Mental Health Assessment of Children and Adolescents

1. Mental Health Assessment of Children and Adolescents Chapter 24

2. Assessment Process for Children and Adolescents • Based on Standards of PMHN of Children and Adolescents (ANA, 2000) • Follows same format as adults except: • Children need simple phrases (more concrete). • Corroborate information with adult • Direct questions, rather than open-ended • May use play media • May not be able to provide accurate time

3. Comprehensive Evaluation • Biopsychosocial history • Mental status examination • Additional testing as needed • Information from other agencies

4. Collecting the Data • Clinical interview – primary tool • Depends on developmental level of each child • Establish a treatment alliance. • Assess interactions between child and parent.

5. Interviewing Techniques • Interview child and parent separately. • Children provide better information about internalizing symptoms (mood, sleep, suicide ideation). • Parents provide better information about externalizing symptoms (behavior, relationships).

6. Discussion with Children • Explain the assessment process. • Adapt communication to child’s age. • Elicit any concerns the child may have. • Be “real” in interactions.

7. Discussion with Parents • Ask for a detailed description of their view of problem. • Allow parents to express frustration. • Be non-judgmental.

8. Building Rapport • Maintaining appropriate eye contact, speak slowly, clearly and calmly with friendliness and acceptance. • Use a warm, expressive tone. • Show interest in what is being said. • Make the interview a joint undertaking.

9. Preschool children: Have difficulty putting feelings into words, thinking concrete School-aged Children: Able to use constructs, provide longer explanations Adolescents: are egocentric, increased self-consciousness, fear of being shamed Use play; conduct assessment in play room. Establish rapport through competitive games. Let them know what information will be shared with parents. Direct, candid approach. Conducting the Interview

10. Biopsychosocial Assessment:Biologic Domain • Thorough history of psychiatric and medical problems • Consider genetic vulnerability • Medications • Neurologic examination

11. Assessment:Psychological Domain • Discussion of life changes and losses • Mental status • Developmental assessment • Psychosocial development • Language • Attachment • Temperament and behavior • Self-concept

12. Temperament • Easy - positive mood, regular patterns, positive approaches, low emotional intensity • Difficult - irregular patterns, negative responses to new stimuli, slow adaptation, negative mood and high emotional intensity • Slow-to-warm temperament - negative, mildly emotional response to new situation, but adaptation evolves

13. Risk Assessment • Ask straightforward questions. • Have you thought about hurting yourself? • Have you ever acted on these thoughts? • How would you hurt yourself? • What do you think would happened? • Have you ever hurt yourself? • When a child shares information regarding an intent to commit suicide or hurt others, it must be shared with parents.

14. Assessment: Social Domain • Family relationship • School and peer adjustment • Community • Functional status • Stresses and coping behaviors

15. Developmental Assessment Maturation • Intellectual functioning • Gross motor functioning • Fine motor function • Cognition • Thinking and perception • Social interaction and play