Ch 4_Assessment, Diagnosis & Treatment

ASSESSMENT, DIAGNOSIS & TREATMENT

Chapter 4

CLINICAL ISSUES

Basics of the Decision-Making Process

  • Clinical Assessment: Initial step employing systematic problem-solving to understand children with emotional, behavioral, and cognitive disturbances.

  • Investigation: Utilizes detective work; flexible and ongoing hypothesis testing. Evaluates:

    • Emotional, behavioral, and cognitive functioning of the child.

    • Role of environmental factors.

    • Nature, causes, and predicted outcomes of issues.

CLINICAL ISSUES

Idiographic vs. Nomothetic Case Formulation

  • Idiographic Case Formulation: Focuses on individual assessment for a unique understanding of the child or family.

  • Nomothetic Formulation: Draws general conclusions applicable to large groups of individuals.

    • Tendency to Specify: Tailored assessments.

    • Tendency to Generalize: Broad categorizations.

DEVELOPMENTAL CONSIDERATIONS

  • Understanding child development norms is vital for assessing referrals.

    • Isolation of symptoms may not correlate with overall adjustment.

    • Symptoms defined by age inappropriateness signify childhood disorders.

    • Functional impairment is a key consideration in diagnosis.

PURPOSES OF ASSESSMENT

Core Functions

  1. Description and Diagnosis:

    • Clinical description provides a summary of unique behaviors, thoughts, and feelings indicative of psychological disorders.

    • Diagnosis involves analyzing data to determine the nature or cause of the issue.

  2. Prognosis and Treatment Planning:

    • Prognosis: Predictions about future behavior under specified conditions.

    • Treatment Planning: Applying assessment data to devise treatment strategies and evaluate effectiveness.

CLINICAL ASSESSMENT & DIAGNOSIS

  • Components of Assessment:

    • Symptom Presentation

    • Clinical Interview

    • Collateral Information

    • Referral Notes

    • Behavioral Observations/Assessments

    • Psychometric Testing

    • Differential Diagnosis

    • Idiographic Formulation

    • Management/Treatment

CLINICAL INTERVIEWS

Overview

  • Utilize significant time effectively for information gathering.

  • Include developmental and family history.

  • Unstructured Interviews: May provide low reliability and biased information.

  • Semi-Structured Interviews: More reliable, incorporate specific queries.

THE CLINICAL INTERVIEW: CHILD CASES

Initiation

  • Conducted early in assessment, can involve follow-ups.

  • Participants:

    • Parents

    • Siblings

    • Referred child

    • Clinicians

Family Interview

  • Focus on:

    • Frequency, intensity, and impact of symptoms on functioning.

    • Family dynamics, school history, and developmental milestones.

Child Interview

  • Must be age-appropriate.

    • Incorporates play and varies between structured and unstructured formats.

    • Observes clinician-child interaction patterns.

    • Assesses mood, behavior, language use, and other cognitive functions.

BEHAVIORAL ASSESSMENT

Goal

  • Evaluate child's thoughts, feelings, and behaviors in specific contexts.

  • Focus on** Target Behaviors**: Influencing factors explored through ABC model (Antecedents, Behaviors, Consequences).

ABCs of Assessment

  • Antecedents: What triggers the behavior.

  • Behaviors: Actions of concern.

  • Consequences: Results of the behavior, which can reinforce it.

FUNCTIONAL ANALYSIS OF BEHAVIOUR

Process and Importance

  • Identify various antecedents and consequences.

  • Develop relevant hypotheses regarding influential factors.

  • Use tools like rating scales to evaluate behaviors against benchmarks.

Example Analysis

  • Child refusing school correlates with teasing, leading to behavior avoidance due to distress.

  • Consequence of refusal (staying home) reinforces the behavior (avoiding distress).

NOTES ON BEHAVIORAL OBSERVATION

Procedure

  • Parents and observers collect baseline data on behaviors in real-life settings.

  • This data serves to compare behavior changes pre and post-intervention.

PSYCHOLOGICAL TESTING

Definition

  • Tasks assessed under standardized conditions to determine knowledge, skill, or personality traits.

Interpretation

  • Scores compared to norm groups, keeping in mind limitations relating to demographics.

Types of Testing

  • Developmental Tests: For infants and children to identify risks and capabilities.

  • Intelligence Testing: Assess cognitive abilities (e.g., WISC, WPPSI).

  • Projective Testing: Involves ambiguous stimuli to reveal personality features.

  • Neuropsychological Testing: Links behavior with brain function.

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

Current Edition

  • DSM-5-TR: Contains specificity for subgroups within disorders (subtypes, co-occurring conditions, and severity).

NOTES ON DSM-5

Overview

  • Classification: Organizes disorders into clusters based on shared features.

  • Differential Diagnosis: Elimination of non-matching disorders to finalize diagnosis.

KEY TERMS

  1. Specifier: Identifiers for subgroups within a disorder.

  2. Primary Diagnosis: Most significant diagnosis.

  3. Comorbid Diagnosis: Additional diagnosis coexisting with the primary.

  4. Differential Diagnosis: Process to narrow down potential diagnoses.

INTERVENTIONS

Spectrum of Approaches

  • Combines treatment, prevention, and maintenance strategies.

  • Interventions based on disorder features, outcomes, and ongoing evaluations.

NOTES ON INTERVENTION

  • Intervention should focus on the child and maintain therapeutic gains through broader systemic approaches (parental involvement, school strategies).

  • Aim for improvements on individual, familial, and societal levels through comprehensive engagement methods.

SECTIONS TO BE COVERED IN TUTORIALS

  • Slides 28-31 covering Treatment and Prevention (pp. 109-122).

MOCK TEST/EXAM QUESTION

  • Discuss the purpose of clinical assessment, including components for full marks.

MOCK TEST/EXAM QUESTION: MODEL ANSWER

  • Components include Description, Diagnosis, Prognosis, and Treatment planning with outlining details of each component.