On Being “Strengths Based”

3 kids musclesWhen I describe my work, I proudly say that my perspective is “Strengths Based.”  Recently, some people have asked what that means (Oh.  Good point).

Every one of us, regardless of the type of work we do, carry biases and values.  If someone tells you they have none, run, do not walk, in the opposite direction.  The important thing, as ever, is integrity–being willing to name and own our bias, our slant, the beliefs and values that we bring to our work.  These are mine: in my work with children and families, I look for and work with strengths.  I have little to no interest in deficit.  I understand and respect that there are people–many people–who see the utility in diagnosis and figuring out “what’s wrong”–it’s just not my kuleana (just have never found an equivalent word in English.)

Like everything else, like every collection of words, “strengths based” undoubtedly exists on a bit of a spectrum, meaning different things to different people.  My “bent” undoubtedly resides pretty close to one end of that spectrum.  People may disagree.  That’s okay.  If I am anything, I am principled.

Wow.  How ironic–and spot on for this post–that as I type the word spectrum (twice in one paragraph!), which simply means a range of points or characteristics between two opposite endpoints, I am acutely aware that in many communities it is shorthand for Autism Spectrum Disorder.  Just to be clear, I’m not talking about ASD.  I’m talking about another kind of spectrum.  More like this one: spectrumYes.  I embrace all the colors. Let me explain.

First, let me say that the massive and profound shift in our culture to either/or (“you’re with us or you’re against us”) is one of the great frustrations of my professional and personal life.   Above all, it has made communication difficult, especially for those of us who reside in “the middle.”  Every time, for example, that I have tried to have discussions about the potential for overdiagnosis of ADD/ADHD in the United States, I have been met with a strong emotional (usually angry) response along the lines of “my son DEFINITELY has ADD, and the medication has completely changed his life in school!”  Admittedly, this confuses me.  Those of us who are arguing the middle, and discussing the potential for overdiagnosis, are in NO WAY saying that the diagnosis does not exist, that associated medications are not beneficial, nor are we saying anything about any individual child.  It is surely possible for your child to genuinely have ADD or ADHD and benefit from associated medications AND for many other children to be misdiagnosed.   As you can probably tell, I am not inclined toward black and white–I am an “and” person.  Two things can be true.

The other thing that undoubtedly colors my perspective is that I believe a healthy dose of skepticism is a very good thing.  Every parent–heck, every adult–knows the many merry-go-rounds of “eat this, not that” and “do this, not that”….followed, at a later date by “strike that, reverse it.”  There is much we don’t know.  We’re always experimenting and learning.  Many psychotropic medications have never been tested with children, have no official dosages for children and are not technically “authorized” for use with children, and yet we are prescribing and defending them hand over fist.  To me, that sounds like something deserving of skepticism, which, fortunately, is right up my alley.

So, what does it mean when I say that my work is “strengths-based”? It means that when I work with families and children–even children whose behavior or presentation is outside the boundaries of what we would call “typical” or “normative”–I focus on who they ARE, what they can DO, and the ways in which they are completely competent.  I freely admit that I have little to no interest in what is WRONG with children–their “deficits”–and that I have a profound trust in the process of development.  Again, this does not mean that I discard the usefulness of those who do look for or treat particular “disorders,” only that I am not comfortable in that role.

It means that I believe that we are heading, as a society, toward a world in which nearly all of us have “disorders,” which begs the question…when everyone is “disordered”, what is this norm that we are all diverging from?  Who is left?  And what is it that we find so comforting about diagnosis…and for that matter, homogeneity?

It means that I believe that, in way too many cases, we are increasingly pathologizing normal childhood, and making our children the convenient “identified patients” for the ills of our education systems, parenting, and society–and personally, I don’t feel good about that.  And it’s not only children…there is evidence that we are pathologizing the normal range of emotion, leading us down the dangerous slippery slope toward some sort of imaginary neutral state in which everyone’s emotions exist within a very narrow and controlled little band.  For some reason, we seem able to recognize and easily condemn the danger of such a pattern of labeling in historical context (i.e. the diagnosis of “hysteria” frequently used in Freud’s time and prior, which most people I know seem to agree was a blanket pathologizing of women’s emotions), but when it is suggested that we may be doing exactly the same thing in 2015, we respond with a defensive “Oh, no, it’s not the same thing at all!”  I think it is.  (Ironically, as I write this, NPR is devoting a full hour to just this phenomenon.)  I am alarmed at the overuse of medication that has not even been tested on children, and the dismissal of side effects, both short and long term.

It means that I genuinely believe in the immense power (positive or negative) of self-fulfilling prophecy; the research repeatedly bears it out. I choose strength.

It means that I believe there is a huge range of “normal” (i.e. not pertaining to any diagnosis) in children (and adults), and that we can respond proactively to needs for support around any and all issues within that range without the need for a diagnostic label, deficit description, or alarm of any sort.

It means that there are mountains of data (not including anecdotal data, which is also voluminous) that show, beyond a shadow of a doubt, that parenting and other factors in children’s lives shape children’s behavior in powerful and often permanent ways.  When I see a child with significant behavioral issues, or a family struggling to maintain a peaceful coexistence, I tend to look at the patterns in place and the triggers and skills of the adults, long before I consider some sort of “disturbance” in the child.  Sure, not all adults are eager to examine their contributions, and some continue to frame it as “blame” (I do not); their reluctance does not justify attributing the problems to disorder in the child.

