When diagnosis is uncertain: variation in conclusions after psychological assessment of a six-year-old child

Abstract

A six-year-old child was independently assessed by three licensed educational (school) psychologists and one interdisciplinary team in the UK. All but one of these practitioners believed their assessment to be the first. The aim was to compare the practice of assessors and their conclusions especially in diagnostic categorisation. The methods of assessment and conclusions of the four resulting reports were compared using thematic analysis. There was agreement about the child's specific learning difficulties, intellectual abilities and need for additional support. However, there were extensive differences in the methods of assessment and notable differences in three sets of conclusions, especially in the use of diagnostic terms: one practitioner identified the child's difficulties as dyslexic in nature, the second one identified them as primarily dyspraxic and the third one reported a 'borderline probability of Asperger's Syndrome'. The diagnosis, therefore, remained uncertain from initial assessment, exposing inherent overlap between diagnostic categories. The disparities in conclusions are discussed in terms of differing contexts and methods of assessment. The validity of diagnostic categories as discrete is questioned. Even where practitioners describe uncertainty, the use of diagnostic terms may be interpreted unambiguously by other actors.

A piece of the puzzle: Student clinicians’ report writing tendencies and the misalignment with recommended practices.

“…Psychological reports have been criticized for lacking clarity, particularly in the diagnosis section (Cormier et al, 2019; Pentyliuk, 2002). Ambiguous wording, such as “probably meets criteria for,” may be used by psychologists who are not confident in their conclusions (Russell et al, 2012). Communicating being uncertain about a diagnosis is not only preferred by patients but has also been shown to increase their trust in their clinician because of the expert’s honesty (Olson et al, 2019; Santhosh et al, 2019).…”

What's in a name? Perspectives of dyslexia assessors working with students in the UK higher education sector

“…On the other side of the Atlantic, systematic reviews of dyslexia diagnostic reports have demonstrated a similar lack of consistency and reliability (Harrison & Holmes, 2012;Proctor & Prevatt, 2003;Sparks & Lovett, 2009;Watkins, Glutting, & Youngstrom, 2005); in the UK, a smaller study, in which a 6-year-old child was independently assessed by four different educational psychologists, resulted in the use of four different diagnostic labels (Russell, Norwich, & Gwernan-Jones, 2012). In the UK, it has been informally observed and acknowledged for years, as outlined in the introduction to this paper.…”

“…What has hitherto been missing from the research literature, though, has been quantified and detailed evidence from those practitioners engaged in diagnostic assessment within the sector. On the other side of the Atlantic, systematic reviews of dyslexia diagnostic reports have demonstrated a similar lack of consistency and reliability (Harrison & Holmes, 2012;Proctor & Prevatt, 2003;Sparks & Lovett, 2009;Watkins, Glutting, & Youngstrom, 2005); in the UK, a smaller study, in which a 6-year-old child was independently assessed by four different educational psychologists, resulted in the use of four different diagnostic labels (Russell, Norwich, & Gwernan-Jones, 2012). The current study, focused on the diagnostic assessment of dyslexia in UK HE students, provides evidence justifying much of the criticism and concern in the sector that was formerly based on unsystematic observation and anecdotal reports.…”

Co-Occurrence of Developmental Disorders: Children Who Share Symptoms of Autism, Dyslexia and Attention Deficit Hyperactivity Disorder

“…One concluded that the child had dyspraxia, two that the child had dyslexic difficulties, and a third that borderline AS was likely. We interpreted these differences in the use of diagnostic labels as dependent on settings that varied during assessments, and assessment methods that exposed different types of behaviour (Russell, Norwich, & Gwernan-Jones, 2012). This work suggests that which diagnosis is assigned depends to some extent on social and cultural factors as well as actual symptoms.…”