Parents are naturally concerned about their child being “labeled.” Some are even so afraid of having a label put on their child that they resist getting a professional evaluation of the child’s difficulties. Other parents are actually relieved when they get a label to put on their puzzling concerns. So what is in a label and when is it useful?
How Not to Use Labels
First of all, labels should never be used to pigeonhole a child. We must always remember that every child is a unique individual with talents and abilities along with the challenges.
Secondly, a label should not be used as an excuse to limit our expectations of what our child might be capable of. When I was studying psychology in the 1960s, it was said that Down’s syndrome children could not be taught to read. Consequently, there were no real efforts made to teach them. Now we know that with appropriate methods many of these children can indeed be taught to read. The psychologists and educators of long ago have been proven wrong!
Thirdly, labels should not be broadcast to the child’s extended environment. Labels can easily be picked up by peers and used to alienate the child. Every generation or so labels have to be changed, because they have taken on distinctly negative connotations. A new, supposedly less damaging term, is adopted, only to have to be changed again another generation later.
Earlier terms for the various degrees of mental retardation such as “idiot” or “moron” are long gone as legitimate labels. These classifications were changed to mildly, moderately, or profoundly retarded. But the word “retarded” is no longer acceptable, so we now call these children “mentally challenged.” How long will it be before that term needs to be changed?
What about other labels that we currently use, which do not refer to intellectual ability? Terms such as “autistic” or “learning disabled” could easily be subjected to the same fate, if we do not use them responsibly.
Appropriate Uses of Labels
Labels are useful when they help us better understand the nature of a child’s difficulties. Giving the problem a generally accepted name can aid in the communication between professionals as well as with parents. Labels can also help with obtaining funding and other resources. Let’s explore these uses of labels in more detail.
A Label Can Help Us Understand Your Child’s Needs
Every child is unique and no two children fit the exact same profile. Nevertheless, as we assess your child’s difficulties, we might find a pattern that broadly matches that of certain other children. If this leads to a diagnostic label, it will help us know how to better teach your child.
Say that you are told your child is on the “autism spectrum.” We now know a great deal about how children on the spectrum learn differently from most other children. Knowing the diagnosis, teachers and therapists can employ teaching strategies that are more likely to be successful than traditional methods.
The same is true for other diagnoses. Speech therapy methods that work well with most articulation disorders are likely to miss the mark if the child has apraxia of speech. Knowing the diagnosis will help the therapist use more appropriate methods. We don’t need to waste time on ineffective strategies before figuring out what your child really needs.
A Label Helps Us Communicate About Your Child’s Challenges
A proper label helps the professional team more readily discuss your child’s issues in order to jointly plan interventions. At some point, you are likely to be seeing a new doctor, therapist or teacher. A diagnostic label then gives you a good starting point for discussing your child’s challenges.
Once we are able to put a name to your child’s difficulties, we can better communicate with you about the challenges you and your child are facing. We can draw on past experience and general knowledge about the type of issues you are dealing with. Based on that knowledge, we can discuss challenges your child might face in the future. This helps you to be more proactive in helping your child.
A proper label can also help you search for more insight into your child’s challenges. The Internet has become a great resource for gaining such insights. But, without the label you would not have a good starting point for your search.
Some years ago, a child entered our preschool with only one word, “mama,” in his vocabulary. Any attempts to verbalize beyond that one word resulted only in “uh-uh-uh”. The parents believed it was due to a hearing problem. As I worked with the boy, I became increasingly convinced that he also had verbal apraxia.
After I explained this to his mother, she immediately started researching the suggested label on the Internet. She came across the official website for CASANA, a parent support group for children with childhood apraxia of speech. This ultimately helped her obtain additional services for her son. This would not have happened, had I not used the apraxia “label” when explaining my observations to the mother. (Read more in CAS—What We Can Learn from Two Case Studies.)
A Label Can Help You Obtain Funding and Other Resources
Labels are essential for any billing purposes and are therefore important in communicating with physicians. Unfortunately, insurance companies seldom cover speech therapy. They consider most speech-language problems in children to be developmental or “educational” rather than “medical.” There are some exceptions.
Most diagnostic labels used for speech-language problems do have a medical billing code attached to them. That does not mean, however, that insurance companies will pay for services. Some diagnoses are more likely than others to generate funding. Autism and CAS, Childhood Apraxia of Speech, are somewhat more likely than many others to get coverage. That is because they are considered to have a neurological basis.
If your child has a speech problem that will require long term, intensive services, such as CAS, it is worth pursuing coverage. Some insurance companies are more lenient than others. Medicaid tends to be more likely to cover speech therapy than most insurance companies.
Labels Are Not the Final Word
While labels can be very helpful, you should be cautious in accepting a given “label” as the final word. Your child is constantly developing and learning. What appears to be the most appropriate diagnosis at one point may later give way to another.
When it comes to speech and language development, there are often several interacting factors. Persistent ear infections in the young child can cause a significant delay in speech development. It can then easily be concluded that the hearing problem is the sole cause of the child’s speech problem.
We sometimes see a child’s speech failing to catch up as expected after successful treatment of a hearing problem. I have in such cases often found that there is another factor involved. The two factors interact, and sorting out which of the factors is having the greatest effect can take time.
There are other reasons why it can take time to arrive at a specific, diagnostic label. How the child responds to intervention will many times tell us more than formal tests. I have at times found myself disagreeing with the diagnosis given by another professional, who has drawn conclusions based on a single, diagnostic session.
In summary, labels can be very helpful, especially when they give us direction for how to best approach the problem through therapy, instruction, or home activities. On the other hand, they can be harmful if misused or incorrect. It is therefore important to use labels carefully and with sufficient confidentiality. Let us appropriately label the problem but not label the child.