Diagnosis in child mental health

Exploring the benefits, risks and alternatives
CFCA Paper No. 48 – July 2018


This paper has reviewed some of the debates, complexities and nuances of diagnosis in child mental health. Such a review suggests that current mental health diagnoses are best seen not as scientific facts, but rather as cultural tools used to understand different varieties of psychological distress and impairment, and to distinguish between "normal" and "pathological" thoughts, feelings and behaviours. This is not said in an effort to discredit the DSM or any other diagnostic system. Where would we be without tools? And it is certainly not intended to deny or diminish individuals' suffering. Seeing diagnostic categories as cultural tools simply opens a door to different questions and ways of understanding, e.g.:

  • "Is this the appropriate tool for the task at hand?"
  • "Would other tools produce different outcomes?"
  • "Just because I could use this tool, does it mean I am obliged to?"

It is hoped that this paper will encourage practitioners to bring such questions to their work with children and families.

It is important to critically question diagnostic systems and processes. Such questioning can help ensure that mental health interventions are grounded in an accurate understanding of the difficulties that service users face. And it can encourage service providers to make appropriate decisions when working with children and families.

While this paper has offered readers a high-level understanding of diagnosis in child mental health, many of the specific practice implications and dilemmas that follow from this understanding are beyond its scope. For instance, this paper touched on the issue of mother-blaming, noting that biological explanations of mental health difficulties can shift the locus of blame away from mothers and towards their children's brains. Any attempt at promoting biopsychosocial or relationally oriented approaches to mental health assessment and treatment must reckon with the prospect of mother-blaming, because it challenges one of the only social narratives assuring mothers that they are not to blame for their children's difficulties. There are ways to address such risks, but they require a more detailed treatment than can be provided in this paper.

This paper began with some examples of controversies in the area of child mental health. While such controversies can illuminate particular problems, they also tend to be polarising, such that discussion becomes dominated by the voices of those who espouse certainty. Mental health practice, too, is often led by those who feel sure of their understanding. The obvious problem with this is that the field of paediatric mental health is full of uncertainties. The best responses to such uncertainties are humility, curiosity, caution and openness to all options and alternatives.

This paper has not delved into the intricacies of diagnosis simply for academic purposes, but rather because children who are experiencing mental health difficulties deserve to be met by practitioners who are awake to the complexity of the difficulties before them.

Critical reflections

  • Have your views about diagnosis in child mental health changed after reading this paper? Have they been confirmed?
  • Has this paper challenged you to think differently about your work with children and families? In what ways?