On Wed, 15 May 2013 00:04:27 -0400, Friar Broccoli <
eli...@gmail.com>
wrote:
When I read your post, I wondered what obvious thing you thought you
had missed. Most people fail to foresee the future either because they
misinterpret what they see in the present or because they misinterpret
the past. In saying that you failed for foresee the future you have
something in common with Dr. Frances. He missed it, too. The
difference between you is that while you say that you missed the
obvious, he says that what happened was an unintended consequence.
Maybe he is just another narcissist overtaken by events. That seems to
be the policy excuse du jour in the US.
That brings up (at least) two objections to Dr. Frances. First, he has
known for at least five years that adding behavior to the diagnostic
criteria had what he now refers to as 'unintended consequences.' On
the other hand, I don't believe for a second that they didn't know
that behavior is both the least expensive and the most accurate
diagnostic tool when they wrote it into the DSM.
What they didn't expect was not that behavior doesn't make a good
diagnostic tool, but that behavior was and is bad enough to to use it
a lot. That's a pretty easy mistake to make, particularly if you were
tracked with the other bright students who had an easy time in school,
especially if you came up back when the special ed and emotionally
disturbed kids got short-bused somewhere else.
Second, the finding that the most significant predictor of a diagnosis
is age at the time of cutoff for the next school year is not in itself
an indictment of clinicians. When he says that: "Most people seeing a
doctor on the worst day of their life will get better just through
natural resiliency, time, resources from family and the community and
what we're doing is jumping ahead, giving diagnoses carelessly to
people who don't really need them," the conclusion doesn't necessarily
follow from the premise.
For example, my best friends' two autistic sons did improve--
eventually. It took more than 10 years and it wasn't free. Likewise,
to the extent that the developmental gap narrows over time, why would
Dr. Frances *not* expect that it would be most pronounced in children
younger than their classmates? It might be the case that some of the
wrong people are being treated, but that doesn't show it.
The alternative Frances proposes, smaller class sizes, more individual
attention, and more PE, while not objectional, isn't free either, and
it runs headlong into a political wall.
In this case, the hypothesis that the children receive a diagnosis
because the principal needs money is easily rejected by inspection.
Visit with a group of 'normal' kids and then with a group of kids that
have been diagnosed as autistic. You will find the groups very
different from one another. So do their teachers.
I find the suggestion that you wouldn't notice a difference dubious,
at best. The same applies to the ED kids and those diagnosed with
ADD/ADHD. Notice that Dr. Frances carefully avoids accusing teachers,
counselors, and/or psych professionals of failing to follow the
definition(s) in the DSM. He usually describes them as some version of
pure of heart, but naive.
Consider alternate premises:
1) Like other psych professionals, Frances was interested in figuring
out his own problems. Pathological narcissists are controlling, and
tend to blame others for their own failures. They can be intolerant of
other people's views and they are self-absorbed. They ignore other
people's needs, but speak with conviction and insist that other people
accept their personal narrative.
2) Children's problems are as serious as the mental health
professionals and counselors treating them say that they are. That is,
the boots on the ground have a less colored view of reality.
3) Narcissists commonly tell you what they're about, often by
complaining that the behavior of others is 'bad' while they are doing
the same thing themselves.
Now study the present again. Do you find Dr. Frances regularly in
front of reporters? Can you find his CV? Is he an expert on autism,
ADD, or ADHD? Where are his papers in those areas? It's not hard to
figure out what his areas are: depression, PTSD, OCD, self-mulitation,
etc.
We have already seen him belittling other psych professionals as
well-meaning but naive. It isn't difficult to find him accusing other
psych professionals of pushing their 'pet' disorders, or to find him
doing exactly the same thing. It's also easy to find him saying that
you can't define psychological disorders, even as he tells you how you
should define them.
Over the past six years I had the unusual opportunity to meet perhaps
20 children diagnosed on the spectrum of developmental disabilities.
Teaching them requires a special sort of patience and they are very
expensive to both counsel and to teach. If it were easy to obtain
funding for that purpose, the principal would need to spend very
little time per student doing it. That is, if a diagnosis
automatically resulted in funding, the principal could put that
function on auto.
On the other hand, if there were no funding at all there would be no
reason either to seek a diagnosis or for the principal to seek
funding. When the principal told you that she spends a lot of her time
seeking funding to help kids with special needs, you know that while
there is some funding available, it isn't easy to get.
Ignoring a problem doesn't make it go away, so what you might predict
are: 1) that the number of problems diagnosed will rise to meet the
available funding conditional on limits imposed on the principal's
time; and, 2) that any linear probability model you use will produce a
biased result, i.e., the distribution will be censored.
You might also predict that teachers will be more likely to recommend
testing for students that disrupt the classroom than those that don't,
so that otherwise disruptive students will be the ones who got
diagnosed and medicated. Hence, using the number of diagnoses to
predict the prevailing level of mental illness will also be biased;
most of the non-disruptive mentally ill won't be diagnosed. In the bad
old days, that would have included most of the kids with developmental
disorders.
Kids have problems. If you can get funding to help them, you do.
Social workers will try to use broad interpretations of the
definitions, so that they can help as many people as they can. That,
by the way, leads to a consistently correct prediction of the future.
There will be budgetary politics no matter how you define the problems
and regardless of which tools you use to diagnose them.
I'm not a psych professional, so I have no idea whether 10%, 20%, or
more of the population is ADD, ADHD, autistic, or something else. By
his own admission, Dr. Frances can't tell you that either. On the
other hand, having been paid to ferret out people's psychological
weaknesses and manipulate them for the benefit of the US government,
I'm not uncomfortable saying that conservatively 8 or 9 out of every
10 people I've ever met are somewhere in my undergraduate abnormal
psych book. Even if you can find a competent counselor with a good
track record of actually curing basic problems (most of the ones I've
met have so many problems of their own that they can't even establish
rapport), there will never be enough resources to help everyone.
Whether drugging the problem kids is the best solution is another
matter. I think you can also safely predict that it will continue to
be easier and cheaper to prescribe drugs based on observed behavior
than to improve the quality of the food supply, make sure that the
kids are eating a healthy diet, and/or geting enough exercise. It will
also always be easier than creating a customized learning plan for
each student.