The Long Road to a Diagnosis

The term describes the journey families go through before their child’s mental illness is officially diagnosed. Months often pass between the first suspicion and a confirmed diagnosis. During this time, parents speak with their child’s pediatrician, a counseling center, the school psychologist, and sometimes three or four other specialists. Each views the child from their own perspective. Sometimes it’s attributed to puberty, sometimes to school stress, and sometimes to a temporary slump.

This is particularly evident with eating disorders. Weight loss is initially attributed to sports or a diet; stomachaches to an upset stomach. It takes time for the connection to eating behavior to be recognized—time during which the family oscillates between hope and worry.

For most families, this odyssey consists of a long period of uncertainty. A child is seen, examined, and sent home again because no single finding seems significant enough. Only the pattern over weeks reveals the full picture.

Mental health issues rarely present with clear symptoms. Fatigue, irritability, withdrawal, and changes in eating habits can stem from many causes, including purely physical ones. That’s why doctors first rule out other possible explanations before considering a mental health condition. These nonspecific symptoms are a major reason why diagnosis takes so long.

Added to this are the wait times. According to a survey by the Bavarian State Chamber of Psychotherapists, half of all 10-year-olds wait longer than 115 days to begin psychotherapy. It can take a similarly long time to get an appointment at a child and adolescent psychiatric practice. Those who seek a second opinion often have to start the search all over again.

A third reason lies in the care system itself. Symptoms in children change with age, and responsibility shifts between pediatricians’ offices, psychotherapy, youth welfare services, and hospitals. For parents, this means numerous phone calls, forms, and reports that are passed from one agency to the next. There are usually several weeks between the initial inquiry, the first consultation, and the actual evaluation.

A set order of where to go saves time and effort. The first point of contact is usually the pediatrician. During well-child checkups, the child’s emotional and social development is also assessed, and the pediatrician’s office can rule out physical causes and refer the child to other specialists. Understanding what a pediatrician can and cannot do helps in determining the appropriate course of action.

It’s worth preparing for conversations with specialists:

• Symptom diary: Note the date, your observations, and the duration. For example, when the child eats and how much, when they withdraw, and how they sleep.
• Gather documents: Compile weight charts, report cards, previous doctor’s letters, and notes from school in one place.
• Write down questions: Before each appointment, jot down three specific questions so nothing gets overlooked during the conversation.
• Use the appointment service: Call 116117 to schedule an appointment for a psychotherapy consultation within one week.

In child and adolescent psychiatric diagnostics, the process then includes taking a medical history, a discussion of the psychological assessment, standardized questionnaires for parents and teachers, and a physical examination. The school is also often asked to provide an assessment. Together, these components form the basis for the diagnosis.

The time spent without a clear diagnosis takes its toll. Parents experience self-doubt, sometimes argue about the right course of action, and continue to manage their daily lives on the side. The wait for a therapy spot feels especially long because the child is visibly suffering and is not yet receiving treatment.

It helps to divide the search among several people. One person handles phone calls, another takes care of the paperwork. Psychosocial counseling centers and social-psychiatric services offer consultations even without a prior diagnosis. The time until therapy begins can be made a little easier to bear with coping strategies.

It’s important to set a deadline by which you should receive a response. If you follow up after two weeks without a reply, you’re less likely to fall through the cracks. It also helps to get on several waiting lists at the same time, rather than relying on a single practice. And parents should take their own well-being seriously: Living in a constant state of alert for months on end is exhausting. Seeking help for yourself—whether at a counseling center or with your family doctor—is an essential part of the process.

If your child is losing weight rapidly, shows signs of self-harm, has suicidal thoughts, or is barely eating or drinking, do not wait for a regular appointment. Contact the child and adolescent psychiatry department at a hospital or the medical on-call service at 116117; in an emergency, call 112.

Only a medical or psychotherapeutic specialist can make a diagnosis, typically through a child and adolescent psychiatry department (KJP). Rückenwind Eltern provides coaching support to guide you through this process and helps you make sense of your observations, but it does not replace a diagnosis or psychotherapy. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist and does not make diagnoses.