NBR: Child mental health

aschnee · June 2013

I work in the mental health field with children and adolescents. As a part of my job, I complete evaluations and make diagnoses. Recently, upon sharing the results of some evaluations, parents have said, "I was hoping it was Autism" when I told them that their child had a Disruptive Behavior Disorder. Now, I've certainly heard, "I was hoping it was ADHD" and I understand that just a bit more, as ADHD isn't necessarily a life-long disorder and people know that medication can often alleviate some of the symptoms of ADHD. "I was hoping it was Autism" shocks me however. As a parent, I have a really hard time understanding why I person would hope that their child has a life-long disorder that requires extensive treatment, as opposed to a childhood disorder that can be alleviated through behavior management. If anyone can shed some light on this, I would really appreciate it. I am generally a pretty open-minded person and I am having a hard time making sense of this!

coraggiosa · June 2013

I absolutely cannot understand a parent who would want such a diagnosis for their child. That is just unimaginable to me.

I wonder if they feel like they would get more sympathy from other people if it was autism? That's obviously a ridiculous excuse, but I can see where some people might think that way.

MCPlus · June 2013

I'm with you, but as a special Ed teacher of kids with autism here is what I have gathered with that mindset.
There are so many services, programs, support systems, in home care, and money available for kids with autism it is a desirable diagnosis.
I'm mobile, so desirable should be in quotes.
The parent advocacy groups are super strong in US and are getting more and more services covered by insurance, which is not a bad thing. But you will always have people who want to take advantage of those things.
I would never hope autism on anyone, especially my own child. Sorry you had to deal with that.

aschnee · June 2013

MCPlus:
I'm with you, but as a special Ed teacher of kids with autism here is what I have gathered with that mindset. There are so many services, programs, support systems, in home care, and money available for kids with autism it is a desirable diagnosis. I'm mobile, so desirable should be in quotes. The parent advocacy groups are super strong in US and are getting more and more services covered by insurance, which is not a bad thing. But you will always have people who want to take advantage of those things. I would never hope autism on anyone, especially my own child. Sorry you had to deal with that.

This would make sense to me if I lived in a state where these services and support systems were available. Unfortunately I live in Nebraska, a state where Medicaid does not pay for mental health services for Autism and we have very few of the services and supports that I hear of in other states! I actually know of families who have moved to different states to get services for their children! My frustration with this could be a whole other post, but this is just another reason that hoping Autism on their children is so confusing!

CDMay2006 · June 2013

Based on my experience working with kids with emotional and behavioral disorders, here are my ideas:
- Autism, while still stigmatized, has fewer stigmas than a bx disorder (many people -- even within the education system -- think behavior disorders are purely decision-based/or worse, but autism is accepted as a medical disorder), so the name sounds better.
- Autism is well-known, so it may seem more familiar and less scary to them.
- Also b/c it's well-known, society knows (a little bit about) what to expect of someone with a ASD dx than other diagnoses.
- They don't know the extent to which ASD affects kids and families, or the prognosis, and/or they think autism = Asperger's.
- The parents may already know about resources for families of kids with autism, so it could feel more manageable.

aschnee · June 2013

CDMay2006:
Based on my experience working with kids with emotional and behavioral disorders, here are my ideas: Autism, while still stigmatized, has fewer stigmas than a bx disorder many people even within the education system think behavior disorders are purely decisionbased/or worse, but autism is accepted as a medical disorder, so the name sounds better. Autism is wellknown, so it may seem more familiar and less scary to them. Also b/c it's wellknown, society knows a little bit about what to expect of someone with a ASD dx than other diagnoses. They don't know the extent to which ASD affects kids and families, or the prognosis, and/or they think autism = Asperger's. The parents may already know about resources for families of kids with autism, so it could feel more manageable.

Good points! Thank you! This helps me think through how I can present such diagnoses and treatment plans to parents in the future!

aschnee · June 2013

laurelannie:
Hey! I do the transcription work for doctors and nurses who do evaluations just like that!
That makes me no expert,I'm fully aware of that.
First off, I think that's horrible. Perhaps they are worriednbsp;that they were going to have a hard time convincing people and caregivers in their kid's life that this is a real thing, not made up like so many people think half the diagnoses are, I admit that before my transcription work, I hadn't heard of DBD. Autism is, for lack of a better term, more "legit" sounding, less likely to be questioned.
I'm not justifying their reaction, just trying to figure out their logic.

Yeah, I guess I could see that. When I hear about medical diagnoses that are unfamiliar, I often question it more than diagnoses that I'm familiar with.

smlowe9311 · June 2013

The only thing I can think of (not that it's a good reason) is maybe they feel they understand autism more than the disruptive behavior disorder? Of course they can always research about it and find out what they need to as any parent should.

ravenclaw1 · June 2013

A lot of others said good stuff, I would think that maybe they just don't understand what their diagnoses really means.

magdalina.h · June 2013

It doesn't have to make sense to you. There could be soooooo many background issues that you don't know about.

