Decisions about whether and how to diagnose children with emotional and behavioral disturbances, and whether and how to treat them, are sometimes not clear-cut. When decisions lie within a “zone of ambiguity,” people who emphasize different value commitments can reach different but equally respectable conclusions. We need to tolerate these reasonable disagreements, according to a special report. Pediatric mental health care may benefit by getting clear on where there is fundamental agreement and reasonable disagreement, it concludes.

However, one of the report’s disturbing conclusions is that many children with patently problematic moods and behaviors fail to receive the care recommended by experts. Systemic and cultural pressures compromise the diagnostic process and constrain the treatment choices of clinicians and parents, making it increasingly likely that medication is the only treatment children receive, even if the combination of medication and psychosocial treatment is recommended by experts.

The report is the culmination of a series of five workshops held by The Hastings Center and funded by the National Institute of Mental Health, which brought together an interdisciplinary group including psychiatrists, educators, parent advocates, social scientists and bioethicists. The project was led by Erik Parens and Josephine Johnston, research scholars at The Hastings Center, who wrote the report. The report includes 10 commentaries from workshop participants, listed below.

A video of Parens and Johnston discussing their report, as well as the full text, can be found at the project’s website.