The state is failing children. (Francois LE DIASCORN/Gamma-Rapho via Getty Images)
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Josh’s mum finds it hard to understand him. At school, her son is puppyish, friendly: a 12-year-old who still has the excitability of a primary school child rather than the jadedness of other Year Eights. But at home, his mum explains, it can be a different story. He has no sense of consequences, no situational judgement — and if he gets frustrated, he will sometimes lash out physically. He once wrestled his little brother into the pond. When chastised, he didn’t seem to understand why it was such a big deal.
That same little brother, who has just turned seven, is already catching up with Josh in English and Maths. And unlike Josh, he’s able to regulate his emotions and follow instructions. Their mum fears that Josh may never get there. She knows he needs specialist support, and she knows, at least in theory, how to get it.
His school’s Special Educational Needs and Disability Coordinator — or SENDCo — referred Josh to the NHS’s Child and Adolescent Mental Health Services (CAMHS) for an autism spectrum assessment. CAMHS rejected the referral. The SENDCo then put in a referral for an ADHD assessment. Both times, Josh’s mum did the parenting courses that you have to do to indicate that a child’s home environment isn’t the problem. Having two other children who were doing well both socially and at school wasn’t enough evidence that she’s a competent parent. She kept a three-month diary of Josh’s behaviour, and made notes about the ways in which she and her husband tried to support him. But it was all for nothing: CAMHS rejected the second referral as well.
It can sometimes seem as though CAMHS’s primary job is saying no. Josh’s story is far from unusual. Working as part of an NHS early intervention team, I met the family of another boy, of a similar age, who keeps getting excluded at school because he can’t sit still and stay focused in lessons — but who excels on every sports pitch and behaves well at home, where he can move around and go outside whenever he needs to. That boy got rejected from CAMHS five times.
The team I work in can’t diagnose ADHD or autism. Neither can the SENDCos in schools, even though they’re often experienced and knowledgeable. Diagnoses can only come from a clinical psychologist, a psychiatrist or a highly trained specialist nurse. For most families, this means going to either CAMHS or whatever’s left of their local authority’s educational psychology team. In our small county, that team amounts to one employee. The waiting time for an assessment is between one and two years, which colleagues in neighbouring areas say isn’t too bad.
But to get onto the waiting list, you have to be accepted first. One way for CAMHS to keep waiting times down is to just say no to most referrals. Getting a child the support they need from the NHS is an arduous, exhausting process for schools as well as families — and, of course, for the children, who know that there is something different about them that keeps on causing problems, but can’t be offered any solutions without a diagnosis. SENDCos face rejection after rejection if they request either CAMHS involvement or funding for Education Health Care Plans (EHCPs), which pay for the resources and support some children need to cope with mainstream education.
If, however, parents can afford a private assessment, a booming industry of psychiatrists and educational psychologists is on hand to provide their child with a diagnosis within a week or two. It’s a frictionless, even pleasant experience: you go online, book an appointment and chat to a friendly, highly credentialed specialist. I know this because I’ve done it myself: a few years ago, I had some problems at work, and an ADHD diagnosis helped make sense of them. While Josh’s mum has to justify herself to an institution that holds all the power — an institution that can demand she take courses multiple times and jot down observations for months, all in the hope that her child will be accepted for an initial conversation — paying clients can expect a service that works for them.
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SubscribeDyslexia and ADHD are just middle-class people being able to buy a certificate to get their kids extra time in their exams that other kids do not.
The rest is all BS, isn’t it?
Boys aren’t like girls, and a lot of boys just don’t fit in an academic environment – sitting at a desk listening to a teacher explain abstract concepts. The people who decided this is a mental illness are wicked. But then they are the same class of people who prosecuted the Post Office workers, just to pick a recent example.
An ignorant response. Empathy free people like you have no idea. Fortunately you are an irrelevant minority allowed to rant in an internet corner but with no influence on policy making.
Empathy free, lol,ha ha ha I think I’ve been surrounded by Empathy Free people all my life. Thank goodness. I’d rather learn to “swim” and say “f**k you” than be told to sit by the fire and watch TV don’t worry love,it’s all too hard for you.
It’s not ignorant, there are a small number of very intellectual young people who might benefit from this support but there are many more who are either gaming the system and/or would be better off out of education.
