When false theories obfuscate our judgement

Children playing together: each of them is unique and can only truly be understood within the context of their own individual development. / Picture Wikimedia Commons.

by Dr Eliane Perret, psychologist and special needs teacher

It is not easy today for parents, caregivers and teachers to acquire the knowledge needed to tackle with inner confidence and assurance the demanding tasks that everyday life with children brings. Those who make recourse to self-help books on the market often encounter simplistic concepts that do not stand up to closer scrutiny. Children and young people, our next generation, are, however, dependent on adults who know what they are doing. This determines their future, but also that of a wider community, indeed, of a country and the world. What we need today is a shift in thinking in many respects, in schools but also in families – a rediscovery that children develop within their environment and therefore need age-appropriate challenges and role models. In short, that children depend on upbringing. Why has this often been forgotten today? It is worth exploring further.

‘Am I my brain? Just a biological automaton?’

Slogans we hear today, originating from the field of neuroscience, are used to provide a biological explanation for problematic behaviour in children and young people. We hear about neurotransmitters, the frontal lobe, the brainstem, overload, meltdown, neurodiverse, neuronorm… This is the explanatory framework used today when a child’s problematic behaviour at home or at school leads to a child psychiatric diagnosis based on relevant assessments and questionnaires. Signs of concern in a child are no longer linked to their developmental history, but are attributed to specific characteristics of the brain. In many cases, this results in a diagnosis that requires medication. There is hardly any discussion left about how this paradigm shift has come about in recent years – from an explanatory model grounded in the human sciences to a focus on biological causes. Nor is the question asked whether this shift corresponds to the current state of research. Critical voices questioning the reliability of this approach are therefore largely ignored. One such voice is that of neuroscientist Felix Hasler, a research assistant at the Berlin School of Mind and Brain at Humboldt University in Berlin, a science journalist and an expert in his field. In his book Neuromythologie, published several years ago, he scrutinised the validity of now-commonplace neuronally based testing methods from brain research and posed the question: “Am I my brain? Just a biological automaton?”¹

We haven’t achieved anything …

Someone who should know about the success of current models of mental health is Tom Insel, former director of the NIMH (National Institute of Mental Health). He at least had the honesty to make public his damning assessment of the approach commonly taken at his institute, stating: “For 13 years at the NIMH, I drove forward neuroscience and the genetics of mental disorders, and looking back, I do believe I succeeded in securing a lot of cool work from cool scientists at a rather high cost – I believe 20 billion US dollars – but I do not believe we have made a dent in reducing suicides, reducing hospital admissions and improving the recovery of ten million people with mental illness. I take responsibility for that”.²

‘This has created a huge market for therapies’

The observations of a few other critical voices therefore come as no surprise. More than ten years ago, the two paediatricians Romedius Albers and Thomas Baumann already critically put their finger on the problem in an interview entitled “Release pupils from unnecessary diagnoses”: “We are observing children’s development ever more closely and, as a result, are noticing greater variability. Many deviations from the average are declared to be developmental disorders, and this has created a huge market for therapy. Furthermore, many teachers are at the breaking point. Children who cannot keep in step run the risk of being pathologized”.³ They were referring to the many diagnoses relating to behavioural problems (ADD/ADHD), autism spectrum disorders (ASD), anxiety disorders, depression, suicidal tendencies, etc. – diagnoses that are listed to an ever-increasing extent in the DSM-5, the American manual of psychiatric disorders, or the European ICD-10/11

ADHD? There is no reliable test

Many children, adolescents and, increasingly, adults now attribute their shortcomings at home and at school to a diagnosis. Consequently, they expect consideration, additional support and reduced expectations. It is no coincidence that the Federal Statistical Office (FSO) reported an unprecedented rise in mental health disorders among children and adolescents at the end of 2022.⁴ Oskar Jenni, co-head of the Department of Developmental Paediatrics and full professor of developmental paediatrics at the University of Zurich, also commented on this striking torrent in such diagnoses. Regarding ADHD and possible misdiagnoses, he stated that “[…] uncertainties arise because […] there is no generally accepted model of the disorder, […] no reliable ADHD test is available, […] the disorder overlaps significantly with other medical conditions and reactive behavioural problems in some cases, […] that in practice it is sometimes difficult to distinguish between immature behaviour and the disorder, and finally […], because ADHD symptoms are continuously distributed across the population”.⁵ It remains to be seen, however, whether the classification of ADHD (and also ASD) as a spectrum diagnosis – which has since become standard practice in child psychology and psychiatry assessment centres – brings us any closer to a solution, as this approach, by relying on the same explanatory framework, merely allows a much broader spectrum of symptoms and thus greater arbitrariness. This is the view of Uta Frith, Professor Emerita of Cognitive Development at the Institute of Neuroscience at University College London (UCL). She played a key role in the research projects intended to confirm our current understanding of autism and now says: “For a long time, I was very taken with the idea of the autism spectrum, and it was only in the last ten years that I felt things had gone too far, and very slowly I came to the realisation: ‘No, that’s not right’”.⁶

A vast catalogue of symptoms – and a gap that is ‘overlooked’

