Growing up, I saw firsthand what labeling a child can do. In elementary school, my brother was having trouble staying focused both at home and at school, took 3 times as long to do his homework than his classmates, and struggled to keep anything organized. Not surprisingly, he was diagnosed with ADHD and put on medication.
Even before the meds started, there was a noticeable difference in him as soon as he was informed that “he was ADHD.” He wasn’t the little brother I knew anymore. He became much more negative when talking about himself and he stopped fighting against some of the behaviors associated with ADHD. It seemed like he had given up. He lost hope. All of a sudden he would say that he “couldn’t” do things because he was ADHD. It defined him. I noticed that not only did my brother expect the “typical” ADHD behaviors and characteristics from himself, but my parents began expecting them from him too. If he had a better day, the credit was given to the medication. But bad days were the expectation, and accepted as if it was the new “normal.”
As a Masters student in Individual, Couple and Family Therapy, I learned about a lot of theories and ideas, but one that has changed my entire way of thinking comes from Narrative Therapy.
The person is not the problem. The problem is the problem. This may seem obvious, but something as simple as the language used to describe someone’s struggles can place the problem either inside the person, making the person the problem, or outside the person, making the problem the problem. This is the difference between saying, “he is ADHD” and “he struggles with ADHD” or “ADHD affects him.” The latter two examples separate the person from the problem—they separate my brother from the ADHD.
If the problem is inside the person, or internalized, it is part of the person’s identity, and is assumed to be a fixed part of that person. The language implies that the problem defines that person.
Before the ADHD diagnosis was given to my brother, he acknowledged that struggling to focus, organization, and the time it took to get homework done were problems for him. In spite of this, he was making an effort to improve these behaviors, and solve these problems. And my parents were helping him. Once the diagnosis was given and my brother was told, “you are ADHD,” it all changed. ADHD was the name assigned to all of the problems, and because he is ADHD, he is therefore the problem. It seemed like hope was lost.
What if instead of saying “he is ADHD,” the language was, “ADHD affects him?” This seems like a small change, but it’s actually a significant one. It places the problem, in this case ADHD, outside of my brother. Now, it’s okay for him to dislike it, for my parents to dislike it, and for teachers to dislike it, because it is not my brother they dislike. Everyone can work together to keep ADHD in check, or fight off ADHD. Before the diagnosis, my brother thought and spoke about “the problem” as outside of himself. He called it “distraction problems.” He knew how to combat distraction problems. Everything changed once he was defined as ADHD. If something is a fixed part of you, it’s much harder to change it or alter it. Just like any personal flaw, it also makes it harder to talk about. Though I cannot read his mind, it seemed like being ADHD was much more overwhelming and hopeless for him than being affected by distraction problems. As explained by Freeman, Epston, & Lobovits (1997), “Separating the problem from the person… relieves the pressure of blame and defensiveness. Instead of being defined as inherently being a problem, a young person can now have a relationship with the externalized problem” (p.xv).
Time and time again, I hear children and adolescents using “adult terms” or clinical lingo to describe themselves. They say, “I am ADHD” or “I have Major Depressive Disorder” or “I am bi-polar.” But what does that mean to them? Let’s say a child is told they have “Whangdoodle disorder.” In many cases, the child is subsequently told what that means. “Children with Whangdoodle disorder believe their own lies, get angry easily, and commonly become aggressive.” Now, these behaviors, whether they were happening previously or not, become expected. They are not only expected by the child themselves, but also by their parents, their teachers, and maybe even their peers. Once a behavior is being looked for, it is much easier to find. It becomes a self-fulfilling prophecy. If a parent expects a child to become angry easily, for instance, they might see anger in situations that they may not have seen it in before. Once a child is told enough times that they are shy, they will begin to believe it and start acting as a shy person would. It is the same for any type of label or disorder.
Labels are going to happen. There isn’t much anyone can do to stop it entirely. However, as parents, teachers, friends, or observers of children and adolescents, we should use language that puts the “problem” outside of the child. We can also be sure to use their language. If they see it as “distraction problems,” it is likely they are better equipped to fight off, push away, or hide from distraction problems. Work with the child to team up against distraction problems. How can you help them defeat the problem? Don’t spend so much time expecting, or looking for the negative behaviors. Find the positive ones!
Freeman, J., Epston, D. & Lobovits, D. (1997) Playful approaches to serious problems. New York: W.W. Norton & Company Inc.