Behavioral Disorder or Not?
Updated: Aug 25, 2021
All too often a parent comes into my office and wants an evaluation for a disorder for their child who suffers from anger and impulsive issues.
They may very well have a disruptive, impulsive-control, or conduct disorder, and I can diagnose them with these disorders. Still, the danger of putting diagnostic labels on behavior conditions is that parents often go home with a feeling of satisfaction. They knew all along there was something wrong with their child. They are strong-willed, and now they have a diagnostic answer for their behavior. The underlying premise is that they mistakenly believe that the label is put on their child because of some intrinsic pathological disability underlying all their conduct. Because of this, much of the behavior that needs to be addressed fails to get addressed. Instead, it gets dismissed or excused, or as it often does, it gets medicated, and while medication may be an option for some the behavior still needs to be dealt with.
There may be some vulnerability that stems from a biological or heredity to these behaviors. But few psychologists or therapists would argue they are the direct and only cause. There are many, many factors, and this is where a good therapist can help. It may be a combination of temperament, neurological functioning, trauma, attention deficit, attributional biases, socialization, and environmental factors. In fact, most children who are susceptible to conduct disorder are those both with a biological vulnerability for aggressive behavior as well as difficulty in controlling and managing negative affect (Ingram & Price, 2010). It has also been shown that cognitive restructuring can change the biochemical makeup in your brain. Thus changing any of the "intrinsic" mechanisms to behavioral disorders.
A further point; it is important to note that disruptive, impulsive-control and conduct disorders are not the cause of the behavior; any more than umbrellas are the cause of rain. It is simply a name we have put on a common set of behaviors deemed disruptive by our culture and a psychological board. It is not like in the medical field where you have a diagnosis such as high cholesterol (lipid disorder), leading to heart disease or diabetes.
I am not the only one who feels this way about disorders. Many therapists and therapeutic modalities have gone away from a diagnostic view of behavior, or even personality (we'll save that for another post). That is not to say there is some benefit to putting diagnostic labels on behavior. It makes it easier to research the best therapy methods (if we are all calling disorders by the same thing). It can help us develop a greater understanding of the common risk factors that may serve as mechanisms in developing a disorder. It can also help us, therapists, be on a lookout for some of the more sinister comorbid disorders and how to mitigate for them in therapy sessions.
Disorder or not, the behavior at hand still needs to be addressed. And I must reemphasize, the disorder itself is not an excuse for the behavior. This needs to be clear for the parent who needs more confidence in themselves and help becoming more consistent in disciplining any of the negative behaviors that may arise. I have parents who come to me, thinking there is something seriously wrong with their child. Their adoptive child had fetal alcohol syndrome and traces of other drugs in their system at birth. They want me to fix him! Well yes, he has past trauma that stems all the way back to the womb, but he behaves for his teachers, other adults and authority figures. And he behaves when things are going his way.
Sometimes child therapy involves the therapist helping the parent look inside themselves and what they can do better. That is hard task to do without offending the parent or making them feel worse than they already are. My job is to convince them they already have the necessary tools to help their child and how to utilize them better.
Ingram, Rick E., and Joseph M. Price. Vulnerability to psychopathology. 2nd ed., Guilford, 2010.
Odell Terrell is a mental health counselor in Greensboro, NC. He graduated with a MS in Counseling from Divine Mercy University in Arlington, VA, and places an emphasis on working with spiritual integration, adults and adolescents, trauma, family and children, and grief and loss. Odell received his undergraduate degree from the University of St. Leo's in St. Leo Florida, with a degree in Psychology. He has spent his last 15 years working in the field of emergency services. It is in working with people in emergency situations, both patients and first responders, that Odell has learned how to deal respectively with people in crises mode, helping instill a sense of hope and healing. Odell is happily married, for 17 years, and is the father of 9 children and brings a wealth of knowledge and experience to his family and child therapy practice.