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Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder [Englisch] [Taschenbuch]

Enrico Gnaulati PhD

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2. September 2014
A veteran clinical psychologist exposes why doctors, teachers, and parents incorrectly diagnose healthy American children with serious psychiatric conditions.
In recent years there has been an alarming rise in the number of American children and youth assigned a mental health diagnosis. Current data from the Centers for Disease Control reveal a 41 percent increase in rates of ADHD diagnoses over the past decade and a forty-fold spike in bipolar disorder diagnoses. Similarly, diagnoses of autism spectrum disorder, once considered, has increased by 78 percent since 2002.

Dr. Enrico Gnaulati, a clinical psychologist specializing in childhood and adolescent therapy and assessment, has witnessed firsthand the push to diagnose these disorders in youngsters. Drawing both on his own clinical experience and on cutting-edge research, with Back to Normal he has written the definitive account of why our kids are being dramatically overdiagnosed—and how parents and professionals can distinguish between true psychiatric disorders and normal childhood reactions to stressful life situations.

Gnaulati begins with the complex web of factors that have led to our current crisis. These include questionable education and training practices that cloud mental health professionals’ ability to distinguish normal from abnormal behavior in children, monetary incentives favoring prescriptions, check-list diagnosing, and high-stakes testing in schools. We’ve also developed an increasingly casual attitude about labeling kids and putting them on psychiatric drugs. 

So how do we differentiate between a child with, say, Asperger’s syndrome and a child who is simply introverted, brainy, and single-minded? As Gnaulati notes, many of the symptoms associated with these disorders are similar to everyday childhood behaviors. In the second half of the book Gnaulati tells detailed stories of wrongly diagnosed kids, providing parents and others with information about the developmental, temperamental, and environmentally driven symptoms that to a casual or untrained eye can mimic a psychiatric disorder. These stories also reveal how nonmedical interventions, whether in the therapist’s office or through changes made at home, can help children.

Back to Normal reminds us of the normalcy of children’s seemingly abnormal behavior. It will give parents of struggling children hope, perspective, and direction. And it will make everyone who deals with children question the changes in our society that have contributed to the astonishing increase in childhood psychiatric diagnoses. 


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Back to Normal is outstanding. Careful, measured, wise, compassionate, and powerful.”
—Peg Tyre, author of The Trouble with Boys

“An appeal to level-headedness.”
—Amanda Schaffer, The New Yorker’s Elements blog

“Does your stormy adolescent suffer from incipient bipolar disorder or is she simply sleep-deprived, hormonal and struggling with identity issues typical of her age? Does she need mood stabilizers, or a bedtime and therapy? Is your smart, tantrum-inclined 5-year-old an Asperger’s kid, destined for a difficult lonely life, or is he just very, very bright and sensitive? Drawing on first-rate research and scholarship, Dr. Gnaulati makes a very strong case for going ‘back to normal,’ and taking care of our more challenging children in the ways that are most likely to help them, and the least likely to traumatize them.”
—Daniel Goldin, The Huffington Post
“A valuable guide for parents and educators that includes tips on choosing a therapist and parenting strategies.”
Kirkus Reviews

“Highly recommended for parents, caregivers, educators, physicians, and specialists working with children of all ages.”
—Virginia Johnson, Library Journal

“This is an exceptionally original and useful book.  It offers fresh perspectives on a wide range of childhood behaviors that are of concern to today's parents, educators, and mental health professionals.  Addressing labels ranging from ADHD and autism to bipolar disorders, Gnaulati challenges the widespread rush to see pathology and medicate; he suggests, instead, how various behaviors may actually be expressions of normal development. With a rare combination of creative insight and common sense, Gnaulati helps us appreciate children as they grow and cope with the stresses of modern life.”
—William Crain, author of Reclaiming Childhood: Letting Children Be Children in Our Achievement-Oriented Society

Back to Normal provides a compelling, insightful, and timely explanation of the multiple forces that lead to over-diagnosis and misdiagnosis of our children. It offers parents a much-needed guide to help distinguish behaviors that truly warrant medical intervention from those that may stem from other issues and require different approaches. Well done, Dr. Gnaulati!”
—Diane M. Kennedy & Rebecca S. Banks, authors of Bright Not Broken: Gifted Kids, ADHD and Autism  

