Multimorbidity and diagnostic overshadowing in children — formative SAQs

SAQ 1 — Definitions and problem representation (10 marks)

A 9-year-old has epilepsy, GORD, chronic constipation and anxiety. She presents with new self-injury and reduced interaction. A triage note says “known complex — behavioural.” [1] [10]

Questions

1. Define multimorbidity and diagnostic overshadowing in one sentence each, and state how they differ from comorbidity and from CMC. (4 marks) [1] [6] [10]
2. Write a one-sentence problem representation for this encounter. (3 marks) [14]
3. List four residual risks that must stay open if a behavioural working label is used. (3 marks) [13] [24]

Model answer

Definitions (4). Multimorbidity: two or more concurrent chronic conditions in one child. Diagnostic overshadowing: a known disability or disease label reduces recognition of a second condition. Comorbidity usually frames a secondary condition on an index disease. CMC is a narrower high-need construct (chronic conditions, functional limits, high use, family needs) and is not identical to multimorbidity. [1] [6] [10]

Problem representation (3). Nine-year-old with multimorbidity (epilepsy, GORD, constipation, anxiety) and new self-injury plus reduced interaction from baseline; risk of overshadowing a medical driver of pain or illness; requires structured medical search and open residual risks rather than a closed behavioural label. [14] [17]

Residual risks (3). Any four of: dental/ENT/head-neck pain; constipation or urinary retention; new infection or decompensation; medication toxicity or missed doses; seizure cluster or post-ictal change; safeguarding injury; progressive neurological process. [13] [24] [11]