To many of us, a diagnosis is a label that is used to name a condition, disability, illness, or capacity. This meaning makes diagnosis a noun, and all too often a person, a place, or a thing. While there is no doubt that a label might be useful to help us get medical or other specialist help, stopping at the noun is often counterproductive.
Diagnosis is also a verb and an action, a process, and an unfolding understanding. Diagnosis in this sense is about assessing a situation and the dimensions of how things are working at the moment, to get a snapshot or picture of something important. Assessment and observation of a phenomenon are one step in the process.
Next diagnosis includes a hypothesis of a range of factors leading to understanding the spectrum of possible meaning or the how a situation falls on a graph of measures. Norm referenced systems apply these measures to a large population of people, sometimes within subsets of populations. These assist us to understand the percentile rank of where we might fit within the relative comparison group.
On one hand this approach seems a bit harsh. But on the other hand, the references to a group by comparison can allow us to understand capacities, skills, limitations, and strengths. The positive side of this is much like understanding a tree by the community of trees that make up a habitat. We might focus in on the tree alone, but our view will be limited. Comparison and reference systems allow a more holistic perspective and when used with this intention make much more sense and have more valuable and practical insights for support planning.
From the hypothesis and reference measures or comparisons arise a diagnostic or assessment profile. This is where “labels” and “measures within labels” seems to arise because effectively we have to give a name to something, and we need to understand that something in light of internal and external reference points. The more we have depth and breath built into the picture, the more we can speak to meaningful interpretations of the diagnosis assessment profile.
This is but only the first 3/4 of the situation. The most important aspect for us as therapists is the last part – that is when we speak to outcomes, possible suggestions, ways forward, and support planning. But in all truth diagnosis is still happening. You know why?
Often new information comes to light and this reflects back upon the insight gained in the early assessment process – this is a vital feedback loop. We very often find that family and staff or carers have the greatest insight and wisdom in understand a person’s needs. A really good clinician will help to gather up these insights and to feed this information into a review and positive support plan.
This allows us to provide insightful reviews and commentary to highly specialist practitioners like Psychiatrists who may gain much from reports offered by behaviour specialists and counselling psychotherapists including those of us oriented towards neuropsychotherapeutic support methods.
A few assessments that contribute to diagnosis include:
- The Adaptive Behaviour Assessment System Version 3 (ABAS-3) is highly regarded as a measure of functional capacity. This can help also to create or monitor a support plan and to measure progress over time.
- Given the updates to the new and revised Vineland-3 we are also able to “Support the diagnosis of intellectual and developmental disabilities,” making the assessment more comprehensive. The Vineland has traditionally been used for young people and in school systems but lately is headed out into the community and providing valuable insight and diagnostic information. Like the ABAS3 the Vineland can also speak to planning and help us to understand strengths and areas for growth.
- The Autism Diagnostic Observation Schedule, Second Edition, (ADOS-2) is a fascinating tool that enables diagnosis of ASD and has traditionally been used for early intervention with children and youth. Like the Vineland we suspect that over time ASD assessment and treatment supports has already moved outward from early childhood and reflects all of life support methods.
- Combined with more accessible intelligence measures for people with disabilities in particular, we can speak to IQ as well as to capacity and functional skills. For example we appreciate the Kaufman Brief Intelligence Test, Second Edition (KBIT-2) for intelligence assessments because the tool is more flexible and accessible for both verbal and nonverbal ability and comes with a robust validity and high reliability measure.