I'm a therapist, parent educator, writer and speaker who specializes in supporting parents of anxious children and teens
#140: Diagnosis is more art than science ☀️
Published 5 months ago • 4 min read
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Recently I've started offering ADHD diagnostic assessments in the two states in which I'm licensed (Ohio and Pennsylvania). This is in response to there being very few options in the rural area in which I live, which I realized when we couldn't get our daughter's diagnosis back. Maddi's doctor in Ohio diagnosed her without a big assessment because, well, because she met her and started her on a med regime, which went well (when Maddi, being very ADHD, could remember to take them). But then her doctor retired and Maddi has a diagnosis but it's not an official diagnosis, meaning she hasn't been able to get meds here. (I can't diagnose Maddi because I'm her mom but trying to get her diagnosed made me realize that I should go get additional training so I could do that and so I have.)
Mental health diagnoses can be weird because how/why you get diagnosed depends on what you're trying to do. If you need medication or need school/work supports, then you need a particular kind of diagnosis. If you need counseling or coaching, that's another (easier) one. Different professions diagnosis differently. For example, technically I can diagnose autism but my diagnosis is meaningless if you want accommodations because then the diagnosis needs to come from a neuropsychologist or a developmental pediatrician (if you're a child). Or I can diagnose someone with bipolar but in order to get medication, that diagnosis needs to come from a psychiatrist and sometimes the diagnosis will only come after the psychiatrist observes the impact of the medication on the person's functioning.
I have had kid clients who have seen two different neuropsychologists and received an autism diagnosis from one and not from another. Same kid, same functioning, but one person says no and the child can't get supports so off the parent goes and the next person says yes. Does the child have autism? Well, autism is (like many mental health diagnoses) a cultural construct. Objectively the child IS having an experience, functioning in a particular way but how we case conceptualize that? Depends! And changes over time. Autism diagnosis changed from the DSM IV to the DSM V even though the people with that diagnosis did not change. Confusing, right?
Unlike, say, diabetes (based on a blood test and A1C reading), mental health diagnoses are obviously influenced by who's doing the assessing and when and how. There are evidence-based screeners and paper assessments but they are imperfect because people are complicated and this is especially true when we're talking about neurodiversity. Brains are complex and they express themselves differently in the context of a person's preferences, values, environment, etc. Which is why the TikTok "If you do X then you are Y!" is a real disservice to people. You can do X and be Y or Z or 3.14! That is the art part in the science of diagnosis.
My opinion? A good diagnosis helps you understand yourself, helps you get access to the services and supports you need, and creates more opportunity for growth. If it does not do that -- if it limits, oppresses, or creates prejudice -- it's not a good diagnosis. Have questions? Let me know.
PODCAST
What's up on the podcast
My March 15th podcast is all about giving up (judiciously). It's a thing I talk about a lot in my practice but you gotta be careful how you talk about. You can't just tell someone who's feeling discouraged, "You should give up" but you can explain how giving up can also be an effective way to work through a problem. Listen in and let me know what you think!
I started reading Your Local Epidemiologist during Covid when it was hard to find solid, research-backed information and I've kept on. Dr. Katelyn Jetelina has a Master’s in Public Health and a Ph.D. in Epidemiology and Biostatistics and a passion for keeping the public informed. She writes that her mission is "to break down complex public health science into relatable, evidence-based insights so YOU can make informed decisions." I relied on her newsletter not just to make decisions for myself, but to support my clients in making their own choices, not always aligned with mine (because we are all different people!) but choices that they could research and feel good about.
During the winter she tracks illness across the country so when Flu B was sidelining lots of folks I was talking to, I wasn't surprised -- I already knew it was coming and could let my daughter know so she could mask up on the train. Her most recent post is Top 5 Questions About School Vaccination Requirements. Her answers are clear, footnoted, and reasonable. I hope you find her as useful as I have! 🧡
March highlight
One to One Coaching
There are two ways to get help
The first is the more traditional way: schedule a time to meet with me on Zoom. Great for dedicated, clear questions when you know what you're asking and what a quick strategy or if you want to have several conversations over time. The second is through asynchronous conversation via ClarityFlow. ClarityFlow is accessible via a free app or through your web browser. It's like messaging with a friend where you can post text, audio or video to a conversation and I respond back. You don't have to schedule a time to talk to me, you're welcome to invite a co-parent or caregiver into the space, and you can message me whenever you want. Learn more about both options righthere!
therapist • parent educator • writer/speaker I've been supporting kids & families for more than 30 years. I have my masters in clinical mental health counseling and post-grad certification in infant/toddler mental health.