The other day I was cutting out a label on my daughter's ballet skirt.  The white label showing through the sheer black fabric bothered me (and her), so it was coming off.  As I cut the label, I glanced at what I was throwing away.  Size...just a number.  Company label...don't need it.  Care instructions...here I paused to read.   Wash with similar fabrics, tumble dry low, do not iron...all potentially important instructions, but I'd just have to rely on memory and common sense.  As long as that annoying white label wasn't showing, it didn't matter.

Maybe you get where I'm going with this.  How important are labels in helping to educate students with disabilities?  Like the label in my daughter's dance skirt, most disability labels aren't pretty.  They're functional.  If we remove the label, can we trust our common sense to provide for a child's educational needs?

There's a lot of information out there cautioning against labeling children, and the concerns are valid.  1)  Self fulfilling prophecy:  Do children come to identify themselves and their abilities based on a label?  2)  Over diagnosis and over labeling:  Do schools (and mental health practitioners) diagnose more than they have in the past and is a diagnosis really necessary?  3)  Generalization:  Labels are, by nature, generalizations.  They fail to recognize a child's unique limitations and strengths.  4)  Socialization:  Even though children with disabilities often struggle socially, there is criticism that labeling could cause the child to be singled out further by peers.

We're all familiar with individuals we know personally who we think may meet the criteria for diagnosis of a mental health disorder.  Maybe.  Maybe not.  A serious mental illness is partially defined by a lack of functioning in daily life skills.  If children can compensate and function in school and home environment, a diagnosis may not necessarily serve them.  You've heard the saying, "If it ain't broke, don't fix it."

So to label or not to label?  And does labeling help a student who is struggling academically?

The answer to that question is more likely to be individual than general.  Each parent and educator has to examine the pros and cons for students on an individual basis.  Personally, I'm not opposed to labeling a child if it helps in treatment and access to services in schools that can help a child succeed academically.  That said, here are a few tips and cautions to consider in the label or not labeling debate:

Tips:

• Seek accurate and differential diagnosis.  Work with clinicians that coordinate care with multiple resources, including school and medical professionals.  Collaborative efforts lead to a more clear and accurate picture of what is happening with a child.  I've seen parents complete an evaluation form for ADHD where all the criteria pointing toward a diagnosis were marked, only to have the teacher complete the same evaluation form for the same child indicating that the child meets few or none of the diagnostic criteria in the school environment (and vice versa).  Generally, to meet diagnostic criteria, symptoms exist across a variety of settings.   
• Which leads to the next tip:  Rule out other causative factors first.  Perhaps there is something going on in the home or school environment that better explains the child's symptoms.  Perhaps there is a dietary or medical condition contributing to the symptoms.  This is actually fairly common.  Everyone is different, but personally I'm in favor of the lowest level of intervention possible which is best accomplished by examining a wide range of contributing factors.  
• Medication may not be the intervention of choice for every child, but in cases where medication is indicated as the best treatment option, a diagnosis (label) is necessary.  As I've already said, I'm a huge fan of ruling out all causative factors and focusing on moderate interventions first, but that's not the answer for everyone.  One of the most important developmental tasks of school-aged children is to develop competence.  This requires self-mastry, relating with others, engaging in social relationships, and completing tasks successfully, all of which are difficult for children with any type of mental disability.  If medication can help a child achieve that particular developmental milestone with success, it should be considered as a treatment option.  
• Trust your instincts.  Parents generally know their children better than anyone else and should never apologize for advocating for their child.  Professionals have access to information parents don't have which could be helpful to the parent and the child, but the application of that knowledge is incomplete without guidance from the people who know the child best.  Parents, don't abdicate your judgement to professionals.  Ask questions, get answers, then make a decision that you feel is in the best interest of your child.

Cautions:

• Don't use (or allow the child to use) the label as a crutch.  As a practitioner, I am disheartened when I hear a parent or teacher refer to their child (even indirectly) as incapable because of a diagnosis.  Children with ADHD can do anything other children can do.  They might have to do it differently, but they develop that all-important sense of competence when they are given skills to succeed.  Similarly, children's negative behavior should not be dismissed because of a diagnosis.  A diagnosis is not a get-out-of-life free card.  Frequently I ask parents to picture their child with a physical disability, maybe dwarfism, or a hearing impairment.  Would you want that child to never pursue the same goals and ambitions as other children simply because of a disability?  Or picture an adult criminal who justifies a crime because they happen to have some type of disability.  None of us want to live in that kind of world, and learning the connection between actions and consequences starts before adulthood.
• Next, parents should not rely solely on school resources for diagnosis and treatment.  School systems do a great job of educating children.  As part of that educational process, they are required to maintain a staff of professionals to help children succeed academically.  Professionals such as teacher's aides, speech and language pathologists, school psychologists, and occupational therapists (among others) are hired by a district and are frequently spread between several different schools.  Their focus (as it should be) is on helping children to function in the school environment.  Functioning in a school environment is important for future success, but functioning across all settings is also important.  Include professionals in your child's treatment that will collaborate with school professionals on treatment rather than relying completely on school professionals for treatment.
• Don't give up!  Every school, class, teacher, and intervention is not right for every child.  Too often I see parents react angrily when their child's needs aren't being met in school.  The child's needs are best met if parents keep trying.  The answers don't come immediately, and schools are operated by human professionals who do their best to help children succeed.  There is no guarantee of perfect results.  We know that, but it's difficult for parents to remember when they see their child struggle.  As parents of children with special needs know, there are good days and bad days (even though sometimes it seems as if there are only bad days and worse days).  Tomorrow is a new day.  Try something new.  It might work.  

Returning to the ballet skirt example, there will be times when a label clearly doesn't serve a purpose.  Common sense and good judgement are sufficient, and the freedom of removing the label outweighs the need for the label.  There are other times the label may contain detailed and important information.  Like clothes, not all children are of the wash and wear variety.  Some require specific care instructions or services to continue to function.  In the school setting those special care instructions come in the form of IEP's and 504 Accommodations.  (Look for the next post about using these resources and accommodations to help children in school.)  Unlike the very general dry clean only instructions in clothing, they're specifically tailored to the educational needs of each child and can be a great asset to children, parents and educators.

The bottom line:  It's up to you.  Don't be too quick to get out the scissors and start cutting if a label is the source of meeting your child's needs.  Ask questions and trust your judgement.  This is your journey.