Clinical Diagnostic Definition

Introduction - What is a Diagnosis

Another way to determine if a child has a special need is to see if the child may be identified by a specific diagnosis. Although it is no longer the primary way that professionals define children with special needs, providing a diagnosis is often helpful. To paraphrase the Webster definition, a diagnosis is the art or act of identifying a condition, disorder or disease from its signs and symptoms. When a qualified professional diagnoses a child, he or she looks at the signs or symptoms the child displays, such as various behaviors, ways of communicating, or thoughts that a child may have.

Each child is a unique individual; therefore no two children will have the exact group of signs or symptoms. However, according to various diagnostic criteria such as the DSM IV (Diagnostic and Statistical Manual for Mental Disorders) or the ICD-9 (International Classification of Diseases 9th edition) certain symptoms may be grouped together in a cluster. When a child has a certain number of these symptoms he or she can be considered to have that particular diagnosis.

For some parents who have worked for months and even years to understand their child's unique difficulties, a diagnosis may come as a welcome relief. Finally the pieces fit together and make sense. This isn't a bad or defiant child. This is a child with unique medical, behavioral or neurobiological difficulties. For others a label may create feelings of fear of a permanently disabling condition from which their child will never emerge. It is important to remember that diagnoses are useful as they serve to describe a group of symptoms or behaviors. Yet, every individual is unique and won't fit perfectly in a box, nor should we attempt to make them fit. Individuals grow and change, including children who have been given a specific diagnosis. A diagnosis doesn't define the ultimate potential of any given child.

Why diagnose then?

There are understandable reasons why a parent or caregiver may be hesitant to have a child receive a diagnosis. One is that a diagnosis can label children. If those who love and work with the child see the diagnosis as a restriction resulting in the child not growing to his/her full potential, the diagnosis may have been a disservice. In addition, if the child and those in his or her world see the diagnosis as a problem with little or no opportunity for growth or change, this can hurt the self-esteem of the child. Nobody wants to be seen as a problem; rather, we all want to be seen as human beings and individuals who have potential.

Yet, there are many benefits that a diagnosis can provide. It can be helpful to make sense of previously unexplainable behavior. For example, Miguel is concerned about his son Antonio's lack of verbal language and the problems it is creating in his studies at school. Through the help of a psychologist that specializes in communication, he recently has been informed that his son has been diagnosed with Expressive Language Disorder. Miguel finds this diagnosis a relief. He knows his son has had communication problems, now he knows what he is dealing with and can move more effectively to get Miguel the help he needs.

A diagnosis can also be useful for parents, medical personnel and others to have a common language to understand a child's particular difficulties. In addition, most diagnosable conditions have been studied extensively. Because of that everyone has access to the different ways people have been treated for the particular condition. As a result everyone can draw from what has worked and stay away from what hasn't.

In addition, and perhaps most importantly, a diagnosis may be essential to obtain the needed services for a child. However, it is important to be aware that in many circumstances it is not required that a child have a specific diagnosis in order to receive services. A delay in one or more areas of functional development, and not a diagnosis, may be all that is needed for the young child.

There are various ways by which a child receives a diagnosis. Only a trained and qualified professional can make a formal diagnosis. These professionals often consult books and references that are standard to the medical and mental health fields. In medicine, the standard resource used by physicians to determine a diagnosis is the ICD-9 (International Classification of Diseases, 9th Revision). Diagnosis can be found in many different areas of medicine, and some of the diagnoses are relevant to children with special needs. In the mental health and developmental fields, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), is the standard resource used by mental health professionals, including child psychologists. Talking with a child's pediatrician or a family doctor is a good place to start if a parent has concerns about a child.

As long as everyone realizes that a diagnosis doesn't define a child or his or her ultimate potential, it can be a helpful tool in understanding and treating a child's unique needs.

A description of a child who was helped by professionals who used the Clinical Diagnostic approach is Miran's Story.

Miran's Story: A Child With A Specific Diagnosis

Miran is an energetic toddler with an infectious smile and the skin the color of the shell of a coconut. He was a much-wanted baby-the fourth child and only son of a couple who immigrated to America to start a new life with their young family. Saresh, a solidly built man, suddenly softens when he talks about his son. He tells the story like it was yesterday.

"We were all in the delivery room so excited about Miran's birth. Everyone was congratulating my wife and me. We were so happy to finally have a son. Suddenly my wife's doctor's and the nurses became really quiet and the doctor told us that she thought that there might be a problem with Miran. She said that he might have a genetic condition called Down Syndrome. She showed us some of the features on his face and hands that children with Down Syndrome usually have. They called in another doctor to look at him and they ran some tests. Waiting for the results of the test felt like forever.

Later the doctor told us that the tests showed that Miran did have Down Syndrome and that kids who have it are usually mentally retarded. After he told us that, we really did not hear the rest he had to say that day. We were shocked. We didn't think it was possible because we have three other healthy children. We had lots of questions and didn't know what we would do with a child like him." He smiled at Miran and rubbed his son's hair with his hand. "Now we think he is the greatest."

Because of Miran's specific diagnosis he was referred to his local Regional Center to receive services. Miran's parents learned that even though Down Syndrome can't be cured, getting help as early as possible early intervention for Miran could help him to be the best he can be. Today Miran is a happy toddler surrounded by his doting sisters and parents and is enrolled in an Early Head Start Program. His intervention programs will help him to reach his full potential.


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