What's a parent to do? Diagnostic Conundrums

It's  not uncommon for some children to be diagnosed differently by different professionals, all of whom are qualified and well meaning, wanting to help unravel the complicated presentation that some kids bring.  But when these diagnoses, or diagnostic impressions conflict, what's a parent to do?

First, it is important to remember that kids are very often being assessed in a relatively short snapshot of time.  Even during psychological testing, which usually takes a number of hours to accomplish, there are a number of challenges that have to be overcome:  The child has to find comfort with the tester in a relatively short time, the child has to be able to properly process the commands being made etc.  Also, if the child will ultimately need meds for attention (which is very common among kids on the spectrum, or who are suspected of being on the spectrum) if those meds are not given, or if the recommendation for those meds has not yet been made, the child will test differently than if the meds were on board.  There are many variables that can affect the clinician's view of the child.

Second, kids change rapidly.  A child's presentation from today to six months from now can be very different.  I often tell parents to consider the percentage change six months (for example) represents in a child's life.  If a 5 year old child is seen today and again in 6 months, that 6 months represents 10% of the child's lifetime.  That's a lot of time!  Thus, we can see lots of changes in relatively short amounts of time.  Reconfirmation of a diagnoses, particularly in the "high functioning" range is very important.

And finally, what if, despite all of the variables being taken into consideration there's still confusion as to the child's presentation.  It's common enough for me to see psychological testing from experts in the field who can only speculate as to the child's diagnosis.  Is this a reflection on the psychologist or MD doing the testing or evaluation?  Not necessarily. It sometimes means that the child is, maybe just for this snapshot in time, one who falls in the "grey area."  Some kids are, indeed, difficult to diagnose.

What's a parent to do?  Well, I think that whether there is or is not a clear diagnosis, the key intervention that needs to be made is regarding the primary symptoms the child presents.  Speech delay? Focus on language acquisition.  Non compliance?  Work on increasing compliance.  Inability to relate to peers?  Place the child in situations where peer interaction is a part of the curriculum.  Tantrumming?  Tantrum management (yes there is such a thing!)

Remember, it is the presenting behaviors that we treat when it comes to most developmental disabilities, not the diagnoses.

Fatigue

I'm tired right now.  It's been a long couple of days.  I'm cranky.  Taking a walk around 6:30 this evening, I saw a mom trying to herd a child to walk away from where dad was.  "I want to be with my daddy" he screamed and laughed at the same time playing a bit of a "you can't catch me" with mom who was good naturedly trying to herd him home. The game, however, was quickly turning to more tears than laughter.  I only saw this for a moment as I went by, but thought of how hard the "witching hour" of the late afternoon was for kids.  But by that time of day parents are tired too!  So I recall what parents of kids with autism and other disabilities tell me, that it's a dreadful time, more than with their typically developing kids.

What's the answer?.....well.......I don't know there's a perfect or a simple solution.  It seems patronizing to tell any parent, not to mention the parent of a special kid to simply find time to relax, to remain calm, to remember that the child's tired and cranky too - though I always try to reinforce for parents to do just that whenever they can - you never know when you may need to turn the parenting "afterburners" on.  I also think another aspect of the solution may be through having empathy.  The parent will hopefully strive to empathize with the child's fatigue, hunger, confusion or whatever may be happening.  So too can the parent spend a moment - maybe the briefest moment - to empathize with themselves and how fatigued they are.  Sometimes just taking a moment to consider one's own fatigue can facilitate finding a bit more strength, a bit more patience for the child.