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This article explores how teachers, parents, and child neuropsychiatry services in Italy identify and communicate a student's difficulty that may lead to a diagnostic certification of special educational needs (SEN). Drawing on an ethnopsychological perspective and employing semi-structured interviews with 46 participants, the study investigates the discursive and interactional dynamics underlying referral practices in schools. Using Critical Discourse Analysis (CDA), we examine how perceptions of nonconformity with educational norms become grounds for suspecting pathology, and how such perceptions are shaped by institutional expectations, professional uncertainty, and the search for legitimacy. The results reveal three specific conceptualizations of children: the needy child, the demanding child, and the child with strengths and weaknesses. Findings reveal that difficulties are often framed through comparisons with peers, failure to meet didactic standards, and behavioral non-adherence to school rules. Certification is frequently requested as a strategy for managing uncertainty or delegating responsibility to specialists. The results highlight a systemic inclination toward medicalising school diversity, exacerbated by communication gaps between schools, families, and health services. The study recommends clearer protocols, enhanced teacher training, and culturally sensitive approaches to promote inclusive and dialogic educational practices.<\/jats:p>","DOI":"10.3389\/fpsyg.2025.1672345","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:10:03Z","timestamp":1768205403000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Discourses leading to diagnostic excess: an ethnopsychological study in Italian schools"],"prefix":"10.3389","volume":"16","author":[{"given":"Antonio","family":"Iudici","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana","family":"Caraglia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Cottone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s10833-005-1298-4","article-title":"Developing inclusive education systems: what are the levers for change?","volume":"6","author":"Ainscow","year":"2005","journal-title":"J. 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