Sometimes parents notice their child is not developing or behaving normally, causing concern. Other times, they may not notice all the little things that could present a problem down the road that a medical professional would. Taking steps to prevent developmental delays or ward off potential issues can provide great relief when action is taken early on. A medical evaluation of a child’s development occurs at every well child appointment, making it an important doctor’s visit each year.
When a family is referred out for testing, a second opinion or for diagnosis of a disability, the road can seem confusing and leave families feeling abandoned. However, this is not necessary and you don’t have to go it alone. It is important to understand how the medical evaluation process occurs, what could occur, the policies that need to be followed for medical benefits to cover the appointments, and then potential treatment options. Another important reason to get a medical diagnosis is because it can open doors to services, benefits, therapies, or assistance, and it can provide certain protections under U.S. law in school, the work place, or any other public area.
When something is going wrong, the child is progressing slowly or not reaching milestones, a parent should contact their child’s Primary Care Manager (PCM) and discuss the areas of concern. Parents can help document the challenges the child has, as well as their own concerns, to help create a clear and complete picture of the child.
The things that you document may be:
- Rolling over
- Feeding self
- Dressing self
- Turning their head when they hear sounds or their name
- Looking at faces
- If they hit, tap, or stare at things
- Social or behavioral concerns
This documentation will be extremely valuable, as the child grows and sees more doctors a solid medical history will be requested. The documentation can provide clues to what is happening in your child’s brain.
The child may be referred out for further testing, which includes evaluations through interviews, medical tests, blood draws, or any other form to collect information about the areas of concern. The PCM will put into the computer system a referral to specialty doctors. These referrals to specialists will take a few days for TRICARE approval and will contain a time line of how long the authorization is valid for, as well as the number of visits the child may have to the provider. Making appointments soon after the authorization is important in many areas, as it is common to have to wait a few weeks for the appointment. Subsequent referrals will also use the same process. The specialist that will evaluate your child will vary from location to location, but may include a Developmental Doctor, Neurologist, Geneticist, Psychologist, or Psychiatrist. The reason behind this is that each doctor has specialized training in their field and has an in-depth knowledge of what to look for and how to treat the child’s special needs.
One of the most frustrating things during the process is feeling lost, confused, or in the dark. Asking questions during these appointments is critical so that the parent can learn to be on the lookout for warning signs, changes in habits, or development. Take the time to read up on the concerns you have, your child’s diagnosis, and various treatment options. Actively seek out advice from other parents through support groups, online forums, or from articles without hesitation. These can provide you with options and new ideas on how to help your child.
Children can be screened in the following areas:
- Cognitive: This includes intellectual abilities, such as your child’s ability to reason, remember, and understand.
- Physical: This includes an assessment of your child’s health, including vision, hearing, communication abilities, and the ability to move purposefully.
- Developmental: The child’s progress in a number of areas such as understanding and responding to language, social and emotional abilities, as well as mobility.
- Social: The child is assessed to understand how well the child socializes with others, if they read, understand, and can put body cues or signals into play.
- Behavioral: This assessment is done to indicate behavioral challenges or changes.
- Mental health: This area is screened for mood, behavior, thinking, reasoning, memory, and ability to express oneself. It is also important to screen for anxiety, depression, ADHD, schizophrenia, learning disabilities, or any other mental health disorder.
Often times, there are multiple tests done to determine the areas of concern and to gain a full picture of all the challenges the child may have. This should not cause alarm, even though it may be frustrating and time consuming for the parents, but a clear and thorough picture must be gained in order to get an understanding of treatment options. If we only treat portions of the problems, concerns, or conditions, it would be similar to treating a broken arm with a Band-Aid; in the long run the arm would heal, but not as well as it would have if it was in a cast or a sling. Our hope as parents and professionals is to take the necessary steps to help each child grow up and be the best they can be. Early interventions can provide the best outcome in many cases.
Your role as the parent in the evaluation process is vital. You provide valuable insight to challenges, successes, milestones reached, and delays. You also know when things are not going well and can see what triggers may be present or you may even be able to help calm their concerns. Stay informed of your rights and your options. Be honest and up front about your feelings, what has happened, and what the reality of the situation is. Assist in filling out questionnaires and attending appointments. Ask about the evaluations and tests.
Some questions to ask include:
- What tests will be used and why were they chosen?
- How will the test information be useful in developing a medical or educational plan for my child?
- What type of information will I be asked to provide about my child?
- Will my child be observed in clinical, school, and community settings, or at home?
- What results can I expect to gain from this test?
Tracking correspondence, results, appointments, surgeries, medications, therapies, or anything of importance can make it easier each time a PCS or a change in PCMs occur. If your child has been diagnosed with a disability or medical condition, tracking those things will help when it comes time to get services at the school through an Individualized Educational Program (IEP) or 504 Plan.
If you disagree with the diagnosis or evaluation of your child, you have the right to ask for another evaluation, a different medical professional, or more information. Sometimes, children are just barely outside of diagnosis criteria and do not receive the diagnosis. If this occurs, your best response can be to continue tracking of areas of concern, and reading up on the challenges they face. Consulting with medical professionals can also provide you with guidance on how to best help your child be successful.
“Working Together with Military Families of Individuals with DisAbilities!”