HPI diagnostics: This recession believes there is a “diagnostic business”

CHILDREN – Gifted children, precocious children, zebras, or “high intellectual potential” (HPI) … The terms change, but everyone tends to make a diagnosis in children or adults who have particularly developed intellectual abilities. According to the WHO, 2.3% of children aged 6 to 16 who attend school have early intellectual development. It represents 200,000 children in France.

The final episode of season 2 of “HPI”, a detective saga that hit TF1, will air this Thursday, June 16 at 9:10 pm Audrey Fleurot plays the role of a mother with “high intellectual potential” and the second series of these episodes convinced an average of 9.87 million viewers.

While waiting for season 3, Emmanuelle Piquet, psychotherapist, gives us a look at the reverse of what she once considered a “diagnostic business”. Sa Our children under the microscope: ADHD, high potential, multi-dys & Co: how to stop the epidemic of diagnoses“Written with the book with Alessandro Elia and published in 2021 by the Payot editions, he is concerned about the increasingly systematic cataloging of atypical children.

LH: Have you noticed an increase in consultations to see precocity?

EP: If we stick to the original definition of “HPI”, which is a child with a high intelligence quotient (IQ), nothing more. But if we replace IQ measurement with standards that, according to studies on this topic, have little to do with precocity, such as the need for justice and hypersensitivity, then there are clearly many more diagnoses. It is logical, the children concerned are more numerous!

How would you explain this?

It’s a reassuring answer to put people in boxes and say: it’s because the child is so inside so it doesn’t work. Explaining this, it gives meaning and is very comforting because the child says to himself: “we will stop saying I am arrogant, or lazy, because I have that failure”. Very guilty-free for the adult world, which tells itself that it has nothing to do with it, it’s because it’s like that. So this is an extremely “practical” answer from that point of view.

Psychiatric medicine and in particular child psychiatry want to take inspiration from general medicine, which says: we have symptoms, we have biological markers and therefore we have treatment. For example, for HPI, the primary marker is the calculation of intelligence quotient (IQ).

If IQ is one of the smallest forms of skepticism, most markers are inconsistent in child psychiatry. So easy to find and make a diagnosis. Over the past ten years, when IQ was not necessarily very high – described as “heterogeneous” – the focus had, for example, shifted to children’s hypersensitivity.

We can say a “diagnostic business”, 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 guidance consultation …

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

– Emmanuelle Piquet, psychotherapist

In your book, you even speak of an “epidemic of diagnoses”. How problematic do you think this is?

We will evaluate children who do not need to be diagnosed by telling them that “while you are like this, you will never be able to do that” or “it will be complicated for you”. And so we made a self-validating prophecy.

From the moment we say that a child has HPI, we will know that he is hypersensitive and we will begin to see everything wrong with him, in his interactions with others. We will examine him, which will result in a lot of anxiety and he will not be comfortable with others. All of this would reinforce the idea that in fact, his behavior was problematic.

When you view a child as troubled or troubled, he becomes one. This is logic. If some people refuse to comply with what is expected of them, often the opposite happens.

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

HPI children, for example — and this is highly implicit—, will include the fact that they are so brilliant that things cannot go well with others, who are jealous. And the problem is that while it is appreciated, it can develop a form of pride in some children.

It’s not as productive as telling a girl who is being teased in the yard that it’s because she’s “too pretty”. Not helping. And more, we are not in the context of interaction. These children use this pride as armor, which is highly ineffective. We will need to work with them so that they can do things differently and get stuck in this essentialization.

In your book you write: “to stick labels is to cut the context”. What does this mean?

The idea is to nurture relationships rather than children. In my opinion, it is wiser to make a diagnosis of the context, hence the child’s interactions with his ecosystem or with himself. And to offer them relationships rather than individual solutions, taking into account the school and family context.

We need to change our perspective and stop looking at a child’s cries, for example, as symptoms of hyperactivity, but instead as signs of budding creativity. We can look at what he is doing with these symptoms that are bothering him and see what we can do differently in this context and in these interactions, instead of going right away to have his brain tested to try to find failures.

And if that doesn’t lead to alleviation of suffering, there will always be time to make a cerebral or psychiatric diagnosis. We don’t throw everything away, but we try to see that the interactions and the context before looking for failures in the child.

“We’re moving into another sphere, where even emotions have pathologize.”

– Emmanuelle Piquet, psychotherapist.

Is it 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 that comes with it. And we are in a vicious circle, because at some times the accompaniment is necessary and helps greatly, sometimes it causes the opposite effect.

The fact of having so many specialists who take care of looking at how a child has failures or not, we think with Alessandro Elia that this is part of the problem and of suffering. But the parents are quite reassured here.

You do a lot with teachers. Do they tell you about their difficulties in the face of the proliferation of these diagnoses?

For teachers, this is horrible. From the moment there is this kind of ordering diversity, it is as if they have been transformed into waiters, who go to every table, with different drinks for each.

Every child is treated differently and every parent is also, in their expectation, because they are obviously worried. And so it becomes unmanageable. It is not the teaching of thirty individuals. There is something about the collective that we are missing.

You also wrote that “Littered children were considered‘ normal ’children 40 years ago and now they have‘ neurological disorders ’.

In the latest DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, editor’s note), we speak of “pathological sadness”, when a person continues to cry more than twice a week after a year, after the loss of a person. We clearly see that we have moved to another sphere, where even emotions have become pathological.

The turn taken from parental education, from “I watch you until you’re an adult and then you do” —because that’s the kind of idea—, to “I listen to you and I meet the your needs “, this is a good idea. But it gave the children less obedience. And the less obedient kids, we don’t know how to do. One way to “control” them is to diagnose them and give them medication. In fact, we like butter and butter money.

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