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When our son was four years old, we brought him to a neurologist to see if he could diagnose our son’s behavior. From the time our son was a baby, he exhibited physical habits and intense behavioral tendencies, which we knew were not “normal”.  We thought the neurologist would be able to quickly tell us what our son had and the process to help him could begin. Unfortunately, the neurologist discounted our worries and told us there was nothing abnormal about our son. We were told our son had an immature nervous system.  I remember feeling very frustrated as we left his office. We were disappointed with his answer because we knew something was not right.Three years later, we discovered our son had Tourette Syndrome Plus. It took seven long challenging years to determine he was afflicted with TS Plus. When we did realize what our son had, I couldn’t help but wonder why the neurologist (or all other specialists we visited for that matter) had completely missed the mark in his diagnosis. At first I questioned the neurologist’s competency; however the more I thought about it, the more I realized my husband and I were not totally without fault. Today I’m comfortable enough to say that regardless of the neurologist’s competence, we as parents did not gather enough information for the neurologist to accurately diagnose our son’s behavior. And I know this because we didn’t realize how important all of our son’s behavior was for an accurate diagnosis.  We didn’t think our son’s inability to sleep at night might be connected to his jumping and arm flapping. We didn’t realize his obsessive compulsions were in any way related to his rage attacks. And why would we connect his grimaces to his hyperactivity? Tourette Syndrome Plus encompasses all of these behaviors. Yet at the time, we knew nothing at all about Tourette’s. Accurate documentation and observations of all the child’s behavior and habits in his natural setting are essential for a proper diagnosis. And it’s only with thorough documentation that a proper diagnosis can be made. If parents choose to meet with a medical professional for assistance, the degree to which a physician or a specialist can help the child and parents is only as good as the information the parents feed the professional. Once the diagnosis is made, then the appropriate treatment can be determined.But how does one go about ensuring the documentation of a child’s behavior is sufficient and what exactly should parents or caregivers be observing? This can be a difficult and at times, a daunting task for both parents and professionals. It may not always be obvious what needs to be documented. There are a number of steps parents can take to ensure accurate observations of their child’s behavior. The first step is a willingness to take the time to document the child’s behavior as frequently and as detailed as possible. This means writing down how the child behaves throughout the day.  If the child is school-aged or attends a nursery/day-care, you will need to ask the child’s main educator/caregiver to do the same. Although this documentation is just a temporary measure, the more detailed the information, the better the outcome for the child, family and educator.  Generally one, preferably two months of documentation should be sufficient.Two important variables to remember when beginning this process: The first is all behaviors matter. Whether or not the child behaves in a positive or negative way, their behavior needs to be documented. As a parent, you will want to recognize when your child is most at ease because you may want to re-create this environment.  The second important element is the trigger. The trigger is what made the child behave appropriately or inappropriately. It’s important to list the positive as well as the negative triggers to then be able to reinforce the positive ones. Examples of questions you can ask to determine the trigger include: What happened before the child reacted? Was the child provoked? Was the child involved in a stressful situation at home or at school? Are there disruptions in the family life or at work? Break the day into 4 parts to make it easier to document behavior:1)     wake-up till 12pm (lunch)2)     12pm till 4pm (school or day-care ends)3)     4pm till bedtime4)     night time activity It’s essential to write down how well (or not) your child sleeps. Sleep deprivation can have some serious and debilitating effects on a child’s behavior and how he performs during the day.For quick note taking, have a pen and paper in all rooms of the house your child occupies. Throughout the day when you watch your child, write down in point form: a) What’s happening: a brief description of what your child is currently doing (i.e. playing, drawing, etc)b) Who is involved: who other than your child who is in the same room or engaged with your child (i.e. sibling, parent, and yes, don’t forget the pet).c) How your child is behaving (i.e. calmly, excited, aggressively, etc.) Finally, what your child eats and drinks throughout the day is also critical. This may determine allergies and/or sensitivities you as a parent, may not be aware of. Sensitivities and allergies are becoming more predominant than ever before with children. Remember, diligence in gathering the information is of the utmost importance. It requires a lot of effort and focus on the part of the parents however; the end result will definitely be worthwhile.Next month we will discuss what you can do once you have collected the information.