Chapter 2: Your Child’s Diagnosis

Our society has a love-hate relationship with the notion of success and failure. On one hand, we advocate that everyone’s capable of reaching his or her full potential. At the same time, we quickly attach labels to those (generally children) who do reach for the stars in their own unique style. An adult with boundless energy who’s obsessively focused on one area may be viewed as being successful. A child exhibiting similar traits is judged “at-risk” for academic failure.

There are individuals who truly have learning, emotional, and mental problems caused by a variety of origins or circumstances At one end of the spectrum are mental and physical disabilities related to biochemical or genetic differences and those resulting from an accident during birth or later in childhood. Other causes found to impair learning include socioeconomic issues, dietary factors, and environmental allergens. Rounding out the opposite end of the continuum are the learning disorders that seem to have no medical basis, except that the child is not reaching his full academic potential. This large and growing population of children has been diagnosed with severe psychopathologies simply because they learn or adapt in a manner that differs from the norm.

Disorder Du Jour

There are a number of disorders that are frequently assigned because the diagnostic criteria sort of match the child’s behaviors. In many cases, the disorders are already accepted for adult populations, but are extrapolated to include children. Popular media educate us about these disorders, while parents and teachers grasp onto them in efforts to make sense of why children struggle in school. The diagnoses of choice include Attention Deficit-Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Asperger’s Syndrome, Central Auditional Processing Disorder (CAPD), and Bipolar Disorder, to name only a few.

There is also a burgeoning field of “entrepreneurial disorders” developed and encouraged by both professionals and parent advocates. While many of these labels frequently draw symptoms from actual disorders, other behaviors are added into the mix and new syndromes are born. These up-and-coming popular diseases seem to serve no purpose other than to create more “alphabet disordered” children, while profiting off parents desperate for answers and “cures.”

Disorders or Normal Childhood Traits?

There are common traits among many of the more popular childhood disorders-inattentiveness, high activity level, forgetfulness, a tendency to frustrate quickly, and distractability. These traits are often not due to a brain malfunction, but because many of them are quite normal for children. The real disorders appear to be inappropriate adult expectations and the inability to accept a growing, exploring child’s behaviors. Noted psychiatrist Peter R. Breggin, M.D., states in his book Reclaiming Our Children, “Children don’t have disorders; they live in a disordered world.” From a youthful perspective, a chaotic life does certainly seem rational when parents are preoccupied juggling multiple responsibilities; teachers are overwhelmed; and peers think them odd. Who wouldn’t act out in such a situation?

Acting out indicates a problem for which the child is usually to blame. As a result, countless scores of active, but otherwise healthy, children are unnecessarily labeled and treated. The preferred treatments for these children include intensive therapies, psychotropic medication, or special classes. Not to discount the untold numbers of individuals who have found these approaches to be life-saving tools, but many of these unjustly labeled children simply need interventions consisting of kindhearted direction, respect, and an abundance of patience from the adults in their lives.

Commonly Diagnosed Childhood Learning Disorders

The following information can help you to examine the most commonly diagnosed childhood disorders. It is not exhaustive nor is it meant to replace a professional assessment. Use this section as a starting point to compare and contrast the various symptoms related to learning difficulties. Keep in mind that individuals possessing any of these behaviors do not necessarily have a learning or emotional disorder.

Mental health difficulties are guided by the Diagnostic and Statistical Manual of Mental Disorders, currently in its fourth edition (DSM-IV). The manual is published and periodically updated by the American Psychiatric Association (APA). The following descriptions are based on APA criteria and professional literature.

Asperger’s Syndrome (AS)

The Viennese psychiatrist Hans Asperger identified this cluster of symptoms in the 1940s. Since Asperger noted the syndrome, most European countries have accepted it as a pervasive developmental disorder. Not until 1994, however, did the APA officially recognize it. Some refer to it as high functioning autism, although the two differ in certain ways. Individuals with AS generally possess normal to above-average intelligence and are more capable of developing speech than are people with autism. The principal signs of AS are:

• Difficulty understanding nonverbal behaviors, such as facial expressions and body language
• Inability or difficulty developing peer relationships
• Lack of empathy
• Repetitive use of language and/or motor movements
• Preoccupation with specific parts of objects
• Inflexible in changing routines

Attention-Deficit/Hyperactivity Disorder (ADHD)
Through the years, this has been referred to by a variety of less-than-flattering terms, including minimal brain dysfunction, hyperkinetic reaction of childhood, and hyperactive child syndrome. The APA officially recognized this pervasive developmental disorder in 1980. The principal signs are:

• Inability to pay close attention to the task at hand
• Difficulty organizing tasks
• Easily distracted
• Forgetfulness
• Fidgety or squirmy activity
• Difficulty playing quietly
• Difficulty awaiting turn
• Tendency to interrupt others
• Excessive talking
• Appearance of being “motor driven”

According to the DSM-IV, a child receiving the diagnosis of ADHD must be overly active and have a short attention span.

