we do about it? 

First, we have to think critically about these labels. People often think that psychiatric diagnoses are very scientific, but in fact they are often decided upon by vote, as Thomas Insel, the president of the National Institute for Mental Health (NIMH), the largest funding body for mental health research globally, says: “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” 

Second, we have to consider other factors that may be affecting our children’s minds. Are their symptoms a sign of unresolved grief or trauma? Are they in the wrong environment? It should be standard practice to exhaust all other options before finally settling on a psychiatric diagnosis.

Third, it can really help to reduce suffering by seeing our children’s symptoms as potentially intelligent. What if our children’s symptoms might be trying to communicate something vital to us; what if they were unconscious attempts to heal conflicts in the world around them? (and be prepared, the ‘world’ might include you!). Here are some questions that can help you tune into this level of awareness:

  • What blind spot in our family or in the world might my child’s ‘undesirable’ behaviours be shining a light on?

  • How might their emotions or behaviours be an attempt to regain some power in a situation where they feel powerless?

  • How can I help them express this in a healthier way? (It may be just listening to them, or finding someone else to listen to them, or helping them to write or draw it out. You know what works best for your child.)

  • What’s one simple thing I can do to help improve the environment in which my child is growing?

And finally, whether your child needs a label or not, please remember that they are so much more than that label. Their brains are not broken. They are beautiful, unique, divine expressions of life that can only flourish when in the right environment (hint: not inside a box). 

Louis Weinstock is the author of How the World is Making Our Children Mad and What to do About It

Further reading

5 ways adults can support children with behavioural needs

The mental health toll of silences in families

How can we teach our children healthy boundaries?

How to help your daughter keep her confidence through puberty

How to manage feeling guilty as a parent