When a child is young, figuring out the cause of his or her emotional or behavioral struggles can seem like a never-ending puzzle.
Piecing together evaluations and expert opinions, it’s often a search for the right diagnosis – or, as many parents of children with mental health challenges come to find out, the right diagnoses.
Being diagnosed with more than one mental disorder is more common than you might think, says Dr. Isabelle Beaulieu, Ph.D., a pediatric neuropsychologist and the director of the Oakland Neuropsychology Center in Bloomfield Hills.
“A lot of the children that I see in my clinic will have comorbid diagnoses,” she says. “For example, it’s not unusual for a child with a learning disability to also have some fine motor issues, or some of them have attention problems or even anxiety that is also present.”
Sometimes having multiple diagnoses is simply a result of keeping up with symptoms that evolve rapidly as the child grows. In these cases, a new diagnosis could replace one that wasn’t the right fit.
“The challenge with kids is, as we know, they’re developing. So symptoms change over time,” Beaulieu explains. “What may look early on as hyperactivity, for example, could really be a really highly anxious child. As they get older, it may become clear why they’re having certain difficulties or challenges.”
But comorbidity – or two illnesses occurring at the same time – is also very possible. Among children with ADHD, about 25 percent also have a diagnosed behavior disorder and nearly 20 percent have a diagnosed anxiety disorder, according to the Centers for Disease Control and Prevention.
It’s a situation that often leaves parents wondering which diagnosis is at the root of their child’s difficulties, especially since some treatments are good for one diagnosis but not the other.
“That’s a real challenge,” Beaulieu says. “In certain cases it’s very clear that, for example, the emotional issues or behavioral issues we’re observing are a manifestation of learning difficulties, attention problems or even disorders such as autism.”
When the diagnosis is not as clear, it can help to focus on the symptoms that are currently most disruptive in the child’s life – “how to help the child where they’re at, at that moment,” she explains.
Parents should make sure their child has received a thorough evaluation with a trained professional who can provide the most accurate diagnosis. That’s especially true if current treatments don’t seem to be effective.
“If things are not working well, if the treatments are not sufficient, maybe the reason is that there has been some misdiagnosis along the way,” she says. “I’m a big proponent of getting a comprehensive assessment that looks at all different areas – behavioral, learning, social, emotional – and getting as much information as possible above and beyond what the parents are reporting.”
Be sure to ask about the diagnostician’s background, area of expertise and which assessments will be used. Reviewing school data and medical records is also useful.
“Not all assessments are equal or look at the same areas,” Beaulieu says.
Children should also be observed in academic and social settings, if possible. “That gives us a lot of information and helps clarify what the right diagnosis might be.”
For parents, hearing that your child has more than one mental illness can be difficult to accept. But if labels are a concern, they shouldn’t be.
“Parents will come in and tell me that they don’t want to label their child, and I completely understand that worry or that concern that they have,” Beaulieu says. “However, it’s been my experience that when we don’t identify the underlying reasons for why a child is struggling, we delay the time that they get the appropriate services at school or even at home, and that it generally ends up in a child that is unhappy, is struggling and has low self-esteem.”
Beyond that, parents and children often appreciate finally having a diagnosis.
“Although people have some preconceptions about what specific diagnoses mean, it’s been my experience that parents and even the child have some sense of relief when we can identify and put a name on what it is that they are struggling with and really figure out what is the best treatment,” Beaulieu says. “These children down the road tend to be more well-adjusted emotionally, socially and academically.”
If you have concerns about your child’s diagnosis or need a referral for an evaluation, don’t hesitate to reach out to your pediatrician. And as you work to find the best resources for your child, remember that parents may also benefit from therapy, support groups or connecting with other parents who can relate.
“There are parents that are feeling just the way that they’re feeling or that are struggling with the same issues they’re struggling with,” Beaulieu says. “There is help out there.”
More common than you think
Mental illnesses are common in children. According to the CDC, one out of every seven children ages 2-8 in the U.S. has a diagnosed mental, behavioral or developmental disorder.
Yet there are still people who would be skeptical about whether a child could really suffer from ADHD, oppositional defiant disorder, bipolar or depression – let alone more than one of them.
But these conditions are a fact of life for many children and their families. In this edition of Opening Minds, Ending Stigma, you’ll learn about just how common it is for kids to be diagnosed with multiple mental health disorders and what parents should know about evaluations and treatment.
Children with mental illness – especially those dealing with multiple diagnoses – deserve understanding and compassion. Most of all, they need care and treatment without fear of shame or judgment. Let’s help make that happen.