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.