"We are suffering . . . from a shrinking tolerance for the broad limits of normality," says. Dr. Stanley Turecki, author of "The Difficult Child" and a practicing psychiatrist in New York and Massachusetts.
For such parents as Katie, that shrinking tolerance seems to have seeped into places like her daughter's Girl Scout troop as well as her own extended family, where her daughter's belligerent challenges of strangers and unpredictable episodes of fearfulness have long been a source of critical commentary. They have even seeped into Katie's heart.
"I find myself saying, 'Geez, this is not normal,' " she says. But she's equally unsure that her daughter's perplexing behavior rises to the level of mental illness. "Are people," she wonders, "just haphazardly sticking labels on kids?"
--
Definitions remain fuzzy
There once was a time when a pocketful of well-worn adjectives, accompanied by a shrug, would have been sufficient to describe American kids at the outer reaches of normal: shy, spirited, combative, dreamy, sensitive, fretful -- even odd. All were qualities a child might readily grow out of with guidance or a few years to mature.
The descriptors for such youthful outliers have undergone a linguistic overhaul in recent years, says Ross W. Greene of Harvard Medical School's department of psychiatry. Increasingly, talk of temperamental extremes or social skills that need to be taught or strengthened has given way to the assignment of disorders, deficits and dysfunctions. Nowadays, a kid whose behavior is problematic has to have something -- a diagnosis -- which energizes school administrators, absolves parents of guilt and too often, Greene says, dictates medicating the child with powerful drugs.
In at least four in 10 cases, according to data from the Centers for Disease Control and Prevention, parents who seek professional help for their troubled children come away with at least one prescription medication.
These diagnoses suggest clear evidence that a malfunction of the brain is the cause of the problematic behavior. But despite dramatic advances in neuroscience, that presumption still cannot be verified by a blood test or brain scan. Mental-health professionals instead must base their diagnoses on the presence of a certain number of symptoms, and on a judgment -- by teachers, parents and the professional evaluator -- that the problem behaviors impair a child's ability to function.
