This is a little example I use to clarify the differences between the overall feel of these diagnoses. Every child is different, and severity of conditions also varies. This is meant as an example of the flavor of the diagnoses, not a set checklist sort of test. You can read all the checklists in the DSM IV, but really it comes down to feel, so here's how I think of the differences. Imagine you have 4 children. One child has ODD, one ADHD, one fetal alcohol syndrome, and one bipolar. You give each child a laundry basket full of their clean clothes and tell them to go upstairs, put their clothes away, and bring down their dirty laundry. None of the children bring the laundry back, but it's HOW they don't bring it back that shows what's going on. Just because your child didn't do as instructed doesn't really clarify anything about the problem. Here's the differences between the diagnoses as I see them.
The ODD child dumps the basket on the floor and stomps off, or goes upstairs and dumps it over the railing, but either way they're very clearly deliberately refusing.
The ADHD child takes the basket and goes half way upstairs. You find them sitting next to it 20 minutes later playing with a toy. They look at your irritated expression, see you staring the laundry and jump up, clearly surprised that they had forgotten to take the basket upstairs.
The fetal alcohol child will probably take the basket upstairs, assuming they were calm when you asked. When you ask them later why they didn't put their clothes away and bring you the dirty laundry they will look at you in confusion, as though there were no instructions after the first one you gave. Conversation around your frustration will likely skew on random tangents. Alternately they will refuse to take the laundry upstairs, but with reasoning that doesn't seem to line up, such as because her boyfriend is awesome and laundry is stupid and they're going to be super rich because they both want to be rich, so no, she won't do laundry today.
The bipolar child may do anything. Maybe they follow all the instructions. Maybe they throw the basket at you and start an hour long screaming/throwing fit. Maybe they politely take it upstairs, then poo in it. The response varies from minute to minute. The only thing predictable seems to be that something unpredictable will happen on a fairly regular basis.
These are stereotyped examples to show themes, not meant to be taken as a way to pre-judge someone based on their diagnosis. Sometimes by exaggerating the simplicity of the diagnosis you can more easily see which theme is happening within the complexity of daily life. I hope someone out there will find this helpful in avoiding a misdiagnosis.
As I see it with three special needs children, two now adults and one within two years of being a legal adult, we need diagnosis because we need a label to get services and point us in the general direction for intervention such as therapy and medication. Otherwise, the label does not help the individual and the care providers at all and means little except to be able to tell someone what the general problem is in order to put something in the record. A case in point, a woman I know adopted a special needs child after foster parenting the child for four years. The child's diagnosis allowed the child to receive medicaid, IEP, and other services. After about two more years, the mother suspected the diagnosis was incorrect and asked the child's long time doctor if there could be a mistake. The child's doctor admitted to the mother that the child did not have the genetic condition to which the diagnosis applied. The child's actual genetic condition was just as bad as the official diagnosis that was given, but the child's actual genetic condition was not listed in conditions for which medicaid would provide and was not mentioned in other laws/regulations covering special needs children. Therefore to ensure the child received services needed, the doctor fudged the record. My own experience is that all my children have three different diagnosis, but receive essentially the same services in school. Each behavior is different at times and the same at other times. SUMMARY: A correct diagnosis is not always the best solution nor does even make a different at times.
ReplyDeleteTrue, the diagnosis in the chart isn't really that important. Knowing the real diagnosis may often not matter either except for a couple of exceptions. One, knowing what condition is causing the problem can be essential for medication. For example, giving a bipolar child an antidepressant can trigger a severe manic episode, and dumping a stimulant into an ODD kid who doesn't have ADHD may only increase their agitation. The other exception is for parents who have a hard time stepping back from their anger / frustration. Sometimes realizing that this is mania, or this is an inability to remember, etc will help the parent accept that the child is struggling and not just being difficult on purpose.
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