Symptom Checklists

One of the things I love about blogging is the ability to write down my random thoughts as I do something else -- I'm writing this, for example, as I cook some pasta.

As everyone knows, the watched pot never boils, so writing now is a good use of time.

Today, I took the kid with ADHD to yet another therapist, this time to have some testing done to figure out whether or not he has a non-verbal learning disorder. We explained this to him by saying we needed to know more about how his brain worked. He is SO sick of being tested. I don't blame him at all.

While he was completing various types of mind puzzles with the therapist, I was filling out checklists of symptoms in the waiting room. Any parent with a kid with some sort of behavior problem has completed these. Often the same ones. More than once.

I can't help but be critical of the diagnostic (im)precision in mental health. In part, this is due to my training as a medical sociologist who specializes in mental health. Critiquing the modern medical model of mental health and the DSM is really the field's bread and butter. So, forgive me as I lapse into a semi-sociological discussion of what is wrong with the diagnostic lens.

Some of the questions on the form, presumably already pre-tested on thousands of kids with behavioral problems, seem like typical "problems" for ANY kid. For instance, "does your child never, seldom, or often, leave a trail of his or her things throughout the house?" Are you kidding me? Oh, of course not! My kid tidies up after himself consistently all day long! Or, "does your child never, seldom, or often have a messy closet?" Again, if this is a key diagnostic question, then my whole family is in deep trouble. Another: "does your child never, seldom or often have to be reminded to take a shower or brush his/her teeth?"

If any of you out there with nine-year-old boys NEVER have to remind them to attend to their hygiene, I am in awe of you (and them). Of course, mine is fastidious about clipping his toenails, flossing his teeth, and shampooing twice and conditioning once during each shower. (RIGHT!)

I can show you a LONG line of boys (and not a short line of men!) who need some fairly consistent reminders to shower regularly, change their underwear and wash their hair. I understand that at the extreme end of the continuum, neglect of bodily care is indicative of mental illness. But at the age of nine, it seems more than normal to groan about having to take a shower, or to tell your mother that she's "ridiculous" in her insistence that the underwear be changed daily. It also seems normal to me to lie about having brushed one's teeth, particularly if a favorite TV show is about to come on, or a friend has just arrived at the front door.

So, I obediently completed these forms, all the while contemplating what my answers would indicate. I answered truthfully, though I did provide in the margins some comments as to what I meant by "seldom" or why I might have thought a particular answer to a particular question was truly indicative of NOTHING.

***

Later, I took a few Facebook quizes -- notoriously inaccurate and put together by people who are doing nothing more than having fun. They are not meant, obviously, to be statistically accurate or even informative. According to the quiz, "How gay are you?," I am 65% gay. Fine by me, but apparently my gayness is indicated by my color and fashion preferences, more than anything else. Similarly, I took the quiz, "Who is your celebrity twin?" and got the answer, "Kate Hudson." Hmmm...I think the only thing she and I share in common is small boobs. (Yeah for famous women with 'em; they make the rest of us feel better!)

At the end of the day, while waiting for water to boil (which it is now), I'm left pondering the accuracy of symptom checklists. Obviously two that I took today make no effort to be accurate and have no real influence on my life. But several of the ones I completed for my son *might* have true diagnostic (and therefore treatment) consequences.

I will proceed with caution, for reasons that I hope are already obvious.