3-3 Over Diagnosis

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1 Overdiagnosis of Behavioral and Conduct Disorders in Children and Adolescents NAME Department of Psychology, Southern New Hampshire University PSY 314: Disorders of Childhood and Adolescence PROFESSOR NAME DUE DATE

2 Conduct and behavioral disorders are diagnosed based on criteria laid out in the DSM-5 according to the American Psychiatric Association (APA, 2013). There are multiple conduct disorders and each one has specific symptoms that a child must exhibit or experience before they receive a diagnosis (APA, 2023). Oppositional defiant disorder (ODD) is one of the more widely known behavioral disorders. To receive an ODD diagnosis, a child must display a pattern of at least four symptoms of angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness during a period of at least six months and exhibited during interactions with at least one individual who is not a sibling (APA, 2013). A lesser-known behavioral disorder is intermittent explosive disorder. This condition is marked by recurrent behavioral outbursts of verbal or physical aggression and/or damage of property or physical assault (APA, 2013). For a child to receive a diagnosis of intermittent explosive disorder, they must be at least six years of age and the anger they display must be caused by a provocation of some capacity, but grossly disproportionate to the problem (APA, 2013). Conduct disorder is diagnosed from at least three of fifteen criteria in the past twelve months with at least one in the last six months (APA, 2013). To receive a diagnosis of conduct disorder, a child must repeatedly display aggression toward people or animals, destruction of property, deceitfulness, or theft, and/or a serious violation of rules (APA, 2013). When diagnosing conduct disorder, it should be specified whether the child is unconcerned about their performance, has limited prosocial emotions, a lack of remorse or guilt, a lack of empathy, and/or a shallow or deficient affect (APA, 2013). The DSM-5 also lists pyromania and kleptomania as diagnoses based on an individual’s failure to resist impulses of setting fires or stealing (APA, 2013). The DSM-5 notes the spectrum of emotional reactions with these disorders. While intermittent explosive disorder is in response to external stimuli, individuals with conduct disorder may experience little emotions or empathy (APA, 2013).

3 What factors potentially contribute to the over-diagnosis of these types of disorders? Intervention and treatment are beneficial whenever children are exhibiting conduct or behavioral problems (Luvmour, 2011). But before a diagnosis is made, it is important that any patterns of abnormal behaviors observed should be considered within the context of events in the child’s life (Mash & Wolfe, 2018). Diagnosis without careful consideration can easily lead to overdiagnosis. For example, if a child’s parents are going through a divorce, this may cause him to lash out at his parents, teachers, and even peers. A grieving child may become withdrawn and irritable. These two situations are not grounds for diagnoses because the behaviors are better explained by the situations occurring in the children’s lives. Another cause for overdiagnosis is the reality that many Black and Latino youth are more likely to be diagnosed with conduct disorder compared to their white counterparts (Mizock & Harkins, 2011). According to an article by Mizock & Harkins, “Conduct Disorder has been overdiagnosed in urban, low-income, adolescents of Latino and African American backgrounds,” (2011). Statistical discrimination may be contributing to the clinicians’ assumptions, further contributing the biases. White children are more likely to receive a mood, anxiety, or developmental (i.e. ADHD) disorder than their African American peers (Mizock & Harkins, 2011). While a diagnosis may open doors to treatment options, it also exposes children to stigmatization (Mash & Wolfe, 2018). Teachers and parents may expect underperformance or maladaptive behaviors (Batstra et al., 2012). While having a medical explanation of symptoms may provide the child with some relief, it can easily damage their self-esteem and lead to self- stereotyping (Batstra et al., 2012). Another problem with overdiagnosis is medication. When a child is diagnosed with a mood disorder, oftentimes the treatment is either chemical mood

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