Diagnosis versus Prognosis

When families come to SpeechKids, they usually come with many questions. Why does my child act the way they do? Why don’t they talk the way they should? What can I do about it? Can you help me deal with this?

We try to answer as many questions as we can and find out as much as we can (and hint: the answer to that last question is an emphatic “YES!”)

One of the ways we start to answer questions is to think about a potential diagnosis. But…

When we’re talking about early childhood speech/language delays and disorders, diagnosis is a tricky thing (because we’re mostly using observable behavior rather than 

For some families, a diagnosis answers questions and fills a hole. If this is you, then the diagnosis gives you something to hold onto. Something to believe in. A direction to take that leads to a better place. A place to direct your Google searches.

But for others, a diagnosis creates more questions and holes than it answers. It creates major rabbit holes. I’ve seen parents spiral into confusion, sadness, even despair after receiving a diagnosis. 

And here’s the kicker: They didn’t need to despair!  And here’s why:

Diagnosis is the way we describe what we see when a child isn’t progressing through their developmental milestones in the way that we expect. Diagnosis is a label that we can use to create understanding. It’s a way to “define our terms” in a way that might be meaningful to us, to parents (and, let’s be honest: other professionals). 

Diagnosis often (though not always) informs what kind of treatment we do.

But diagnosis is not the end of any story. 

And diagnosis is not a prognosis.

Prognosis is related to outcome. It’s how we describe “how well” a child will do with intervention. How fast they will “catch up” to their peers. How much they will grow. How far they will go.

Both of these concepts can be pretty fungible in early childhood. 

What looks like “Diagnosis A” can morph and look more like “Diagnosis B” within a few short months. And what looks like a “very severe case with limited progress expected” can transform into something a lot milder with a lot of progress made.

I try to be really clear with parents on the differences between diagnosis and prognosis. This matters.

Kids’ presentations (diagnoses) can change as they develop. And prognoses can change too. A lot.

I often tell the story of a little boy I used to see whom I wasn’t sure would ever speak. At age 2, he was so locked into his own mind -- nonverbal, non participatory, stuck -- that I wondered if he would turn out to be verbal or not. 

But there’s always progress to be made, and so we started to work together. Within a few short months, this little guy was talking in complete sentences and with pronunciation that everyone could understand. He began to express, not only his needs and wants, but his ideas and his thoughts. He was CRUSHING IT. With the help of his parents and his team, he made tremendous progress in a short amount of time.

Would a diagnosis have helped him? Nope. (And in this case, even a prognosis would have been of minimal use. Because he shattered every expectation, every limit, every restraint that those things could have placed on him.)

His presentation changed dramatically in a short amount of time, as a result of early intervention. 

And one thing is clear: early intervention is good for both diagnosis and prognosis.

Getting help earlier rather than later makes everything better.

Because it means that we change the brain earlier.

Because it means that we change the brain at a more fundamental level.

Which means that what comes afterwards is also changed.

And that can be everything.

Whether you’re struggling with a diagnosis, worried about a prognosis, or just plain worried, we’re happy to talk to you. Reach out if you need us.