Cleo421 · June 2013

I'm a clinical psychologist. It is not unusual that a pt wants a certain dx, including parents for their children. This is bc unlike with medical dx, a psychiatric dx is based soley on self slash parent report and behavioral observations as opposed to lab tests, Xrays, etc. Therefore, when i dx your child with a specific disorder, I'm actually not telling you anything you don't know, I'm just telling you the name i call it, and giving you info on tx and possible prognosis. Very different than, for example, giving a pt the results of a biopsy and telling the pt they have cancer. And as pp mentioned, so, so many services and benefits are contingent upon what I sign off of on that paper, esp for school aged children. My specialty is PTSD, and I VERY often get pushback from pts upset that I didn't render a PTSD dx. Not bc they want to be sicker, but bc a lack of a dx precludes certain benefits. I don't think any parent wants their child to have a chronic pervasive developmental delay.

Plus, with the advent of DSMV last month, a lot of the pdds are going out the window anyway!

Cleo421 · June 2013

quote fail, but OP this is in response to your confusion about why it would be of benefit in your state: Public school systems, nation wide, have to give more and specialized services to children with dxable disorders. Nebraska is not excluded from this ::mobile smiley:: Google FAPE.

Cleo421 · June 2013

aschnee:
laurelannie:
Hey! I do the transcription work for doctors and nurses who do evaluations just like that!
That makes me no expert,I'm fully aware of that.
First off, I think that's horrible. Perhaps they are worriednbsp;that they were going to have a hard time convincing people and caregivers in their kid's life that this is a real thing, not made up like so many people think half the diagnoses are, I admit that before my transcription work, I hadn't heard of DBD. Autism is, for lack of a better term, more "legit" sounding, less likely to be questioned.
I'm not justifying their reaction, just trying to figure out their logic.

Yeah, I guess I could see that. When I hear about medical diagnoses that are unfamiliar, I often question it more than diagnoses that I'm familiar with.

To be fair, disruptive bx dx NOS isn't a mobile quote :: real disorder:: its an NOS disorder, meaning Not Otherwise Specified, meaning ::your kid has some acting out but it doesn't fit into the categories of any other disorder and we're not sure what else to call it:: just like any other NOS dx, its a kitchen sink for when more assessment needs to be done or when the sx truly don't seem to fit with anything else but the clinican feels something needs to documented. I use NOSes very sparingly.

Fun fact: the ::quote disorder:: adjustment disorder NOS grew completely from a need for clinicians to be able to get insurance companies to reimburse therapy sessions for pts who really had no dxable disorder or anything wrong with them per se. All of a sudden I tell you someone has an adjustment disorder not otherwise specified, its a real thing and you'll reimburse for it.

ETA: from your posts I gathered the dx you are rendering is just disruptive bx disorder NOS. Of course, conduct disorder and ODD fall under that category, so if you're rendering those specific and IMO more legit dxs, I applogize for misunderstanding!

aschnee · June 2013

magdalina.h:
It doesn't have to make sense to you. There could be soooooo many background issues that you don't know about.

This is a good point!

aschnee · June 2013

Cleo, I am a clinical psychologist as well. Instead of quoting all of your posts, I figured I would just respond in this way. I was referring to DBD NOS with the client yesterday and ODD a few days ago. When sufficient criteria aren't met for ODD, DBD NOS is appropriate, especially given that the child is only 3 years old. I don't think it's necessary to give a higher order dx just so it's not "kitchen sink". My primary concern is not the dx but that appropriate treatment ensues.

Cleo421 · June 2013

aschnee:
Cleo, I am a clinical psychologist as well. Instead of quoting all of your posts, I figured I would just respond in this way. I was referring to DBD NOS with the client yesterday and ODD a few days ago. When sufficient criteria aren't met for ODD, DBD NOS is appropriate, especially given that the child is only 3 years old. I don't think it's necessary to give a higher order dx just so it's not "kitchen sink". My primary concern is not the dx but that appropriate treatment ensues.

Not only is it quote not necessary, it would be unethical to give a specific dx when criteria arent met! I certainly wasn't suggesting to give an inappropriate dx, but was trying to explain why folks would rather a bona fide dx, esp when there's an absence of clear tx recs and prognoses for kitchen sink disorders.

Cool to see another psychologist on this board! Im curious to hear where you got your phd and did residency. Central Florida and Boston Consortium over here! It's such a small world that I wonder if our circles overlap!

CDMay2006 · June 2013

magdalina.h:
It doesn't have to make sense to you. There could be soooooo many background issues that you don't know about.

Sure, but if she is the one delivering the diagnosis to the family, the way she frames it can make a major difference in how the family receives it, which can mean they are more able to quickly process the information and then act on it (medically/getting services, etc.), which is best for the child's outcome.

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