Discussing the Diagnosis with the Patient

Once I have arrived at a careful diagnosis, I try to explain the diagnostic formulation to the patient and family in a realistic and understandable manner. When the patient and those close to him have a clear picture of

Figure 6 Venn diagnostic diagram. The inner square shows key strengths and impairments of an eleven-year-old boy evaluated as he was preparing for transition into middle school. Venn circles within that square identify overlapping diagnostic categories that currently apply, and the outer square highlights important supports and stressors in his immediate environment.

Figure 6 Venn diagnostic diagram. The inner square shows key strengths and impairments of an eleven-year-old boy evaluated as he was preparing for transition into middle school. Venn circles within that square identify overlapping diagnostic categories that currently apply, and the outer square highlights important supports and stressors in his immediate environment.

my understanding of the nature and causes of the patient's difficulties, they are usually more willing to collaborate in the development and monitoring of recommended treatments. They may also be able to correct aspects of my formulation that may be incomplete or mistaken.

I usually present the diagnosis with a simple drawing of two squares and overlapping circles. In a conversation with the patient (if the patient is old enough to understand and participate in such a discussion) and with key family members, I draw a moderately large square on a paper to represent the patient as a person. Within this square I note several important strengths of the patient, such as "very bright," "musically talented," "good at fixing things," "hard working," and "very supportive of family."

Within this "patient square," I then draw one or several overlapping circles to represent each appropriate diagnosis, which perhaps includes ADHD, explaining in understandable terms what each diagnostic term represents. These circles can be drawn as in the Venn diagram in Figure 6, each sized to represent the current importance of the problem to the patient, and overlapping to represent interacting effects.

After the patient square and overlapping circles are drawn and discussed, I draw a larger square around the first square, this one to represent the environment in which the patient lives and works. On this square important environmental strengths or stressors can be noted. These might include "a very understanding teacher," "Dad's expert help with math," "adjusting to a new job," "recently divorced," "being taught by an inexperienced teacher at school," "worrisome financial pressures," and so on.

The purpose of the overlapping circles in squares is to provide a clear and manageable description of the nature of the patient's current difficulties in the context of important personal strengths and environmental stressors. As part of this collaborative process, it is essential also to consider a wide range of other disorders that often occur with ADHD.

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