“Dr. Gnaulati suffers from an acute case of common sense. His work with thousands of children and adolescents and his scrupulous reviews of the literature lead him to question the fashionable rush to pathologize young people, to misdiagnose them, and to medicate them unnecessarily. He casts a bright light on psychiatric mispractice and reminds us of how common sense psychotherapy that attends to feelings arising in the contexts of family and school can restore the dignity of the child, alleviate anxiety, and modulate the dangerous tendency of adults to misunderstand,  scapegoat, and rush to judgment. This is a brilliantly incisive reexamination of treatment practices by a ferociously humane practitioner.”
—John M. Broughton, Associate Professor of Psychology and Education at Teachers College, Columbia University

“This compelling, readable book examines disordered behavior in the context of the insane policies and expectations imposed on today’s children. Dr. Gnaulati describes in heart-rending detail how pressure to perform and conform in kindergarten is literally driving normal young children—especially boys—to frustration and distraction, making them hate school, and leading to a plague of misdiagnosis and unnecessary medication. Every parent and grandparent of a child labeled ADHD, bipolar, or on the autism spectrum should read this humane, common-sense guide.”
 —Edward Miller, founding partner of the Alliance for Childhood and co-author of Crisis in the Kindergarten
“This book is a welcome antidote to an alarming trend.” —Publishers Weekly

From the Hardcover edition.

Über den Autor und weitere Mitwirkende

Enrico Gnaulati is a clinical psychologist based in Pasadena, California. His work has been featured on Al Jazeera America, KPCC Los Angeles, and online at the Atlantic and Salon.

From the Hardcover edition.

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Die hilfreichsten Kundenrezensionen auf (beta) 4.7 von 5 Sternen  48 Rezensionen
13 von 14 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen A Counterbalance to the Hysteria of Over-Diagnoses 29. September 2013
Von M. JEFFREY MCMAHON - Veröffentlicht auf
Format:Gebundene Ausgabe|Vine Kundenrezension eines kostenfreien Produkts (Was ist das?)
Having twin 3-year-olds, one diagnosed with high-functioning autism, I read Guaulati's book with great interest, taking care not to be too eager to believe all his explanations for why we overdiagnose children with ADHD, bipolar disorder, and autism. After all, I don't want to be in denial. Nor do I want experts like Gaunati to use their experience to give parents false hope.

Back to Normal is not, thankfully, a book for enabling those parents who want to be in denial about their children's conditions. Rather, Gnaulati uses his experience to responsibly and convincingly show how other factors can cause us to exaggerate or misdiagnose our children's problems. He writes there is a "tendency in our society to medicalize children's behavior and to categorize . . . reactions to stressful life situations as proof positive of a psychiatric diagnosis." His book aims to counteract that tendency.

Our society's misdiagnosis of behavior, Gnaulati argues, is the result of many factors, which he analyzes with great clarity and illustration. These factors include wanting our children to fit a perfect template of emotional growth and when there's a lag, we're to quick to pin a pathology to the problem; the overuse of mental health jargon in our everyday conversations; the profit incentive of pharmaceutical companies to oversell; how doctors and therapists are primed to think in terms of disease rather than use commonsense; rigid, oppressive teaching "solutions" that actually make the child more anxious; the use of special ed as a smokescreen for remedial education; sleep deprivation and its effect on children's moods; our society's obsession with mass media, the Internet, and smartphones, which all glorify a bipolar mentality that we too often unwittingly emulate.

Back to Normal is an effective antidote to the hysteria of over-diagnosing behaviors that can be better explained with commonsense while not asking parents to be in denial with their children who have legit diagnoses. Highly recommended.
13 von 14 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen A great book that should find its way onto any parent's bookshelf. 20. September 2013
Von Simon Oliver - Veröffentlicht auf
Format:Gebundene Ausgabe
Back to Normal by Enrico Gnaulati should be required reading, not just for parents dealing with an ADHD, Bipolar or Autism but for all parents, educators and really anyone who deals with children on a professional basis.

At a time, when as Gnaulati points out, ADHD diagnoses are more common than the cold and we're suffering from an epidemic of over-prescribing of medication not recommended for or in some cases even tested on children, he offers a well reasoned and balanced approach, based on his own extensive experience, not just explaining his points, but offering solutions.

As a father of two young sons who deals with his fair share of "boy" energy on a daily basis, I found "Back to Normal" not just honest, refreshing, and insightful but also something you rarely find in a book on this subject - reassuring.

