Parents Guide to Getting Good Care
What Should I Look for in Diagnosis?
There are no blood tests or the like for psychiatric and learning disorders, so the diagnosis depends on a detailed picture of a child’s moods, behaviors, test results, etc. So a clinician depends on the information she gets from the child, parents, teachers, and other adults who have knowledge of him.
A good clinician will ask you detailed questions about your child’s behavior, diagnosis symptoms, as well as her developmental history and your family’s history.
She will also use tools designed to help get an objective take on those behaviors and symptoms.
Some of these tools take the form of structured interviews, in which a clinician asks a set of specific questions about a child’s behavior. The clinician’s questions are based on the criteria for each psychiatric disorder in the Diagnostic and Statistical Manual, adapted for children. The answers are then used to determine if the child meets the criteria for a particular disorder.
For instance, a clinician might use something referred to as ADIS (Anxiety Disorders Interview Schedule), or the K-SADS (Kiddie Schedule for Affective Disorders and Schizophrenia) to determine whether a child should be diagnosed with one or more psychiatric disorders.
Some of the tools used to aid in diagnosis help are rating scales, in which the child is rated numerically on a list of symptoms. For instance, BASC (Behavior Assessment System for Children) is a set of questions that are customized for parents, teachers, and the patient, to utilize multiple perspectives to help understand the behaviors and emotions of children and adolescents. While this scale is not used as a diagnostic tool, it can alert clinicians to areas that are elevated (anxiety, conduct problems, depression) which may indicate that further exploration of a specific area is necessary.
For children who may have ADHD, tools commonly used include the SNAP rating scale for teachers and parents, which scores kids on how often each of a list of a 18 symptoms occur.
On the other hand, the CPT (Continuous Performance Test), which rates a child’s ability to complete a boring and repetitive task over a period of time, is the gold standard for differentiating kids whose inattention is a symptom of ADHD rather than some other cause, such as anxiety.
A-DOS (the Autism Diagnostic Observation Schedule) is a set of tasks that involve interaction between the tester and the child which are designed to diagnose autism.
These are just some examples of the kinds of tools qualified diagnosticians use to identify disorders.
Most important: Do not accept treatment from a clinician who does not offer a diagnosis for your child. Just as a headache can be caused by many different things, worrisome behavior or moods can be symptoms of a range of psychiatric and developmental disorders. It’s a mistake to try medications to see if they work on the symptoms without a diagnosis that’s clearly explained to you, and based on substantial evidence.
What are some questions I should ask?
When looking for a mental health specialist to provide an evaluation for your child, you’ll want to be prepared with questions that will help you decide if a particular clinician is a good match for your needs:
- What kind of training do you have?
- How will you involve the family in the treatment?
- If your child has an anxiety disorder, such as OCD, separation anxiety disorder, or a specific phobia: Do you do exposure therapy? (The answer should be yes.)
- How much experience do you have diagnosing children whose behaviors are similar to mine?
- Are you board certified and/or licensed?
- How do you arrive at a diagnosis?
- What are the recommended treatment options and where should I go?