Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Chapter 4 Assessment, Diagnosis, and Treatment

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Clinical Issues  The Decision Making Process  Begins with assessment, a collaborative process of systematic problem-solving strategies to understand children and their family and school environments  child’s emotional, behavioral, and cognitive functioning  the role of environmental factors  nature, causes, and likely outcomes of the problem

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Clinical Issues (cont.)  Developmental Considerations  Age, gender, and culture must be considered when making judgments about abnormality and when selecting assessment and treatment methods  Ethnic minority youth are often misdiagnosed  Cultural information is necessary to  establish relationship with child, family, teachers, and counselors  motivate family members to change  obtain valid information  Refer to counselor, psychologist  Culture-bound syndromes: recurrent patterns of maladaptive behaviors associated with different cultures or localities

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Clinical Issues (cont.)  Developmental Considerations (cont.)  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 pattern of symptoms typically define childhood disorders

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders by a licensed professional  Clinical Interviews  The most universally used assessment procedure with children and their parents  Information is gathered in a flexible manner over many sessions and integrated with other forms of assessment  Provide a large amount of information during a brief period  Often include a developmental history or family history  Semistructured interviews: Since most interviews are unstructured they lack standardization, which may result in low reliability and selective or biased information  asking specific questions provides consistency to be more reliable

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Behavioral Assessment  Evaluates the child’s thoughts, feelings, and behaviors in specific settings to formulate hypotheses of the problem and its treatment  Target behaviors are the primary problems of concern and the factors that control or influence them  “ABCs of assessment”: observe the Antecedents, the Behaviors, and the Consequences of the behaviors  Behavior analysis/functional analysis of behavior  a general approach to organizing and using assessment information  to identify a wide range of antecedents and consequences  the goal: to identify as many potentially contributing factors as possible, and to develop hypotheses about which are most important and/or most easily changed

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Behavioral Assessment (cont.)  Checklists and Rating Scales  Standardized reports concerning a child’s behavior and adjustment  Often allow for a child’s behavior to be compared to a normative sample  Economical to administer and score  Lack of agreement between informants is relatively common, and is often highly informative  The Child Behavior Checklist (CBCL) is used cross- culturally and gives clinicians a useful profile

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Behavioral Assessment (cont.)  Behavioral Observation and Recording  In natural settings  use baseline data to 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  may not be accurate in part because children often know they are being watched and may react differently as a result

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Psychological Testing  Tests are tasks given under standard conditions with the purpose of assessing some aspect of the child’s knowledge, skill, or personality  A child’s scores are compared with a norm group, although the norm group may have limitations in terms of race, ethnicity, culture, SES, etc.  Test scores should always be interpreted in the context of other assessment information  Developmental tests: used to screen, diagnose, and evaluate infants and young children and identify those at risk

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Psychological Testing (cont.)  Intelligence Testing  Evaluating a child’s intellectual and educational functioning is a key component in clinical assessments for a wide range of childhood disorders  Many definitions of intelligence  Wechsler: “the overall capacity of an individual to understand and cope with the world around him”  The Wechsler Intelligence Scale for Children (WISC-IV) is among the most frequently used intelligence scales  emphasizes fluid reasoning abilities, higher order reasoning, and information processing speed  Other commonly administered tests are the Wechsler Preschool and Primary Scale of Intelligence (WPPSI- R), Stanford-Binet-5 (SB5), and the Kaufman Assessment Battery for Children (K-ABC-II)

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Psychological Testing (cont.)  Projective Testing  it is believed that the child projects his or her own personality, including unconscious fears, needs, and inner conflicts, on the ambiguous stimuli  despite controversy, projective tests are among the most frequently used clinical assessment methods  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

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Assessing Disorders (cont.)  Psychological Testing (cont.)  Personality Testing  Personality: an enduring trait or pattern of traits that characterize an individual and determine how he or she interacts with the environment

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Classification and Diagnosis  Classification: a system for representing the major categories or dimensions of child psychopathology and the boundaries and relations among them

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Classification and Diagnosis (cont.)  The Diagnostic and Statistical Manual (DSM)  Began with World Health Organization’s International Classification of Diseases (ICD) in 1948, followed by American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) in 1952  Revised many times over the years; current edition is DSM-IV- TR  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 (GAF)

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Classification and Diagnosis (cont.)  DSM (cont.)  Criticisms of the DSM-IV-TR:  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 capture the interrelationships and overlap known to exist among many childhood disorders  fails to emphasize situational and contextual factors (although it does consider culture, age, and gender)  sometimes improperly used, such as when a specific diagnosis is needed so a child can qualify for special services

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Classification and Diagnosis (cont.)  DSM (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:  disagreement about effectiveness of labels to achieve their purposes  negative effects and stigmatization  can influence children’s views of themselves

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Treatment (cont.)  Treatment Goals  Outcomes related to child functioning:  reduce/eliminate symptoms  reduce degree of impairment in functioning  enhance social competence  improve academic performance  Outcomes related to family functioning:  reduce level of family dysfunction  improve marital and sibling relationships  reduce stress  improve quality of life  reduce burden of care  enhance family support

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Treatment (cont.)  General Approaches to Treatment (cont.)  Cognitive-behavioral treatments focus on identifying and changing maladaptive cognitions, teaching the child to use cognitive and behavioral coping strategies, and helping the child learn self-regulation  Client-centered treatments attempt to create a therapeutic setting that provides unconditional, nonjudgmental, and genuine acceptance of the child, often using play activities (young children) or verbal interaction (older children) to enhance personal growth and adaptive functioning

Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Treatment (cont.)  General Approaches to Treatment (cont.)  Family treatments focus on the family issues/disturbances underlying children’s problematic behavior  Biological/medical treatments view child psychopathology as resulting from biological impairment or dysfunction and rely primarily on pharmacological and other biological approaches to treatment  Combined treatments make use of two or more interventions