Diagnosis Again

“Link is a patient of mine, his diagnosis is Attention Deficit Hyperactivity Disorder…” The handwritten note continues with details of medication, but the words are blurred by the tears in my eyes. It is so small this piece of paper, handwritten on a prescription pad. I wipe away the tears with an angry swipe of my hand. Nothing the paper says is news. Link was diagnosed years ago and has taken medication ever since. The only reason I hold this paper is because Link’s current IEP team mentioned that his official diagnosis is not documented in their paperwork. They have a two-inch thick binder full of papers about Link –skill test results, IQ test results, language test results, nine years worth of specialized educational plans, psychological reports–but none of them include this diagnosis. I’m told that if I add this little paper to their stack, it may open up additional support options for Link. So I called the Doctor’s office and he mailed me the paper. It changes nothing. I can’t explain why seeing it written down should make everything feel more real. It just does.

Infants have incompletely formed brains. There are many things that they are incapable of comprehending until their brains develop further. The remainder of childhood is one long biological trade-off, alternating body growth and brain development in a careful dance to optimize the probability of survival. This means that children experience periodic bursts of new comprehension. Suddenly they see the world in new ways and have to re-evaluate everything based on their new comprehension of it. This is why a five-year-old who has never drawn on the walls before suddenly begins to treat the entire house as a huge canvas. The teenage years are hugely important brain development time. Teens are nearing adult comprehension and begin to look forward toward fending for themselves. They desperately need to have an identity and a goal. Link is fourteen, his childhood comprehension of himself is no longer adequate. He has outgrown many of the childhood tools he used to manage his cognitive differences, but has yet to acquire comparable adult tools. He was left with an awareness of being different and little vocabulary for explaining why. He struggled. His struggles drew the attention of myself, his teacher, Howard, and the school psychologist. It was time for a new round of testing. We needed to assess what changes brain development has made and then based on that information we needed to create a plan. We’re mid-testing now. I don’t know what the plan is going to look like except that a huge part of it is sitting down with Link, showing him the test results, and explaining to him what they mean. Link is old enough to be included in the planning. This is part of the process of turning his life over to him.

Link is not the only child for whom I have a prescription pad diagnosis. I have participated in counseling and management of issues for all of my four children, for children of neighbors and friends, for relatives, even for acquaintances. I’ve helped people with ADHD, Autism, Aspergers, Bipolar Disorder, Multiple Personality Disorder, PTSD, Psychotic episodes, Anxiety, and Depression. Psychology fascinates me and I study it everywhere. I’ve learned enough vocabulary that people ask me about my credentials. I have none, only experience. Yet I am not an expert by any means. And even those who are experts are regularly baffled by the intricacies of human minds and needs. So I study my son. I read the reports until my brain is tired. I gather a team of credentialed experts to help him. Or rather, they gather themselves because, once again, exactly the right people are in place to help with this process. The elementary school psychologist who sat me down all those years ago and told me I might want to consider ADHD is now working at the junior high school. Once again she is here to help Howard, Link, and I as we gather information and plan for what comes next.

Most of what comes next is exactly what we’ve already been doing; small adjustments in classrooms and at home. The necessary changes are so small that it is hard to believe that they are necessary. We make the changes so that Link can learn without floundering. This time one of the small necessary things is including Link in the process so that he will understand himself better. He will be informed and thus able to act upon information rather than stewing in fear and ignorance. I take the prescription paper and I put it on the stack of things to deliver to the school psychologist. Perhaps this declaration of diagnosis will help open a door which Link will need to walk through. My feelings about it are for me to work through without troubling Link.