I'm concerned about a 5-year-old in my class whom, I am told, has attention deficit hyperactivity disorder, or ADHD. He certainly has some difficulty staying focused, but his behaviors seem so different from a child I had last year in my class who also had ADHD. I'm trying the same strategies that worked last year, but I'm having little success. What am I doing wrong?

Teachers and parents are frequently presented with bewildering diagnostic terms as well as more disturbingly familiar ones, such as mental retardation or emotional disorder. Often left to figure out what exactly these labels mean, adults must act on their impressions of whether a child with a particular diagnosis can be helped and, if so, how.

Limiting with Labels

Traditional diagnostic labels serve several important purposes. They help professionals keep track of the types of problems children experience and help researchers study the causes of and treatments for those problems. But labels also pose significant limitations. First, by grouping different individuals together under a large category of what they appear to have in common, we risk grouping together children who are actually very different from one another.

Taking a Closer Look

A clear example is the attention deficit hyperactivity disorder label. The ADHD diagnosis focuses on the similarity among children who are inattentive, possibly overly active, and who perhaps can't concentrate well enough to follow directions. By settling for the label ADHD to explain their behavior, we underemphasize many important differences among them. One child may be inattentive because he can't plan or sequence his actions well. Another may have trouble processing incoming information. Yet another may be oversensitive to sound and, when confused, becomes inattentive and disruptive. A child may be hampered by a little bit of all of the above while another exhibits none of these characteristics but is simply restless and very anxious. You can see that seemingly similar behaviors can have very different origins. And each behavior calls for very different treatments. The danger of using labels is that the uniqueness of each child is lost. Settling for a label often becomes more confusing than helpful.

Building Individual Profiles

How, then, can we categorize special-needs children in a way that allows us to research and have a better understanding of their common problems, and how can we design effective treatment strategies? To achieve true understanding and effective intervention, we have to focus on the uniqueness of each child rather than group them under some broad category of common behavior. We need to look at certain dimensions of each child, such as the ability to communicate or relate. In other words, this approach allows consideration for the way each child processes sights, sounds, and touch, as well as the way he plans and carries out actions. All these observations will help determine the child's profile.

Examining Developmental Labels

Another problem with traditional labeling is that it often doesn't take into account a child's level of development. In contrast, our profile includes each child's functional level of emotional, social, and intellectual development. Interactions with family members are another important part of this individual profile. Together, these pieces help teachers and parents carry out a specifically designed intervention plan. We can begin to understand what underlies a special-needs child's challenges and go straight to the heart of each child's ability to think, feel, and interact to improve whatever needs improving.

Observing and Describing

Sometimes a teacher tells us that she has a new child in her classroom who is autistic, and she wants to know how to work with an autistic 5-year-old. Or she spots a child who she thinks has ADHD and asks how to help him. We explain to her that we can be much more helpful if instead of using a label she tells us, for example, that the first child seems indifferent to other children and plays alone rather than enjoying interactive dramatic play. Or that the second child finds it difficult to pay attention when there's lots of noise, many instructions, or when a task requires multiple steps.

If the teacher spells out a child's profile like this, we can more easily guide her toward more effective strategies and solutions. Of course, it's also important to try to understand why these particular things are occurring with these particular children. And the approach that seeks to understand a child's unique qualities doesn't rule out using medication if and when it's medically appropriate.

Moving Beyond Labels

For several reasons, it is often difficult to give up traditional labeling. Having a ready label makes the child's behavior less mysterious or scary. It becomes something about which there is ongoing research, treatments, and, broadly speaking, ready answers. Labels give us a sense that the problem is manageable. And then, too, using a label implies that the disorder is responsible for the child's behavior and, therefore, we don't have to look at what's going on around him or her. Of course, this oversimplifies the problem and limits the opportunity to do things that could potentially be very helpful.

Applying labels to very serious perhaps even hopeless disorders, such as autism or mental retardation, can lead to giving up on a child. These labels should not evoke so gloomy an outlook. If we look at a child in terms of his unique characteristics, we might see ways that lead to improvement.

For all children, but especially children with special challenges, we recommend an active program of interactions at school and at home. The design should be based on each child's individual qualities and developmental level. ECT