Should I tell my son about his diagnoses?

Question: My son is in sixth class and nearly 12 years old. He has always been a bit anxious and sometimes obsessive. We took him to see a psychiatrist recently as he had become very rigid about what foods he eats and obsessive about food texture and how it is prepared. The psychiatrist diagnosed him with severe sensory disorder and moderate to severe generalised anxiety. She also said he had traits of high functioning autism and the possibility of developing obsessive compulsive disorder particularly in relation to food and eating.

Myself and my husband were a bit shocked at the number of diagnoses in the report. Though our son has always been a bit anxious and sometimes challenging, he is also a happy, confident and academic boy. He is popular and has friends, loves his GAA and is doing well in school (according to the teacher). It does not make sense to me that he might have autism given that he is good socially.

I worry do we need to get him further assessed or to address the diagnoses in the report, but his dad feels strongly he does not need to be labelled and things are fine. Should I take him to other professionals and who should I take him to see?

Also, should we talk to our son about all his issues and diagnoses – we just told him that he was seeing the doctor to talk about his worries about food.

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Should I tell him what is in report?

Answer: Mental health diagnoses are not definitive categories and are really behavioural descriptions of clusters of symptoms. Diagnoses titles such as generalised anxiety disorder or obsessive compulsive disorder can feel a bit shocking and may imply a level of severity or seriousness that is not there. Diagnoses are certainly not fixed or absolute and often are matters of opinion. Frequently psychiatrists disagree on what the correct diagnosis is and lots of children (like your son) don't fit particularly well into any one category. Many children have traits of one or two diagnoses but don't fulfil the full criteria for either. Some mental health professionals are hesitant about using diagnoses, preferring to focus on the necessary treatment needed for individual problems, and some are much more generous and likely to list all the potential diagnoses ( or partial diagnoses that a child might have).

What matters most is the implication and meaning of a mental health diagnosis. Sometimes this can be positive in that it can provide a helpful understanding of what is going on for your child (such as anxiety) as well as providing access to treatment and services (schools will require formal diagnosis before applying for additional resources). Sometimes the implications can be negative, in that a diagnosis can feel like a self-limiting description that the child lives into or it can inhibit their self-belief and ability to get on with life. What matters most is how a diagnosis is explained and understood by a child and what actions it inspires them and the family to take.

Given the above, it is important to take a critical look at the psychiatrist’s report and to understand it in context before you decide what action to take. It is your judgment call, how much to talk to your son regarding the diagnostic opinion, but it would be perfectly okay not to mention them at this stage, given how they can be a double-edged sword and it all depends how they are interpreted. If all is going well in most domains of your son’s life, then there may be no need to talk through diagnoses at this stage and it may be better to deal with the particular problems as they occur in his daily life (eg food issues, anxiety).

You can of course access treatment and support for your son without recourse to having a formal diagnosis. For example, you could take him to see an occupational therapist who might support him around his sensory issues and develop a programme with him to tackle his rigidity around eating food that you can implement at home (a dietician may be able to help you with this also). Or you could take him to see a psychologist who might set up a structured programme with him to tackle his anxiety and to manage his obsessions. Or he could go to a play therapist who will support him to improve his overall well-being and confidence.

When seeking professional support for your child, often the most important thing is the quality of the individual professional and their ability to relate to and engage your child (rather than their particular discipline). Of course you may decide to not take him to see anyone at this point and continue to support him getting on with life in the many areas where he is already successful (eg school and supports). There are also some great self-help children’s books and online resources on tackling anxiety and most other childhood issues that you could try in the first instance.

– John Sharry is founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books, including Positive Parenting and Parenting for Teenagers. See solutiontalk.ie for details of courses and articles.