A DISCUSSION ON CHILD MENTAL HEALTH DIAGNOSIS

Empowering Students

ADHD • Anxiety • Depression

Are We Helping Children, or Helping Labels?

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A DISCUSSION ON CHILD MENTAL HEALTH DIAGNOSIS

This discussion is intended to be thought provoking

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Mental health conditions are real and personal, but complicated

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Built with a mix of research and experience

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Look beyond the DSM

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ADHD • Anxiety • Depression

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TODAY'S JOURNEY

Six Acts, One Question

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The Landscape

Why diagnoses are rising

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The Science

What we know — and don’t

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The Cost of Labels

Identity, language, expectation

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Schools

Support without dependence

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Clinical Humility

Bias, systems, and pressure

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The Future

A both/and framework

INTRODUCTION

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ACT 1

The Landscape

Diagnoses of ADHD, anxiety, and depression in children have climbed for two decades. Before we ask what to do about it, we need to understand why.

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DISCUSSION

Why Are Diagnoses Increasing?

Greater Awareness

Parents, teachers, and clinicians recognize symptoms earlier and more consistently than a generation ago.

Broader Criteria

Each DSM revision has widened diagnostic thresholds, capturing milder and more varied presentations.

Access to Care

Insurance parity and school-based screening mean more children are evaluated at all.

Environmental Shift

Sleep, screen time, structured play, and academic pressure have all changed markedly since 2000.

ACT 1 — THE LANDSCAPE

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THE SCALE OF THE SHIFT

A Generation of New Diagnoses

7.1M

U.S. children diagnosed with ADHD (2026)

Up from 6.1 million in 2016 — about one million more children in six years

1 in 9

U.S. children carry an ADHD diagnosis

Ages 5–17, the highest rate on record

78%

of newly diagnosed children have a co-occurring condition

Anxiety, depression, or a learning disorder alongside ADHD

Source: CDC/NCHS Data Brief 499 (2024); CDC ADHD data reports, 2016–2022.

ACT 1 — THE LANDSCAPE

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THE NUMBERS

Current Prevalence Among U.S. Children

KEY TAKEAWAY

ADHD and anxiety now affect roughly one in nine to one in ten children — and most diagnosed children carry more than one label at once.

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Pharmacology has a MAJOR role/ stake in diagnoses.

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Illustrative estimates compiled from CDC/NSCH and NHIS surveys (2016–2022); methodology and survey years differ across conditions, so treat as directional rather than a single-year snapshot.

ACT 1 — THE LANDSCAPE

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THE TREND

The Direction of Travel, 2016–2022

KEY TAKEAWAY

The line moves one direction. Whatever forces are driving it — awareness, criteria, environment — they are accelerating, not leveling off.

Illustrative trend based on CDC ADHD diagnosis counts, U.S. children ages 3–17; intermediate years interpolated for display.

ACT 1 — THE LANDSCAPE

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THE FRAMEWORK

It’s Rarely One Cause

Rising

Diagnosis

Rates

Awareness

Criteria

Access

Environment

ACT 1 — THE LANDSCAPE

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ACT 1

“We saw DSM-IV as a guidebook, not a bible – a collection of temporarily useful diagnostic constructs , not a catalog of real diseases. We tried to make this abundantly clear in the introduction of the DSM-IV and at great length in the DSM-IV Guidebook. Unfortunately, I am not sure anyone ever read the Gudidebook. People shouldn’t worship the DSM categories, but it does make you a better clinician to know them.”

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Dr. Allen Frances, Chair of the DSM-IV

Allen Frances, Saving Normal: An Insider’s Revolt against Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (New York: HarperCollins, 2013), 73.

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REFLECTION

Have you ever had a student “own” their disability?

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What about a parent “own” their child’s disability?

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A story to share?

ACT 1 — THE LANDSCAPE

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ACT 2

The Science

These are real, studiable conditions with real neurobiology. They are also imprecise categories drawn around fuzzy, overlapping human experience.

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THE HONEST PICTURE

What We Know, What We Don’t

What We Know

• ADHD, anxiety, and depression involve measurable differences in attention, arousal, and mood regulation systems.
• Genetics and environment both contribute; heritability estimates are moderate to high for all three.
• Early, appropriate support improves long-term academic and social outcomes.

What We Still Don’t

• No blood test, brain scan, or biomarker confirms any of these diagnoses — all rely on behavioral observation.
• Where "typical" ends and "disordered" begins is a threshold we set, not one nature draws for us.
• Why symptoms cluster differently across children remains poorly understood.