If you are representative of people with empathy then I am very lucky not to have it.
You are the kind of person who harms children.
Unfortunately, there are many children with special needs (whatever we choose to call these – and whether we consider them mental health problems or not). And these can arise even with what most of us would consider good parents. Children can find themselves in circumstances where they are unable to cope.
And these children do need help. CAMHS is essentially the only option available for most people and a nightmare to get help from (which of course makes it easier for middle class parents to work the system). But this is easy for no one – no parent wants to be in this situation. Nor is going private a quick or easy option as the article suggests.
No doubt there is some “BS” around here and a small amount of performative disability humble-bragging from a few parents. But my experience suggests that those parents who have children with these problems don’t talk about it in public.
Like it or not, the increasingly complex and stressful nature of modern life means that mental health is a growth industry. Better to be honest about this and encourage good people to work in it than write it all off as “BS”.
Would be interested to hear, Tom, if you have any first hand or close experience with a child that has a diagnosis and the family that is living with it. Girls can have ADHD and Autism too. As in the article I am worried my daughter will struggle to operate independently and will be with us long behind 17 when I left home.
These issues are likely down to left and right brain developing at different rates.
This was evident many years ago and has only got worse. Some of the cleverest, ablest students got extra time in exams where every minute counts who were perfectly capable of getting top marks without that time – mock exams couldn’t just dole out extra time due to the lesson ending. Back then you didn’t have A* markings so the bar was lower but now parents who want their kids to get the top grade almost need to give them some advantage (tutoring, extra time etc.). Gone are the days where we were out playing cricket the weekends before A-levels, glancing at revision textbooks while waiting to bat and joking about the swots who were at home behind a desk. I don’t envy today’s students, it seems like a meat grinder.
I think the author doesn’t go in hard enough on parents who do this. She does a good job of displaying the disservice that it does to vulnerable young people but there aren’t any real suggestions for how to end the practice. Exam performance has shown New Labour’s policy of putting those with less serious mental disabilities in with their peers to be the right approach – the previous regime (while well meant) put a lot of kids in the “problem” pile too early in their lives and they were never able to get out.
One of the biggest difficulties with ADHD is that there are other things that can give similar symptoms.
I’m the father of a 30 yr old who has ADHD, he most definitely has it because we raised him.
My wife & I have fostered children for many years. He & his sister were the 2nd set of children we had.
They came to us for the weekend & stayed 3 years.
They moved on & then the placement broke down.
Social Services approached us to take D back on a long term basis as he had been more settled with us.
By the time he returned he was in primary 3 & school was a nightmare for him.
He was soon diagnosed with ADHD & medication was prescribed.
However him taking it, deeply worried us. He’d go from a jolly but boisterous 8 yr old to a little zombie in 5 minutes.
We had to give him it at school but we never gave him it any other time.
We managed his behaviour & although he was always ‘on the go’ he was never destructive.
I think that was because we knew he couldn’t cope with a rigid regime.
His teenage years were difficult, mostly at school because he got labelled as a bad boy & tended to play to the label.
The low point was the day he got excluded for punching another boy. I still remember the words of the Headmaster who told him he was the worst pupil they’d ever had & told me I was a poor parent.
(by this time we’d adopted him)
After he left school ( with few qualifications) we discovered he liked welding & fabrication so we got him on a training course.
I can recall clearly getting a phone call from the guy who ran the training organisation complaining that he was looking out the window when they were teaching maths.
I asked him if I could come & see him, he was reluctant but said yes.
I said this to him “Most of the lads in that class are interested in fast cars & girls with short skirts” “I doubt any of them had their birth mum ringing them on the way in, begging for money because she knows he’s got a training allowance” I suggested he let D loose with a welder first thing in the morning instead of forcing him to learn maths.
I met the manager by chance 3 months later & he said “You know, you were right, he’s doing much better” I replied with a wink “Strange that, I’m only his dad”
Over the next year, left on his own with a welder, our son made that manager a car trailer any professional would have been proud of.
He’s now married, has just bought his first house & is in a supervisor role with an engineering business. He has his own company van etc etc.
Why have I written all this?
2 reasons.
Firstly to give people hope. A young person’s life isn’t over if they don’t do well at school. In fact it’s just begun.
