HPI Diagnostics: This vignette thinks there is a “diagnostic business”

Children – gifted children, early children, zebras, or “high intellectual potential” (HPI) … the terms evolve, but all tend to make a diagnosis of children or adults with particularly developed intellectual abilities. According to the World Health Organization, 2.3% of children aged 6-16 who attend school are mentally precocious. This would represent 200,000 children in France.

The final episode of Season 2 of “HPI,” the hit police epic on TF1, will air on Thursday, June 16 at 9:10 PM. Audrey Floro 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 three, psychotherapist Emmanuel Pique gives us her perspective on the reversals of what she sometimes considers “diagnostic activity.” in Our Children Under the Microscope: ADHD, High Potential, Multitasking, and How to Stop the Diagnosis EpidemicThe book, co-authored with Alessandro Elia and published by Payot Editions in 2021, is concerned about the increasing systematic indexing of non-model children.

LH: Have you noticed an increase in counseling to detect premature maturation?

EP: If we stick to the original definition of “HPI,” a child with a high IQ, there isn’t much. But if we replace the measurement of IQ with criteria that, according to studies conducted on this topic, have nothing to do with accuracy, such as the need for fairness and hypersensitivity, then it is clear that there are a lot of diagnoses. It makes sense that the children involved are more numerous!

How do you explain that?

It’s a very reassuring answer to put people in boxes and say: It’s because the child’s functioning is malfunctioning because of this feeling inside. It explains, it gives meaning and is very comforting because the child says to himself: “We will stop saying I am arrogant, or lazy, because I suffer from this failure.” He is completely devoid of guilt for the adult world, which he tells himself that he has nothing to do with him, because he is like that. So it’s a very “practical” answer from this point of view.

Psychiatry and especially child psychiatry wanted to take inspiration from general medicine saying: We have symptoms, we have a biomarker and therefore we have a treatment. For example, for HPI, the main mark is the calculation of intelligence quotient (IQ).

If IQ is one of the least bred doubts, most signs are not unanimously held in child psychiatry. So it is easy to find the diagnosis and make the diagnosis. Over the past 10 years, when IQ was not necessarily high – described as “heterogeneous” – the focus has shifted, for example, to childhood hypersensitivity.

We can talk about “diagnostics work”, when we see the prices charged: 98 euros for the first consultation, 410 for an intelligence 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 kid inside of him is stuck like this.'”

Emmanuel Pique, psychotherapist

You even talk in your book about the “diagnostic epidemic.” How problematic is this in your opinion?

We will diagnose children who should not be diagnosed by telling them ‘Since you’re like this, you won’t be able to do it’ or ‘It’s going to be complicated for you’. So we create prophecies that come true.

From the moment we say that the child has HPI, we will conclude that he is hypersensitive and we will begin to look at everything that is wrong with him, in his relationships with others. We will audit it, which will generate a lot of anxiety and will be less comfortable with others. All of this will reinforce the idea that his behavior is indeed problematic.

When you look at a child as a problem or a troubled one, he becomes one. That’s logical. If some people refuse to comply with what is dropped on them, then most often the opposite will happen.

What “self-validation prophecies” are you talking about regarding children with HPI?

HPI kids, for example – and this is very implied – will incorporate the fact that they are so smart that things can’t go well with others, who are jealous. The problem is that when appreciated, it can develop into a form of arrogance in some children.

It’s as counterproductive as telling a little girl who’s being harassed in the yard because she’s “too pretty.” does not help. And what’s more, we are not at all in the context of interaction. These kids are using this arrogance as a shield, which is largely ineffective. We are going to have to work with them so that they do things differently and get out of this foundation.

In your book, you write: “Pasting labels is cutting out context.” what does that mean?

The idea is to nurture relationships, not children. It is wise in my opinion to make a diagnosis of the context, and therefore of the interactions the child has with his ecosystem or with himself. And to offer them relational rather than individual solutions, taking into account the school and family context.

We need to change our outlook and stop seeing a child’s tantrums, for example, as symptoms of hyperactivity, but instead as signs of heightened creativity. We can look at what he’s doing with these symptoms that make him suffer and see what we can do differently in this context and these interactions, rather than going right away to diagnose his brain to try and figure out the failures.

And if this does not relieve suffering, there will always be time for a mental or psychological diagnosis. We don’t get rid of everything, but we really try to see the interactions and context before looking for the failures in the child.

“We’ve moved on to another area, where even feelings become satisfying.”

Emmanuel Pique, psychotherapist.

Is this also a way for parents to benefit from premium support for their children?

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

The fact that there are so many professionals that are interested in looking at how a child is going to fail or not, we and Alessandro Elia believe that this is part of the problem and the suffering. But parents are very assured of this.

You work a lot with teachers. Do they tell you about the difficulties they face in coping with the spread of these diagnoses?

For teachers, it’s terrible. From the moment there is this kind of injunction to discriminate, it’s as if they’ve turned into waiters, moving from table to table, with a different drink for each one.

Every child is different and every parent too, in their expectations, because they are clearly anxious. Thus it becomes difficult to control it. It is not an education for thirty people. There is something to lose in the association.

She also writes that “garbage kids were considered ‘normal’ kids 40 years ago and today they suffer from a ‘neurological disorder’.”

In the most recent DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Editor’s note) We talk about “pathological grief”, when a person continues to cry more than twice a week after a year, after someone has disappeared. We can clearly see that we have moved to another area, where even feelings become satisfying.

The role from parent education, from “I watch you until you’re an adult and then you’ll run” – because that was kind of an idea – to “I listen to you and meet your needs”, was a good one. But it gave the children less docile. And the less willing children are, we don’t know how to do it. One way to “subjugate” them is to diagnose them and give them medication. In fact, we want butter and butter money.

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