ADHD, TED or TOD: when the child actually has a disorder – 07/22/2023 – Equilíbrio

My son doesn’t sit still. Or he is too quiet. He’s taking a long time to speak, how can you not compare with the neighbor’s baby, who is younger and doesn’t shut up? Does he have a mental disorder?

The likelihood of that answer being yes has expanded quite a bit in recent years. Research shows variations, but data from the CDC (American agency for disease control) exemplifies this expansion well. In 2020, 1 in 36 children aged 8 and under were classified as having autism in the United States, up from 1 in 150 in 2000.

This network goes through background disorders, sometimes genetic, sometimes environmental, such as ASD (Autistic Spectrum Disorder) and ADHD (Attention Deficit Hyperactivity Disorder). Another condition on the rise is TOD (Oppositional Defiant Disorder), which is often confused with typical behaviors of those early years of life —symptoms include difficulty dealing with frustrations and frequent outbursts of anger, but in a tone above that of a childish tantrum.

First, it is necessary to consider that methods for identifying disorders have become more sophisticated and have gained attention in recent decades. So it is clear that their frequency among us will increase.

There still remains the challenge of understanding whether our children are in fact increasingly in shambles or whether we are facing a boom in diagnoses that are not always accurate, which label someone as having a complex condition from an early age without a more thorough investigation.

The short answer is: both alternatives are correct.

A deeper reflection involves discussing cultural factors that disturb the new generation and the role of social networks in all of this, for better or for worse.

If, on the one hand, information circulates quickly, letting more people know about disorders previously reduced to phrases like “that’s how children are”, on the other hand, virtual profiles often lead to hasty conclusions.

Human Resources professional Michelle Regina da Costa, 33, suspected that there was something wrong with her youngest. Alice spoke almost nothing to her almost 2 year old and walked on tiptoe, traits associated with autism.

The suspicion was dispelled within three months. With the help of the pediatrician, before making such a decisive diagnosis, Michelle changed her routine at home. Alice watched more than four hours of TV a day. The sessions for “Mundo Bita” ended almost completely. Parents, immersed in work and household chores, also made more effort to interact with their daughter.

Michelle discarded the autistic hypothesis once and for all when she went to pick up her daughter at her mother’s house after the stop. “She ran to hug me, she said ‘Mummy’s here!’.” She had never done anything like this. Today, Alice talks, counts numbers, sits down to play. All unreleased.

The popularization of diagnoses “overly generous in labeling a child [com uma desordem]” made an already serious situation worse, according to pediatrician Daniel Becker, himself a digital phenomenon, with 840,000 followers on Instagram. “You create hysteria. The child is a month late to speak a word, and people are shouting ‘autism’ on the networks. A panic that leads to seeking inadequate resources that the market ends up offering. Of course, who loves this is the pharmaceutical industry.”

There’s a lot of subjectivity at play — unlike, say, pneumonia, which just takes an x-ray to nail that it’s there. In such cases, the ball is split between neurology and psychiatry, and the boundaries between chronic disorders and circumstantial episodes are porous.

Becker proposes a test: put “Do I have ADHD?” in English on Google. The first links are a quiz with simple questions like “can you finish a project?”. Things that happen to everyone. Then the subject is convinced that he has the disorder, goes to the specialist and is medicated.

The damage is exponential on the younger ones. Their brains are like modeling clay, more moldable to external factors ranging from food to medicine that, it is worth remembering, can come with dangerous side effects.

Misdiagnoses also carry social consequences by contributing to the stigmatization of those who are labeled with a disorder, in addition to overloading the health system with an oversized problem.

A study published in 2022 by Canadian psychiatrists investigated the use of TikTok to spread mental health content. Analysis of the 100 most popular videos about ADHD on the social network revealed that 52% propagated misinformation about the topic, such as saying that being competitive is a symptom, and 89% were produced by people with no training in the health field.

Of the videos considered misleading, 71% took common pictures, from anxiety to mood swings, to be unique to ADHD. None of them guided their viewers to seek a specialist to confirm the diagnosis.

It would not be the case, however, to corner the internet as a tool to better clarify the population about mental disorders, says Luis Augusto Rohde, president of IACAPAP (World Association of Child and Adolescent Psychiatry and Related Professions). “The sharing of personal experiences by influencers can be useful to generate awareness and demand for professionals. We have to work together [a esse grupo] so that the quality of the information given is based on scientific evidence.”

It is another important side of the coin: detecting a disorder as soon as possible is essential so that the person has a better chance of being treated properly. And having popular accounts talking about the topic can make a lot of people wake up to a previously ignored problem.

“There is, of course, a portion that, trapped by an incorrect diagnosis, will evolve in a way that worsens their clinical condition”, says pediatrician Lilian Nakachima Yamada, who researches the incidence of autism in premature babies in her doctorate at USP (University of São Paulo). “But a reasonable portion of suspicions are confirmed after specific evaluations among this public that makes self-evaluations.”

This was the case for influencer Camila Mafra, 32. When her twins Noah and Theo were 1 year and 3 months old, she decided to investigate why they didn’t reach expected milestones for their age. “We called, and they didn’t answer. They didn’t say goodbye. The food selectivity was terrible, they ate beaten soup and that was it.”

One day, on Instagram, he liked a publication by another mother of twins. “She announced that the boys were autistic and explained what the characteristics were. I read thinking, ‘Guys, she’s talking about my children’.”

Camila says that she went on a pilgrimage to doctors and heard a lot of things along the lines of “this is normal, each child has their time” or “get out of the internet world”. It took seven months to reach the ASD diagnosis. With intensive therapy, progress came quickly. Even the beach, where Noah and Theo wouldn’t go barefoot because of their hypersensitivity to the texture of the sand, was no longer a problem.

Before being “a worried mother who thinks that everything is autism than the child who clearly suffers from something, and the family says that doctor ‘x’ said that there is nothing”, he says. “I prefer to sin by excess.”

Pediatrician Yamada advises weighting. “I hear a lot that ‘all children today have some disorder’, which is clearly not true. The networks spread a lot of information, and the layman picks part of them and ‘lauds’ children, students and patients.

His colleague Becker underscores the importance of recognizing the mental health crisis at this early stage of life, exacerbated by the Covid-19 pandemic. Our kids are more depressed, hyperactive and eating a lot of ultra-processed junk food. They have too many screens at their disposal and too little contact with parents who are overworked.

“They react to a system that is crushing their childhood. If we say ‘ah, the problem is that they have a disorder, so let’s treat it with a little medicine’, what are we doing? Throwing all the responsibility of society under the rug in the genesis of this crisis.”

He suggests always looking for specialized help, such as neuropediatricians and child psychiatrists, and a second opinion if the first is medicalizing. “If there is no good conversation in the consultation [sobre o dia a dia do menor de idade]it got off to a very bad start.”

Rohde, from IACAPAP, does not see misdiagnosis as a generalized evil and warns of the risks of relying on “a limited handful of cases” in private practices frequented by the upper class. “The perverse thing about presenting distorted data is that it once again penalizes children and adolescents from underserved socioeconomic classes. [Isso] fuels government measures that want to restrict spending on mental health in the country.”