Complex Diagnostic Evaluations

One of the challenges of psychological diagnosis is that many conditions share symptoms.

Consider a child who can't concentrate.

That could reflect ADHD. But a child who is constantly worrying may also appear distracted because their attention is consumed by anxious thoughts. A child with OCD may have difficulty completing work because they are checking, second-guessing, or trying to make things feel "just right." A depressed adolescent may have difficulty concentrating because of low energy and reduced motivation. And a child with a learning disability may disengage during schoolwork because the task requires substantially more effort than it does for their peers.

The behavior we see is difficulty concentrating. The reason underneath it can be very different. The same is true for many concerns.

A child who avoids peers may be experiencing social anxiety, autism, depression, or a history of difficult social experiences.

A child who becomes distressed by change may be autistic, anxious, struggling with OCD, or experiencing difficulty with executive functioning.

A student who rarely completes assignments may have ADHD, a learning disability, anxiety, perfectionism, depression, executive functioning difficulties—or several of these interacting at the same time.

Identifying the symptom is only the beginning. Understanding what is driving it is what allows us to help.

We don't begin with an answer and look for evidence to confirm it.

Differential diagnosis is the process of systematically considering the different conditions that could explain a person's symptoms and determining which explanation—or combination of explanations—best fits the complete picture.

Instead of asking only "Does this child have ADHD?” we might ask "What are all of the possible reasons this child could be having difficulty with attention, organization, and work completion, and which explanation is best supported by the evidence?"

That means looking at patterns across developmental history, behavior, cognitive functioning, academic performance, emotional functioning, social experiences, executive functioning, observations, standardized testing, and functioning across different environments.

It also means actively considering evidence that doesn't fit a diagnosis. Our goal isn't to prove that your child has the diagnosis that brought you through the door. Our goal is to determine the explanation that best fits your child.

A diagnosis isn't valuable simply because it gives a name to a set of symptoms.

A good diagnosis gives us information about how a person's brain works.

Two children can display nearly identical behaviors for very different reasons—and therefore need very different support.

A child avoiding school because academic work feels overwhelmingly difficult needs something different from a child avoiding school because of severe anxiety. A child who can't begin an assignment because of ADHD-related executive functioning difficulties may need different strategies from a child who can't begin because perfectionism has made choosing the "right" answer feel impossible.

When we understand the why, we can make better decisions about the what next.

Accurate diagnosis can guide treatment, educational supports, accommodations, parenting strategies, expectations, and the way the adults in a child's life understand and respond to their behavior.

It can also help the child develop a more accurate understanding of themselves—recognizing not only where things are difficult, but why certain things may require more effort and what helps their brain function at its best.

Many families come to TLC after months or years of trying to understand their child.

Your child may already have a diagnosis, but something still doesn't seem to fit. Perhaps treatment hasn't helped as much as expected. A school and therapist may see very different things. Different providers may have offered different explanations. Or a previous evaluation may have identified one area of concern while leaving other important questions unanswered.

We don't assume that a previous diagnosis is either right or wrong.

We review the information that is already available, consider your child's development and current functioning, and ask: Does this explanation still make sense when we look at the whole picture?

Sometimes a comprehensive evaluation confirms what families already know. Sometimes it identifies an additional diagnosis. And sometimes it provides a different explanation altogether.

Families who complete an evaluation at TLC have access to ongoing consultation with Dr. Savaiano at a reduced rate of $200 per hour, including help understanding and implementing recommendations, navigating educational supports, and coordinating next steps with other professionals.