Organisations Bias Diagnosis and Treatment Pathways

Organisations find the diagnosis they were set up for, creating a label that is passed on without critical re-appraisal – ‘sticky labels’. Resulting oftentimes in inappropriate treatment. Culprits are not only the obviously dedicated services such as those  for Autism Spectrum Disorders (ASD) but missionaries of monopoly training bodies such as EMDR and IAPT. The danger is that the Organisations do not seriously consider a contradictory diagnosis.

 

Recently I saw a 14 year old, two years ago a panel decided that he met criteria for ASD. No individual clinician in the ASD pathway had been definitive about an ASD diagnosis, and the possibility had only been raised when he was aged 11. His social communication was in fact good, interrupting mum appropriately in the Consultation. He clearly had behavioural problems, but there had been no consideration of a possible alternative DSM-5 diagnosis of ‘conduct  disorder with limited prosocial emotions’, instead the Panel concluded ‘will need to be taught social skills methods which suit his ASD needs’ but this has never happened in the intervening 2 years. When Panel decisions are made there is a need to be wary as they make riskier decisions (groupthink). His GP has now suggested that he be guided to a general counselling service for adolescence. No chance it seems of CBT appropriate to his and/or his mum’s needs!

In similar fashion EMDR therapists find PTSD everywhere and IAPT finds a mix of anxiety and depression ubiquitous resulting in poorly targetted treatment.

Dr Mike Scott

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