ACT 2 — THE SCIENCE

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THE HONEST PICTURE

What Some Experts Say

What An Expert Says on ADD

• “Many proponents of the notion that ADD is a widespread and severe neurobiological disorder have used the fact that children do better on stimulants as confirmation that a particular diagnosis is valid and correct. But evidence suggesting stimulants can help pretty well everyone undercuts that argument. This self-reinforcing, but sometimes false confirmation may be another explanation for the continuing explosion in the numbers of people being diagnosed and using drugs.”

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• Ray Moynihan and Alan Cassels, Selling Sickness (New York; Nations Books, 2005), 79.

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What An Expert Says on Depression and Anxiety

• “There are no known biological causes of depression in the lives of patients who routinely see psychiatrists. There is no known genetic link in depression. There is no sound drug treatment for depression.”
• Breggin, Toxic Psychiatry, 183.
• “Materialists have made the erroneous assumption that anxiety disorders, depression, and other mental illnesses are primarily due to chemical problems in the brain and that they are best treated with drugs. But this theory is still unproven.”
• Whitfield, Truth about Mental Illness, 38

ACT 2 — THE SCIENCE

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THE DIAGNOSTIC DILEMMA

Where Symptoms Overlap

ADHD

Anxiety

Depression

restlessness • irritability

worry • avoidance

low mood • withdrawal

Sleep problems

Poor concentration

Sleep problems, poor concentration, and irritability appear across all three diagnoses. A single symptom rarely tells you which label — if any — fits.

ACT 2 — THE SCIENCE

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A CLOSER LOOK – when a team feels like a diagnosis is warranted

The Same Symptom, Three Possible Stories

ACT 2 — THE SCIENCE

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AUDIENCE CASE

Two Students, Similar Behaviors

Girl, Age 9

• Struggles to finish independent work; stares out the window during instructions.
• Forgets homework at home three times a week.
• Recently, her parents separated.
• Sleeps poorly; describes "my brain won’t stop."

Boy, Age 10

• Struggles to finish independent work; stares out the window during instructions.
• Forgets homework at home three times a week.
• No recent changes at home reported.
• Sleeps well; describes school as "boring."

ACT 2 — THE SCIENCE

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SAME SYMPTOMS, DIFFERENT STORIES

What Changes the Diagnosis?

ACT 2 — THE SCIENCE

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REFLECTION

What else could explain these symptoms?

Are we intervening long before the label?

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Schools have13 eligibility categories (not everything fits nicely)

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Before reaching for a diagnostic label, what questions would you ask first?

ACT 2 — THE SCIENCE

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MORE REFLECTION

What about YOU as a School Psychologist ?

Can you help a child by reshaping thinking prior to the label?

Before reaching for a diagnostic label, what questions would you ask first?

ACT 2 — THE SCIENCE

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MORE REFLECTION

Have you ever met someone who doesn’t have ADD?

ACT 2 — THE SCIENCE

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ACT 3

The Cost of Labels

A diagnosis can open doors to support. It can also quietly close doors to expectation, effort, and identity. Both happen at once.

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ACT 3

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“Psychiatry has become deeply ingrained within the fabric of our culture, winding through our most prominent social institutions and coloring our mundane daily encounters. For better or worse, the DSM is not merely a compendium of medical diagnoses. It has become a public document that helps define how we understand ourselves and how we live our lives.”

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Former President-elect APA

Jeffrey A. Lieberman, Shrinks: the Untold Story of Psychiatry (New York: Little, Brown and Company, 2015), 291.

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ACT 3

“Labels can also create self-fulfilling prophecies. If you are told you are sick, you feel and act sick, and others treat you as if you are sick. The sick role can be enormously useful when someone is truly sick and needs respite and care. But the sick role can be extremely destructive when it reduces expectations, truncates ambitions, and results in a loss of personal responsibility”

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Frances, Saving Normal, 109.

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LANGUAGE MATTERS

Identity vs. Diagnosis

Our Role in cognitive reshaping is IMPORTANT

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"He IS ADHD"

• The condition becomes the whole identity, not one feature among many.
• Invites a fixed mindset: this is just who he is, not something that can shift.
• Can subtly excuse behavior rather than explain it.

"He HAS ADHD or He HAS attentional issues"

• The condition is one part of a fuller person — named, not defining.
• Leaves room for growth, strategy, and change over time.
• Separates the diagnosis from the child’s worth and potential.

