How many times have you heard a psychiatric diagnosis questioned based on the possibility that the behaviors are JUST something else. You know the drill: “C’mon doc, are you sure this ADHD thing isn’t a fancy label for kids who are JUST (insert lazy, bad, spoiled, etc.)?” Another common one is “Can’t a kid JUST be sad without being called depressed?”
There is a very legitimate question in there, but it is not the one most people are asking. Indeed, we are called upon every day to try and make a call as to whether particular behaviors fall beyond developmental expectations and are thus deserving of a diagnosis. The problem, though, lies with the alternative and specifically in the assumptions behind that word: JUST. The implications are that if a set of behaviors are a JUST then the following must also be true.
a) Their origin differs from the origin of “real” symptoms and aren’t particularly interesting
b) Nothing can be done about it
c) We can and should be blaming the child, parents, or both rather than framing the issue as something to do with brain function
All of these assumptions are likely wrong, although much more research is needed to address them more fully. For now, however, there is overwhelming evidence that nearly everything we assess in child mental health (mood, attention span, aggression, autistic traits) exists, at least on the surface, as a quantitative continuum rather than in binary yes/no disease form. As such, making a diagnosis of ADHD is a bit like officially calling somebody “tall” or “smart.” What is much less well understood, however, is whether or not the mechanisms that underlie JUST traits or personality are shared, but perhaps amplified, when it comes to full-fledged disorders, or whether there may be lurking more discrete etiologies for at least some of those with the more extreme behaviors that qualify for a diagnosis.
In the meantime, the word JUST simply doesn’t make sense. Child behavior at all levels is complex, derived from a large array of mutually interacting genetic and environmental, and amenable to change with the proper approach.