Secondly, by its nature our education system is designed to meet the needs of children who’ve not got any problems. Once a child/young person is outside of that norm, the educational system is like a straight jacket for them.
Unless you can find teachers & other educators who are willing to be flexible & understanding then it’s just a constant battle.
An inspiring story and thank you for sharing
I agree with Douglas. I don’t know exactly how we can improve schooling but let’s at least start by giving up the daft idea that most should attend university.
In Bryan Caplan’s book, The Case Against Education, one of his proposals is that children should be able to leave at 14 for work.
In the UK we should somehow stop being so snooty about those who left education when young.
Actually we now have far too many graduates and way too few HGV and fork lift drivers, waste collectors, paramedics, tree surgeons … the list goes on.
Excellent post. I had a similar experience with a sibling who couldn’t cope with school but who found a niche and was able to lead a happy and successful life. Terrifying to think that in today’s system his personality would have been medicalised, only re-enforcing his perceptions of inadequacy and outsider/loser status. Plus there are the unknown long-effects of the drugs these kids are being given. Not all change is progress.
I wish more schools had trade classes. My school had automotive training, and a lot of young men found good paying jobs. However, the district severely cut back on the program. I’m a retired high school teacher, and I had few problems in my classes (I saw myself as the apex predator of the classroom.) However, I did over the years have some incorrigible kids. Some of them just couldn’t stay in their seats. Some of them were seriously mentally ill. I’m a pretty patient person, but some kids , usually the mentally ill students, could ruin class for the other students. Even the kids who can’t stay still can be exhausting. These kids would be better served in a trade school than reading MacBeth. Unfortunately, most school districts think they’re all going to Berkeley.
I should add that the kids with ADHD were not mentally ill.
It’s all a load of cobblers. The mother diesn’t understand that the boy just isn’t built for sitting in a room being lectured at. He’s built for winning boat races, civilising the Sudan as a district commissioner and setting up his own small business. In a less feminised system he wouldn’t be medicalised and doped up, his differences would be tolerated. 95% of these diagnoses are sheer nonsense, and gameplaying by incompetent mothers who want Timmy to get a free laptop for his A-levels.
In some circles an ADHD diagnosis has become a fashion accessory.
And Aderall is a sought after drug for college students.
And possibly an excuse for poor (indulgent) parenting….?
“It’s all a load of cobblers.”
I’m an American who often worked with Brits and enjoyed their uique turns of a phrase. This is a new one! I had to look it up! I suspected it had to do with cobblestones but was surprised to see it’s actually about shoe maker’s tools! Thanks!
Like Long Covid and the diagnosis of autism in middle-aged middle-class adults, this is another manifestation of the modern mental health complex. In short, it is a condition ‘suffered’ by children who play too many computer games or over-enjoy digital entertainment nowadays, meaning they don’t have the attention span (or the desire) to do their homework when they could be doing these other activities.
The NHS is odd but not atypical in that it is structured like Soviet central planning while run by fashion-conscious left-liberals, and nothing is trendier than the mental health platform.
My son gas been diagnosed with ADHD and it has affected his school work. Since he has been on medication his school performance has improved substantially and he is calmer and happier. Those who assert that ADHD doesn’t exist and the medication is pointless or. Worse undesirable, are not professionally qualified to comment. Thankfully such people have no influence on either policy making or BICE prescription guidelines both of which are left to qualified experts.
Completely agree. I think a lot of people commenting here are simply fortunate enough never to have encountered children or families with this problems. When you see or experience some of this first hand, your perspective certainly changes.
Elsewhere in this thread is another father’s story of how drugs were not a panacea for his son. Also, no one has said ADHD does not exist, though a case can be made that it is grossly over-diagnosed. Before you hang your hat on who is “professionally qualified to comment” or not, keep in mind that multiple people with all sorts of letters by their names are spearheading the gender craze and ready to mutilate children.
The long term effects of this kind of medication are unknown though. Everything is a trade off.
I see.
So you are one of the parents who has drugged your son because you cannot deal with male behaviour.
Like all the parents who have transed their children because they fell for obvious BS, have done something horrible and irreversible and so can never admit it and so try to force the same on others.
Much of the disagreement centres on the ‘marginal’ cases as opposed to those where it’s much more obvious a v significant disability does exist. Think important we try and distinguish if we can.
