Discussing the Diagnosis:

Building Trusting
Relationships with Parents
10 Key Elements in the
Diagnostic Conversation
Marilyn J. Monteiro, Ph.D.

© 2010 Marilyn J. Monteiro, Ph.D. www.autismconversations.com

Discussing the Diagnosis
Buil d i n g T r u sti n g
Relati o n s h ip s w ith Pa r e n ts
10 Key Elements in the Diagnostic Conversation
by Marilyn Monteiro

The conversation in which the evaluation team

discusses a child’s diagnosis with parents is a
complex one.

What is the best way to structure this important

conversation?

How does one best approach this daunting task?

At what point in the conversation is it best to directly

state a diagnostic label of autism or autism spectrum
disorder?

Here are 10 key elements in the diagnostic

conversation that help put parents at ease and guide
the evaluator through the process of describing
the child’s behavioral profile and pattern of
developmental differences.

© 2010 Marilyn J. Monteiro, Ph.D. www.autismconversations.com

 10 Key Elements
in th e D i ag n osti c Conv e rsat ion
by M a r i lyn Monteiro

1. C
 onsider delivering the diagnosis
in an informal collaborative team meeting
Think of this as the follow-up to your initial conversation
Parents needs to hear this important information about their child without focusing on legal paperwork

2. Start by sharing details or stories about their child

Set the tone for the conversation as being about their child as a unique individual

3. Express genuine appreciation and enjoyment of the child

Warmth and a positive tone signal your competence in delivering this difficult diagnosis

4. Use the descriptive triangle of differences depicted in

Autism Conversations to lay out behaviors and gain
consensus on the diagnosis
The visual framework provides a focus point for parents and evaluators
Parents have something tangible to take with them at the end of the conversation
Know the knowledge level of the parents and gear your comments to that level

5. Avoid starting out by stating the child meets

the criteria for a diagnosis
Remember to describe the child first and then link that description to a diagnosis
When the diagnosis comes first the opportunity to establish a bond and to discuss the child in detail may be lost

6. Stop and listen

Ask periodically if what you are saying describes their child
Leave time in between your points to invite parents to share their thoughts and observations

7. Allow time for grieving

Anticipate that there will be a build up of emotions throughout the conversation culminating in overt grief once the
actual diagnosis is stated
Choose your words carefully but do say something to acknowledge the process

8. Anticipate questions about the child’s future development

Being able to ask the questions is part of the grief process
Asking questions is a sign of trust

9. E
 xpress appreciation for the opportunity to get to
know their child
Parents appreciate knowing that you respect the unique nature of your relationship to them and their child

10. End with collaborative teaming

Leave the session with the parents with a consensus regarding the diagnosis
Link the child’s behavioral profile to a few practical and specific educational recommendations
Tell them the next steps in the process

© 2010 Marilyn J. Monteiro, Ph.D. www.autismconversations.com

Quick reference checklist
diag n ost i c co n v ersations wi th par e nts
by Marilyn Monteiro

4
Check the box when completed

1 . Consider delivering the diagnosis in an informal

collaborative team meeting

2. Start by sharing details or stories about their child

3. Express genuine appreciation and enjoyment of the child

4. Use the descriptive triangle of differences depicted

in Autism Conversations to lay out behaviors and gain
consensus on the diagnosis

5. Avoid starting out by stating the child meets the criteria for
a diagnosis

6. Stop and listen

7. Allow time for grieving

8. Anticipate questions about the child’s future development

9. E
 xpress appreciation for the opportunity to get to
know their child

10. End with collaborative teaming

© 2010 Marilyn J. Monteiro, Ph.D. www.autismconversations.com