HPI Diagnostics: This shrink believes there is a “diagnostic business”

CHILDREN – Gifted children, early children, zebras or “with high intellectual potential” (HPI) … The concepts are evolving, but all tend to diagnose children or adults with specially developed intellectual capacities. According to the WHO, 2.3% of children aged 6 to 16 who go to school are intellectually premature. This would represent 200,000 children in France.

The final episode of season 2 of “HPI,” a detective story that is a hit on TF1, airs Thursday, June 16 at 9:10 p.m. Audrey Fleurot plays the role of a mother with “high intellectual potential,” and this second series of episodes has already convinced an average of 9.87 million viewers.

While waiting for season 3, psychotherapist Emmanuelle Piquet gives us her glimpse into the back of what she sometimes considers a “diagnostic business”. IN Our children under scrutiny: ADHD, high potential, multi-dys & Co: how to stop the epidemic of diagnoses“Book co-authored with Alessandro Elia and published in 2021 by Payot editions, she is concerned about the increasingly systematic cataloging of atypical children.

LH: Have you noticed an increase in consultations to detect haste?

EP: If we stick to the original definition of “HPI”, which is a child with a high IQ, there is not much more. But if we replace the measurement of IQ with criteria that, according to studies on this subject, have little to do with haste, such as the need for justice and hypersensitivity, then there are clearly many more diagnoses. It is logical, the children in question are more!

How do you explain that?

It is a very reassuring answer to put people in boxes and say: it is because the child is like that inside that it fails. It explains, it makes sense and it’s very soothing because the child says to himself, “We stop saying I’m arrogant or lazy, it’s because I’m failing. It’s very innocent of the adult world, which tells itself it has nothing to do with it, it’s because it’s that way. So that’s an extremely “practical” answer from that point of view.

Psychiatric medicine and in particular child psychiatry wanted to draw inspiration from general medicine and said: we have a symptom, we have a biological marker and therefore we have a treatment. For example, for HPI, the main marker is the calculation of the IQ.

If IQ is one of the least annoying skeptics, most markers are not unanimous in child psychiatry. So it is easy to find and make a diagnosis. During the last ten years, when the IQ was not necessarily very high – described as “heterogeneous” – for example, the focus has shifted to children’s hypersensitivity.

We can talk about a “diagnostic company” when we see the prices charged: 98 euros for the first consultation, 410 for the IQ test, 98 for the report, 88 for a family counseling …

“It’s a very reassuring reaction to put people in boxes and say: it’s because the child is like that inside him that it’s failing.”

– Emmanuelle Piquet, psychotherapist

In your book, you even talk about an “epidemic of diagnoses”. How problematic do you think it is?

We need to diagnose children who are not to be diagnosed by telling them “as you are like this, you will never be able to do it” or “it will get complicated for you”. And then we create self-validating prophecies.

From the moment we say that a child is HPI, we will infer that it is hypersensitive and we will start looking at everything that is wrong with him, in his relationship with others. We will scrutinize him, which will create a lot of anxiety, and he will be less confident in others. All of this will reinforce the idea that his behavior is actually problematic.

When you look at a child as problematic or anxious, he becomes one. That’s logic. If some people refuse to conform to what is projected on them, very often the opposite happens.

What are the “self-validating prophecies” you are talking about regarding children diagnosed with HPI?

For example, the HPI children will -and it is very implicit-, integrate the fact that they are so intelligent that it can not go well with the others who are jealous. And the problem is that as it is appreciated, it can develop a kind of arrogance in some children.

It’s as unproductive as telling a little girl being teased in the yard that it’s because she’s “too pretty”. It does not help. And what’s more, we are not in an interactional context at all. These children use this arrogance as armor, which is deeply ineffective. We need to work with them so that they do things differently and come out of this essentialization.

In your book, you write: “sticking labels is cutting into context”. What does it mean?

The idea is to take care of the relationships rather than the kids. In my opinion, it is much wiser to make a diagnosis of the context, therefore of the interactions that the child has with his ecosystem or with himself. And to offer them relational rather than individual solutions, taking into account school and family contexts.

We need to change our view and stop seeing a child’s outburst, for example as symptoms of hyperactivity, but rather as signs of bubbling creativity. We can look at what he does with these symptoms that make him suffer and see what we can do differently in this context and these interactions, instead of immediately going to diagnose his brain to try to find error.

And if it does not lead to a relief of the disorder, then there will always be time to make a cerebral or psychiatric diagnosis. We do not throw everything overboard, but we are already trying to see the interaction and coherence before we look for failure in the child.

“We have moved into another sphere where even emotions are pathologized.”

– Emmanuelle Piquet, psychotherapist.

Is this also a way for parents to benefit from privileged support for their child?

Yes, of course: if there is no diagnosis, there is no support provided. And we are in a vicious circle, because just as much at certain times, the accompaniment is necessary and helps a lot, just as much sometimes it gives the opposite effect.

The fact of having lots of specialists who take care of looking at how a child has failed or not, we believe with Alessandro Elia that this is part of the problem and the disorder. But it is very reassuring for the parents.

You work a lot with teachers. Do they tell you about their difficulties in dealing with the prevalence of these diagnoses?

For teachers, it’s awful. From the moment there is this kind of injunction to differentiate, it is as if they were transformed into servants going from table to table with a different drink for each one.

Every child is considered different, and every parent is also in their expectations because they are obviously worried. And then it becomes unmanageable. It is not a teaching of thirty individuals. There is something about the collective we are losing.

You also write that “Dirty children were considered ‘normal’ children 40 years ago and today they have a ‘neurological disorder’.

In the latest DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, editorial note), we talk about “pathological sadness” when a person continues to cry more than twice a week after a year, after someone’s disappearance. We can clearly see that we have moved into another sphere where even emotions are pathologized.

The phrase taken from parenting education, from “I keep an eye on you until you’re an adult and then you manage” – because it was a bit of a thought -, to “I listen to you and I meet your needs”, it was a good idea . But it made children much less docile. And the less docile children, we do not know how to do. One way to “suppress” them is to diagnose them and give them medicine. In fact, we want the butter and the butter money.

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