DSM-V and the Autism Diagnosis: Is The Change Hurting Children?

July 18th, 2014

Fuss

There has been lots of fuss about the DSM-V and the autism diagnosis; will it result in less children meeting diagnostic criteria and therefore less children getting the services they need? Is this concern legitimate? I’ve written about this in prior posts, but here I’ll provide further elaboration.

What’s the problem, and what is the diagnostic criteria?

Is the DSM-V Autism Spectrum Disorder (ASD) diagnosis the issue at hand, or is it another DSM-V diagnosis that might be a “problem”?

First let’s take a brief look at the ASD, the criteria includes:

1. “Deficits in social communication and social interaction” manifesting in, for example, poor back-and-forth communication, deficient eye contact, and absence in an interest in peers or inability to sustain the relationship/interaction.

2. “Restricted, repetitive patterns of behavior, interests, or activities, and/or hyper or hypo-sensitivities.

There are also specifiers for severity of the social and verbal deficit, and the extent of restricted interests. Finally, there are specifiers for “with or without intellectual impairment”, “with or without language impairment”, and “associated with a known medical or genetic condition or environmental factor”.

So, you can see that this criteria, with the specifiers, cover everything from what formerly was called ‘Autistic Disorder’ at the more severe end; ‘Asperger’s Disorder’ at the ‘high end’ and ‘Pervasive Developmental Disorder NOS’ for those in-between.

Is There Another Diagnosis?

Yes, there is another ‘competing’ diagnosis, and this is where there may be a potential “problem”. In that regard, the DSM-V has a new diagnosis referred to as “Social (Pragmatic) Communication Disorder (SCD), which entails “persistent difficulties in the social use of verbal and nonverbal communication manifesting in”, for example, difficulty “greeting others and sharing information”, using “overly formal language”, and “following rules for conversation” such as in turn-taking and rephrasing, and “difficulty understanding what is not explicitly stated.”

This diagnosis would cover those kiddos who may have autism-like verbal and social deficits and kiddo’s who ‘don’t quite get it’ socially, but who do not have any restricted or repetitive patterns of behavior or interests.

Which DSM-IV diagnosis will be most affected by the SCD diagnosis?

At least a portion of the kiddo’s who would have been diagnosed with Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) will now be diagnosed with Social Communication Disorder (SCD). Research published in January 2014 in the American Academy of Child and Adolescent Psychiatry found that about 8% of kids diagnosed within the autism spectrum under DSM-IV have subsequently been changed to SCD, which is a far-cry from the 20% predicted earlier by the Center for Disease Control (CDC). Most of the children whose diagnosis was changed had been diagnosed with PDDNOS, and were changed to SCD, which is understandable given that PDDNOS has such vague criteria. Those who had been diagnosed with Autistic Disorder or Asperger’s Disorder under DSM-IV were largely unaffected.

Nonverbal Learning Disability

Another “diagnosis” that may be impacted is “nonverbal learning disability” which essentially is the same as SCD. However, given that there has never been a formal DSM-IV “nonverbal learning disability” diagnosis, now these NVLD kiddo’s too have a better diagnostic fit with SCD.

Consequence of the DSM-V?

It’s likely this change in diagnosis to SCD, for the very few children who will be affected, will generally be positive. In that regard, having seen these kiddo’s first-hand, they clearly struggle with verbal and social skills, but are not “autistic”. Up to now, the diagnostic options have been few besides PDDNOS. These children can still obtain services consisting of individual and group speech/language, and outpatient social skill training, while avoiding the autism diagnosis that does not quite fit anyway.

Hope that helps to clarify the effect of DSM-V regarding the “Autism Spectrum Disorder” vs. PDDNOS, Autistic Disorder, Asperger’s, and Social Communication Disorder.

Feel free to follow-up with me, with any questions at jcarosso@cpcwcare.com.

Would You Rescue Your Spouse Before Your Kids?

