unspecified trauma and stressor related disorder vs unspecified neurodevelopmental disorder in neglected kids.

[borne_before]

So I am working with a young man who has a history of neglect (severe social impoverishment and opportunity for affection/interaction). He meets the diagnostic criteria for autism spectrum disorder and is engaging in self-injurious behaviors. Despite consistent behavioral consultation, we have not been able to get these behaviors completely under control and I and referring him to a community ABA provider that takes someone his age (extremely hard to find). They requested an updated evaluation, including the ADOS, just to make the insurance is happy.

There is also some issues with this patient school and I feel like they often overlook his history of neglect. I am wondering what your thoughts of adding an unspecified trauma and stress-related disorder, in addition to the autism, stereotypic movement disorder, and intellectual disability.

I am also wondering if a case could be made for an unspecified neurodevelopmental disorder due to the early history of severe neglect, including prolonged periods of isolation with minimal human interaction, which likely compounded his developmental challenges. As research suggests that early deprivation can significantly impact neural development, attachment formation, and the acquisition of crucial social-communication skills - this environmental trauma occurred during critical developmental periods, potentially exacerbating his autism-related challenges, could be captured somehow, right?

I realize I don't have to do this, but I feel like formally tagging a diagnosis might help increase some understanding of this patient as a whole human, complete with a history, in healthcare and educational settings.

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[psych.meout]

Does giving him any of these diagnoses offer benefit that having a concise but informative summary with his existing diagnoses does not?

Is there any confusion, misinterpretation, or other drawback to offering those specific diagnoses in this unique case that might not fit what the average clinician would conceptualize for them?

 

[ClinicalABA]

Obviously you want to have accurate and complete diagnoses. However, I'm not sure that would accomplish what you want it to. Do you envision a scenario where another stakeholder in the client's treatment/education who currently does not know or care about his history that would- all of the sudden- begin to care because you gave him a new diagnosis? If you are expecting an ABA provider, teacher, SPED director, etc. to understand not only what you mean with a diagnosis of "unspecified trauma and stressor related disorder/neurodevelopmental disorder" but to also know what to do about, you're going to be even more frustrated. That's your training and your job, not theirs.

In situations like these, I find you're most likely to be successful when you can make specific, reasonable, and implementable suggestions in line not only with the research, but with the abilities and training of those you expect to implement them. General strategies are not helpful. If you can't tell them what to do and when to do it, don't tell them to do anything. Having been on the other side of this, reading a report from a clinician that tells me that I need to "account for his complex history of trauma and the interaction between that and his other psychiatric diagnoses" makes me want to pull out my hair, even though I have none left to pull out. You have information and training that they don't have regarding these things, and if you can't give them specific, actually implementable strategies then it's not reasonable of fair (or- most importantly- effective) to expect them to. Changing/adding to a diagnosis- even if clinically indicated- and expected non-psychologists to know what to do with that info and getting pissed when they don't is a bit passive aggressive. Heck, expecting most psychologists to know what to do with that info is unfair. Give yourself credit that you have specialized skills and training that others don't have and should not be expected to have.

It's tough work you're doing, and it can be a slow and frustrated process, but that's what it is. You'll figure it out!

 

[smalltownpsych]

So I am working with a young man who has a history of neglect (severe social impoverishment and opportunity for affection/interaction). He meets the diagnostic criteria for autism spectrum disorder and is engaging in self-injurious behaviors. Despite consistent behavioral consultation, we have not been able to get these behaviors completely under control and I and referring him to a community ABA provider that takes someone his age (extremely hard to find). They requested an updated evaluation, including the ADOS, just to make the insurance is happy.

There is also some issues with this patient school and I feel like they often overlook his history of neglect. I am wondering what your thoughts of adding an unspecified trauma and stress-related disorder, in addition to the autism, stereotypic movement disorder, and intellectual disability.

I am also wondering if a case could be made for an unspecified neurodevelopmental disorder due to the early history of severe neglect, including prolonged periods of isolation with minimal human interaction, which likely compounded his developmental challenges. As research suggests that early deprivation can significantly impact neural development, attachment formation, and the acquisition of crucial social-communication skills - this environmental trauma occurred during critical developmental periods, potentially exacerbating his autism-related challenges, could be captured somehow, right?

I realize I don't have to do this, but I feel like formally tagging a diagnosis might help increase some understanding of this patient as a whole human, complete with a history, in healthcare and educational settings.

I think this is more of a call for more and better research and better overall conceptualization of complex causal factors and how to address those as a field or society than it is for a specific diagnostic description. I have worked with numerous kids from foreign orphanages that were neglected and deprived in various ways and seen the effects. Also, many of these patients who have been neglected have in utero exposure to intoxicants and other teratogens. This being said, completely agree with above post about identifying what will be useful to help others to help the patient and that is usually going to be simpler and more specific.