In this four-part series, we are going to dive into the experience of a mental health diagnosis for children: how to know if a child should be tested, what to look for, what questions to ask, how to explain a diagnosis to the child, and more. Dr. Méroudjie Denis, a Licensed Psychologist and our Director of Clinical Program Innovation will break it down. 

In part one, we explored the stigma and fear that surround a mental health diagnosis. 

In part two, we discussed how to know when to test for mental health concerns. 

In part three, we are looking at the process of testing.  

When a parent or caregiver decides to test their child, how do they get the child tested? What are the different routes?  

There are a couple of ways to have a child tested. The first is through a pediatrician. This is often the first step most caregivers take because many families have a pediatrician already and don’t need to find a new provider for testing. Not all pediatricians do assessments, and some test for certain diagnoses, such as ADHD, but not others. Another route is through a licensed mental health professional, typically a psychologist, who specializes in assessments. And sometimes the child’s school can support in receiving an evaluation. To qualify for an evaluation through the public or charter school, there must be an educational need.  

Many families go through their pediatrician for these assessments. Ideally, a child will have a relationship with a pediatrician over time which can help factor into the evaluation. A pediatrician typically does a screener and provides a ratings scale that shows how the child scores along a spectrum.  

We think of the results from a pediatrician like a blood test. A blood test may tell the doctor that the patient has elevated markers that may indicate a disease or infection. When the results of the blood test come back, most doctors would then do additional testing to determine the cause of the elevated markers. They wouldn’t necessarily take the elevated markers and go straight to treatment. Given the time spent with the patient and the extent of the evaluation results from a brief screening through the pediatrician, results may indicate ADHD-type symptoms, for example, but it could also be linked to consistent lack of sleep, learning difficulties, or trauma. When the results come back, it can provide guidance about what kind of specialist and resources a parent may want to look further into.  

The mental health assessment with a psychologist can be more comprehensive. Typically, it involves a parent interview and child interview, or play observation, depending on the child’s age, and explores reason(s) for concern, developmental history, family history, overall functioning at home and school, relationships and more. Depending on the reason for concern, testing may include cognitive and academic testing or specific screeners for various diagnoses. These can be very long and comprehensive and some involve observing the child not only in their office but also at school or another setting.  

What can a parent expect as a result of testing?  

A good assessment should do two things: it should answer the reason for referral by underlining the child’s areas of struggle and it should also highlight the child’s strengths. These strengths are important to call attention to as they will be a valuable resource for the child to supplement their areas of struggle. 

When a parent has a child tested, and the child has been given an official mental health diagnosis, what have you seen as typical responses? 

Typically, when parents receive a diagnosis they feel one of a couple different ways. All of these responses are valid and none is better than another.  

Some parents feel a sense of relief and validation. These are parents who have been struggling with an issue for awhile and now have a name and reason for the challenge. These parents often feel validated in the struggle and a sense of agency knowing that they can move forward with intervention and support.  

Some parents receive a diagnosis and it feels like a gut punch. These parents often experience grief as a result of the diagnosis. Many of the stigmas and fears we talked about can come to the surface. This is a perfectly natural response to receiving big news and makes complete sense.  

And lastly, some parents can feel completely invalidated from the result. These parents can feel that the diagnosis doesn’t seem right for some reason. Sometimes this is because what the caregiver knows about the diagnosis doesn’t align with their child’s experience, like when a parent hears the word “autism” and thinks of a nonverbal child, not fully understanding the spectrum of behavior that correlates to that diagnosis. Sometimes a parent may feel like the provider wasn’t listening or doesn’t understand their child at all, in which case a second opinion might be helpful.  

There can also be other reactions, or a combination of these reactions. It’s important for parents to understand that however they feel, it is valid. Some parents may need support for themselves working through the diagnosis and I encourage parents to reach out to a mental health professional or other trusted adults to take care of their own emotional needs throughout this process as well.   

Does a diagnosis typically come with intervention suggestions and support?  

It really depends on the diagnosis, but yes, typically a diagnosis is accompanied by suggested interventions. Whether this includes medication, therapy or special accommodations depends on the specific diagnosis. 

If an intervention is suggested that doesn’t feel right to a parent, they can always engage in conversation to ask if there are any other options available.  

If a child is placed on any kind of medication for a mental health condition, the child should also be receiving behavioral health interventions, such as therapy. In order to treat any sort of mental health condition, the child must learn to understand thought patterns, how to express their emotions and work through any trauma or challenges. Sometimes children have to be on medication to learn or maintain these skills, but I am a strong believer that medication alone is not enough from the onset. Medication does not teach the skills often necessary to positively navigate the challenges that can be associated with some of the diagnoses we have discussed. Medication can manage symptoms, but it does not get to the core of the problem and does not equip the child for long-term mental wellness. The process of finding mental health support can be daunting, so parents can ask their pediatrician or school counselor or district mental health team for recommendations. Depending on a student’s educational need, they may be eligible to receive support and intervention through their district as well. 

In the final post, we will discuss sharing testing results with the child.