The child with only an attention difficulty would be diagnosed “attention-deficit/hyperactivity disorder, predominantly inattentive type.” Children can also be diagnosed with “ADHD, predominantly hyperactive-impulsive type,” indicating that they’re hyperactive, but don’t exhibit attention problems. A child exhibiting many symptoms may not merit a formal ADHD diagnosis and is labeled “attention-deficit/hyperactivity disorder not otherwise specified (NOS).”

This pervasive development disorder may also include mental retardation or other physical disabilities. The principal signs are:

• Difficulty understanding nonverbal behaviors, such as the ability to read facial expressions and body language
• Inability or difficulty developing peer relationships
• Lack of empathy
• Delays (or lack of) speech development or inability to speak
• Tendency to exhibit idiosyncratic behaviors
• Inability to play in a “make-believe” manner
• Repetitive use of language and/or repetitive motor movements
• Preoccupation with specific parts of objects
• Inflexible in changing routines

Bipolar Disorder
This mood disorder is cited in the DSM-IV, but it is a diagnosis generally reserved for adults. Recently, however, it has become a popular practice to assign this diagnosis to children. The APA, the American Association of Child and Adolescent Psychiatrists (AACAP), and other mental health organizations believe that this disorder is rare in children. The following symptoms were not compiled from the DSM-IV, but from the various advocacy groups who subscribe to the theory that a bipolar disorder is applicable to children.

• Irritability
• Depression
• Grandiose beliefs
• Hyperactivity, inattention
• Low frustration level that easily evolves into explosive tantrums
• Aggressive behavior
• Bossy behavior
• Difficulty making a shift from one activity to another
• Night terrors
• Fear of social situations

Communication Disorders
Communication disorders are characterized by problems with the transmission and retrieval of speech. A child may have a hard time expressing herself in ways that others can understand (expressive language disorder); she may be unable to control the rate and tone of verbalizations (expressive language disorder); or she may have difficulty understanding certain aspects of speech (receptive language disorder). These disorders also concern the processing of information; a person who has communication disorder may also find it hard to sort through auditory or visual stimuli.

An auditory processing disorder may present long- or short-term memory lapses. A person may have problems following multistep instructions and separating important sounds from those that don’t matter while in a noisy environment.

Those with visual processing disorders may not be able to distinguish one item from a similar one, such as determining the letter “b” from the letter “d.” Delayed large motor skills can affect one’s ability to run, skip, or jump. Small motor development also affects writing and other skills requiring hand-to-eye coordination.

Learning Disabilities
Learning disabilities (LD) are diagnosed by the administration of standardized achievement and intelligence tests, although LD-specific assessment inventories may also be used. When an individual is not achieving at the expected level of competence for her chronological age, intelligence (also determined by standardized tests), and expected educational levels, she would be diagnosed with a learning disability in one or more specific areas such as reading, writing or mathematical abilities.. These deficits interfere with daily living skills and manifest themselves as visual or auditory information processing disorders.

Can’t Read

Dyslexia is the term used to describe difficulty reading accurately or with comprehension of subject matter. Dyslexia may also include the inability to spell and reversals of symbols (letters or numbers).

Can’t Add
Dyscalculia is a mathematics disorder that also affects one’s ability to understand abstractions. A person with dyscalculia may have a poor long-term memory for mathematical concepts. He or she may also commonly omit or reverse symbols while reading or writing math problems.

Can’t Write

Dysgraphia is a writing disorder, whether it be the actual physical act or content expression. The individual may be able to complete written work, but does so very slowly in order to produce intelligible results.

Mental Retardation
Mental retardation is defined as intellectual functioning less than the average IQ of 100 (determined by standardized testing). This level of impairment affects daily living skills and communication to varying degrees, depending on the severity of the disorder.