All in all a fascinating book, and one that I wouldn't hesitate to recommend.
12 von 14 Kunden fanden die folgende Rezension hilfreich
Von Geraldine Ahearn - Veröffentlicht auf
Format:Gebundene Ausgabe|Vine Kundenrezension eines kostenfreien Produkts (Was ist das?)
I have been reading important, well-researched information for many years on the extensive examination of overdiagnosis and misdiagnosis of mental health issues on our children in this country, which has increased to a remarkable statistic over the last 20 years. The reason for my interest on this subject matter involves my clinical experience as a health professional for 30 years, combined with 35 years of caring for my special-needs child with multiple-disabilities, both mental and physical since childhood. As a sub-Nurse working in the largest school district in the state of New York, combined with working for special-needs children and caring for my own child for 35 years, I have researched several helpful books and guides on essential healthcare information on mental heath issues, and treatment. Enrico Gnaulati has delivered one of the most helpful guides I have read up-to-date. The author chronicles a powerful common-sense guide on the overdiagnosis and misdiagnosis of ADHD, autism, and bipolar. When working in the schools, I began to become extremely concerned on the increasing mental health disorders of our children in this country with a rapid rate of diagnosis, researching questions and answers to the current issues, for elementary and high school students. The author chronicles important information through years of clinical experience as he highlights common sense psychotheraphy, and childhood behavior mistaken for ADHD. This guide is a valuable resource for all medical professionals, as well as teachers, and parents. Enrico Gnaulati discusses the difference between psychiatric disorders, versus behavioral disorders that stem from social issues. The author explains the differences as he portrays individual cases that were examined carefully, and many misdiagnosed. In addition, Enrico Gnaulati highlights that educators must be well informed as to the specific needs of each child, prior to proper medical treatment, essential for the child's health and well-being. This book is outstanding in every aspect on the issues of mental healthcare and specific individual treatment, as it sheds a new light on psychiatric mispractice. Educational, extremely useful, and highly recommended!
7 von 8 Kunden fanden die folgende Rezension hilfreich
3.0 von 5 Sternen Intersting but a Bit Frustrating 19. Dezember 2013
Von CrimsonGirl - Veröffentlicht auf
Format:Gebundene Ausgabe|Vine Kundenrezension eines kostenfreien Produkts (Was ist das?)
As parent to one confirmed and two suspected "twice exceptional" (gifted + learning disabled) children, I found "Back to Normal" a very interesting read. I absolutely agree with Dr. Gnaulati's concerns about overdiagnosis and overmedication. I think we as a society are far too quick to pathologize children who simply are placed into an inappropriate school environment. My son has been diagnosed with ADHD but we've been able to manage it without medication though the flexibility of homeschooling. If he wants to practice his times tables orally while bouncing on a trampoline rather than having to sit quietly and fill out a worksheet, that's fine by me.

What I found frustrating, however, was Dr. Gnaulati's misunderstanding of how autism and related disorders can present themselves. He makes these sweeping generalizations such as knowing that a boy couldn't have Asperger's simply because he engaged in pretend play. People with ASD (especially girls) can, in fact, be highly imaginative and creative in their play. My daughter, whose ASD diagnosis was confirmed by 4 different specialists (developmental pediatrician, pediatric neurologist, school district IEP team, and Regional Center psychologist), is very imaginative despite having major impairments in speech & language, social interaction, repetitive behaviors, etc. The chapter on autism is by far the weakest in Dr. Gnaulati's book and I worry that parents of kids who truly are "on the spectrum" might get a false sense of security from it. A much better book to read is Bright Not Broken: Gifted Kids, ADHD, and Autism because that covers a lot of the same "is it giftedness or is it autism?" but with authors who actually know what they're talking about.

I highly recommend this book for educators and parents of kids with a suspected or formal diagnosis of ADHD. Educators and parents of kids with a suspected or formal diagnosis of autism should instead read "Bright Not Broken".
7 von 8 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Social worker 21. September 2013
Von Janet Sue Chunn LCSW - Veröffentlicht auf
Format:Gebundene Ausgabe
Back to Normal is the book that I have been waiting for, both as a mother of a son, and as a social worker with over 20 years of experience in the field. Dr. Gnaulati writes in such a readable ways about kids who are caught in adverse life events resulting in them temporarily acting crazy, as distinct form kids who are truly suffering from real diagnosable conditions. His narrative approach, backed up by research, clarified so much for me and should be a practical resource for parents, educators, and mental health professionals. This book has made me more thoughtful and open-minded about thinking about children's problems and how sometimes the even the craziest of behavior can be understood and worked with, rather than viewed as evidence of a disordered brain in need of medication.
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