PSYCH 3615 Lecture 4 Sept 29, 2008 ASSESSMENT DIAGNOSIS

2. The Decision Making Process Typically begins with a clinical assessment, which is directed at differentiating, defining, and measuring the child’s behaviors, cognitions, and emotions of concern, as well as contributing environmental circumstances Assessments are meaningful to the extent that they result in practical and effective interventions

3. The Decision Making Process (cont.) Idiographic vs. Nomothetic Case Formulation idiographic case formulation involves a detailed understanding of the child and family as a unique entity nomothetic case formulation emphasizes more general inferences that apply to broad groups individuals

4. Developmental Considerations Age, gender, and culture must be considered when making judgments about abnormality and when selecting assessment and treatment methods Normative information must be considered knowledge about normal development needed to make decisions about abnormality isolated symptoms not typically related to children’s overall adjustment age inappropriateness and patterns of symptoms typically define childhood disorders

5. Symptoms That Best Discriminate Between Referred & Non-Referred Children (Achenbach et al., (1991) Poor schoolwork Can’t concentrate or pay attention for long Lacks self-confidence Behavior doesn’t change after punishment Disobedient at home Has trouble following directions Sad or depressed Uncooperative Nervous, high-strung, or tense Feels worthless or inferior Disobedient at school Looks unhappy without good reason

6. Purposes of Assessment Description and Diagnosis clinical description summarizes the child’s unique behaviors, thoughts, and feelings that together make up the features of a given psychological disorder diagnosis involves analyzing information and drawing conclusions about the nature or cause of the problem, and in some cases, assigning a formal diagnosis

7. Purposes of Assessment (cont.) Prognosis and Treatment Planning prognosis involves generating predictions regarding future behavior under specified conditions treatment planning involves making use of assessment information to generate a treatment plan and evaluating its effectiveness

8. Sample Treatment Plan

9. Clinical Interviews The most universally used assessment procedure Often includes a developmental and family history May incorporate a mental status exam Differ in degree of structure (e.g., unstructured, semi-structured)

10. Domains to be explored in clinical interview Birth-related history Milestones Medical history Family structure & history Child’s social & emotional functioning Child’s behavioral & academic functioning Description of the problem from all viewpoints Attempts to deal with the problem Expectations for treatment

11. Behavioral Assessment Emphasis on observing child’s behavior directly “ABCs of assessment” - involves observing the antecedents, the behaviors, and the consequences of the behaviors Functional analysis of behavior - a more general approach, the goal of which is to identify as many potentially contributing factors as possible, and to develop hypotheses about which are most important and/or most easily changed

12. Behavioral Assessment (cont.)

13. Behavioral Assessment (cont.) Checklists and Rating Scales often allow for a child’s behavior to be compared to a normative sample usually economical to administer and score lack of agreement between informants is relatively common, which in itself is often informative

14. Structured Interview Questions from BCFPIManaging Anxiety Subscale Does your child worry about doing better at things? Does your child worry about past behavior? Does your child worry about doing the wrong thing? Does your child worry about the future? Is your child afraid of making mistakes? Is your child overly anxious to please people? 1- never; 2 – sometimes; 3 - often

16. Behavioral Assessment (cont.) Behavioral Observations and Recording provide ongoing information about behaviors of interest in real-life settings recordings may be done by parents or others, although it may be difficult to ensure accuracy children often know they are being watched and may react differently as a result

17. Psychological Testing Tests are tasks given under standard conditions with the purpose of assessing some aspect of the child’s knowledge, skill, or personality Test scores should always be interpreted in the context of other assessment information Developmental tests are used for the purpose of screening, diagnosis, and evaluation of early development

18. Psychological Testing (cont.) Intelligence and Educational Testing is a central component in clinical assessments for a wide range of childhood disorders most popular intelligence scale is the Wechsler Intelligence Scale for Children (WISC-IV), which is well-standardized, reliable, valid, and provides measures of verbal comprehension, perceptual reasoning, working memory, and processing speed

19. Psychological Testing (cont.) Projective Testing involves presenting the child with ambiguous stimuli and asking the child what he or she sees it is believed that the child projects his or her own personality, including unconscious fears, needs, and inner conflicts, on the ambiguous stimuli projective techniques, including figure drawings and play, may be used to help children relax and to make it easier for them to talk about difficult events

20. Psychological Testing (cont.) Personality Testing may assess a child in terms of the “Big 5” Factors: timid-bold agreeable-disagreeable dependable-undependable tense-relaxed reflective-unreflective may use interviews, projective techniques, behavioral measures, or objective inventories

21. Psychological Testing (cont.) Neuropsychological Testing attempts to link brain functioning with objective measures of behavior that are known to depend on an intact central nervous system often involves using a comprehensive battery that assesses a full range of psychological functions, including verbal and nonverbal cognitive functions, perceptual functions, motor functions, and emotional/executive control functions

22. Classification and Diagnosis Categorical vs. Dimensional Classification “classical/pure” categorical approach assumes that every diagnosis has a clear underlying cause and that each disorder is fundamentally different dimensional classification systems assume that a number of independent dimensions or traits of behavior exist and that all children possess these to varying degrees

23. Classification and Diagnosis (cont.) The Diagnostic and Statistical Manual (DSM) a multiaxial system consisting of five axes: clinical disorders personality disorders and mental retardation general medical conditions psychosocial and environmental problems global assessment of functioning

24. Classification and Diagnosis (cont.) DSM (cont.) criticisms of the DSM-IV: fails to capture the complex adaptations, transactions, and setting influences crucial to understanding and treating child psychopathology gives less attention to disorders of infancy/childhood fails to emphasize situational and contextual factors fails to capture the comorbidity known to exist among many childhood disorders sometimes improperly used, such as when a specific diagnosis is needed in order for a child to qualify for special services

25. DSM-IV-TR Categories that Apply to Children Mental Retardation Learning Disorders (reading, math, written expression) Communication Disorders (expressive, receptive, phonological, stuttering) Pervasive Developmental Disorders (Autism, Rett’s, Asperger’s) Attention Deficit & Disruptive Behavior Disorders (CD, ODD) Feeding & Eating Disorders of Infancy & Early Childhood Elimination Disorders “Other” Disorders (separation anxiety, selective mutism, reactive attachment disorder, stereotypic movement disorder)

26. DSM-IV-TR Categories not Listed Separately for Children Mood disorders (depression, bipolar disorder) Anxiety disorders (specific phobia, social phobia, obsessive-compulsive disorder, post-traumatic stress disorder, acute stress disorder, generalized anxiety disorder, anxiety disorder due to a general medical condition) Eating Disorders (anorexia nervosa & bulimia nervosa) Sleep Disorders (dyssomnia, parasomnias)

27. Classification and Diagnosis (cont.) Pros and Cons of Diagnostic Labels pros: help clinicians summarize and order observations facilitate communication among professionals aid parents by providing recognition and understanding of their child’s problem facilitate research on causes, epidemiology, and treatments of specific disorders cons: may lead to negative perceptions and reactions by child and others