• Mild: IQ level between approximately 50 to 70
• Moderate: IQ level between approximately 35 to 55
• Severe: IQ level between approximately 20 to 40
• Profound: IQ level below 25

Oppositional Defiant Disorder (ODD)
Children with this conduct disorder generally behave in a hostile and defiant manner toward adults. The principal signs are:

• Loses temper
• Deliberately annoys others
• Blames others
• Tends to be easily annoyed
• Tends to be vindictive
• Tends to be argumentative
• Refuses to comply with rules or requests

Obsessive Compulsive Disorder (OCD)
An individual with this personality disorder has abnormal obsessions, compulsions, or both. These may include:

• Frequent and unusual attention to washings, arranging items, touching, and continuous checking
• Unusual fear of being contaminated by germs
• Extreme moral concerns or religiousity, unrelated to cultural or faith-based associations
• Developmentally inappropriate sexual or aggressive thoughts
• Fear of harming self or others
• Stubbornness in regard to change
• Extreme need for perfection
• Inability to discard broken or otherwise unusable objects

Tourette’s Disorder
A tic disorder that produces intermittent abnormal and uncontrollable motor and verbal behaviors, such as barking, twitching, and swearing.

Other Disorders and Syndromes

Many syndromes and disorders are not accepted by the established professional medical and mental health organizations. The symptoms of these disorders frequently mirror current diagnoses with only minimal differences. The newly identified constellations of symptons may eventually be accepted by professionals after rigorous academic research.

Nonverbal Learning Disorder (NLD)
The psychologist Helmer R. Myklebust developed this term after his research determined that many children present symptoms similar to ADHD and autism, but do not fall within the diagnostic criteria for either. They display such symptoms as:

• Lack of motor skills and poor coordination
• Poor visual recall
• Inability to discern spatial relations
• Deficits in social skills
• Difficulty shifting from one activity to another
• Adult-like speech and rote-reading abilities (hyperlexia) may develop at an exceptionally early age (preschool years)
• Excellent ability for rote memorization
• Poor mathematics skills

Dysfunction in Sensory Integration (DSI)
Identified by occupational therapists, this cluster of symptoms is similar to autism. It is often treated with physical therapies, such as hard rubbing or brushing techniques, compression of the body using weighed vests, and a special diet. Those diagnosed with this dysfunction:

• May or may not want to be touched by others
• May display stereotypical behaviors related to stomping, bumping, or spinning
• May be oversensitive to sounds, tastes, odors, and clothing textures
• Difficulty with small and large motor skills and coordination
• May possess processing disorders

Do these disorders actually exist? Yes, many do. Could your child be ADD or bipolar and that’s why he’s unable to sit still and learn? That question can only be answered by you in consultation with trusted medical and mental health professionals.

Are Tests and Evaluations Really Necessary?

The answer is “it depends.” Parents whose children display a clear physical disability will want standardized tests and professional evaluations. They will need formal diagnosis to qualify for such services as speech, physical, and occupational therapies through public and nonprofit providers.

Parents as Assessors

However, most parents are quite capable of assessing their own child’s strengths and weaknesses. Many homeschooling parents see no need to have their child’s behavior or characteristics compartmentalized into little diagnostic boxes. My husband and I made the decision to seek consultations with our son’s pediatrician and a clinical psychologist because we wanted to rule out mental retardation, autism, or a medical condition. Once the professionals had determined that he possessed normal intelligence and was physically healthy, we made the choice to bypass formal testing and diagnosis for potential learning disorders.
LJ, a parent in Portland, Oregon, also decided against a formal diagnosis for her homeschooled son, who has always been homeschooled. If enrolled in school, LJ’s son would’ve been labeled because he could not read at the traditional age of eight or nine years old. Since homeschooling allowed him to learn at his own pace, he has never viewed himself as “different” for not learning to read until the age of twelve.

Parents as Researchers

Many parents decide to thoroughly research their child’s “troublesome” behaviors before approaching practitioners. Many medical and mental health professionals do not appreciate parental input during the early stages of assessment. Regardless of the professionals’ opinion, it’s a sound practice for parents to enter the diagnostic process armed with information regarding the potential causes of your child’s difficulties.
“I diagnosed my oldest son long before seeking professionals” recalls Erika, a California homeschooling mother of three sons. “It was a motherly instinct that prompted me to read about various developmental disabilities.” Erika poured through Internet resources, professional research, and observed other children who behaved similarly. She determined that her sons, ages three, seven, and nine, all display various symptoms related to autism, AS, and ADHD. The two youngest boys have never received formal diagnoses. Erika’s oldest son was assessed and briefly participated in an early intervention program sponsored by the public school before the family began homeschooling.
Homeschooling parent LJ contends that diagnoses are not always necessary for a child to learn: “Adults have the power and therefore, the responsibility to meet the needs of the child–with or without a label.”

