February 1, 2008

10:55 AM

School Bullying & Accurate Diagnosis by Dr. Roger Perry, HSPP

Dr. Roger Perry, HSPP will create a blog article on a variety of topics related to mental health each month. With over 40 years experience in clinical psychology, we are excited for him to share with us his words of wisdom. We welcome your feedback on his articles or suggestions for future discussions as well!

School Bullying & Accurate Diagnosis

Over the next several months I will undertake discussions of several topics in the area of mental/emotional/behavioral health that have become of very high interest in schools, families, and in the general community. I will attempt to address these topics keeping in mind that there is usually a spectrum of "symptoms" that may range from "normal" to pathological associated with most diagnostic entities. Some of these common mental health, emotional health, and behavioral health diagnostic categories that are often misdiagnosed or overdiagnosed are Anxiety Disorders, Depression, Oppositional Defiant Disorder, and Attention Deficit/Hyperactivity Disorders. I will try and point out some danger signals that should occasion referral to a professional. I will also address pitfalls to avoid when reporting history and symptoms to the professional such that the identified "client/patient" is not misdiagnosed or over-diagnosed by the mental health professional.

I plan to begin with the topics Post Traumatic Stress Disorder (PTSD), Bipolar Disorders, Phobic Disorders (to include school phobias), and Add/Adhd as an example of how many of us begin the referral process by self diagnosis and continue with selective symptom reporting to the diagnostician.

For example, a large part of the perceived behavioral problems and mental health concerns in public and private schools (K-12) is due to the child who is overly anxious, fearful, and/or behaviorally explosive. We also hear a lot in the media about bullies in schools. It has been my experience a child who is being bullied may experience signs that may look like anxiety, depression, inattentiveness, or otherwise acting inappropriately and behaving in an antisocial manner. These children may be brought to the attention of the teachers, counselors, school administrators, and their families. As a result of associated conferences, there is often a diagnosis of ODD (Oppositional Defiant Disorder), ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder, etc. The child may be medicated as an attempt to effectively intervene and deal with the problem based on these diagnoses.

Unfortunately, it is clear that if better histories were taken and parents and other adults did not select symptoms to be reported based on others who had similar problems and were similarly diagnosed and if more reasonable expectations and proposed interventions were available for adoption by those involved that the child, the school, the family, the courts, and the community would be better served by a more precise diagnosis and comprehensive understanding of the problem.

In the example I have just described, I have frequently seen children who felt they were the targets of bullies begin to show signs and symptoms that are typical of many of the diagnoses that could be considered. These symptoms will then frequently become over reported to fit with a diagnosis even though they were not necesarily expected behaviors and reactions to bullying.

Thus, let's observe well, report accurately, and commit to interventions based on strong communication between all involved and our comprehensive understanding of all variables.