It means that, in my experience, so many of us are so impatient and anxious and eager for our children to succeed and often unaware of the natural trajectory of child development that we have lost all sight of “unfolding”, the natural diversity of styles and rates of learning.  We Readinessget help for our children at 18 months because we are told that they don’t have large enough vocabularies.  We are pleased because the therapies work–their vocabularies grow.  Of course, at the same time, time is passing, and they are getting older, and it is nearly impossible to extricate maturation from intervention…so we actually have no idea whether the explosion of words is due to the therapy or simply because they got older.  I was struck today when I encountered this article about Audrey Lang, a current high school student who was not yet able to read and write in 6th grade.  My guess is that the great majority of us–and certainly most of our medical advisors–would regard a child who cannot read in 6th grade (or 1st grade, for that matter) as possessing a “deficit”, a “learning disability”, or at the very least, a “problem.”  In most households, that would cause serious alarm.  And yet–read the article–was it any of those things?  What would happen to our world if we were to trust our children to know their own development?

All this being said, I know and respect that there are many parents who welcome and embrace diagnosis (of all sorts) at earlier and earlier ages, especially as we currently have systems of service and payment that demand that sort of classification for access to support.  I understand.  And (there’s that and again), I feel strongly that the dysfunction–the “disorder”–belongs to a system that demands that we label children in order to obtain support.  Why can’t we offer support of all kinds to all children and families who need it, based on their actual needs, with or without attaching a label?  What are the specific benefits, other than to bureaucracy, for children to have a particular label or diagnosis?  Do we subconsciously create limits for our children through those classifications?  Is it possible that we are sacrificing children–who have no voice or vote, and thus no genuine consent–to a set of restrictions (self-imposed or otherwise) that may last them a lifetime?  What benefits do they (not we) derive from their diagnoses that would not exist without the labels?

I also know that many of us find great comfort in knowing “what we have” or “what our children have” because, as human beings, we like putting things in boxes, stock-footage-baby-in-cardboard-boxand it helps us understand our children better and support them more authentically.  Of course, being better equipped to understand and support our children could hardly be called a bad thing.  The question remains: is it fair to put our children in boxes because we don’t have the skills or the ability to understand them without those boxes?   Is there an alternative?  Might we learn how to accept our children as unique individuals and embrace the wide range of human experience and expression without regard for labels?  How would our lives be different living and raising a child with Asperger’s, for example, if we did not know they had Asperger’s–if we lived in a place where people did not use those classifications?  Would they still be the same child?  Would we still be the same parents?  Is the benefit of diagnosis for the child?  For  us?  Or for the institutions and communities with which we and they interact?  I do not presume answers to these questions, I only propose that they be asked.

Which bring us to early intervention–something which you would think I support without reservation, as it highlights the amazing opportunities available to us to help our children make powerful adaptations by intervening in the earliest years of life.  And again, I call your attention to the “And” construct.  Yes.  I am in support of early intervention for those that need it.  And… a great deal of my experience with early intervention is one of watching a whole lot of hammers walking around, seeing nails in every direction.  I hear of “toddlers in need of help with social interactions,” as if virtually all toddlers do not hit or bite, and as if parallel play were not a normal developmental stage of play.  I hear of 2 year olds in need of language support because they are not speaking clearly, ignoring the fact that a huge percentage of the adults walking around–including those that are extraordinarily articulate–did not speak clearly as 2 year olds.

So, does this mean that I regard all children as “equal” in their challenges?  Absolutely not–some of us surely have far greater challenges than others.  Does this mean that I don’t see a value in intervention and support, especially during the early years, to ameliorate or address those challenges?  Absolutely not–I not only find such intervention helpful, but in many cases, critical.  Does this mean that I regard many of those problems as systemic, rather than residing in the child themselves?  Yes.  I do.  The developmental delays so common in impoverished communities, for example, are not “features” or “disorders” belonging to the children in those communities.  The children are no different from any other children.  Delays are simply a “side effect” of poverty and all that comes with it.

I have heard it said that we could all sit down and leaf through the DSM, and most of us could find ourselves in there somewhere.  As adults, we have that choice–to see ourselves and everyone else in the frame of disorder.  Do we have the right to make those choices for our children (even without a corresponding manual that really is designed to pertain to them), providing a label that may follow them throughout their lives?  Maybe we do.  Maybe we don’t.  How do we decide?

Some of you I will have the privilege to meet one day, if we don’t know one another already.  Maybe we will get to work together for the benefit of children–yours, mine, theirs.  You deserve to know the lens through which I see children–all children.  I do not see children through labels.  In most cases, I would actually prefer not to know if they do have a diagnosis, as it is relatively meaningless to me.

For me–after 35 years of working with thousands of children, including children with disabilities–a child is a child is a child.  Each has their strengths.  Each has their challenges. All of them more alike than different.    In my work, for the most part, I choose not to engage with systems that, in my view, minimize all that a child brings to the table simply by the use of a few carefully placed words.

I choose strength.

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