Pros and Cons of Formal Diagnosis

You’re sitting on the fence about seeking professional assessment. You want to do the right thing for your child, but your intuition tells you that this could be a case of a late bloomer being misdiagnosed with a serious disorder. Let’s examine the positive and negative consequences of receiving a formal diagnosis for your child.

Diagnoses Can Be Helpful

On the positive side, knowing that your child has a verifiable disorder provides an understanding as to why he behaves in certain ways. Knowing that your child has difficulty sitting still or staying focused on a task will help you develop responses to work with him more effectively. Also, a diagnosis allows mental health professionals to communicate with one another using a specific term, rather than rattling off a list of symptoms each time they discuss a child’s case.

Diagnoses Can Impact a Lifetime

In contrast, one of the negative side effects of a formal diagnosis is that the child may feel like “damaged goods,” that he is not like other children. These children are isolated with other special needs children or pulled out of their regular classroom to participate in what most children refer to as “the dummy classes.” There’s a high likelihood these children will be teased or bullied by others, which places them at great risk for developing low self-esteem, depression, and possible suicidal ideation.

In addition, children’s reactions to stressors are frequently misdiagnosed as serious mental disturbances. A child may also “act out” when suffering from a “hidden” medical condition, such as hyper- or hypothyroidism, diabetes, or some other serious illness.

Finally, if a young child has a diagnostic label affixed to her, that label may follow her throughout life. Let’s say your fidgety five-year old is driving his kindergarten teacher crazy. He peppers her with constant questions (and of course, he doesn’t raise his hand before asking them); he can’t stay in his seat because he’s busy exploring the classroom for “interesting stuff”; and he gets bored quickly. His teacher tells you that your son has attention deficit/hyperactivity disorder (ADHD), and he should be assessed and treated by a physician immediately so that he doesn’t fall behind academically. Worried for your son’s future, you rush him to a doctor who agrees with the ADHD diagnosis because he observed your son fidgeting impatiently (there’s a great climbing tree outside the office). The doctor prescribes stimulant medication that makes your son feel crummy, but he’s quiet in class and seems to be focusing better on his studies. Your son continues these medications throughout his school career and, upon graduation, decides to enlist in the military. He has a well-documented medical history of a “mental disorder” and long-term methamphetamine use. Unfortunately, the U.S. Department of Defense has a policy of rejecting recruits with such backgrounds. Although this is only one example, the potential for future abuse of medical records could prevent your child from gaining access to a long-desired career.

Diagnosis Is a Personal Decision

Deciding whether to seek diagnosis for your child when you recognize that his abilities differ is very much an individual decision, similar to determining whether homeschooling is the best option for your family. Many children do benefit from early identification and treatment. Conversely, the incidence of many childhood disorders would plummet by simply allowing children to mature at their own pace.

Whether your child is truly affected by learning difficulties or she simply moves at her own unique pace, homeschooling has much to offer such a child. Families are free to experiment with various methods, materials, and learning styles. The options are endless. You move at your child’s pace, using practices that emphasize his strengths and bolster his weaknesses. One of the innumerable joys of homeschooling is marveling at your child’s abilities when learning finally starts to click.

Simple Starting Points

Read well-researched books and articles on child development. It’s helpful to understand the ages and stages theories, as well as what’s considered normal and delayed development. Look for materials written by developmental or cognitive psychologists who tend to hold a “whole child” view, in contrast to educational professionals’ focus on measuring learning levels. Steer clear of “trendy” ideas.

Become an “expert” on your own child. Make a list of those behaviors you find “troublesome.” Identify one or two that concern you most, then observe when those behaviors occur. Was your child tired or hungry? Has your child recently experienced a loss, such as a friend moving away or the death of a family member or beloved pet? Determining your child was reacting to a situation outside of his control is helpful to understand and manage difficult behaviors.

Don’t rush into anything. Becoming an expert requires time and effort. Take your time to observe your child and research possible causes for behaviors. When you think you’ve found your child’s exact disorder, keep searching, it may not be the right one. There’s no need to rush into a misdiagnosis.

Create partnerships with professionals. Educational, medical, and mental health professionals should view parents (and the child, if appropriate) as a partner in the assessment process. These professionals must respect your input as an equal partner. If your research indicates that your child is a late bloomer. and you don’t agree with the practitioner’s ADHD diagnosis, don’t be intimidated into accepting a misdiagnosis. Find a professional who will work with you.

Develop an internal truth detector. Undoubtedly, everyone has an opinion about what’s “wrong” with your child and what treatment you should follow. Remember, there are no “cures.” You need to wade through vast amounts of information to determine what works for you and your child. Rubber hip boots are optional.

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