AVOIDING MISDIAGNOSIS IN OUR CHILDREN
The overlap of symptoms between different disorders can be confusing for parents, and at times therapists!!!. When understanding the complexity of this it is important to realise that different therapists receive training in different areas.
For example a Psychologist is trained extensively in human behaviour and cognitions making them better placed to understand behavioural disorders and symptoms such as ADHD, learning and developmental disorders such as developmental delay, intellectual disability and giftedness, Oppositional Defiance Disorder to name a few.
An Occupational Therapist is trained in helping people participate in everyday activities such as eating, sleeping, self-care, and learning by addressing underlying difficulties like fine motor, problem solving, attention, and sensory processing skills. Hence they have a greater understanding of how our motor planning and senses interact with the environment
A Speech Pathologist is a specialist in language and speech development, and such have an extensive knowledge communication difficulties and disorders and the symptoms of these. Making them the experts in receptive and expressive language problems and speech disorders.
When making a diagnosis the symptoms of a disorder often cross over all of these domains, for example in Autism a child will display difficulties in communication (speech pathologist domain), sensory processing (occupational therapist) domain and social interactions (psychologist domain). What’s more an Occupational therapist will be better placed to make a decision as to whether the sensory processing symptoms are more related to other sensory disorders such as Sensory Processing Disorder, Sensory Integration Disorder etc and a speech Pathologist will be able to make a decision as to whether the speech and language problems are more associated with other communication disorders such as Social (pragmatic) Communication Disorder etc. The Psychologist is best placed to determine if the is a learning or developmental disorder that may be better accounting for social and /or communication problems.
Lets look at ADHD and Autism diagnosis:
The usual result if a child can’t consistently sit still in class, or sit to do homework or is constantly fidgeting or talking too much is a diagnosis of ADHD.
However it is important to recognise that any child under stress, suffering from anxiety or with sensory processing problems will present similarly. Therefore it is vital to have a Psychologist and occupational therapist discuss the possibilities that the fidgeting and inability to sit still is not the result of underlying anxiety or a hyper-arousal that is caused by sensory processing problems. Although the presenting behaviours are consistent with ADHD they may well be caused by another disorder meaning that ADHD should not be diagnosed.
For example a child who does not follow directions well (one of the key symptoms of ADHD) may be:
- Unaware that direction have been given because they have trouble discriminating sounds or has difficulty planning their motor control to respond (Sensory processing disorder, Autism, Communication Pragmatic Disorder) OR
- Gets started on following the direction but has difficulty remembering or following through on verbal directions (The reason why children with ADHD cannot sit still).
Or a child who lacks self control and misbehaves may be:
- Touching, pulling or poking other children or objects to receive more tactile input from others around them (sensory processing disorder, Autism) OR
- Talking over the top of others, unable to wait their turn and take turns (ADHD).
There are so many factors to consider before diagnosing a child with any disorder. A misdiagnosis can have so many implications including incomplete treatment. Unfortunately another result is children with multiple diagnosis where each specialist has seen them individually and made their own diagnosis which have then been presented together, making it look like the child has 2,3 or even 4 diagnosis. We see many children with 3 or more diagnosis where often one of the diagnosis can account for the syptoms of the other.
It is vital that a skillful evaluation and assessment takes place that involves a multidisciplinary team of specialists, as each specialist is most likely to see only the disorders that relate to their specialist area, a multidisciplinary team can explore all options and ensure that the correct diagnosis is given.