Complex and Mixed Presentations

Human beings are complex creatures, and life can also become complicated. Neuro-developmental and behavioural difficulties are influenced by genetics, neuro-biochemistry, neuronal circuitry and neuro-anatomy, hormones and age related changes. These biological factors are in a continual interplay with exposure to environmental factors including, family and psychological factors along with life events and stressors that are often out of our control. The emerging field of Epigenetics is helping us understand the complex interactions between these environmental factors and they way they switch certain genes on or off, leading to the development of various symptoms or syndromes. It is therefore hardly surprising that often when parents or teachers become concerned about a child, they frequently can’t identify exactly what is wrong, but they know that something is not quite right.

Developmental and behavioural problems commonly present with a number of symptoms, with uncertainty regarding their root cause. Learning, emotional or social difficulties are all influenced by each other and a myriad of other factors. In addition, problems can coexists, overlap, mask, masquerade, compound or even alleviate each other. For example, children with Autism Spectrum Disorder, not uncommonly, may also have Attention Deficit Hyperactivity Disorder. Both disorders can impact learning, increase anxiety, reduce motivation, change social behaviour and increase family stresses. This in turn may result in altered parenting patterns and reduced resources, which may further impact the child’s progress and development.

Assessment by a Developmental and Behavioural Paediatrician can help untangle and identify the root causes, elucidate complex interplays, vicious cycles and lead to specific strategies that address the issues appropriate to their priorities.

The specific interventions and progress will need to be regularly monitored not only to ensure that they are effective but also to continually adjust and recalibrate as the interactions between the symptoms evolve over time, requiring a review or reordering of priorities.

Children in the “Syndrome-mix” or with “Shadow syndromes” need specialised attention. The child’s strength and adaptive skills need to be promoted whilst parents and siblings may need additional guidance in this complex and challenging terrain. Empathy, support, acceptance, cooperation, realistic expectations are all key factors in optimising outcomes.

Whilst focusing on future outcomes,  it is paramount for children, families and communities to maintain connectedness and find enjoyment and meaning in the journey together.

Due to the brain’s neuroplasticity and the critical time period for social development (being the preschool years) it is important that children ideally be identified and diagnosed in the first few years of their life. If you have concerns about your child, delaying assessment may prove counterproductive especially with strong evidence now that early intervention does improve functional outcomes.