“Dyslexic with features of ADHD”, “intellectually deficient”, “severely autistic” and “learning disabled” are labels that the mental health and special education fraternities stamp on children with resolute certainty. But the ramifications of such classifications are seldom questioned. While diagnostic labels do carry merit and can transform a child's life positively, a label is also a cross that the child has to bear. Analysing the pros and cons of labelling can better orient parents and teachers on how to deal with a diagnosis of a child. Just as a label can enable a child to receive appropriate interventions, the potential drawbacks can also be circumvented if parents are aware of the limiting scope of psychological diagnoses.
In many instances, a label imposes order on unfathomable behaviour. Ravi's parents were flummoxed by their son's inability to perform in school as the child seemed bright and even precocious otherwise. From tutors to beatings, from late night coaching to tantalising rewards, his parents had tried everything. Was the child simply lazy, stubborn or stupid? His parents had heated arguments. Finally, when a diagnosis of dyslexia was made, a sense of calm returned to their house. Ravi's reluctance to read for pleasure, his misspellings, his tendency to by-heart his texts, his asking his granny to read aloud to him — suddenly, the child's inexplicable behaviour fell into a coherent pattern. His parents were then able to seek the right kind of remedial instruction and were also able to avail of accommodations on exams.
Likewise, when Amita received a diagnosis of Asperger's Syndrome, her parents were able to connect the disparate dots. In addition to putting a stop to misguided treatments, they felt they understood their child. Her inability to sustain eye contact was not just shyness, her inattention not just naughtiness, her inability to adapt to new routines not just adamancy. The frustration of getting her to make friends and follow instructions now morphed into a positive resolve to provide the best help for their special child. As a result, Amita's parents started handling her issues more maturely. “Before she was diagnosed, I thought she was being plain stubborn,” confessed her mother.
Thus, while labels can help parents understand and deal with a child in more humane ways, a label can also be extremely confining. Even though diagnostic labels are accorded with black-and-white conviction, often psychological and psychiatric diagnoses encompass many shades of grey. Most psychological constructs like attention, intelligence and depression fall on a continuum; thus, a person's dysphoric mood may range from mild sadness to extreme dejection. Every one of us has periods of inattentiveness, bouts of sadness and a feeling of being intellectually compromised. When does ‘normal' inattentiveness turn into ADHD, regular sadness into depression and incompetence into “borderline intellectual capacity”? While clinical diagnoses are typically made on severity, frequency and duration of symptoms, we must remember that the categorical distinctness implied by a label is not set in stone. Moreover, symptoms across disorders often overlap and two disorders may coexist in a person, thus making diagnosis a rather thorny affair.
Second, a label boxes a child within a clinical frame and brings the disability into focus. As sociologist Erving Goffman points out, a person with a label has to be extremely mindful of “minor failings” as all his behaviour is perceived through the lens of his disability. Thus, if a child who is known to be mildly autistic throws a tantrum, his misbehaviour is seen as a manifestation of his autism. However, if his autism is not known to the observer, his tantrum may be viewed as a regular part of growing up.
Focusing on negatives
Labels also highlight a child's deficits without paying any heed to her individual strengths. A child may have ADHD, but can have extraordinary musical talent; a child with Asperger's may be a gifted painter; a dyslexic may be an avid bird-watcher and a slow-learner very compassionate towards pets. A label also ignores environmental features that may exacerbate a problem. A child with ADHD may be inattentive in an academic setting but may be able to sustain focus and build elaborate models while playing with a Lego set. While the label points a finger at the child, it does not brand the context that may exacerbate a child's difficulties.
Moreover, labels tend to perpetuate stereotypes and disregard individual differences. According to psychologists Beatrice Wright and Shane Lopez, “human perception is coerced by the mere act of grouping things together.” While we readily accept that ‘normal' kids can be quite different in terms of their personalities, preferences and proclivities, we tend to assume that all children with a particular clinical tag are alike. However, we do not realise that children are labelled based on a finite number of attributes. Thus, kids with the same label can differ considerably on other dimensions. So while most children with autism have difficulties with communication and social skills, they vary not only in terms of the severity of their deficiencies, but also with regard to their interests, hobbies and intellectual capacities.
Finally, labels are not as neutral as they seem on a clinical report. Parents and children have to cope with the social stigma that sticks like static to clinical labels and the discrimination that results from them. As a society, we Indians tend to be rather unforgiving and categorise people for life. The idea that an individual can change and succeed despite failing early on is not readily embraced by the average Indian. Once a child acquires a label, she has to carry its load on her fragile shoulders for life.
Even the developers of DSM-IV, the Bible of psychiatric classification, emphasise that it is essential to “capture additional information that goes far beyond diagnosis”. As Wright and Lopez point out, when a child receives a label, parents and teachers may try and reduce the child's deficits by providing the child with various interventions. But it is equally important that we pay attention to a child's strengths and nurture them. Furthermore, we need to assess the environments in which children operate and provide as many resources and opportunities so that each child can flourish in unique and different ways.
The author is Director, PRAYATNA, Centre for Educational Assessment & Intervention. She may be reached at: firstname.lastname@example.org.