In my work with parents of young children, many come to me after noticing some concerns with their child’s developmental milestones. While all children develop at their own pace, some young children experience challenges with emotional regulation, language and motor milestones, and/or sensory processing that leave their parents wondering if an evaluation is needed.
Most parents already know that children need an evaluation to receive support services at school or a clinical diagnosis for insurance to cover therapeutic services. But some parents who pay “out-of-pocket” for therapy services or enroll their child in private school wonder: 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 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.
On 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?
Is their emotional overwhelm causing stress at times of transition, toileting, or eating?
Are these lagging skills or behaviors getting in the way of your child getting to school or daycare in the morning, transitioning throughout their day, 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 plan for the best school fit, the best support at home, and the best targeted interventions. This path leads to your child feeling seen and understood.
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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. Parent-teacher collaboration begin here and it is the most important relationship you can foster during your child’s school-age years.
A Note About Special Education in the United States
Gen-X and millennial parents 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 are included with their neurotypical peers as much as possible. This is why I’m so passionate about helping all teachers, not just special educators, stay up to date of the evolving field of understanding neurodivergent learners.
Facing Your Fear of the Label
If you are feeling resistant to having your child evaluated, let’s get real for a moment about your own fears. I have walked this path as a parent so I understand how emotional the experience of the evaluation process can be. It feels like you’re about to open a door you can never close again. Just trust me, once you better understand your child’s brain, you will never want to close that door; you will want to walk through it with your child and then help the rest of the world understand them better.
Every parent experiences this phase differently. Some are so fearful of having their child labeled that they put off their child’s evaluation, delaying much-needed services. Some parents will begin therapies to support their child’s symptoms, but the larger question(s) of what is explaining their child’s developmental needs remains. I’ve worked with parents who have their child evaluated but wait until their child notices they feel different to explain to them how their brain works.
You will figure out what is best for your child, just know that most parents I work with are so thankful for the detailed evaluation and recommendations of what to do next. Years later, parents (including myself) are so glad they started the process when they did. Your child deserves to understand how they learn and you can’t help them understand it until you understand it first.
Your Child’s Inner Experience vs. Observable Behavior
In recent years, many autistic teens and adults as well as those diagnosed with ADHD have been sharing their lived experiences more openly through writing blogs and sharing their perspective on social media. In my own training for conducting evaluations, all data collected was based on a clinician’s observations and caregiver’s description of a child’s behavior. But we are beginning to learn more and more about the lived experience of neurodivergence by listening to first-person accounts. Of course, many children do not have the self-awareness, insight, or language skills to express what they experience, but once they do, we need to listen. Your child’s description of sensory overwhelm or anxiety related to academic demands is not only valid but highly informative to those working with them, especially if their experience doesn’t match their outward behavior due to masking.
What a Diagnosis Is and Is Not
While a diagnosis does not change your child, it should change the perspective of everyone who is working with them. If a child was considered “difficult” or “noncompliant” before the diagnosis, now they are seen as “having difficulty” due to a skill 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 information to get curious about what triggered a stress response. A child who was described as "aloof" or "self-directed" before an evaluation, now has parents and teachers who understand that solo play helps them self-regulate. Now, they leave solo play uninterrupted and learn how to support emotional regulation and engagement before dysregulation happens.
Remember: No two people are the same. No two children are the same. Not even two children with the same clinical diagnosis or educational classification are the same. A comprehensive evaluation will outline your child’s 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 is the starting line, where we begin to understand and ask more questions about how to support, teach, and connect with a child. Only then can we begin understanding how they learn so we can explain it to them when they are ready.
Changing Your Mindset
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 actually a child's stress response to teachers and parents expecting too much. A quality evaluation will outline your child’s individual strengths and weaknesses so that you know where to add support and structure for weaker skills while continuing to encourage and develop strengths and areas of interest.
Imagine 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 safe, which first requires us to connect, 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 you don’t speak. You’d be pretty disengaged, right? We wouldn't expect much from you until you could understand what is being asked of you. If you were required to participate without the necessary skills, you would likely feel anxious, avoid engaging, or quit altogether. So, sometimes, lower demands are exactly what a child needs to feel satisfied with their progress.
It’s Better Over Here
Prior to a diagnosis, there is often confusion about what a child can do versus what they are choosing to do. After the diagnosis, you enter a world where behaviors are seen as stress responses to be solved rather than your child’s “choice.” When you fully accept your child’s neurodivergence, you walk through a figurative door, on to the other side of more understanding of your child's strengths, interests, and knowledge of what your child needs to thrive. It’s better over here.
Let’s Stay Connected!
~Dr. Emily
I’m Dr. Emily, child psychologist and former school psychologist, and I’m on a mission to help parents and teachers be the best adults we can be for the neurodivergent kids and teens in our lives. This isn’t about changing the kids, it’s about changing us. Learn more with my resources for parents, teachers, and schools at www.learnwithdremily.com.
**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.**