June 20th, 2014

Here’s a story for you

A Dad and his son were fishing in a boat. The son looked toward his Dad and inquired, “Dad, if Mom and I fell out of the boat and were drowning, who would you save first?” His Dad, without hesitating, responded “son, I’d have your Mother in the boat, and dried off, before I’d even think about coming after you.” The son, astonished, looked with eyes wide and was about to exclaim his disapproval but stopped, appeared contemplative, then grinned and said, “yea, that’s the way it should be.”

The kid’s pretty wise

The son came to understand that the strength of the home, the foundation of the family, is Mom and Dad, together in harmony, close in their relationship, working for the family, strong in their bond, and on the same page with the kids. It’s true, there is no stronger glue to hold the family together than when Mom and Dad are secure in their relationship, which helps the kids to also be secure with themselves. Secure kids are far more likely to be calmer, more compliant, and easier in disposition. Of course, we don’t want to interpret the story literally, any number of factors may contribute to the Dad rescuing his son first (his wife is a better swimmer…) but, of course, that’s not the point of the story.

Single parent?

If you’re a single parent, for whatever reason, then you’re undoubtedly doing the best you can, and God bless you in your efforts. The sentiment of this post in no way diminishes your diligence and love for your children, or suggests that your child is not healthy and happy. The basis of this story is simply to express the importance of parents remaining strongly committed, and clearly there are advantages of having two loving, committed, and harmonious parents working together with the kids. In a single-parent situation, of course, when possible, it’s optimal that both parents, despite separated, remain highly involved with the children, civil with one another, and work toward having consistent expectations between the homes.

Bottom line?

Simple; do whatever you can to maintain the sanctity, security, commitment, closeness, and bond in your marriage. Place your spouse first in your life (well, technically, second to God, but He too understands the importance of two becoming “one”… see Genesis 2:24). Live like it’s you two against the world, and you’ll always be ready for that overboard plunge. God bless.

Are Your Kids “Lazy”, Or Are They Being Lazy?

June 5th, 2014

Subtle difference?

Well, it’s really not so subtle. It’s the difference between labeling your child, or simply describing an annoying and transient behavior.

What’s the big deal?

When we call our kids “lazy”, “rude”, “liars”, “thieves”, or whatever, we are defining their character, and suggesting that this is their enduring quality. Okay, so now you’re saying, well, they are!! That may be true, but I’ll bet you can think of lots of times when your child is motivated, nice, told the truth, and did not steal. Even if the particular behavior is somewhat enduring, your child is still young; their personality is molding and shaping, and you’re in a strategic position to help shape it in the right direction.

What “labels” tend to do

Okay, here’s a scenario for you; you’re young, impressionable, don’t have a solid grasp or sense of yourself as a person, and have a tendency to believe what you’re told especially when told by the most important person in your life. In this scenario, you’re consistently told that you’re “lazy” or a “liar” or whatever. One can imagine that you may come to personally identify and internalize these traits, and expect to consistently behave in that way. Note that kids, and people, often live up (or down) to expectations.

A better option

Here’s a better option for you; label the behavior, rather than the child. Quite simply, for example, say “you’re lying” rather than “you’re a liar”; or you’re being lazy, or you’re being rude”. This option is definitely better than directly labeling the child, but it’s still not the best option.

An even better option?

Yes, there is an even better option. Instead of labeling the child or the behavior, simply redirect the behavior, describe very specifically what you want to see, and use the situation as a teachable moment. Think about it, calling your child “rude” does not teach; it simply degrades and disparages. Instead, if you’re child calls you a name, rather than call him “rude”, describe the behavior as unacceptable, explain how he could have better-expressed his frustration, maybe even have him repeat the more appropriate words, and then implement a fair consequence. Same holds for “lazy”. Rather; tell your child exactly what you need to see him doing, set a firm limit for him to get started, and then implement a consequence if necessary.

You get what you praise

If your child has a particular problem with not being especially motivated, or telling mistruths, or taking items, then pay very close attention to her behavior and praise big-time when your child demonstrates the pro-social alternative. Remember, if you consistently praise a behavior, it is much more likely to be repeated. Sticker charts also do wonders.

