One of the biggest issues I encounter as a child and adolescent therapist is that many families are often very misinformed about mental health, available treatments, and the NOS category.
NOS is considered by some people to be the “throw away pile” or “umbrella category” that clinicians use when they either do not have enough proof to diagnose an individual or if an individual is exhibiting symptoms that do not fit neatly into the categories of the DSM (Diagnostic and Statistical Manual of Mental Disorders). Sadly, part of this is true.
This article will briefly discuss the NOS category.
NOS stands for None Otherwise Specified and is often tagged onto the end of a diagnosis such as PDD (Pervasive Developmental Disorder-NOS), Bipolar Disorder-NOS, and Mood Disorder-NOS. It allows clinicians to communicate with each other and to document symptoms of a particular disorder that do not (at the time) fit the criteria needed to make the full diagnosis. For example, if your son exhibits idiosyncratic behaviors, stemming (i.e., humming, rocking back and forth, etc), is very rigid, is very literal and concrete, struggles with social relationships, and could talk about a favorite subject for hours without considering the toll it is taking on you, you may think he would qualify for the diagnosis of autism spectrum disorder. However, if your son does not fit into the other criteria of the disorder, a clinician may assign the label “PDD-NOS.”
It has been my experience that parents are confused about the NOS category and do not understand that NOS could actually be a good thing. If a child, adolescent, or adult is diagnosed with something that ends with NOS, the probability of that person “outgrowing” symptoms, exhibiting different symptoms, or not having the disorder at all is quite likely. For example, a moody adolescent who is diagnosed with mood disorder-NOS, may actually show signs of diminishing reactivity over time. In fact, symptoms of BPD (borderline personality disorder) in some individuals may diminish over time with age, experience, and treatment. The same is often true for the PDD-NOS diagnosis or for kids diagnosed with ADHD.
It is important that we keep in mind that diagnoses are labels and they don’t always explain symptoms. Labels also do not always explain why some individuals seem to “overcome” their symptoms while others do not. Misdiagnosis is also a very likely event in the world of diagnoses.
As a result, it is important for parents to know that our diagnostic system is flawed and spun by cultural and societal influence. In many cases, a clinical diagnosis can be opinionated or based on what a clinician believes could be the problem or presenting concern at the time. This could change.
You can visit a smorgasbord of psychiatrists, therapists, and other health professionals to only find out that each assessment is a tad different. Even more, many mental health professionals at various levels of experience, culture, political beliefs, and clinical knowledge disagree.
It is often up to parents, families, and caregivers to become advocates for their family members by educating themselves while humbly receiving the input of the clinician. One of the most important weapons I encourage families to adopt is a learning spirit and open mind.
With an open mind to learn information contrary to our current belief system(s), families can excel to a greater level of knowledge about the truth of what we “scientifically” know and do not know.
I wish you all the best