It is boom in diagnosis of learning deficits such as dyslexia or disorders such as autism; in many cases it is a question of false diagnoses which risk sticking a label on the child that can compromise not only his schooling but also his future.
This is what he explains Michele Zappella, head of the Department of Child Neuropsychiatry of the General Hospital of Siena until 2006 and author of the book (Urra – Feltrinelli) Children, labeled – Dyslexics, autistic and hyperactive: misdiagnosis and exclusion.
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“In the 70s-80s the prevalence of autism was 4 children per 10,000 in different countries of the world – he explains Zappella – today in many Western countries the figure has increased by many tens of times in a few years, for example a research conducted in the USA estimates the cases at 250 per 10 thousand, that is, one child in 40 would be autistic, which is a lot “. The Italian figure is also high, hovering around 1 per cent (one school-age child for every 87).
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This surge, explains the child neuropsychiatrist, coincides with the increasing use for diagnostic purposes of questionnaires or psychological tests structured in trials, considered decisive for the diagnosis of Autism Spectrum Disorders. But often these tests – based for example on the assessment of the child’s ability to understand others or interact with others – give misleading diagnoses. In this dimension, many diagnoses can pass for autistic children who have other difficulties, such as social anxiety, speech disorders, difficulty in using mouth movements to pronounce words and phrases. “Furthermore – he explains – the suspicion of autism creates very strong anguish in mothers, so much so that 4 out of 5 go into depression”, with symptoms that persist even after some time from diagnosis. And this can have profound negative repercussions on the child’s development.
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The label epidemic also affects the learning disabilities, continues Zappella: for example the dyslexia, with an increasing prevalence, passing from figures just over 1% in the 1970s to 3.1-3.2 up to 4.2%, according to data from the Ministry of Education, relating to the years 2016-17.
In reality, only a small fraction of these children labeled as dyslexic are true cases of dyslexia, he explains; others have reading delays, which often depend on inadequate teaching and precarious family socio-economic conditions. In France for example, Zappella notes, only one in five children with reading delays is diagnosed with dyslexia. The problem is that a reading delay that can be solved without problems has the same symptoms as dyslexia.
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The most serious thing, the expert points out, is that the school which is the place where the child with disadvantaged family situations should be helped, can actually end up making things worse, signaling the child as dyslexic or with other learning problems. In fact, there are other learning disorders, such as that related to mathematics, the dyscalculia, for which similar problems can occur.
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Fortunately he followed a different trajectory in Italy on Attention Deficit Disorder with Hyperactivity (Adhd), for which in countries such as the United States there is an increase in prevalence, from 6.1% in the years 1997-1998 to 10.2% in the years 2015-2016. In Italy, on the other hand, it remained at lower values, with an average of 2.9%; it is likely that the legislative measure requiring the use of psychostimulants such as ritalin only in specific Regional Centers (third level centers) did it make an important contribution to containing diagnosis and pharmacological therapies.
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In the meantime, however, the label epidemic harms the children involved: the diagnosis often changes the identity of the child, who internalizes his ailment; he defines the child by the negative aspect that is attached to him, with a label that seems to mark him in life and also compromises him in the future and in working life. So the label ends up generating a vicious circle that overwhelms the child, who feels hopeless for recovery, so a diagnosis that should be helpful ends up penalizing him in a sort of self-fulfilling prophecy which involves everyone, from families to teachers. The very idea of school inclusion results in marginalization and the etiquette generates a sense of resignation that demeans and cancels talents and abilities often present in children with various types of difficulties.
It is important, therefore, he concludes Zappella, before making a diagnosis, evaluate all the possible factors at play, from the child’s age to the environment of origin and emotional difficulties, not underestimating aspects of development such as the age at which he began to speak.
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