Child Assessment

Goals and Objectives Collect accurate data – relevant and reliable Presenting concerns and Sx Daily and academic fx Work/study habits Interpersonal patterns Personality Temperament Motor skills Cognitive skills

Goals and Objectives Make Accurate Conclusions: Diagnosis Guide the Treatment Plan Assess effectiveness of current and previous coping styles and treatment attempts

Clinical Interview Good Clinical Interview efficiently yields relevant and significant information and opens up clarity and insight into problem. Key: Rapport with child and family Join with the most accessible member Join with the most powerful member Join with the child

“Joining” Keep in Mind: Parents come in extremely anxious and vulnerable and are desperate for help and clarification – be honest, objective, and empathic Child- feels confused, pathologized, the “bad child” Be clear with the child about who you are and what your purpose is: “I’m Dr. Saadia and I help boys and girls talk about their thoughts and feelings and find ways for them to feel better.”

Dimensions of a Clinical Interview See my Child Intake Assessment Form (handout) - Go over Dimensions of Child Assessment

Theoretical Perspectives Developmental Normative Developmental Assumption: Genetic, Environment interact in adaptive and nonadaptive ways. Explores Developmental Maturation and Environmental Fit for Child Interview focuses on assessing child’s developmental maturation compared to peers. Good to assess delays in cognitive and emotional development

Theoretical Perspectives Cognitive-Behavioral Humanistic-Phenomenological Focuses on Child’s thoughts, assumptions, and perceptions Problem-Solving Style Environmental contingencies to maladaptive behavior, patterns of rewards and punishments Assumption: Maladaptive behavior is a result of child’s experience of the world. Every child strives for self-actualization if basic need for positive unconditional regard is present.

Theoretical Perspectives Family Systems Psychodynamic Family Structure/Rigidity Assigned Roles Attachment/Closeness Resources Power Dependency/Reliability Availability of Resources Child’s Object-Relations Child’s differentiation/regression Attachment pattern Defenses/ Conflicts

Special Considerations Child’s Verbal Ability, Insight Child’s comfort with a Adult Stranger Family interview vs Child Solo What is appropriate to discuss? Parent’s blocks to discussing concerns with child Parent’s refusal to “label” ADHD and Asperger’s/Autism with child

Special Considerations Duty to Protect Abused or Neglected Children Child/Infant Mortality: Accidental Deaths At Risk Factors: Poverty Low Birth Weight/Medical Illness Lack of Child Proofing/supervision Parent Drug and Alcohol use

Special Considerations Parental Deception (conscious or uncons) Parents taking control of interview Parents dictating dx and tx Parents who turn the interview into a therapy session for themselves Child who is uncooperative or unresponsive

Assessing Strengths Resiliency Indicators: Infant alert, eye contact, smiles, responsive and sociable Child has healthy self-esteem, persistent w/goals Secure Attachment, Warm Family environment Strong, Cohesive, Extended Family Support Middle/upper SES Community with good schools, daycare, supportive social network

Consent and Confidentiality What is consent? Consent from child and parents Explaining consent to child: Developmentally appropriate language Divorced Parents: Who gives consent? Confidentiality (ethics) vs Privilege (legal) Child vs Adolescent

Case Discussion: “Emily” Mother arrives with her 9 year old child concerned about separation anxiety. The child walked in with mother closely attached to her leg and sat next to her mother with face averted through out interview. Child ignored therapist attempts to engage with her. Mother stated that child only exhibit anxiety upon leaving for visits with her father. Parents are undergoing divorce. Mother asked that therapist not involve the father in the tx stating that she believes he is the cause of the child’s anxiety and hopes that she obtains sole custody for the sake of the child. What ethical/ legal considerations must you address? What hypothetical considerations do you have about the family dynamic? What are your diagnostic concerns about the mother, child, attachment? Given the possible issues here, what is the best approach to the initial assessment process? What questions do you have as you proceed with your assessment?