One Child, Two Diagnoses: A Discrepancy Can Steal a Future

A few weeks ago, a father came to me for help applying for his four-year-old daughter's disability pension. Her certificate lists her diagnosis as Down syndrome with intellectual disability. Getting to that single line, though, had taken the child through three assessments, three professional opinions, and left her father more uncertain each time.

A clinical psychologist's report from the Central Government Institute for persons with disabilities, diagnosed it as ‘Mild Autism’ and recommended reassessment in six months. Confused, he sought a second opinion at a Government hospital where the psychologist recorded Down syndrome with intellectual disability instead. Wanting a third view, he then took her to a Senior Resource Person at the Government Education Department, who independently arrived at the same finding: Down syndrome with intellectual disability.

Two diagnoses, three professionals. An early diagnosis is the first step toward everything a child with special needs is entitled to: timely intervention, the right school placement, therapy and family support. If the diagnosis is wrong, it can quietly close those same doors. That's exactly why no child's diagnosis is supposed to rest on a single professional's opinion alone. The best interest of the child demands a coordinated examination.

Putting a Finger on the Anomaly

With these reports in hand, the father approached the CMO Medical Disability Board. A panel consisting of physician, orthopaedic specialist, ophthalmologist, ENT specialist and senior psychiatrist reviewed every psychological report and medical document on file, and issued its certificate: Down syndrome with intellectual disability. It noted specifically, ‘no Mild Autism’.

That a four-year-old should need three assessments and a Board hearing just to get a straight answer, made me ponder that this case may not be an aberration. I went looking for how the mismatch happened in the first place.

The Government Hospital psychologist was forthcoming. She'd assessed the child, followed up over several sessions, and stood by her finding, adding that reassessment was always available if doubts remained.

The CMO and the Deputy Director of Health Services, Kashmir, put me in touch with a doctor from the Board, who confirmed the certificate was completely aligned with the evidence on file. On the Mild Autism note, he offered a guess: it may have come from an intern. He added that autism spectrum disorder rarely co-occurs with Down syndrome in his experience, and where autistic traits do appear, "autistic features" is usually the apt phrase to be used instead of a label like Mild Autism.

The institute that had written the Mild Autism report was harder to pin down. Its Director never returned my calls or messages. The head of the relevant unit did speak with me, and she asked for the child's name and CRR number, told me to gather responses from every other office involved, which I already had, and said that the parents had been asked to bring the child back for reassessment.

However, she did not elaborate on how the original report was arrived at. She simply noted that it matched what the parent had described and asked me to contact the Director with further questions.

Nobody, in the end, could explain why the diagnosis had diverged. And that's the real concern. What safeguards exist to stop a four-year-old from collecting conflicting clinical opinions? When assessments disagree, parents are left in a dilemma and confused, unsure which piece of paper to trust, even as the fallout is immense: certification, support, interventions, services, educational provisions, and every opportunity tied to the diagnosis.

Towards a Multi-disciplinary Diagnosis

Hema Gowri, a senior rehabilitation professional with over 25 years in the field, helped me understand what had gone wrong. She described three models of collaboration: multidisciplinary, where specialists assess separately with little coordination between them; interdisciplinary, where they assess separately but share and discuss findings; and transdisciplinary, where a team works as one from the start.

This child had only ever received the first kind. The model Gowri considers most workable in practice is the multi-disciplinary one. Programmes like the Rashtriya Bal Swasthya Karyakram, launched in 2013, exist precisely to build the interdisciplinary habit into routine screening. The new 2024 Gazette guidelines, she added, now caution psychologists against diagnosing in a single sitting.

One child cannot reasonably hold two conflicting clinical diagnoses and wait for an honest review. The real question is not merely “Who made the mistake?” but “Who is responsible for ensuring that the child receives an accurate, coordinated, and evidence-based assessment?”

Conflicting diagnoses can affect a child’s education, therapies, rehabilitation, benefits, and long-term future. A child’s rights must never become the casualty of poor coordination between Rehab professionals or institutions. Every assessment must be evidence-based, every discrepancy must be investigated, and every decision must be guided by one principle: the best interests of the child.