[Reader-list] Relieving our children of labels

[Chintan Girish Modi]

>From http://www.thehindu.com/arts/magazine/article881892.ece
A rose is a rose is a flowerBy ARUNA SANKARANARAYANAN

“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.

*Helpful diagnosis*

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.

*Never neutral*

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: arunasankara at gmail.com*