Many parents wrestle with important questions after learning about their child’s diagnosis.
Individual and Family Connection’s team of expert pediatric clinicians share their answers to these questions in an interview about diagnosis with the team’s Clinical Director, Ritamaria Laird.
After all, are labels truly helpful? (Ritamaria Laird)
I recently had a conversation with a respected psychologist who had just diagnosed an eight year old client of mine with ADHD. As we talked, I shared my own beliefs about disclosing diagnoses to the kids I work with. In general, I believe disclosing helps normalize, fights stigma, and gives many kids an external reason as to why things are so difficult for them. I also believe sharing diagnoses sets the child up for empowerment, helping them to see their diagnosis as a superpower. This comes with challenges, of course, that will need overcoming. However, it’s nothing to be ashamed of…so why keep it secret?
The psychologist then respectfully shared her thoughts on the subject. She gave me a compelling and new perspective by explaining she does not use labels (the diagnosis). Rather, she names symptoms and behaviors in order to help externalize these challenges kids face. She has found that the child separates their challenges apart from who they are and makes sense of these challenges as symptoms that the adults around them see. This preserves a level of respect as the adults and the child begin to work on how to make life easier for them. Nearly the same goals…but she does not disclose the diagnosis.
Therapists, what are your thoughts? Should children know about their diagnosis?
How could sharing a diagnosis help? (Julianne Neely)
One thing I am thinking, is that we never hide a medical diagnosis from a child, so why would we hide a mental health diagnosis? Is it because of stigma? The thing that is different about medical diagnoses is that a lot of time they are obvious. They are not something you can hide. I believe that just because you CAN hide a mental health diagnosis, doesn’t mean you should. I want the kids I work with to own their diagnosis as one of the amazing parts of them. A lot of diagnoses open doors to entirely new communities of other people who share many of the same symptoms. Community adds strength and normalizes the condition. I wonder, if we are just going to go on and communicate symptoms, what is the point of diagnosis at all?
What would it be like for a child to grow up unknowingly with a diagnosis, such as ADHD, and later find out that all the adults in their life knew, but never told them? I fear that the child would grow up thinking they are stupid or inadequate because they didn’t learn like their peers. This could become a core belief, one that could have been avoided, had someone told the child that actually, they had ADHD!
“…sharing diagnoses sets the child up for empowerment and helps them to see their diagnosis as a superpower…”
Julianne Neely MSW, LCSW
Could it be harmful? (Erin Fisher)
I take it case by case. The one thing I feel strongly about that Julianne shared, was the importance of finding a community and group of others who can identify with some of the things that ‘make you, you.’
For teens…
I think for some teens it can be empowering and liberating to know a diagnosis. Some of my clients who are very literal and analytical in thinking, find that having a diagnosis is really helpful. It allows for some of the ambiguity and wondering of “why am I like this?” to be put to rest.
But I have also seen teens cling to a diagnosis in an unhealthy way. They may manifest additional symptoms that they found were associated with their diagnosis, over-think their behaviors, and try to apply it to their diagnosis. Ultimately, it makes them feel “worse” about themselves.
When a child wants to know
However, I don’t think that a diagnosis should be hidden or lied about if the client is asking. If they are asking, they are likely looking for understanding. Another factor I think that matters largely is if medication is being used to help treat a diagnosis. I do think the child needs to know and understand their diagnosis and the intention of the medication. A child should know/understand what and why they put something into their body. I believe this would also help the child to be able to identify differences in their behavior. They will learn the impact of the medication, as well as positive/negative side effects.
In general, I do not typically provide my clients with a diagnosis. Unless, that is, they are older or showing curiosity in obtaining a diagnosis. I tend to focus more on identifying behaviors and symptoms than an actual diagnosis itself. For example, anxiety. Instead of saying “your anxiety”, I will identify the focus of the worry as the anxiety such as “your anxieties about _______.”
By not applying the label to the client and applying it to the thought, it allows them to feel more empowered. The focus is now on challenging that thought and not “fixing” something that is wrong with them.
With some of my upper elementary school aged clients, I will help them begin transitioning from using the language of “worries” to “anxieties.” I find that this language transition helps begin the introduction to their diagnosis. It starts conversations about identifying behaviors and additional symptoms beyond thoughts. I find that this language can sound less condescending, and therefore allows the child to feel less defensive.
Importance of psychoeducation
A big part of our job is to normalize behaviors for parents as well. We provide psychoeducation to empower parents to feel confident both in their child, and in their understanding of their child’s needs. It also benefits them to know how to best help their child to thrive. After articulating a diagnosis to a client, the next part of therapeutic work is to provide them with psychoeducation about the diagnosis. In addition, discussion about how it is experienced in them. It is helpful to make sure the same language used in therapy is also the language being used at home.
“I have also seen teens cling to a diagnosis in an unhealthy way- manifesting additional symptoms that they found were associated with their diagnosis”
Erin Fisher MSW, LCSW
Should parents disclose this information to their child? (Sherry Fleydervish)
There is something powerful in discussing diagnosis with children and especially adolescents. I also make an effort to label symptoms as a subset of their diagnoses, helping clients separate themselves from their symptoms and find more control. This helps clients externalize their struggles and gives them a sense of understanding that THEY are not the problem. They start to understand that their diagnoses may be making it difficult for them to move on from this anxious thought (or whatever they may be experiencing at that time). This perspective helps me know that I am helping my client change the narrative to the symptoms they are experiencing.
Of course, there are cases that I don’t share the diagnoses with the client. In these cases, I still make an effort to use diagnostic language when labeling symptoms. Similar to what Erin said, using diagnostic language with some of the younger kiddos can minimize their defensiveness. It often helps find common language to discuss the symptoms with their parents.
I’d like to share a case that stood out to me when thinking about this question. A client of mine came in after an “insightful and inspiring” session with her new psychiatrist. She stated that her doctor helped her understand the role ADD plays in her life, outside of school particularly, and alongside the anxiety. She also helped her understand how her medication effects the relationship between ADD and anxiety. The change in my client’s perspective of her diagnoses was written all over her face. She said she felt powerful and more in control of the ADD. This sense of control was inspiring. It also served as a reminder that this conversation wouldn’t have happened if we did not discuss her diagnoses.
All in all, our jobs are to lessen the stigma around mental health and help our clients’ parents improve communication with their children. We are always curious about the relationship our parents have with their children and even their children’s diagnoses. We aim to empower them to use this as fuel to better understand their kids. Or, like Rita said, their superpower!
Common Goals
While it seems that the opinions vary therapist to therapist, there certainly is a common goal across the board. The goal is to help children better understand themselves, to prevent feelings of shame, and to ultimately empower kids and families to see the strengths, despite having to navigate challenges.