Anyone who examines the diagnoses commonly used today will notice that they are often based solely on lists of symptoms – focusing on the “defective” part of the child. Whereas heredity was previously invoked as an explanation in such cases, the emphasis today lies on brain physiological processes. Neurodiversity or neuro-normativity as explanatory models? Heredity in a new guise? Where does this leave the child with their personality, their developmental history and their social environment? In this way, highly topical findings from developmental psychology and anthropological research – based on a holistic approach to the development of a child’s personality, which occurs within his social environment – are overlooked or neglected. Among their major themes is the significance of the child’s social-emotional development. Associated with this are names such as Mary D. S. Ainsworth, John Bowlby, Paul L. Harris, Peter Hobson, Henri Julius, Gianni Kugiumutzakis, Michael Tomasello, Colwyn Trevarthen, Emmy Werner, Lev Vygotsky and many others.⁷ Am Du zum Ich (From ‘you’ to ‘myself’) is therefore an apt title for the book by Henri Julius, who holds a chair in Education at the University of Rostock, specialising in emotional and social development.⁸ His book succinctly summarises the latest research findings from developmental psychology. These findings should serve today as an important guideline for psychological, educational and psychotherapeutic practice.

The courage to look closely

However, the biological perspective on children, which has received extensive media coverage in recent years, is now obscuring the view for many parents (and professionals). The extensive lists of symptoms associated with specific diagnoses in psychiatric manuals can also be quite impressive. “Just like with my child”, might be the conclusion. This may provide temporary relief for affected parents. However, it overlooks the current state of research and the bigger picture, as it fails to take into account the child’s entire individual developmental history. On closer inspection, diagnoses therefore never offer a solution; they merely record what can be observed on the surface. They are misleading, because they do not explore with necessary depth the question of “why” the child is having problems. For example, anxiety, fear, pessimism, harshness or coldness in an adult or caregiver have often led to deep discouragement in a child, which the child masks in various ways. The diagnosis itself prevents the development of an inquisitive approach to learning or the ability to be with other children in a friendly way. In many cases, such children shy away from demands, refuse to do tasks, withdraw into their own world, or resort to temper tantrums, prolonged crying or shrill screaming. No test can provide the answer for why this happens; rather, it requires an in-depth understanding of all the factors that have led to the child becoming a problem child. Such an understanding – in other words, a shift in thinking – would also pave the way for an optimistic future – for the children, their families, and the wider community.

We need a different perspective

These days, however, one frequently comes across parents who lack the knowledge and courage to take a closer look. They fail to take into account that bringing up a child is a demanding task that challenges parents in every aspect of their lives. You must introduce the child to life and help them overcome their difficulties, without either under- or overburdening them. The emotional states of the child and their counterpart mesh together like two cogs. Mistakes can occur that are difficult for those involved to spot, but which require careful correction. It’s a challenging journey for both child raisers and children! This goal cannot be achieved through impatience and violence, nor through a sheltered environment of pampering or “tricks” and behavioural programmes. That is why it can never be a question of assigning blame to someone who has made mistakes. It is therefore to be hoped that the child and those close to him will have the courage to embark on a new path. In doing so, the adults open up new prospects for the child’s future life. We need an emerging generation that does not allow false theories to obscure its view. It takes courage to look closely! By engaging with these issues, we can develop an understanding of how personality develops. Only in this way can a sense of human bond with our fellow human beings flourish, one that nurtures the desire to contribute to a more peaceful coexistence in the world.

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¹ Hasler, Felix. (2012). Neuromythologie. Eine Streitschrift gegen die Deutungsmacht der Hirnforschung. (Neuromythology: A polemic against the interpretative power of brain research) Bielefeld: Transkript

² Insel, Tom. Quoted in: Fuchs, Thomas. (2023). Psychiatrie als Beziehungsmedizin. (Psychiatry as relational medicine) Stuttgart: Kohlhammer.

³ Albers, Romedius. In: Schmid, Simone. Erlöst die Schüler von unnötigen Diagnosen (Spare pupils from unnecessary diagnoses). In: NZZ am Sonntag of 6 November 2011

⁴ They were the most common cause of hospital admissions among 10–24-year-olds, more so than injuries, accidents or physical illnesses. Federal Statistical Office. Pressemitteilung: “Psychische Störungen: beispielloser Anstieg der Hospitalisierungen bei den 10- bis 24-jährigen Frauen” (Press release. Treatment of mental disorders among young people in 2020 and 2021. Mental disorders: unprecedented rise in hospital admissions among women aged 10 to 24). https://www.bfs. admin.ch/asset/de/23772011

⁵ Jenni, Oskar. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (Attention deficit/Hyperactivity disorder). In: Monatsschrift Kinderheilkunde. 164, 271–277 (2016). https://doi.org/10.1007/s00112- 015-0030-6

⁶ Frith, Uta. Warum ich Autismus nicht mehr als Spektrum betrachte (Why I no longer view autism as a spectrum); https://www.tes.com/magazine/ teaching-learning/general/uta-frith-interview-autism-not-spectrum

⁷ An excellent overview of these research findings can be found in: Kissling, Beat. (2022). Sind Inklusion und Integration in der Schule gescheitert? (Have inclusion and integration in schools failed?) Bern: Hogrefe. pp 109–160

⁸ Julius, Henri. (2020). Am Du zum Ich. (From ‘you’ to ‘myself’. Bond-guided pedagogy: The Care Programme). Independently published.