I often get asked how important it is to have a “correct” diagnosis to treat the associated symptoms, since the symptoms of many diagnoses are similar. This comes up frequently in my office regarding treatment of autism spectrum disorders (ASDs), since this is my area of specialization.
Focusing on the “Symptoms of Concern”
As far as the autism spectrum is concerned, psychotherapy will not be different based on which diagnosis was given to the child. The three main diagnoses currently in use (Autistic Disorder, Asperger’s Syndrome, and PDD.NOS) are spectrum disorders. That means that people could have some or many of the characteristic differences and still get the same diagnosis. Conversely, one person given the diagnosis of Autistic Disorder could most want to address social skill deficits in therapy, and the same might be true for another person who was given the diagnosis of PDD.NOS, even if their symptom profile was different in other ways. What this comes down to is that whenever someone is seeking psychotherapy for autism spectrum symptoms, the psychotherapist would still focus on the symptoms of concern to the client, so the diagnosis is less relevant.
A Correct Diagnosis?
Another related point is that the diagnosis itself, or at least the one originally used, may not always be correct. For instance, I see many young people in my office who have been diagnosed by another professional with “Asperger’s Syndrome” but who really should have been given the diagnosis of “Autistic Disorder” because they had a significant language delay, which technically excludes the Asperger’s diagnosis, and on closer inspection they have the sufficient number of symptoms to meet the autism criteria.
Disclosure Facilitates Therapy
However, I do think it is important to know if someone is on or off the autism spectrum when making treatment decisions. For instance, if a child had obsessive symptoms, and those symptoms were just being treated from an anxiety standpoint but the child truly had an ASD (since obsessiveness can be a symptom of either an anxiety disorder or an ASD), then it might be found that the expected amount of progress was not being made. If it was then uncovered that the obsessiveness was part of an ASD, the expectations for changing that characteristic might be modified, and instead the focus might shift to channeling that quality into something productive, such as a career interest, rather than thinking the obsessiveness would be greatly reduced through cognitive behavioral therapy for anxiety.
I think this issue applies in a broad way to psychotherapy for many psychiatric diagnoses. For therapy to be effective, you need to know if someone is on or off the autism spectrum, or has any type of anxiety, or any type of mood disorder. But once you know the general symptoms of concern (worry, social skills deficits, mood dysregulation, and so on) then the psychotherapy treats those problematic symptoms.
The Health Insurance Dance
There is another way that the diagnosis matters, and that is when services are being obtained. For instance, some services are only provided to those with Autistic Disorder and not to those with Asperger’s or PDD.NOS. Many health insurance companies will not cover psychotherapy for ASD diagnoses (if the ASD is the only, or primary diagnosis) but they will cover psychotherapy if an anxiety disorder is the primary diagnosis, even if there is an ASD as a “secondary” diagnosis. Most therapists are aware of this, and if they are trying to help a family obtain coverage from their health insurance, they will then be more likely to diagnose a child with both an anxiety disorder AND an autism spectrum disorder and focus the treatment on the anxiety disorder.