Child with multiple problems: Clinical complexity and uncertainty

Abstract

When practising neurodevelopmental–behavioural paediatrics, responsibility rests with the individual clinician to interpret research evidence in their daily work. This is not necessarily an easy task. Children do not usually present with single, easily definable problems. Complexity and uncertainty are present from the outset due to heterogeneity inherent in the diagnoses available, patterns of comorbid problems and the unique challenges of each child's social context. This article examines the resulting clinical challenge and offers potential responses. Rather than striving to eliminate uncertainty with strategies such as extensive assessment, the goal is to work effectively and efficiently within the limits of what can be readily known. Suggested strategies address complexity by considering the components of what is going on (biological, developmental, transactional) as hypotheses shared within each child's system of care. These hypotheses can then be tested and revised systematically as further information arises along the journey of treatment and longitudinal care.

A national harmonised data collection network for neurodevelopmental disorders: A transdiagnostic assessment protocol for neurodevelopment, mental health, functioning and well‐being

“…It is well established that children with neurodevelopmental disorders who present to health services will commonly receive a single primary diagnosis that guides future treatment (Hiscock et al., 2017 ; McDowell, 2018 ). However, diagnostic overshadowing, where symptoms are attributed to an identified condition rather than being considered as indicators of comorbid conditions, is common and occurs irrespective of the complexity with which an individual presents (Hendriksen et al., 2015 ; Kerns et al., 2015 ).…”

Quality and accessibility of written development assessment reports provided to caregivers in a publicly funded child developmental assessment service

“…Considering NDCs, the high rate of co-occurring conditions and diversity of presentations may contribute to the lack of consistency in neurodevelopmental assessment practices and subsequent reports. Children with NDCs can sometimes receive a single diagnosis that guides their treatment (McDowell, 2018). Further symptoms or developmental divergence may be incorrectly attributed to a single diagnosis rather than transdiagnostic needs, sub-threshold or additional diagnoses.…”