Nothing. Not a thing's wrong according to the Diagnostic and Statistical Manual. Difficult kids, for better or for worse, defy diagnosis. They don't meet the criteria for any official disorder, not ADHD, Autism, Conduct Disorder, not even a personality disorder (e.g., Anti-Social, Borderline or Narcissistic Personality).
They're not pathological, psychotic or sociopathic. As psychiatrist Thomas Freidman, a professor at Weill Cornell Medical College, pointed out in a recent New York Times article, these individuals not only fall through the diagnostic cracks, they challenge our notions about psychiatry and psychology. Dr. Friedman wrote about one family, the woman who'd come to therapy depressed and anxious and her 17-year old son who had a history of being rude, defiant, and anti-social, basically the root of his mother's troubles (Accepting That Good Parents May Plant Bad Seeds):
If the young man did not suffer from any demonstrable psychiatric disorder, just what was his problem?It's natural to point fingers at parents, their lack of discipline, the prenatal environment, the time span between siblings, the choice of preschool, too much tv, Wii, plastic bottles, sugar, white flour, or whatever we can think of to explain the disparity between good parenting and bad children.
My answer may sound heretical, coming from a psychiatrist. After all, our bent is to see misbehavior as psychopathology that needs treatment; there is no such thing as a bad person, just a sick one.
But maybe this young man was just not a nice person.
For years, mental health professionals were trained to see children as mere products of their environment who were intrinsically good until influenced otherwise; where there is chronic bad behavior, there must be a bad parent behind it.
It goes against not only modern mental health but our era of hyper-parenting where experts and authorities provide all manner of recommendations and directives. Do this, do that, don't do this or that and your child will turn into a smart, thoughtful, successful adult. But a genetic predisposition to be insensitive, disobedient or selfish, maybe a toxic mix of the Big Five personality features, challenges this deeply ingrained, American can-do parenting imperative.
Certainly there are things parents or a good therapist can do to ease living with or being one of the more trying but yet still functioning members of society. Gotta fault the doc for suggesting otherwise. It's not like the mental health field has nothing to offer. Just because we can't diagnose them doesn't mean therapy is a lost cause. As I've written before, we get stuck on labels and diagnoses, for one because that's what many insurance companies require to reimburse therapy visits. But it omits the reality of many children and adults struggling with a collection of behavioral and psychological symptomatology that don't fit neatly into the DSM. In fact, it's not just these temperamentally trying kids who fall through the diagnoses.
I've witnessed families going through this and can report their strain and frustration is no less real than those with a child diagnosed with ADHD or autism. At least with a diagnosis there's a clearer path for therapists to follow and a clear explanation for the problems. I'd imagine it's not uncommon for the parents of unpleasant children to end up in therapy themselves, like the mother coping with depression and anxiety. Especially when they've been told there's nothing (officially) wrong with the kid who's complicated home life for years. I'd probably blame myself. It's easier to blame the environment (i.e., mom and dad) when there's no clear diagnosis. As much as we recognize the large genetic components of ADHD and other disorders the same is not true of troublesome personalities.
Whereas there's a large body of empirical literature speaking to the resilient child, the kid from the dysfunctional home or who suffered early trauma or adversity that rises above it to become a well-adjusted young adult - as Dr. Friedman noted, there is no comparable research about obstreperous children coming from well-adjusted parents. But the difficult child hasn't been neglected in pop psychology.
Check out all the How-To-Parent The Prickly/Wild/Spirited/Explosive/Strong-Willed Child books on Amazon.
For coping with the challenging adult there are even more books. In fact, at my local library I just picked up Difficult Personalities: A Practical Guide to Managing the Hurtful Behavior of Others (and Maybe Your Own). Sounds like a good one to have on hand for the next family reunion or PTA meeting. But my favorite has to be Perfect Phrases for Dealing with Difficult People: Hundreds of Ready-to-Use Phrases for Handling Conflict, Confrontations and Challenging Personalities. That one might stay in my car next to the emergency supply of Hot Tamales and Excedrin Migraine.
I have sympathy for those irksome personalities when they're young but when they run the school, coach the soccer team or work in the children's library, somehow it all vanishes. All the more reason why the mental health field shouldn't let these kids slip through.