Question: A well-known educator recently spoke out strongly against "labeling" a child. Even if a child has a mental health issue and is receiving services, we must make sure he/she is not labeled. The remark struck a chord with me as 2 of my children are currently in therapy one for behavioral issues and one for anxiety. While the idea of not labeling a child sounds nice in theory, I am not sure how to put it in practice. At the end of the day my son knows he has behavior issues and that they are serious enough for him to require help. He does have a reputation as a trouble maker - that's the reason he is in therapy in the first place. My daughter knows she has anxiety and part of the work with her therapist is giving a name to the problem and her starting to realize when something is part of her anxiety vs something "real". Can you please share your thoughts on the issue of "labeling" and child and how it can be avoided?


I am not sure who this educator is and what exactly he said, but overall, I certainly agree. Generally speaking, labeling is not advised. There are some merits to diagnosis, which I will share later, but it is usually not recommended to share this with the child. Standard diagnostic labels such as ADHD, ASD, LD, ODD, OCD, GAD, etc. may not be accurate and may not be helpful. 


Possible problems with labels including the following. First, people may come to see only the diagnosis and not the person. The ADHD or LD tends to follow the person around and educators and peers tend to overfocus on that. Second, our labeling is based on an all-or-nothing categorical system, which may not be correct.  In a categorical system, a person is viewed as either having a specific disorder or not, depending on decisions made about the threshold set for diagnosis. However, the reality is that such problems are more dimensional in nature. This means that symptoms are present to some degree in many people and the central question is how much. It becomes more of a problem that warrants treatment based on severity and interference. An additional problem with labeling is that it can lead to a self-fulfilling prophecy as well as stigma. Carrying a label can make the person feel inadequate and different and can also change how others see this person.    


 Based on the above, many propose the utilization of a functional classification system.  The central focus underlying this is on "what can this child do?" rather than "what does this child have?". This approach involves two fundamental premises. First, everyone has struggles and nisyonos in life--this is normal. Second, instead of putting a diagnostic label on the person, we focus on the specific area of weakness that this person struggles with. Examples of these functional domains can include social skills, executive functioning, emotion regulation, verbal communication, self-regulation, or literacy. The overall message is that we all need to work on becoming better and improving our skills. One person may need to work on social skills, a second person on emotion regulation, and a third on concentration and executive functioning skills. The bottom line is the focus is not on a pathologizing label, but rather on the areas that the person needs to work on, while normalizing the need to do this work. 


That being said, there can be some advantages to diagnostic labeling. Professionals use diagnostic labels. This is an effective way for them to communicate with each other; it allows for a common language to refer to certain types of people in a shorthand and efficient manner. It also aids in research, which ultimately leads to better treatment. In addition, it helps for insurance reimbursement. Aside from professionals, diagnostic labels can be effective for some parents. Having a name for a condition can help the parents acquire knowledge and take better action for the situation.  For example, diagnosing a child with autism can help parents do research to understand the core condition. This then helps change the way they view the behaviors from bizarre and badly behaved to different but (more or less) well-behaved.  For some children especially with severe struggles, it also can be helpful to label and externalize the issue. For example, some children may benefit from understanding things like "this wasn't me doing that, it was my ADHD or OCD" that pushed me to act out that way. This then can protect them from self-blame and helps them defuse accusations from others such as laziness or stupidity. Overall, labeling for the child is a complex decision that needs to be made after careful consideration of the child, the specific struggle, as well as the intensity of it.