When a child is struggling, it is natural to want an answer.

Is it ADHD? Anxiety? Autism? FASD? Trauma?

For children with histories of adoption, foster care, or kinship care, the answer is not always straightforward. Many of the behaviors associated with common mental health and developmental diagnoses overlap with behaviors we see in children who have experienced early adversity, disrupted attachment, prenatal exposures, multiple transitions, or chronic stress.

A child may struggle with attention. Another may be impulsive, anxious, constantly moving, easily overwhelmed, or unable to regulate big emotions. Some children have difficulty sleeping, navigating friendships, tolerating transitions, or managing everyday expectations.

Those behaviors are important, but they don’t always tell us why they are happening.

The Same Behavior Can Tell Different Stories

Consider a child who gets out of bed at night and searches the kitchen for food.

For one child, that behavior may be connected to a history of food insecurity. Even when food is now consistently available, their brain and body may still operate from an expectation that food could disappear. For another child, nighttime eating may be connected to ADHD and dopamine-seeking behavior. Another may be struggling with anxiety or a lack of felt safety that makes settling into sleep difficult. For another, an underlying sleep disorder or developmental difference may be contributing.

The behavior looks the same. The reason behind it may be completely different.

And if we only focus on stopping the behavior, we can miss the child’s actual need.

Diagnosis Should Answer “Why?”

A diagnosis can be incredibly helpful when it is accurate. It can give families language for what they are experiencing, guide treatment, open doors to appropriate services, and help the adults surrounding a child adjust their expectations and support. But a diagnosis should do more than describe difficult behavior. This is particularly important with labels such as Oppositional Defiant Disorder (ODD). A child may absolutely appear oppositional or defiant, but those words describe what we are seeing, not necessarily what is driving it.

It is a little like saying a child has a fever. The fever matters, but we still need to know what is causing it. Is the child overwhelmed by sensory input? Are expectations exceeding their developmental abilities? Is impulsivity making it difficult to stop and think? Is anxiety driving a need for control? Has the child learned through previous experiences that adults or environments are not always safe? Those questions lead us somewhere very different than simply deciding a child is refusing to cooperate.

Trauma Complicates the Picture

Trauma can affect attention, sleep, emotional regulation, executive functioning, relationships, impulse control, and a child’s ability to feel safe. ADHD, anxiety, autism, FASD, and other diagnoses can affect many of those same areas.

And sometimes both are true.

That is why evaluating children with complex histories often takes time. A three- or four-hour evaluation can provide valuable information, but sometimes the clearest picture emerges as we get to know a child across environments and over time.

We may need to ask: What happens at home compared with school? Is this child holding everything together all day and falling apart once they reach the safety of home? What happens when sleep improves? How does the child respond when expectations are adjusted to their developmental level? What changes when they receive occupational therapy, counseling, medication, or increased relational support?

Sometimes intervention itself gives us new information.

Developmental Age Matters, Too

A child’s chronological age does not always tell us what they are developmentally ready to do.

Children who have experienced early trauma or significant adversity may reach developmental milestones at a different pace. A behavior that looks concerning when compared strictly with same-age peers may make more sense when we understand the child’s developmental history. That does not mean ignoring concerning behavior. It means getting curious about it.

Instead of only asking, “How do we make this stop?” we can begin asking, “What is making this so hard?” That shift matters!

A Child Is More Than a Diagnosis

At The Adoption & Foster Care Clinic, our interdisciplinary approach allows providers from different specialties to look at different pieces of a child’s story and then bring those perspectives together. There are times when we agree immediately. There are also times when we challenge one another, gather more information, try an intervention, or simply give a child more time before deciding whether a diagnosis fits.

That process is intentional, because the goal is never to collect labels. The goal is to understand the child well enough to provide the right support.

A diagnosis can be part of that understanding, but it should never become the entirety of a child’s story.

This season on Beneath the Branches, we’ll take a closer look at several diagnoses we commonly encounter, including anxiety, ADHD, autism, and FASD. We’ll explore what these diagnoses can look like, where symptoms overlap with trauma, and what parents and professionals should consider when deciding whether further evaluation may be helpful. When it comes to behavior, what we see on the surface is only one part of the story. Sometimes the most important question we can ask is:

What’s happening beneath the branches?