Happy and Harmonious

You want your home to be a happy, pleasant, and cordial environment, right? Of course. You’ll go a long way to making that happen after dropping labels, describing behaviors you instead want to see, relying on firm consequences without yelling and emotion, and using lots of praise. Not to be redundant, but think about it, how do you feel when you’re called lazy, rude, or a liar? Would you do better calling your husband “lazy” or simply telling him exactly what you need and that he’ll suffer a consequence (he knows what you mean) if he does not immediately help you?

Hope this was helpful. By the way, if you have any helpful personal experiences, or other good alternatives to labeling, please share at jcarosso@cpcwecare.com. Thanks.

Don’t Miss These Helpful Parenting Resources!!

May 22nd, 2014

At cpcwecare.com you can find a bunch of helpful parenting resources.

Here are a few:

Check out our TV programs from “CPC Presents” covering any number of topics including:

o Facts and fallacies about autism
o Teenage cutting
o Understanding fears and phobias
o Facts and fallacies about ADHD
o Trichotillomania
o Selective mutism
o Managing behavior problems
o Bipolar Disorder in Children
o Video game addiction
o Back to school anxiety
o ADHD and Learning Disabilities
o Child custody issues
o Childhood sleep disorders
o And more

· We have a link to the AppleTreeInstitute.com site that offers on-line step-by-step guidance on how to effectively manage children with autism and/or behavioral challenges. We also have a link to our dyslexiatreaters.com website.

· Of course, the CPB Blog is available (you’re reading it now) offering lots of tips and guidance on everything from autism, to learning issues, behavioral problems, mood, anxiety, and more. Please pass it on to a friend so they can sign-up as well.

· Our “Autism Spectrum” section answers the most common questions about the autism spectrum

· Under ‘Parent Resources’ we have our CPC Answers Series with over a dozen packets providing information about ADHD, Toilet Training, Mood Disorders, autism, dyslexia, Reactive Attachment Disorder, Encopresis, and more. Under that same section, we also offer a categorized index of helpful websites and resources on everything from autism to ADHD, and diet to sensory integration.

· Don’t forget our fun ‘Just for Kids’ section offering fun and educational games and activities.

· Of course, the site can also be used to locate our offices, make an apt, and download our intake packet.

We trust you’ll find the website to be easy to navigate and helpful. Let us know of anything you’d like added to the site. Have a great day!!

Five (5) Things You Really Need To Know About Special Education

April 29th, 2014

1. The School District Does not have to evaluate your child just because you submit a signed request to evaluate.

When you submit a written and signed request for an evaluation, the school district has 15 days to meet as a team, discuss your child’s educational needs, and provide a written response with indication of a game-plan to meet your child’s needs. That “game-plan” does not necessarily need to include a referral to the school psychologist for an educational evaluation. It may, rather, include any number of other options including modifications to how the classwork is assigned. However, you can appeal their feedback and request due process in that regard.

2. To determine eligibility for special education services, most Districts still use the 15 point discrepancy rule

If your child is evaluated by the school psychologist, various tests are administered (IQ, Academic…). The scores are listed as “Standard Scores” with an average of 100 (average runs from 90 to 109). There generally needs to be a 15 point “discrepancy” or difference between the IQ score and the academic scores (reading, math…) for a child to be deemed eligible for special education (Specific Learning Disability). For example, if the child obtains an IQ of 100, then it’s expected the reading and math scores will also be about 100 (it’s expected that the child will achieve at the same level as their IQ). However, if the reading or math scores are 85, that’s a 15 point difference and would qualify the child for special education (under the classification of a Specific Learning Disability). Less than a 15 point difference would preclude qualification. Other factors are also considered including PSSA scores, grades, work effort, prior opportunity for being appropriately educated, and English language proficiency. However, the 15 point rule is often primary.

