Formulation

Diagnosis ≠ Formulation

Applicable to many disorders, seminar example is ASD

Autism: a brief overview

  • Global prevalence approx. 1 in 100 children (for diagnosis)

  • Triad of impairment or 2-domain approach → social communication and restricted behaviour pattern

  • Psycho-educational, developmental and behavioural interventions are the core interventions

Diagnosis

Diagnosis is typically:

  • In young childhood

  • Or older children upwards when social demands exceed capacity to cope

  • More boys receive diagnosis

  • Can take many years for diagnosis

  • Lots of unknowns, stereotypes and co-morbidity ext.

  • Often put on the scale low to high functioning

Constant change and debate in what language should be used when discussing autism e.g. functioning labels, person first language, words such as disorder, notions of disability ext. → can depend on context and individuals who are being referred to.

A typical assessment

  • ADI-R standardised semi-structured clinical review for parents/ care givers; questions scored on clinician’s judgement

    • Quality of social interaction

    • Communication and lang

    • sensory interests and stimming

    • Medical history

    • Observations at school/home/social play groups ext.

  • plus ADOS

Formulation

  • Core skill of profession of clinical psychology and appears in the regulatory requirements of counselling, health and forensics

  • Can be alternative to diagnosis but more often sits alongside

  • Used to develop/ clarify hypotheses

Advantages

  • Person-centred

    • acknowledges that human experience does not come in neat parcels

    • Supports the person to take control of their own narrative

  • Responds to the criticisms that diagnosis can sometimes be

    • deterministic and rigid

    • slow

    • lack in reliability and validity

    • socially-situated

    • distressful for person/ families

    • can cause stigma

Aims

  • Resist expert judgement

  • Draw out the persons strengths and challenges in context

  • Avoid individualising (this only happens to you) and pathologizing

  • Foci on the role of trauma and abuse in psychological presentation

  • Be flexible

The five P’s of case formulation

  • Presenting problem - what do the person, family and clinician consider to be the issue?

  • Predisposing factors - what biological environmental and psychological factors put this person more at risk?

  • Precipitating factors - what significant events happened before this issue becoming a problem?

  • Perpetuating factors - what maintains the issue?

  • Protective factors - what support and resources does the individual have that are helping with this issue?