How to Make Affirming Diagnoses

Language is important.

As a testing psychologist, I am constantly thinking about the language that we use in our reports and in our feedback sessions with clients. We are taught that we need to defend and support the diagnosis we are making by explicitly stating the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria that the client meets.  However, focusing exclusively on the literal wording used in the DSM can lead to strict adherence to the medical model of disability and result in the use of pathologizing and shaming language that can be difficult for our clients to hear/read.

It is entirely possible to “make our case” and use affirming language. As evaluators, we should think about how we can frame the DSM criteria in a way so our clients feel understood and not shamed by us. We do this by recognizing that the DSM exists to provide a common language for providers who diagnose. By nature, this language focuses on “deficits” and “symptoms”, but it doesn’t take into account the full, unique picture of each client’s circumstances, which is why we shouldn’t directly regurgitate it to them. We can take our conceptualization a step beyond the DSM and consider the contextual factors at play. Consider the cultural, societal, and relational contexts that the individual functions in and how these frameworks contribute to their challenges. Then, take the DSM criteria and translate it to our clients in language that is strengths-based and affirming.

For example, some cultures value direct eye contact, which means that assumptions about indirect eye contact (the other person isn’t listening, the other person is rude) are easily made. However, many autistic and ADHD individuals actually listen better and can process spoken language more easily when not making direct eye contact. Rather than viewing indirect eye contact as a symptom to be treated, we can view it as a difference to be accepted. So, when writing a report about or providing feedback to someone who does not consistently make direct eye contact, instead of using the DSM language of “deficits in nonverbal communicative behaviors” or “abnormal eye contact”, we can respect and honor their differences by saying, “the individual demonstrated a preference for indirect eye contact.” 

As I’ve worked to make my reports and feedback sessions more affirming, I’ve developed a list of tweaks we can make to typical report language. Here’s a good place to start! 

Two lists that state how to replace medical model language with neurodiversity affirming language. These read: instead of deficit, try differences; instead of symptoms, try traits; instead of challenging behavior, try communication distress, instead of inflexible/rigidity, try thrives on routine/familiarity; instead of avoids eye contact, try preference for indirect gaze.