Why a Diagnosis Is (and Isn't) Important

In my work with parents of young children, many are in the early stages of monitoring their child’s developmental milestones after noticing some concerns. While all children develop at their own pace, some young children experience concerns with emotional regulation, language and motor milestones, or sensory processing that leave their parents wondering if an evaluation is needed. 

Most parents understand that children need an evaluation to receive support services at school or a clinical diagnosis for insurance to cover therapeutic services. But what if a family is paying privately for services or what if your child goes to private school? Is a diagnostic evaluation really necessary? 

The short answer is "Yes." An evaluation is the beginning of your journey in learning how to connect with and support your child, and how to help others do the same. It tells us where to go next, and without it, we run the risk of our child being misunderstood by teachers and even therapists. Children continue to grow and change over time so having an evaluation in the preschool years can be incredibly important to look back on when your child is older. 

When deciding when it’s time to schedule an evaluation, I always ask parents these questions: 

Is your child’s behavior interfering with their ability to get quality sleep, connect with you, or engage in play with others? 

Are these lagging skills or behaviors getting in the way of your child getting to school or daycare in the morning, connecting with peers, or developing new skills? 

If yes, then it is time to investigate. What are the lagging skills? What are the strengths? What are the triggers? Answering these questions leads us to planning for the best school fit, the best support at home, and the best targeted interventions. This path leads to your child being understood.

Clinical Diagnoses vs. Educational Classification

So, what is the difference between clinical and educational? Psychiatrists, Psychologists, and other therapists are going to use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR) to classify a diagnosis, which is needed for insurance purposes. According to the DSM-5-TR, there are three types of ADHD, one Autism Spectrum Disorder with varying levels of severity, multiple types of learning disabilities, and different types of anxiety and depressive disorders.

On the other hand, there are only 13 educational classifications under the Individuals with Disabilities Education Act (IDEA). Therefore, a child’s educational classification is not as specific as their clinical diagnosis. This is just fine, as long as everyone working with your child has access to comprehensive evaluation reports and fully understands your child's strengths and needs for support. This is where parent-teacher collaboration begins and is the most important relationship you can foster during your child’s school-age years.

A Note About Special Education in the United States

My generation (parents who attended elementary school in the 1970s and 1980s), may remember special education services differently from the services our children receive today. Under public education law 94-142, our children are to be educated in the Least Restrictive Environment with their same-age peers to the maximum extent possible. Do separate classrooms still exist for some? Yes; however, students with disabilities should be included with their neurotypical peers as much as possible. This is why I’m so passionate about helping teachers stay up to date of the evolving field of understanding neurodivergent learners. More on that here. 

Children with an Individualized Education Plan (IEP) under IDEA who are being educated in the general education setting along with their same-age peers may receive support as minimal as extra time on a test or as comprehensive as small group academic instruction in a classroom of students with similar needs with a special education teacher. It’s important to understand that each state, county, and even school vary on how these services are implemented. Parents may feel that one school is very supportive of their child’s needs, while they feel another school in the same district is doing the bare minimum. This is why building strong relationships with teachers and advocating for your child’s school support is so important.

Facing Your Fear of the Label

I’ve met parents who are so fearful of having their child labeled, that they will put off their child’s evaluation which can lead to delaying much-needed services. Some parents will begin therapies to support their child’s symptoms, but the question of what is globally explaining their child’s developmental needs remains. I have walked this path as a parent so I understand how emotional the evaluation process feels for parents. However, parents I work with are so thankful for the detailed evaluation report that recommends what to do next. Years later, parents (including myself) are so glad they started when they did in processing that their child is on their own path.

What a Diagnosis Is and Is Not

While a diagnosis does not change a child, it should change everyone's perspective who is working with the child. If a child was considered “difficult” or “noncompliant” before the diagnosis, now they are seen as “having difficulty” due to a learning or social weakness, or “resistant” due to anxiety or sensory sensitivities. A teacher may have misunderstood a sensory meltdown for “acting-out” behavior, but after the diagnosis we have more data to determine what triggered the behavior. A child who was described as "aloof" or "self-directed," now has a roadmap for parents and teachers to increase supports for emotional regulation, attention, and social engagement. The evaluation report and diagnosis lead to a shift in expectations and a plan of individualized support.

Remember: No two people are the same. No two children are the same. And, certainly, no two children with the same clinical diagnosis or educational classification are the same. A comprehensive evaluation will outline these individual differences, but a diagnosis will not. What we must all understand is that the diagnosis is never the finish line. It is not where we stop asking questions because we think we understand the child based on one word or phrase. The diagnosis and evaluation report are the starting line, where we begin to understand and ask more questions about how to support, teach, and connect with a child.

Adjusting the Bar for Success

Parents will say, “I don’t want him labeled because I don’t want his teacher to expect less of him.” The truth, however, is that many problematic behaviors are a child's response to teachers and parents expecting too much, at this developmental level or with this particular skill. A quality evaluation report will outline the individual strengths and weaknesses of your child so that we can adjust the bar on weaker skills, for now, while continuing to encourage and develop strengths.

An example of "adjusting the bar for success" is the child who is very intelligent, but who cannot emotionally self-regulate in order to learn in a classroom. No one can learn without first feeling emotionally regulated, without which we cannot connect with, trust, or engage with those who are teaching us. Think about how you feel when you are really stressed; not much thinking and learning happens until you feel calm again, right? Or, how would you feel sitting in a classroom where the instructor is only speaking a language unknown to you. You’d be pretty disengaged, right? We wouldn't expect much from you until you could understand what is being asked of you. If we expected you to participate, you would likely feel anxious, avoid engaging, or quit altogether. So, sometimes, lower expectations are what a child needs to feel successful, and then we raise the bar as their skills develop.

It’s Better Over Here

After the evaluation and diagnosis, you enter into a realm where the behavior no longer feels like the child’s “choice." Prior to a diagnosis, there is often much confusion about what a child CAN do versus what they are CHOOSING to do. After the diagnosis, you walk through a figurative door, on to the other side of more understanding and acceptance of your child's strengths and what your child needs to thrive. It’s better over here.

Let’s Stay Connected!

~Dr. Emily

Learn more about Dr. Emily’s resources for parents and teacher at the buttons below.

**All content provided is protected under applicable copyright, patent, trademark, and other proprietary rights. All content is provided for informational and education purposes only. No content is intended to be a substitute for professional medical or psychological diagnosis, advice or treatment. Information provided does not create an agreement for service between Dr. Emily W. King and the recipient. Consult your physician regarding the applicability of any opinions or recommendations with respect to you or your child's symptoms or medical condition. Children or adults who show signs of dangerous behavior toward themselves and/or others, should be placed immediately under the care of a qualified professional.**