Q: My six-year-old son is having problems at school and at home. He finds any change to routine really hard and can throw a tantrum at the slightest change to something he expected to happen. He seems to have trouble making friends at school and is often quite stressed about going. The teacher says he is doing okay academically but she finds him easily distracted and says he can, at times, be challenging in the classroom.
We brought him to be assessed at a mental health service and they said he had some autistic traits and that he also suffered from anxiety, with a tendency to be obsessive. They could not decide whether the anxiety or the autistic traits were his main problem. One of the team also suggested that he could have some symptoms of attention-deficit disorder because he can be distracted in school.
To be honest, I found the assessment process very confusing and I feel as if I still don’t know what is wrong with my son. What should I do to help him?
A: Your question highlights the complexity of assessing emotional/behavioural and developmental problems in children. While there can be an emphasis on seeking a diagnosis for a child, many children with specific special needs don’t fit into any neat diagnostic category.
Frequently, children can have a range of difficulties that could be representative of a range of different diagnoses. For example, a child may have symptoms of attention and impulsivity that could be characterised by attention-deficit hyperactivity disorder (ADHD), or have problems in social communication that are a feature of an autistic-spectrum disorder, or display worries and obsessions that could indicate a specific anxiety disorder.
Focus on getting an individual picture of your child’s difficulties
Rather than trying to find out “what is wrong” or seeking a specific diagnosis, I think a more useful approach can be to seek a full and rich picture of your child’s difficulties and needs so that you can learn how to help him.
If you are unclear about the advice you received, I would suggest you consider returning to the team where you got the original assessment (and/or contact other services if required).
I suggest you try to get a multidisciplinary assessment from a range of health professionals such as speech and language therapy, psychology and occupational therapy, as this will give you a multidimensional picture of your son’s difficulties and needs.
A good assessment from a skilled professional will give you a sense of how your son functions in a range of domains and identify what resources and supports he might need at school.
Crucially, a good assessment should give you a clear plan of how to help your son progress and provide similar guidance to the teacher on how to help him in the classroom.
Understand your child’s strengths and abilities
When working with families I find it important to appreciate that each child is unique, whatever diagnoses they might receive: each child has his or her own individual personality that comes with its strengths and weaknesses.
As well as getting a detailed picture of the problems, try to build a holistic picture of your son’s abilities and areas of strength. What does he like doing? In what areas is he at his strongest? When is he at his happiest?
By identifying areas of strength you can discover ways to help him compensate for the problems he has and even find ways of overcoming them. For example, when he is doing something he really enjoys, this will help him manage his anxiety. Taking up an interest or activity that he likes and is good at will provide the best context for him to make friends.
Communicate assertively to get the help your son needs
Sadly, parents often report very mixed experiences of getting the assessment and supports they need for children with special needs, especially when these are complex and not easily specified. Unfortunately, they can feel they are being shuffled around between services and/ or experience long waiting lists.
As a parent you have to be assertive and clued in to get the supports your child might need. Go back to the professionals and assertively ask the questions you need to ask.
If you are dealing with specific issues and problems, ask for practical help and intervention. In addition, you may find it beneficial to contact the many parent organisations that help children with special needs such as aspireireland.ie (for autism/Asperger syndrome) or hadd.ie (for ADHD).
Tackle problems one by one
Whatever diagnosis you receive for your son, at the end of the day, as a parent you still have to decide how best to help him and to deal with the day-to-day challenges you experience.
A good approach is simply to tackle the behavioural problems that emerge one by one, while being sensitive to your son’s needs. If you are having problems with helping your son manage a change to a routine, perhaps you could make sure to prepare him for that change by doing up a clear picture schedule.
For example, as well as verbally reminding him of what is going to happen, you could draw out the steps of the new routine on a chart. Visual pictures and reminders work very well with children with attention- or autistic-type difficulties.
Also, if the most challenging problem you have to deal with is your son’s tantrums, take time to coach him in positive strategies for dealing with frustration. Once again a pictorial “when I feel frustrated” chart might work well with picture lists of options such as “taking a break”, “going out on the trampoline” or “counting breaths” could help him understand.
Dr. John Sharry, Irish Times Newspaper, November 2014. John writes in The Irish Times Health+Family every Tuesday.