3. The 15 point discrepancy model is why many kids, who may need special education, don’t qualify

It can be quite challenging to obtain a 15 point discrepancy, especially in the lower grades, and even more-so if a child has a lower IQ, say in the low average range. For example, if a child has an IQ Standard Score of 82 (low in the low average range), then the reading and math standard scores would have to be as low as 67, which is quite deficient and unlikely except in the most severe of situations. So, kids who have a lower IQ, and who are often in most need for special education, are often excluded. Keep in mind that, in this scenario, a child with a Standard Score of 70 in Reading is clearly struggling, but does not qualify because there is less than a 15 point discrepancy. This is a situation that most school districts acknowledge as a problem and try to provide alternative options such as Title I and similar programs.

4. The benefit of using grade-equivalents in addition to standard scores

A child may have a Standard Score of 87 in reading comprehension, which is at the upper end of the “low average” range and, on the surface, does not appear significantly deficient and often would not lead to a child meeting criteria for special education (under the classification of a specific learning disability). However, despite the low average score, the grade-equivalent (the grade-level on which the child is working) for that child may be two grades behind, truly revealing the degree to which the child is struggling. Most often, grade-equivalents are not listed in the report, and their importance tends to be down-played for various reasons I won’t bore you with today. However, I’ve found that grade-equivalents are important and need to be reviewed, discussed, and taken seriously during team meetings.

5. A classification of “specific learning disability” or “learning disability”, used by the school district, is essentially synonymous with “dyslexia”

The terminology used by school districts (Specific Learning Disability, Other Health Impairment…) comes straight from the Pennsylvania Department of Education in Harrisburg. This Department tells the Districts what terms they must use to receive funding. Consequently, school districts use the term “specific learning disability (SLD)”. It’s important to know that well over 90% of all kids who fall under the classification of SLD, have dyslexia (or dysgraphia, or dyscalculia…). In that regard, the reason they have a specific learning disability is because they have dyslexia. I’ve written at length about dyslexia, so feel free to read my prior posts about that disorder on the cpcwecare.com blog.

What does this mean for you?

In summary, there are lots of accommodation options besides directly referring to the school psychologist for an evaluation. In fact, you may find the process faster and smoother to receive feedback from the team regarding simple and efficient things they can do, now, in the classroom to help your child, and things you can do at home rather than waiting 60 days for the school psychologist to complete and present evaluation results. This is especially true given that a 15 point discrepancy is often needed for eligibility to receive special education services, and the chances are not great your child will have that discrepancy; especially in the lower grades. A 504 Plan may be more than sufficient and is much faster to develop. A 504 Plan is used for children who have a diagnosis for which various modifications can be used to ensure they have the same opportunity for an appropriate education as everyone else. It’s often used, for example, with kids who are diagnosed with ADHD. Ultimately, however, it’s vital to obtain information about what you can do at home to help your child learn. Again, see my prior posts about dyslexia (learning disabilities) for specific tips and suggestions.

Also, feel free to email me at jcarosso@cpcwecare.com

Autism / New On-Line Parent Training Program: Requesting your Suggestions

April 18th, 2014

We are delighted to announce:

Apple Tree Institute

AppleTreeInstitute.com is an Online Training program offering videos and webinars to help parents of children with autism and/or with behavioral problems.

Our goal is to make the site as helpful, user-friendlyand cost-effective as possible.

We would be indebted if you would view the Web site at AppleTreeInstitute.com, and share your thoughts with us about other topics that you’d like covered, and any suggestions to improve the Web site?

Please forward your thoughts to Dr. Robert Lowenstein, M.D. at r4lowe@gmail.com and Dr. John Carosso at jcarosso@cpcwecare.com.

Thank you again – your feedback is vital and appreciated.

How is ADHD Diagnosed? (and is it over-diagnosed?)

March 27th, 2014

Pathologizing?

There is wide-spread belief that children are over-diagnosed and over-prescribed, which implies that some kids are ‘just being kids’ and we’re pathologizing them, i.e. giving them a diagnosis, counseling, and medication when we should, rather, be sensitive and accommodating to the wide-spectrum in children’s activity-level and ability to attend. Is this an accurate perspective?