ACT 3 — THE COST OF LABELS

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TRY THIS INSTEAD

Small Shifts in Everyday Language

ACT 3 — THE COST OF LABELS

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A QUIET RISK

The Learned Helplessness Cycle

Child struggles;

adults name it "can’t"

Adults lower

expectations

Fewer chances to

practice independently

Child internalizes

"I really can’t"

ACT 3 — THE COST OF LABELS

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THE FLIP SIDE

Expectations Shape Outcomes

The Pygmalion Effect

• Decades of classroom research show that teacher expectations measurably shift student performance.
• A diagnosis can raise expectations ("now we’ll get him the right help") or quietly lower them ("he can’t help it").
• Children read adult expectations closely and often rise or fall to meet them.

The Practical Question

• Does this intervention build the skill, or does it permanently replace the need to build it?
• Is the goal comfort today, or capability over time — and can it be both?
• Who is revisiting the plan as the child grows, and how often?
• Does the child understand/buy into the plan?
• Are there ways a child can help build the vision for the outcome?

ACT 3 — THE COST OF LABELS

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AUDIENCE POLL

Accommodation or Enablement?

A student is allowed to skip oral presentations indefinitely due to anxiety. Where’s the line?

ACT 3 — THE COST OF LABELS

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ACT 4

Schools

Classrooms sit at the center of this tension — asked to accommodate difference and build independence, often in the same fifty minutes.

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THE CORE TENSION

Support vs. Independence

Support

Independence

The goal isn’t balance at a single point in time — it’s a ratio that shifts deliberately as a child grows.

ACT 4 — SCHOOLS

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THE REAL TARGET

Executive Function Skills Worth Teaching

Planning

Breaking a task into steps and estimating how long each will take.

Working Memory

Holding instructions in mind long enough to act on them.

Self Regulation

Pausing before reacting; resisting a more tempting distraction.

Flexibility

Adjusting a plan when the first approach isn’t working.

ACT 4 — SCHOOLS

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THE REAL TARGET

School Psychologist Role

Instill Belief

You can do this!

Nothing can hold you back.

I can manage this feeling!

Self Talk

I think I can.

I know I can.

I can.

Perseverance

Keep pressing onward.

Never say never.

If you don’t succeed try again.

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Identify Support

I’m here for you.

Educate school team.

Your parents are on board.

Your teacher is on board.

Safe place.

ACT 4 — SCHOOLS

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FROM ACCOMMODATION TO SKILL

Teaching the Skill Underneath

Accommodation Alone

• Extra time on every test, indefinitely, with no plan to reduce it.
• An adult repeats instructions rather than teaching a checklist habit.
• A quiet corner is offered but never paired with a coping strategy.

Accommodation + Skill-Building

• Extra time now, paired with explicit instruction in time estimation.
• A visual checklist the student learns to generate independently.
• A quiet corner taught alongside a specific calming strategy to practice.

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• School Psychologists help BUILD and/or GUIDE the Skill Building!

ACT 4 — SCHOOLS

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TEACHER LANGUAGE

Responses That Build Capability

ACT 4 — SCHOOLS

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REFLECTION

Do our plans prepare kids for adulthood —

or just for this classroom?

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How do you MATTER every day?

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No workplace will offer unlimited extensions or read instructions aloud twice.

ACT 4 — SCHOOLS

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ACT 5

Clinical Humility

Clinicians are not immune to the same shortcuts as anyone else — and the systems around them don’t always reward slowing down.

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THE HUMAN FACTOR

Cognitive Biases in Diagnosis (our intervention teams do this as well)

Anchoring

The first hypothesis heard — often from a worried parent — disproportionately shapes everything that follows.

Confirmation Bias

Once a label feels likely, evidence that fits gets noticed; evidence that doesn’t gets explained away.

Availability

A clinician who just diagnosed three ADHD cases is primed to see a fourth.

Time Pressure

A fifteen-minute visit rewards a fast, familiar label over a slower differential.

ACT 5 — CLINICAL HUMILITY

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BIAS IN PRACTICE

Anchoring: A Closer Look

How It Happens

• A parent opens the appointment with, "I think he has ADHD, like his cousin."
• That framing becomes the lens for the next fifteen minutes, even unconsciously.
• Alternative explanations — sleep, anxiety, a recent move — get less airtime.

What School Psychologist Can Do

• Ask open-ended questions before any label is mentioned by anyone in the room.
• Deliberately generate two alternative explanations before settling on one.
• Revisit the working diagnosis after new information, not just at intake.

ACT 5 — CLINICAL HUMILITY

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BIAS IN PRACTICE

Confirmation Bias: A Closer Look

How It Happens

• Once "ADHD" feels likely, fidgeting reads as a symptom — while calm focus reads as "a good day."
• Follow-up questions unconsciously seek confirming answers rather than testing the hypothesis.
• Disconfirming details get filed away as exceptions rather than evidence.

