To tell or not to tell
I am often asked by parents whether or not they should tell their child the diagnosis? It’s a good question, and of course the answer is somewhat complex.
Focus on symptoms, not the diagnosis
I find that it’s rarely beneficial to place a ‘label’ on the symptoms, and subsequently on the child. Rather, I find it helpful to focus on the two or three primary issues or behaviors and explain to the child that you, your child, and the treatment team are going to work improving those issues, e.g. compliance, social skills, safety awareness… The more specific you can be in describing the targeted behavior(s), the better. So, rather than tell a child that he or she has “ADHD” or “autism” and you’re going to treat that “disorder”, I find it more helpful to explain to the child that they have challenges, for example, paying attention in class, or with standing too close to friends, and they’re going to be helped in that regard by specific strategies.
Why not explain the diagnosis?
Explaining the diagnosis can be counterproductive. The child can feel ‘stuck’ in their diagnosis, which often can be stigmatizing and have negative connotations, and people often come to identify with their diagnosis, ie. “I’m ADHD”, or “I’m autistic”, or “I’m Bipolar…”. No, your child is not ADHD, or autistic; rather, your child has a diagnosis of autism; or has a diagnosis of ADHD…; the diagnosis is not ‘them’ as a person but is only a small part of their many wonderful traits and characteristics. Also, sometimes kids will use the diagnosis as an excuse, “I did that because I’m ADHD…” that too is counterproductive.
When to explain the diagnosis?
I find that, as children mature, they become increasingly inquisitive and insightful. At some point, it’s not uncommon that a child begins to sense that something is ‘different’ about them compared to their peers. It’s not uncommon that, in those situations, the child may approach the parent and ask “what’s going on with me… why am I different… I’m not like other people….” In those instances, it’s likely time to explain the diagnosis while, at the same time, focusing on strengths, abilities, and that the child IS NOT their diagnosis, but that the diagnosis simply reflects a cluster of signs and symptoms with which the child and parent will continue to target in treatment.
It’s also important to emphasize that the symptoms can be improved, and you can site examples of your child having risen above the ‘diagnosis’ in any number of ways.
At times kids will find the information about their diagnosis to be a relief ("I always knew I was different, but never knew why") but others may feel quite distressed with the news. Use a reflective approach (see my earlier posts on that technique) and remain supportive and reassuring. It may help to allow them the opportunity to meet other kids with the same diagnosis (a support group can be quite helpful).
Sum it up
I find that, in general, it’s best to not focus on labels and diagnoses but, rather, describe signs and symptoms that are going to be targeted and overcome. This strategy is empowering, motivating, and directive. However, there are times to discuss the diagnosis, especially if the child is relatively mature, has good self-awareness and insight, and is asking questions about why he or she seems or behaves ‘differently’ from peers. There are a number of helpful books and resources to help with this process; feel free to email me if interested.
Hope that helps. Feel free to email any questions at firstname.lastname@example.org
Dr. John Carosso