Just the facts Mam’

First, lets look at the stats: Rates of children, ages 4-17, diagnosed with ADHD are at about 7.8% (according to a recent National Health and Nutrition Examination Survey), which is not especially high, and stimulant prescription rates range between 4.3% and 4.4%, which you can see is substantially lower than 7.8%. Also, in that same survey, it was found that only 48% of the ADHD sample had received any mental health care over the prior 12 months, which would suggest children are, actually, being under-treated.

How is the diagnosis made?

To make the point further, if a clinician uses a strict clinical protocol, false-positives (inaccurate diagnosis) should be kept to a minimum. I provide a thorough explanation of the evaluation process in my video on the ‘evaluation process’

But here is a quick overview of specifically what is needed for an ADHD diagnosis: Click Here to Watch YouTube Video

-The child must have a long-history of demonstrating the core ADHD symptoms of inattention, impulsitivity, and hyperactivity. ADHD does not suddenly ‘spring-up’ one day after years of attentiveness. It’s usually something teachers and parents see from as early as the pre-school years.

-The signs are seen in multiple locations (school, home, community…).

-The problem is really getting in the way of the child’s functioning.

-Someone else in the family also has a similar problem with inattention, impulsivity… (ADHD tends to run in the family).

The problem cannot be explained better by some other malady. For example, if the child is distressed, depressed, anxious, or has learning issues, that may explain the symptoms better than ‘ADHD’. In that regard, if a child is experiencing some sort of stress or serious problem, it’s likely he or she will be preoccupied and subsequently have trouble concentrating.

So you can see…

If this protocol is followed, it’s far more likely that there will be an accurate diagnosis, and an effective treatment plan can then be established. I’ve written at length about proper strategies to address ADHD (please see my prior blog posts) that include a consistent and predictable routine, visual reminders, an organized environment, extra attention and assistance, counseling to improve insight and coping strategies and, in some cases, a medication consultation.

Questions?

If you have questions about this process or your child’s diagnosis, email me at jcarosso@cpcwecare.com or call the office. I’d be happy to answer your concerns.

Top Ten Parental Discipline Strategies!!!

March 6th, 2014

Without further ado, here they are:

1. ASSUME CONTROL
Control based in Action/Relationship
Don’t entertain explanations
Project self-confidence
Business-like
Give direction, don’t make requests

2. AVOID ARGUMENTS AND EMOTION
Cut-off communication if child becomes belligerent
Avoid reasoning with child
Give direction and walk away
Communicate: It’s your problem, not mine
1-2-3 Magic

3. PLAN FOR NEXT TIME
Discuss ahead of time what will happen if noncompliant
Also discuss between parents – PLAN AHEAD and BE ON THE SAME PAGE
Predetermined expectations and consequences (behavior charts…)
Most problem behavior is predictable and patterned
Be consistent
Don’t give a direction if not ready to back-it-up (each time you do that, you lose some control)

4. DON’T LECTURE
Brief and to the point
Humor
No emotion (be the James Bond of parents)
Don’t explain or lecture
1-2-3 Magic

5. FOCUS ON THE PROBLEM BEHAVIOR; BE SPECIFIC
Be specific (what you want, and what you like)
No emotion, model self-confidence
Don’t focus on “attitude” – focus on behavior

6. AVOID DISTRACTIONS
Turn off TV, video games
Remove siblings
Remove siblings, friends
No distractions during confrontations and chores

7. USE POSITIVE PRAISE AND EMOTION
Catch them being good
Whisper (softer and closer)
You get what you praise
Attention-Tank (fill child’s attention tank with positive praise)

8. SELF-DISCLOSURE
Use judiciously and cautiously
I-Feel Statements (“I feel frustrated when you ignore me…”)
Tell them how you feel, don’t show them (control your emotional response)

9. ROLE MODEL APPROPRIATE PROBLEM-SOLVING
‘What you do speaks so loudly, I can’t hear what you say’
Words and emotion are your enemy (brief, no emotion)
Role model effective problem-solving

10. PICK YOUR BATTLES
Be flexible
Check-in later

Research Findings: Can We Trust them, Part II

February 27th, 2014

Two years ago I wrote about the problems we face trusting research findings. To bring you up-to-date, here is my follow-up post. Unfortunately, the situation isn’t much improved.

