In her response to O’Reilly, Bottema-Beutel explains that caregivers and clinicians collaborate through talk to construct the social reality of a "pathologized child". Rather than viewing this pathology as purely inherent to the child, she argues that these characterizations are partially structured by the negotiating practices required to access services. Consequently, the construction of the child's condition is shaped by the institutional necessity of identifying a "doctorable" problem that warrants entry into the mental health system.