A couple of weeks ago in court, the validity of diagnosing LuLu with both RAD and PDD-NOS (an autism spectrum diagnosis) was called into question. You see, the DSM-IV states that autism must be ruled out in order to diagnose RAD. And LuLu carries both “labels”, not diagnosed by the same professional, but she still has them both on numerous medical records, along with other diagnoses that professionals debate as to whether they can co-exist.

So, while the DSM-IV is pretty clear that the diagnostician needs to rule out autism, it doesn’t clear up the question in our minds, for sure. So I began asking people – her treating professionals, other professionals and countless parents of adopted children with a variety of diagnoses. The overwhelming consensus is there are lots of adopted children out there that exhibit both trauma reactions, often manifesting themselves as either PTSD or RAD, or both. AND they exhibit developmental delays, including autism spectrum disorders. There’s also a raging debate about whether RAD and bipolar can co-exist and how you tell which a child has. And it’s even been suggested to me that autism and Tourettes/OCD can’t co-exist, although I find less instruction on this in the DSM-IV.

While diagnoses have a certain importance, parents are overwhelmed by it all. Especially when a professional (who is trying to be thorough, conservative, and honest) tells you that it is very difficult to accurately diagnose complex children, so the diagnosis may change over time. So what does that mean? Does it mean the child used to have a disorder but doesn’t now? Does it mean that another doctor was wrong? Or that the disorder evolved into something else? In reality the answer could be YES to all three.

So I threw out the RAD vs PDD diagnosis question and got all kinds of responses – responses from parents saying that their child carried both labels, responses from therapists saying you have to rule out autism, responses from other therapists saying autism doesn’t exist if the child attempts to communicate with you (wonder where that leaves Aspergers), responses from LuLu’s treating therapists who believe she exhibits many signs of both, but agree her attachment is significantly healed, while so many delays and processing issues still remain (not to mention oppositional behaviors, anxiety and, of course, tics).

And the more questions I asked…the more confused I got.

So what’s a parent to do?

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