A particularly valuable tool in understanding the “logic” of an individual’s behavior is that of a good personal history. Early in my career, I tended to under-estimate the value of that information in the diagnostic process. Seeing patients who were adopted, where limited history was available, immediately reinforced the importance of a complete history in the diagnostic process. A particularly valuable and productive diagnostic tool in neuropsychology is that of a detailed and accurate (and sometimes lengthy) developmental/neurodevelopmental, medical, and personal history of the patient. Many disorders and their symptoms have a prominent genetic-base (i.e., “runs in the family”), experienced by other members of the family (e.g., anxiety, headaches, gastrointestinal problems, depression, ADHD, cancer). Where there are similar symptoms in other family members, it potentially explains the basis of symptoms observed in the patient. This not only facilitates better understanding of the observed symptoms but also in identifying successful treatments of benefit for symptoms of other family members.

Genetic family history can be very important in understanding a child’s learning disorders, behavior, physical, or other developmental problems. Obtaining genetic history of alcoholism, substance abuse, or smoking is not a matter of criticism of family values, social judgment or poor health decisions, but rather commonly follows a genetic history of anxiety. Most addictive behaviors are driven by anxiety. A history of weight problems, difficulty self-calming, tactual sensitivity (i.e., resistive to being held), unusual levels of reactive irritability and easy agitation in siblings are also indications of potential genetic basis of anxiety. Many emotional/behavioral disorders or characteristics have a genetic basis.

Towards the end of better understanding the “logic” of the patient’s symptoms, it becomes particularly important to understand the individual patient’s medical history. Understanding the patient’s birth history and subsequent developmental progression is very important to understand the individual patient. While there is always some variation in developmental progression for children, an overall neurodevelopmental profile may suggest specific risk factors for future behavior. Pregnancy is a “hazardous event”, given that there many things that CAN happen, but usually don’t. Details of the progression of the pregnancy are important to understanding potential neurologic injury (e.g., hypoxia, stroke, Fetal Alcohol/Drug Exposure). Such events contribute to neurodevelopmental progression of the individual patient, exhibiting signs of neurodevelopmental disorders. Complications of pregnancy can result in potential neurologic injury, obvious or not. In our current cultural environment, Fetal Alcohol/Drug Exposure is a potential factor commonly reported in adoptive children. Commonly, a variety of learning/neurodevelopmental disorders are observed, including “Nonverbal Learning Disorder (NLD). Neurobehavioral disorders evident in extreme behavior (e.g., neurogenic irritability, low stress and frustration tolerance, rage) may be observed.

Developmental progression post-delivery (i.e., developmental milestones) is also a critical consideration in understanding symptoms and characteristics of the child. Deviation from an expected progression of developmental milestones can be of significance or can be just a variation of “normal” development. Understanding a child’s sleep habits is also of interest to better understand the wake/sleep cycle that should become progressively more established as the child matures. An experienced healthcare provider will be helpful in determining the difference. The medical history is also important for early childhood illnesses or injuries beyond routine kinds of illnesses. Car accidents, especially injuries with loss of consciousness and more severe medical conditions (e.g. seizures, falls) are of help in understanding development. While the ultimate consequence of brain injury is death, the most common are neurobehavioral and neurodevelopmental consequences, reflected in a variety of extreme behaviors (e.g., rage, decreased stress and frustration tolerance, neurogenic irritability, learning problems, etc.). Although when asked, mothers deny knowing very much, but they usually know a lot more than they realize.

In our society, we expect that if we can diagnose (i.e., name) a disorder, we can fix it. Unfortunately, that is not the case. As a clinical neuropsychologist, I am less interested in identifying a DSM-IV TR diagnosis than I am in understanding the specific neurodevelopmental “logic” of the patient, pharmacological, behavioral, and developmental. For many children with “behavior disorders” they also experience developmental/neurodevelopmental disorders that require and will benefit from specific intervention strategies. All the king’s horses, and all the king’s men….