1. Assessment, Diagnosis, & Treatment
Chapter 4

2. 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

3. CLINICAL Assessment

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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)

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

14. 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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18. 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?

19. 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

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

24. Diagnosis

25. 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

26. 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

27. Treatment

28. 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

29. 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

30. 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?

31. 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