Assessment, Diagnosis, & Treatment

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Presentation transcript:

Assessment, Diagnosis, & Treatment Chapter 4

Outline Clinical Assessment Diagnosis Treatment Clinical Interview Behavioral Assessment Checklists (e.g., CBCL) Psychological Testing Developmental tests IQ tests Projective tests Personality tests Neuropsychological tests Diagnosis Treatment

CLINICAL Assessment

What is a Clinical Assessment? Examine & describe: Emotional functioning Behavioral functioning Cognitive functioning Describe frequency, intensity, & severity of symptoms Determine age of onset & duration of symptoms Assess environmental factors Gather data using interviews & tests Determine whether symptoms meet diagnostic criteria for a given disorder

What Information does a Clinical Assessment Provide? Idiographic formulation = detailed understanding of individual child Nomothetic formulation = broad inferences that apply to large groups of individuals (e.g., children with depressive disorder) Clinician uses nomothetic knowledge to inform idiographic case formulation

What is the Purpose of Assessment? Diagnosis = determine whether symptoms meet criteria for a given disorder Comorbidity = when 2 (+) disorders co-occurs within an individual (e.g., childhood depression and anxiety) Treatment planning generate a plan to address child’s problems evaluate its effectiveness

Who assesses? How do we assess? Multidisciplinary treatment team (e.g., psychiatrist, social worker, psychologist, speech pathologist) Multimethod assessment approach using variety of methods (i.e., interviews, observations, questionnaires, tests) from different informants Clinical interview conducted separately with child & parent(s) Questionnaires, psychological tests, & behavioral assessments

Components of Clinical Assessment Clinical Interview Behavioral Assessment Checklists (e.g., CBCL) Psychological Testing Developmental tests IQ tests Projective tests Personality tests Neuropsychological tests

1. Clinical Interview Parent or teacher refers child Assessor works to build rapport with child Clinician works to engage child through play/projects/games Assessor gathers information flexibly over several sessions

1. Clinical Interview Information gathered: presenting problem key symptoms (onset, duration, severity) developmental & family history Child’s birth Developmental milestones Child’s medical history Child’s psychiatric history Family history family (who lives in the house?) & social relationships school history & performance Interview findings integrated with other test results

2. Behavioral Assessment Evaluate child’s thoughts, feelings, & behaviors in specific settings Use this information to formulate hypotheses about the problem and how to treat Observe specific target behaviors directly (e.g., aggressive behaviors in CD) ABC framework used in understanding behavior A = Antecedents, or events immediately preceding the behavior B = Behavior of interest C = Consequences, or the events that follow the behavior

3. Behavior Checklists Child, parent, &/or teacher asked to rate presence/absence of wide range of child behaviors Pros Standardized Comparable with a reference group of children – same age & gender Can compare parents’ reports, or parent & teacher report Gold standard = Child Behavior Checklist Also, rating scales focusing on particular disorder (e.g., ADHD, depression, anxiety)

Components of Clinical Assessment Clinical Interview Behavioral Assessment Checklists (e.g., CBCL) Psychological Testing Developmental tests IQ tests Projective tests Personality tests Neuropsychological tests

4. Psychological Testing Developmental Tests – Screening, diagnosis, & evaluation Screening = identifying children at risk, who may be referred for more thorough evaluation Intelligence Tests – Behavioral problems can cause intellectual deficits Intellectual deficits can be part of the MH disorder Sometimes relationship between intellectual functioning & MH is unclear Gold standard = Wechsler Intelligence Scale for Children (WISC-IV) 10 mandatory subtests Age range 6-16 yrs IQ scores on the WISC-IV are good predictors of academic achievement Also, preschool version

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4. Sample WISC-IV Items Similarities In what way are a pencil and a piece of chalk alike? Vocabulary What does running mean? Comprehension Why do we wear shoes? What is the thing to do if you see someone dropping a package? Information How many legs do you have? What must you do to make water freeze?

4. Psychological Testing Projective Testing Child presented with ambiguous stimuli (inkblots or pictures of people); child describes what s/he sees Or, child is asked to generate words or drawings Child “projects” personality onto ambiguous stimuli Controversial: Some think projective tests work well; others feel that they are not reliable/valid Examples – Rorschach, CAT, draw-a-person, or informal play/drawing

Components of Clinical Assessment Clinical Interview Behavioral Assessment Checklists (e.g., CBCL) Psychological Testing Developmental tests IQ tests Projective tests Personality tests Neuropsychological tests

Diagnosis

Classification & Diagnosis Why is diagnosis important? For treatment planning For facilitating communication about patient, patient’s sx, proposed tx, & prognosis How do we diagnose? Assessment data Diagnostic and Statistical Manual (DSM) Includes diagnostic information on a range of MH disorders Some disorders = ‘disorders usually first diagnosed in infancy, childhood, or adolescence’ (e.g., MR) Other disorders not listed separately for children (e.g., depression) Diagnostic criteria for children and adults are same / very similar to those for adults Less attention paid to disorders of childhood De-emphasis on situational & contextual factors Increasing awareness of the importance of the role of family in MH DSM is a categorical system This can prevent some children from receiving services because of a missed ‘cut off’ score

Pros and Cons of Diagnostic Labeling Helps clinicians summarize and order observations Facilitates communication among professionals and parents For parents, the label can be validating Descriptive terms help clinicians locate research and clinical data and facilitate research on causes & treatments of disorders Improvement in reliability Cons: Stigma associated with labels (esp for children) Self-fulfilling prophesy (once labeled, others may perceive the child and react to him/her differently) Labels can negatively influence a child’s view of him/herself

Treatment

Treatment Effective interventions place treatments to problems within a developmental context How might a treatment for depression differ for a young child versus adolescent? Interventions range from: prevention early intervention treatment

Treatment: Cultural Considerations Historically, interventions failed to consider cultural differences & experiences of ethnic minority children Cultural compatibility hypothesis – treatment is likely to be more effective when compatible with the cultural values of the child & family People from different cultural backgrounds have different values, beliefs about mental illness, parenting practices, religious beliefs This should be integrated and respected within the therapeutic relationship Some research suggests treatment is more effective when child’s caregiver and therapist have same ethnic background

Treatment: Ethical Considerations Clinicians must follow ethical principles Increasing emphasis on involving children as active partners in decisions about their own psychological treatment Ethical issues are complex when working with children Confidentiality When can a child refuse treatment?

Treatment Effectiveness Children receiving therapy demonstrate greater improvements than children not receiving therapy Average child who is treated is better off than 75% of children not receiving treatment Treatment effects are long lasting, with effects at f/u nearly the same as post-treatment Treatment effects are 2x as large for problems specifically targeted in the treatment (e.g., anxiety) as opposed to nonspecific areas of functioning (e.g., social skills) The more sessions, the greater the improvement Caveats: Community-based clinics treat more complex cases, more comorbidity, more severe cases, and have less well-trained therapists than research study clinics Most children with MH problems do not receive treatment for their problems Rates of treatment are highest for ADHD and behavioral problems, lowest for substance abuse, eating disorders, anxiety