Some evidence does point to growth in ‘marginal’ cases with the ‘system’ incentivising a confirmatory diagnosis. Accessing more resources or time, being the obvious driver. But some really do need significant additional help and the condition much more debilitating.
Focusing on ‘marginals’ – I think there is some evidence too that kids the youngest, or younger, in their school year struggle more with potential ADHD labelling. It’s obvious if a child is almost a year younger than some peers the powers of concentration likely to be different and the kid may be more disruptive. If that child then gets labelled as a problem early by teachers et al it becomes almost self fufilling prophecy. And then if diagnosed with ADHD chances of siblings having similar diagnosis increase as ADHD believed to have some genetic component, albeit we cannot test for that as yet (if ever).
Begs a question about do we send kids to school too young? But a separate debate perhaps.
As regards the system then favouring those with greater ‘means’, nothing new in that. The dilemma is how we assess and fund the right capacity in CAMHs without drifting into over medicalisation. Not a simple balance, and it does seem we all need to do more as parents (and Grandparents) in perhaps further understanding what we’ve done to our young to drive an increase in mental health issues.
Where’s Josh’s dad? I only ask…
Not a lot of people know this but in 2010 THEY threw the switch and stopped caring,or rather having to officially care. They didn’t tell us that,they left us to work it out for ourselves and some of us did but there are still lots of bewildered souls who call into radio discussions with sad stories of children not getting that special needs assessment,of parents not having been informed their teenage daughter hasnt been in school for months,leaving the parents not only wondering where she has been going all day but why the school didn’t even notice she wasnt there. Remember in 2010 Nick Clegg and David Cameron in the Rose Garden both announcing the huge hike in student fees. That was the moment they said to us,”we’ve had it with trying to please you ungrateful bastards,nothing is ever enough,from now on we’re going to f**k with you and screw you,and laugh at your consternation and confusion” of course they didn’t word it like that and it was the covid experience that opened my eyes to it and a lot else as well including the narrative of the 20th century we are taught. They don’t care now and they don’t have to care. I dont mean individual persons in whatever capacity cant be sympathetic or care a bit in individual terms but how much do you have to get paid to REALLY care about stupidly behaving, obstructive,charmless people who are no asset,even if you feel sad for them you’re not going to want to bust a gut.
Wake up People. Grow up People. Home educate your kid. If you can’t individually form a SMALL group. It’s obvious clever people are going to push in and take advantage as that is the whole point of being clever,to be first in the queue. It may not be Fair but as my parents always told me Life’s Not Fair.
Any child who is happy and and thriving in the modern school system has far more serious ‘mental health’ problems in store than the bored and rebellious. This is to discount the 20% who are just seriously thick, a concept that is no longer entertained.
As a parent of two children with an ASD diagnosis, there are too many people who game the system for their (or their child’s) advantage. Knowing the doors open to additional benefits, including specialist schooling (which also includes independent schools – if/when needs can be met), funds etc, parents will often look to manufacture a diagnosis to get access. I learned this from talking to people in my county’s SEN team. The problem is they have to treat all requests/approaches as if they are genuine, and go through the same processes with each. This means parents who actually NEED the support, are left hanging.
My son had a year of part-time school, because his school was unable to cope with him, and was then without ANY secondary education for the following year (this was after schools returned from Covid), and now has to go to a school in the next county.
We waited 2 years for the first appointment for my son to be diagnosed, they then outsourced the process, and my daughter’s assessment took 9 months. I was actually told that whilst I could go for a private diagnosis, it would not unlock my son’s access to a special needs school until he had been seen by the NHS.
As for CAMHS, we were referred to them 4 times for an ADHD assessment (requested by a school he has now left), and each time we had one appointment and then no appearance of a (promised) follow-up, until finally it was 5th time lucky. As we expected, he doesn’t have ADHD.
“In systems such as the NHS, healthcare is rationed, and the implication is that you’re supposed to be grateful for whatever you can get.”
Hope my fellow Americans see this and reject any move toward nationalized health care here.
It’s not nationalised – there’s still plenty of private healthcare in the U.K., as the article points out.
Many years ago, when adhd first reared its head in America the BPS held a meeting about whether to include it or not as an illness to be diagnosed.