The information, or misinformation, we face daily

You may have read the recent study out of Warwick Medical School in the UK suggesting that kids from families that frequently moved when the child was young (resulting in child often-changing schools) have an increased risk of psychosis. I imagine there a bunch of parents feeling guilty that they may have “caused” their child’s mental health issues because they frequently moved years ago. This type of interpretation, or misinterpretation, is all too common. Hardly a day goes by when we don’t hear another such aspersion from the news media. Why might this be off-base? That is correlational and observational-type research (not randomized or double-blinded); it’s not cause-effect. It’s simply indicating an apparent association between these two things; moving, and later evidence of psychosis. There are ample alternative explanations; for example, given that schizophrenia is predominately genetically-based, and can lead to job and housing instability, it’s reasonable to assume that families with a higher schizophrenia-loading are more apt to move, and it’s more likely that one of the children will later show some signs of psychosis. One may not have “caused” the other as the news reports would have you believe.

What made all the difference?

How are we able to cease making such associations between likely unrelated events? Historically, such capacity is relatively recent; think about it, how did we come to stop using ‘bled-letting’ to “cure” illnesses? What made the medical community finally realize these approaches were ineffective, and how did we come to realize that subsequent medical treatments were effective beyond simply doing nothing (or draining the blood out of somebody)?

Randomization

Yes, that simple word, but not so simple a process, saved the day for medicine and all subsequent treatment approaches to this day. The concept is relatively recent; first hypothesized and documented in the 1930’s, but not used to assess surgical treatment until the 1960’s. In the absence of randomization and, even better, single or double-blind controls, there are all sorts of things that can make you think the treatment works, or doesn’t work, when it really does, or doesn’t. These things are called confounding variables, and they wreak havoc on a study’s or a “treatment’s” apparent result or effect. Keep in mind that blood-letting was the treatment of choice for 2000 years and continued into the late 19th century. So much for basing a treatment on one’s clinical observation.

How much havoc?

Well, here’s the sad truth; when it comes to the predictive value of studies, randomized trials have an 85% Positive Predictive Value (PPV) rate. However, once you leave the world of randomization, it gets really bleak, really fast, with PPV dropping to between 20% and .1% for nonrandomized epidemiological studies (you know the ones, announced daily on the news saying that if you eat something in particular you’re going to get some type of horrible malady; or if you move, your child may become psychotic). This led to the prominent researcher, Dr John Ioannidis, asserting that half of all research findings are false (even worse, he suggested that 90% of all medical research is inaccurate, and 50% of the research deemed ‘most reliable’, in the most reputable journals, is inaccurate). In that regard, it doesn’t matter if the research is coming from the most reputable of journals; it was still found to be flawed (see hormone-replacement therapy, vitamin D for heart disease, and coronary stints, among countless of other research topics).

It’s also common to find a self-serving statistical sloppiness. In a 2011 analysis, Dr. Wicherts and Marjan Bakker, at the University of Amsterdam, searched a random sample of 281 psychology papers for statistical errors. They found that about half of the papers in high-end journals contained some statistical error, and that about 15 percent of all papers had at least one error that changed a reported finding—almost always in opposition to the authors’ hypothesis. These errors have far-reaching implications. For example, claims based on fMRI brain-scan studies are increasingly being allowed into court in both criminal and civil cases. However, study in 2009 found that about half of such studies published in prominent scientific journals were so “seriously defective” that they amounted to “voodoo science” and “should not be believed.”

What to do?

