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Diagnosing developmental problems in children: parents and professionals negotiate bad news.

OBJECTIVE
To examine how parents and professionals engage in a process of negotiation over what labels to use and what developmental meaning to ascribe to those labels when imparting a diagnosis of mental disability to parents of young children.


METHOD
We performed a sociolinguistic analysis of 10 feedback sessions with parents whose children had been diagnosed by a clinical team as developmentally disabled.


RESULTS
Professionals shied away from explicit use of labels; they preferred to describe children's deficits with rate descriptors (e.g., "slow"). Parties to the sessions see-sawed between optimistic and pessimistic statements. That is, when parents seemed despairing, professionals would try to hold out hope; when parents were unrealistic, professionals gave more blunt statements. Parents who received the most ambiguous interpretations seemed left with diagnostic questions still unanswered; those who received more forthright information appeared better able to move on to issues of prognosis.


CONCLUSIONS
Diagnoses of developmental disabilities are jointly constructed by parents and professionals. We recommend larger and more controlled studies on the relationship between negotiation and labeling in diagnostic feedback interviews and the impact of these processes on parental satisfaction and adaptation.