Diagnosis

I see lots of parents, some of whom are comfortable with labels and are seeking one for their child to explain why things just aren't going as expected, and some of whom are extremely uncomfortable with labels, but know something is going on. I feel both sides of this need to be addressed to ensure parents understand and are comfortable with diagnostic labels and what they mean. Furthermore, practitioners need to be sensitive to the impact a label can have on their clients. They should never be used lightly, but at the same time, if the label appears appropriate and necessary, then do not hesitate.

What diagnostic labels won't do: they obviously cure nothing and won't make the problem easy to understand. Just because we make a determination that a child appears to have, for example, Autism Spectrum Disorder doesn't mean that we now know why the child does what he does (or doesn't do) certain behaviors, nor do we know *exactly* what to do to help him. Diagnostic labels are also a clinical "best guess", which is by its nature not exact. It is limited by our current knowledge (we know a lot more these days, but it's still very limited). 

There is also no guarantee that a child will be able to receive the services that would be most helpful for her diagnosis. Sadly, parents may struggle with insurance, other health providers, and schools for services. That doesn't mean that these organizations are "the enemy." Parents must convince them that the child's needs are big enough that the organizations need to spend time, money, and resources to address those needs. Their resources are limited, and even very well-meaning and caring people may decline to provide services because they don't have the resources or are saving them for children with even greater needs. 

Ultimately, a diagnostic label should be functional: identify a significant impairment in general life functioning, otherwise it is "subclinical" (meaning that maybe there is something unusual, but it isn't likely to severely impact life functioning).

What diagnostic labels will do: while they don't make the problem easy to understand, they do give us some insight into what may be going on and what may be helpful for the child. Research in disabilities helps us know what kinds of treatments may be work better. However, not every child has the same needs, nor will every child respond the same way to a treatment program. Simply understanding a little more about why a child behaves in the manner she does can help us to be more patient with her, and can greatly improve the relationship between a parent and child (for example, knowing that a child with ADHD is not always stubbornly defying a parent's requests).

Diagnostic labels can also, at the same time, break a parent's heart and give the parent some peace of mind. It can be a great relief just knowing that it's not because you, the parent, are somehow "failing" your child (a feeling many parents appear to experience); that it's not something you could have foreseen or understood. However, for many parents the diagnostic label may come as a shock or be confirmation of their worst fears. That's hard to take, and it is entirely understandable to need time to process it, come to terms with it, and recover emotionally. Nobody should feel ashamed if they cry or are angry. As a practitioner, I expect these things and I do not hold it against parents if they are mad at me (I'm the source of that potentially terrible information, after all).

Practitioners should be non-judgmental. We also must maintain our distance so we can still be objective and help parents understand their child's difficulties and needs. Maintaining that distance can be hard to do without appearing cold. Therefore, I would ask that parents please forgive us if we appear cold at times. Sometimes that is the only way we can cope with an otherwise challenging situation.

In the end, I would ask parents to not resist seeking evaluation or help if something appears genuinely unusual in their child's development. Early identification and intervention can make a huge difference. Don't worry that you're being a hypochondriac or alarmist either. A good practitioner will politely and tactfully let you know if your child's development is normal, and will not judge you for being concerned about your child's welfare. Knowledge of a diagnostic label is then yours, and yours alone. Practitioners will not share the results of evaluations with anyone without your consent, though we may suggest you share the information with certain people (for example, schools or medical professionals) if we think it would be helpful.