We’re bombarded daily with news of the ‘latest research’ asserting one thing or another. What can we believe? I wish I had an easy answer for you. All I can communicate, as emphatically as possible, is that if the research is not based in randomization, then it’s a crap-shoot. Moreover, factor the all-too-common politicization of research findings that further bias the results. Bottom-line: always be skeptical, always look below the surface, study the research design, do not take the news reports at face value, and don’t take the reseacher’s findings, as reported directly in the study, at face value. In that respect, lots of researchers will report findings that sound convincing (they want to get published, get tenure, and be seen on 60 Minutes) but are based in correlational or even purely observational designs, both of which are ripe for errors. To make the matter worse, even randomized designs can have problems and inaccurately skew the results in a favorable light (see “enriched” design).

Where do we go from here?

We have a few options:

1.) read and accept research results, as the mainstream press and journals would prefer,

2.) believe nothing and remain skeptical about everything you read and hear,

3.) learn how to effectively analyze research, or

4.) don’t read anything and turn off your TV.

Option 4 doesn’t sound so bad, but I suggest options 2 and 3. It’s not easy, but the alternative is, in my opinion, worse.

If you want some resources to learn about effectively interpreting research, email me at jcarosso@cpcwcare.com.

God bless you in your ongoing pursuit of the truth.

When Should You Tell Your Child The Diagnosis?

January 16th, 2014

To tell or not to tell

I am often asked by parents whether or not they should tell their child the diagnosis? It’s a good question, and of course the answer is somewhat complex.

Focus on symptoms, not the diagnosis

I find that it’s rarely beneficial to place a ‘label’ on the symptoms, and subsequently on the child. Rather, I find it helpful to focus on the two or three primary issues or behaviors and explain to the child that you, your child, and the treatment team are going to work improving those issues, e.g. compliance, social skills, safety awareness… The more specific you can be in describing the targeted behavior(s), the better. So, rather than tell a child that he or she has “ADHD” or “autism” and you’re going to treat that “disorder”, I find it more helpful to explain to the child that they have challenges, for example, paying attention in class, or with standing too close to friends, and they’re going to be helped in that regard by specific strategies.

Why not explain the diagnosis?

Explaining the diagnosis can be counterproductive. The child can feel ‘stuck’ in their diagnosis, which often can be stigmatizing and have negative connotations, and people often come to identify with their diagnosis, ie. “I’m ADHD”, or “I’m autistic”, or “I’m Bipolar…”. No, your child is not ADHD, or autistic; rather, your child has a diagnosis of autism; or has a diagnosis of ADHD…; the diagnosis is not ‘them’ as a person but is only a small part of their many wonderful traits and characteristics. Also, sometimes kids will use the diagnosis as an excuse, “I did that because I’m ADHD…” that too is counterproductive.

When to explain the diagnosis?

I find that, as children mature, they become increasingly inquisitive and insightful. At some point, it’s not uncommon that a child begins to sense that something is ‘different’ about them compared to their peers. It’s not uncommon that, in those situations, the child may approach the parent and ask “what’s going on with me… why am I different… I’m not like other people….” In those instances, it’s likely time to explain the diagnosis while, at the same time, focusing on strengths, abilities, and that the child IS NOT their diagnosis, but that the diagnosis simply reflects a cluster of signs and symptoms with which the child and parent will continue to target in treatment.

It’s also important to emphasize that the symptoms can be improved, and you can site examples of your child having risen above the ‘diagnosis’ in any number of ways.

At times kids will find the information about their diagnosis to be a relief (“I always knew I was different, but never knew why”) but others may feel quite distressed with the news. Use a reflective approach (see my earlier posts on that technique) and remain supportive and reassuring. It may help to allow them the opportunity to meet other kids with the same diagnosis (a support group can be quite helpful).

Sum it up

I find that, in general, it’s best to not focus on labels and diagnoses but, rather, describe signs and symptoms that are going to be targeted and overcome. This strategy is empowering, motivating, and directive. However, there are times to discuss the diagnosis, especially if the child is relatively mature, has good self-awareness and insight, and is asking questions about why he or she seems or behaves ‘differently’ from peers. There are a number of helpful books and resources to help with this process; feel free to email me if interested.

Hope that helps. Feel free to email any questions at jcarosso@cpcwecare.com

God Bless!