They quite sensibly at the time decided that if children could wait and pay attention in one situation, they had the developed mental mechanism to do it in another.
Things have changed now of course, due to it having achieved special needs status.
I did research on adhd in middle childhood when training and found that simple concentration games and reading books or improving hand eye coordination worked just as well as knocking them out with Ritalin.
There is an organic illness called hypo kinetic disorder.
In those cases which are rare, children find themselves unable to calm down, even when they are desperately interested in something. they really do not have a choice and meds in those cases can help.
When I was a parent caught up in this, state schools were not allowed to accept private diagnoses not could educational support plans be accessed on the basis of private recommendation. CAMHS was the only route. It took 10 years from referral to diagnosis for my child, by which time he had aged out of the children’s service and was diagnosed by adult psychiatry.
It’s among several luxury labels, including the eating disorders that were the scourge of middle- to upper-middle class girls a generation or so ago, and the gender craze taking hold now. I don’t doubt that ADHD is real but it’s hard to see how drugging children into a stupor accomplishes much. This generation of (mostly) males has reached adulthood. How’s that working out? By almost every statistical measure, the outlook for young men is depressing, from dropout and suicide rates to a lack of interest in young ladies to the video game habit so many have. And no one is done any favors by conflating ADHD with autism.
Great article, thanks.
I do know that psychologically and intellectually challenged kids take up all the classroom time. The answer to best serve your own children, if you can, is to send your child to a private school and if you can’t afford to French Immersion (in Canada) or some other special program where there aren’t many struggling kids.
The lack of resources dedicated to diagnosis and support for ADHD is so short-sighted. Early intervention and treatment can transform academic and social outcomes for children. As Hugh Marcus said, flexibility and understanding are paramount.
My son was diagnosed with ADHD when he was 7 years old, after he hid in the cloakroom at his public elementary school in New York, triggering a complete lockdown. We were filled with trepidation when we went to meet the principal, only to have her apologize to us on behalf of the school for failing in their duty of care towards him.
The support of a teacher’s aide over the next four years, as well as extra time in exams and appropriate medication on an ongoing basis, have helped him to adapt and thrive. It hasn’t always been easy for him, but having the right support in place allowed him to work hard and fulfill his potential. We couldn’t be prouder of him.
I can only imagine how difficult it must be for parents and children who have to wait years even to get a diagnosis. My heart goes out to them.
Don’t you have paediatricians in the UK? Here in New Zealand they (whether public or private) do the diagnosis for autism and ADHD. Once diagnosed you become eligible for certain state supports.
I’ve heard that to get an official bit of paper endorsing that you are Autistic you just pay a Consultant £400 and he hands it very. It’s a market place deal.
In the UK at present it confers nothing on you except being able to wave it about and say you have it. However I do know one Autistic person with just such a recently acquired certificate is now campaigning to have this condition recognised as an illness for which you can claim to not work and have sickness benefit,by whatever name it’s called now. This campaigner is or was a high flying tv producer and I’ve actually heard of and even watched some of her TV shows. Her voice was intelligent and well modulated and her words showed a cultured and educated person. Rather than a hindrance to her life and career,she more seemed to embody that idea that because she has autism and thought differently to us Muggles thus her creativity was a gift. So why she wants sickness benefit as well I don’t know but every little helps they say.
Competitive mental illness: “My child is so disabled he needs special treatment”. “No, my child deserves the special treatment”. You know what would solve this argument? Dissolve the nanny state. You want special treatment? Pay for it. Or find a charitable org who will. Libertarianism would solve this.
Profoundly depressing and important read. This is the sort of stuff the guardian used to do well before it disappeared up its own fundament.
Inclusion. Yes, that.
Some years ago I spent a morning in my son’s year 6 class helping make Christmas decorations. The teacher’ every other remark was directed at one boy who could not stay put. As in “class doo such and such, Johny sit down, class turn to page. . . Johny turn around.” I also remember hearing about an unsupervised indoor playtime when my son, standing at the back of the room, suddenly found himself instinctively ducking to avoid a pair of scissors thrown across the room by another pupil.
This is why we sent our sons to private secondary education, despite the sacrifices it entailed. Many are not so fortunate.
That expression ‘He’s a lovely boy’ in this context always tells me all I need to know.