What School Psychologist Can Do

• Actively ask: "What would make me change my mind about this?"
• Invite a second observer — teacher, co-clinician — before finalizing.
• Document the disconfirming evidence, not only the confirming evidence.

ACT 5 — CLINICAL HUMILITY

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BEYOND THE INDIVIDUAL CLINICIAN

Does the System Shape the Diagnosis?

Structural Pressures

• Insurance reimbursement often requires a billable diagnostic code before any service can be covered.
• Some school/private services and accommodations are gated behind a formal diagnosis, not just a documented need.
• Shorter visit windows reward pattern-matching over exploratory conversation.

Questions Worth Asking

• Would this child receive support without a diagnostic label — and if not, what does that say about the system?
• Is the diagnosis describing the child, or unlocking a resource the child needs regardless?
• Who benefits, and who is burdened, when diagnosis becomes the only gateway to help?

ACT 5 — CLINICAL HUMILITY

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THE PRESSURE POINT

What Converges on a 15-Minute Visit

The

Diagnostic

Decision

Insurance codes

Time limits

School requirements

Parent expectations

ACT 5 — CLINICAL HUMILITY

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THE PRESSURE POINT

A Look at Medical Testing

ACT 5 — CLINICAL HUMILITY

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Randon Thought Regarding Lack of Medical Testing

Without a definitive medical test, using an ever-changing DSM for diagnosis….

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Is it too simple to say that ADHD, Anxiety and Depression are adverse feelings?

ACT 5 — CLINICAL HUMILITY

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TABLE DISCUSSION

Feelings?

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I’m feeling hyper; anxious; or down

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Feeling are real – we all have them….

Could feelings All or None be a disability?

ACT 5 — CLINICAL HUMILITY

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TABLE DISCUSSION

Fun with Feelings

Happy

Jealous

Confident

Overwhelmed

Bored

Shy

ACT 5 — CLINICAL HUMILITY

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TABLE DISCUSSION

Do children understand they have power over feelings?

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Where do YOU help as a School Psychologist?

ACT 5 — CLINICAL HUMILITY

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Hypothesis

ADHD / Anxiety / Depression

– Cinematography

- Social Media

- Awareness

• Performance (tests, teams, etc.…)

NEW NORMAL?

ACT 5 — CLINICAL HUMILITY

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ACT 6

The Future

Not diagnosis versus no diagnosis. A better question: how do we use tools so they serve the child in front of us?

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BEYOND EITHER/OR

A Both/And Framework

Diagnosis Can…

• Unlock services, accommodations, and funding a child genuinely needs.
• Give families language for an experience that felt confusing or isolating.
• Guide evidence-based treatment when used as a starting hypothesis, not a verdict.

And We Must Still…

• Keep teaching the underlying skill, not just accommodating its absence.
• Revisit every label as the child grows and circumstances change.
• Protect the child’s sense of identity alongside the diagnosis.
• Educate students what a “feelings diagnosis” is and build skills to self regulate

ACT 6 — THE FUTURE

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WHAT TO DO MONDAY MORNING

Five Practical Takeaways

Ask First

Generate two alternative explanations before reaching for a label.

Watch Language

Say "has ADHD or attentional difficulties," not "is ADHD" — in your own speech and others’.

Teach the Skill

Pair every accommodation with explicit instruction in the skill it stands in for.

Revisit Often

Treat every diagnosis and plan as a hypothesis to re-check, not a permanent verdict.

Loop in Families

Make the child’s own voice part of the conversation, not just the adults’.

ACT 6 — THE FUTURE

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REMEMBER THE STAKES

What We’re Really Deciding

7.1M

children now carry an ADHD diagnosis

Each one a specific child, not a statistic

78%

have more than one label at once

The full picture rarely fits one category

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question worth asking every time

Does this diagnosis increase this child’s agency?

Source: CDC/NCHS Data Brief 499 (2024); CDC ADHD data reports.

ACT 6 — THE FUTURE

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THE ULTIMATE QUESTION

Does this diagnosis increase the child’s agency — or diminish it?

If you remember one question from tonight, let it be this one.

ACT 6 — THE FUTURE

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“The diagnosis should serve the child — not the other way around.”

— Closing thought

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“A diagnosis is a snapshot of current functioning, not a prophecy of human potential.”

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Dr. Ross Greene

— One more closing thought

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Thank You

Questions & Discussion

Empowering Students with Anxiety, Depression and ADHD

�Nick.benge@beechwood.kyschools.us

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