Syndrome society: Stop normalising mental illness and labelling children as disordered, says top psychologist

The psychologist works with some of Scotland’s most high-risk and vulnerable children, many of whom have committed serious violent or sexual crimes, but also works with less high-risk children referred to NHS mental health services.

She said the rise in diagnoses can impact waiting times for Child and Adolescent Mental Health Services (CAHMS) and availability of appointments for those with legitimate and severe psychiatric illnesses such as schizophrenia or psychosis.

Her comments have sparked a debate among child health experts, with some arguing that not enough children are being diagnosed with certain conditions, specifically ADHD and dyslexia, while others who are suicidal and in desperate need of help are also falling through the gaps.

Experts on the other side of the debate have previously gone so far as to argue that ADHD and dyslexia simply do not exist, or have become so broadly defined that children can be labelled with the conditions too easily.

Johnstone said: “Many people will experience symptoms of anxiety and depression consequent to common life events such as stress, exams, relationship breakdown, loss, grief and change.

“Anxiety and sadness are normal and adaptive reactions to certain events, and it is important that normal emotional reactions are seen in that way and not defined as mental illness or mental health disturbance.”

Johnstone added: “With increasing awareness of mental health issues – which is undoubtedly a very positive shift – runs the risk of net-widening.

“We shouldn’t normalise mental illness – we can only normalise emotional health and mental wellbeing. If we blur the boundaries too much, we run the risk of reducing access to specialist services for those who need intensive and complex care packages and I would be concerned that as opposed to increasing our understanding, it may have the opposite effect.

“To suffer from a serious mental disorder is incredibly challenging and debilitating. We mustn’t lose sight of that.”

At the same time, she argues, parents are not adequately equipped to know how best to help their child, leading to young people being labelled mentally ill and referred to specialist services when they don’t necessarily need them.

She added: “We need to build emotional resilience ... and there should be considerable emphasis on normalising difficult emotions.

“For example, the process of grieving a loved one can be incredibly difficult, distressing and long-lasting and typically involves many shifting and intense emotions. This does not need a mental health diagnosis or treatment. We need to prepare our children to cope and be resilient.”

In Scotland, the number of young people under the age of 19 receiving antidepressants has almost doubled between 2010 and 2018, while those receiving anti-anxiety and hypnotic medication has risen by 180% in the same time period.

Children being given additional support for dyslexia according to the Government’s pupil census data has also soared by 152% in the last eight years, while young people under the age of 19 receiving ADHD prescriptions has risen by 61%.

While official guidelines and experts agree that medication should not be the first port of call, and should be used with other services, evidence shows that more children are being given drugs without the extra therapy or interventions they need.

A Scottish ADHD Coalition survey published last year reported that of 217 parents of children with a diagnosis of ADHD, 93% said their child had been given medication, adding that “in most cases this was down to parental choice”.

The survey found that only 36% of parents had been offered any parental training to help them manage their child’s condition, and fewer than 25% had been offered an ADHD-specific training programme.

Bill Colley, acting chairman of the Scottish ADHD Coalition and an independent educational consultant, said parents play a “critical role” in managing any diagnosis, but he did not agree that many children are being diagnosed incorrectly.

He said: “Parents have a critical role to play but they can only do so if they are informed and supported. The clinician doing the diagnosis often doesn’t have much time to sit down with the parent or the child to explain what, for example, ADHD means. There is a huge gap in services providing parents support, to help them become what I call ‘ultra parents’ to support some of these very challenging kids.”

Colley said he did not believe the rise in the number of children being diagnosed with conditions was a result of any parental desire to explain challenging behaviour or academic failings, adding: “You get stories that parents and families claim children have ADHD to get benefits or to explain challenging behaviour. The evidence doesn’t support that.

“Certainly in terms of ADHD, we are [diagnosing] about one in four or one in five of the children who we would think have ADHD, according to the prevalence information we have. It suggests we are under-diagnosing.

“If you look at children who have autism, ADHD or dyslexia, you will find huge differences although they have the same label. They will be completely different and require completely different levels of support.

“When we’re talking about emotional difficulties, it is pretty clear that we are not always picking up where we need to.

“We are not good, for example, at picking up on young people and young men in particular who are suicidal. There is a huge amount of work to be done around that.

“Diagnostic labels can appear very clumsy at times but it doesn’t mean they are not of benefit.”

Not all professionals would agree, however. In America, where roughly 7% of children are on some form of stimulant medication such as Ritalin or Adderall for ADHD, a growing number of psychiatrists have started discussing whether ADHD and dyslexia actually exist.

Robert Berezin, a Massachusetts psychiatrist and former Harvard professor, wrote a controversial article for Psychology Today, entitled “No, There Is no Such Thing as ADHD”.

He wrote: “All of these children need to be properly evaluated to understand what they need. It might be help for the family. It might be a more open classroom. It might be to help teachers be better teachers. But one thing is for sure: There is no brain condition that generates some disease called ADHD, and none has ever been demonstrated.”

Sami Timimi, consultant child psychiatrist at Lincolnshire NHS Trust, is another who has previously stated similar views around ADHD, arguing that there is “no robust evidence to demonstrate that what we call ADHD correlates with any known biological or neurological abnormality”.

Elaine Lockhart, chair of the Royal College of Psychiatrists in Scotland Child and Adolescent Faculty, said that she would be “very wary” of saying that dyslexia and ADHD are over-used, adding: “I know many adults who went through education who found out later they had dyslexia and they just struggled through. If you have ADHD that is not recognised and treated, we know children can fail at school, they struggle with friendships, home life is difficult. If we look at adults in prisons, they have a very high incidence of ADHD and neurodevelopmental disorders.”

Lockhart worked on the Scottish Government’s CAHMS Taskforce along with a number of other experts to examine how better to support children and families.

She explained: “There is work going on at the moment, trying to address that gap. It’s about helping children and young people to be resilient, helping them cope with life and giving them ways of supporting each other.

“What a lot of children and young people need to do is take a break from the screens, get out into the fresh air, make sure they are eating properly and sleeping enough. If you are really distressed by something and it’s on social media, that is going to make life harder, but that’s not depression as a psychiatric disorder.

“There is no doubt we are seeing more young people, especially girls, who have extreme unhappiness with their bodies, with how they look, who are recognised as having anxiety and depression who are needing specialist help. It’s a full spectrum.

“Maybe at times people are using these names of anxiety and depression as a way to access help. They are looking for something but it may not be they need a response from a mental health service.”