A Single Diagnosis May Not Capture All Challenges a Child Has, New Study Suggests

A new study of kids struggling in school shows that a formal diagnosis—like ADHD or dyslexia—may not always capture all the challenges a child has. Although small, the study suggests it’s important to go beyond a diagnosis to understand all the ways your child struggles.

The study was published in Developmental Science journal. It was conducted at the Centre for Attention Learning and Memory, a research clinic at the University of Cambridge, England.

Researchers studied 530 kids who had been referred to the clinic by educators. They were sent for attention or behavior issues, language problems or trouble in school. Researchers purposely chose kids with many types of learning challenges. Some had a single diagnosis like dyslexia, ADHD or autism, while others had multiple diagnoses or no diagnosis at all. Some were also in speech therapy.

The study collected data for each child. The kids were evaluated on their listening skills, spatial reasoning, problem solving, vocabulary and working memory. They were also given an MRI brain scan, and their parents completed behavior questionnaires.

We asked Understood experts Bob Cunningham, Ellen Braaten, Nelson Dorta and Ginny Osewalt to weigh in.

Key Findings

Using the testing data, the researchers placed the kids into four groups, called “cognitive profiles:”

1. Kids with broad cognitive difficulties, and severe reading, spelling and math problems
2. Kids with typical cognitive abilities and learning for their age group
3. Kids with phonological difficulties
4. Kids with working memory issues

The researchers found that a child’s diagnosis didn’t predict their cognitive profile. In other words, diagnoses didn’t match up with patterns of test scores. Nor did diagnoses correlate with brain function shown by the MRIs.

For example, kids who had ADHD fell into all four cognitive profiles. Some seem to struggle with working memory, others with phonological processing, and yet others struggled in all areas. Some performed like typical learners. The researchers didn’t find this surprising since kids with ADHD often have other learning differences.

Key Takeaways for Parents

The study is valid, but it has some flaws. “The researchers took about 500 kids from one clinic in England,” says Dorta. “That’s a narrow sample, so we should be cautious about generalizing conclusions.”

Another issue is that diagnoses were parent-reported. “The researchers relied on parents to know exactly their child’s diagnoses, when they might not have known,” says Braaten.

Yet, there are some important takeaways. “A single diagnosis is very reliable. The pattern of symptoms that kids have is similar, especially in the case of dyslexia,” says Dorta.

Most kids have more than one issue, however. “Comorbidity (or co-occurrence) is the rule, not the exception for learning and thinking differences. This is true for mental health issues in general,” observes Braaten.

“One child who has been diagnosed with dyslexia may have problems with phonological processing, short-term memory, and math,” says Braaten. Another child diagnosed with dyslexia “may have problems with phonological processing, written expression, and fluid reasoning.” This is why the researchers found that diagnoses didn’t match with cognitive profiles.

Osewalt, who teaches grade school, agrees. "Kids with the same diagnosis can have a wide range of challenges, as well as strengths, in different areas,” she says. “The research reflects what we see in our classrooms every day."

While a diagnosis can help guide treatment, all the experts advise diving more deeply to understand all your child’s struggles. “A comprehensive evaluation is best,” Cunningham says. “It’s important to look at all cognitive, academic, communication and behavior information. Doing so will help determine what will be most helpful to your child.”

“You also shouldn’t limit choices for interventions to the ones most common to any diagnosis,” he cautions. “Instead, look for what will help address areas where your child struggles and also capitalize on your child’s strengths.”

Read more about evaluations and the process for getting one for your child. Learn about co-occurring learning and thinking differences in kids. And find out what to do if you child was just diagnosed.

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