[Posted on 26 September, 2017 by Geir Øgrim]
I dislike my own heading of this blog, but it seems to describe a rather tabloid professional discussion.
Sometimes the child welfare authorities decide that a child has to be placed in foster care or an institution because of deviant behavior and parents who cannot offer the child an acceptable home environment. This is sometimes a necessary decision when other options have proven to be insufficient. Such placements are extremely important in the lives of the children and their parents. A broad evaluation of the child, the parents, their interaction, and the environment in general is needed to secure the best possible explanation of the child’s problems and needs, as well as the strengths and weaknesses of the parents. Experts, most of them psychologists like myself, are called upon to do this job. Too often these experts seem to lack the necessary competence in developmental disorders/ESSENCE like ADHD, autism, Tourette’s syndrome, language impairment etc. Some of them even seem to stick to a view that nearly all severe problems in children are fully explained by psychosocial factors such as reactive attachment disorder, neglect, posttraumatic stress, and ongoing psychosocial trauma. Too often the experts do not account for their conclusions; what diagnostic criteria are applied, the methods and instruments used etc. Has the presence of developmental disorders even been thought of or evaluated?
These issues are complicated and important. Some parents are able to take care of the siblings, but the child with ESSENCE is too demanding even after receiving support and advice. Foster care may be the best solution. A positive collaboration between biological parents and foster parents should be possible if all parties are informed about the child’s difficulties and special needs. In too many cases however, the ESSENCE of the child is not recognized, and the biological parents are more or less tacitly accused of being the cause of the child’s problems. The cure is to place the child in a new environment. If this is not enough, some sort of psychotherapy is needed. This reminds me of the early seventies when the theory of “refrigerator mothers” causing autism was supported by leading clinicians. In some cases the foster child is eventually properly evaluated when the purely psychosocial approach has failed. ADHD, autism, learning disabilities etc. may be discovered, radically changing the approach for helping the child.
Those of us who mainly represent a neurodevelopmental perspective have to admit that there are cases when ESSENCE diagnoses too easily have been seen as the only cause of the symptoms, overlooking neglect, abuse or trauma. We also have to admit that the present diagnostic criteria, based on observed behavior, are far from perfect, and that psychosocial factors can create “ESSENCE look-alikes”. In many of the cases that I see, both perspectives are needed: Children with an assumed genetically based vulnerability are exposed to psychosocial strains; a combination that may cause severe problems.