There are a series of standard steps that need to be worked through in order to determine if a diagnosis is appropriate - and then what diagnosis it is. Here is an example of those steps in relation to a child with a mixture of difficulties in relation to school and social relationships:
DIAGNOSIS Is there a “…clinically significant disturbance in the individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning?”
[1]This is the general question that must be asked at the outset of any diagnostic process. It relates to the DSM-5 overall criteria for having what is defined as a mental disorder – the overarching term for a mental health or psycho-developmental problem. Also note that: “Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.
NEURODEVELOPMENTAL DISORDERSIs there a developmental deficit “…with onset in the developmental period … that produces impairments of personal, social, academic, or occupational functioning?”
[2]This is the question that relates to the diagnosis of a neurodevelopmental disorder in particular. It distinguishes problems that relate to developmental deficits from those that might be due to environmental or general psychological factors (e.g. a mental health problem such as anxiety).
DEVELOPMENTAL DEFICITSIn order to fully explore the neurodevelopmental conditions that may be present in any individual, it is important to be able to identify and list the individual’s developmental deficits. As examples, these can include:
- Social skills
- Communication
- Functioning in an educational setting
- Behavioural Regulation
- Handwriting
FINDINGS FROM ASSESSMENT
The formal assessments aim to identify the underlying cognitive and other issues that relate to the identified deficits. These can include completing psychometric tests, filling out questionnaires, observations in different relevant environments (such the classroom or at home), as well as clinical interviews.
FORMAL DIAGNOSISOnce the assessment has been completed, a diagnosis may be made based upon the developmental history gathered and the evidence from the assessment session.
DISABILITY AND REASONABLE ADJUSTMENTSFor any identified developmental deficits to constitute a disability under the terms of the Equality Act (2010), they must impact on functioning (i.e. ‘normal day-to-day activities’) to a significant degree.
Normal day-to-day activities can include general work-related activities, and study and education related activities, such as interacting with colleagues, following instructions, using a computer, driving, carrying out interviews, preparing written documents, and keeping to a timetable or a shift pattern.
If this is the case, then the disability would then require reasonable adjustments. The reasonable adjustments in such circumstances are generally quite straightforward and relate to the provision of assistive technology in class and exams, rest breaks or extra time in exams and similar steps. There will also be a broad range of specific educational adjustments that might be incorporated in line with the relevant literature about how to manage these issues in the classroom.
