1. Childhood Psychopathology Assessment & Diagnosis

2. Diagnostic Systems Diagnostic and Statistical Manual-5 (DSM-5)
Published in 2013
Numerous disorders added, recategorized, or modified
I imagine that you covered the DSM-5 in abnormal psychology. The DSM-5 defines and includes symptoms for mental health disorders. This was update of the disorder and symptom list since the publication of the DSM-IV in Some of the changes were well received, some remain controversial. In my opinion some of the good changes include the addition of hoarding disorder, the addition of a chapter specific trauma-related disorders, and elimination of the requirement that ADHD symptoms need to be documented by the age of 6. One controversial change includes making one diagnostic category for autism related disorders (they are not considered autism spectrum disorders). Keep in mind, the DSM-5 is not prefect. It is based on what we know at this time and the general consensus of experts in the field.

3. Diagnostic Systems DC:0-3R (Diagnostic Classification 0-3R) 5 Axes:
Axis I: Clinical Disorders
Axis II: Relationship Classification
Axis III: Medical & Developmental Disorders & Conditions
Axis: IV: Psychosocial Stressors
Axis V: Emotional & Social Functioning
There are other relevant diagnostic systems. The DC 0-3R is one that has had some influence but has gained much less traction when competed to the DSM. This system focuses on younger children (ages 0-3). In many cases, the symptom descriptions are merely slightly modified from the DSM or default to the DSM. It is interesting and relevant that the 0-3 focuses on relationship classification (basically parent-child relationship, attachment), as this so central to child functioning, especially at a young age.

4. Zero to Three Classification System
Axis I Primary Diagnosis
Traumatic Stress Disorder
Disorders of Affect
Adjustment Disorder
Regulatory Disorders
Sleep Behavior Disorder
Eating Behavior Disorder
Disorders of Relating and Communicating
Axis II Relationship Disorder Classification
Overinvolved
Underinvolved
Anxious/tense
Angry/hostile
Mixed
Abusive
As discussed in the previous slide, relationship are classified. Relatively few Axis I diagnoses relative to DSM. This may be in part to a more limited range of behaviors and problems in younger children.

5. Diagnostic Systems
ICD-10: International Statistical Classification of Diseases and Related Health Problems (WHO)
The ICD is primarily used by physicians to code medical problems, but the ICD also includes psychiatric disorders. In the US, the DSM-5 is most dominant, but in some settings mental health practitioners use ICD codes. The ICD and DSM are similar, but at the same time, there have been some difference between the DSM and ICD. More recently, efforts have been made to make the 2 more congruent.

6. Assessment
Psychological assessment: systematic collection of relevant information used to evaluate clinically significant psychopathology
Think of an assessment as data collection on an individual level. We want to collect as much data as reasonably possible about a particular individual. Why? As you might imagine, this helps us with diagnosis. But there is more to this. In particular, we want understand how the problem developed for the particular child. This will help us understand how to treat him or her (again think about equifinality and multifinality). In addition, we want to be able to make predictions about outcome- the prognosis. Finally, we want to be able to track change over time.
One important point, if you think about this in terms of data collection, remember that data collection may include error. We get often get a “glimpse” of the individual and make assumptions based on this glimpse. But we may be missing data. For example, what is the parent or child not telling us? Sometimes individuals lack insight when describing the problem and when and how it occurs.
See the 4 pillars of assessment in your textbook.

7. Assessment Strategies: Clinical Interviews
Basic Clinical Interviews (unstructured) Structured/Semi-Structured Interviews Mental status exam
Clinical interviews are typically the foundation of assessment. They can include the above components: Basic clinical interview- the clinician often interviews the caregiver and the child/adolescent. See the following 3 slides for examples of topics covered.
Structured/semi-structured interviews- less common, but have some advantages. You ask specific, predetermined questions. This increases reliability and decreases the likelihood that you will miss something. Mental status exam- typically included in reports. The above are your account of the family and client’s description of their lives and concerns. In contrast, a mental status exam tells you what it is like to be sitting with and interacting with the client. For example, this includes a description of their appearance (e.g., dress and hygiene), mood during the interview, concentration, orientation (to person, place, time, and situation), insight, cooperativeness, etc. See table 3.2 slide (in the powerpoint and in the text).

12. Cognitive Assessment
IQ tests (E.g., Wechsler tests) Achievement tests Other neuropsychological tests
Cognitive tests are administered based in a standard manner. Scores are based on normative data from large samples. More specifically, individuals are compared to same-aged peers. Z scores and t scores are calculated based on difference form the average score for same-aged individuals.
These measures compliment our interviews. A couple of points to consider: (1) never diagnose based on a test alone, and (2) we don’t always do cognitive assessment, the use of these tests depends on a referral question. For example, I may not see a need to do cognitive testing with a child who has problems with anxiety but is getting good grades in school.

13. Z scores are based on the number of standard deviations from the mean
Z scores are based on the number of standard deviations from the mean. Most people (about 68%) are within 1 standard deviation of the mean plus or minus. If you notice IQ scores are a form of z score. The average score of same-aged peers is 100 with a standard deviation of 15. Your score is based on how you do relative to same-aged peers. Two standard deviations below the mean equals an IQ of 70. Individuals who score 70 or below score in the lowest 2.5% when compared to same-aged peers. It is not coincidence that this is typically the rough cutoff for intellectual disability.
Other tests use t scores. Again this is based on normative data. But the mean is typically set at 50 with a standard deviation of 10. For these tests, elevated scores are often defined as scores around or higher (1.5 to 2 standard deviations above the mean or higher).
The standard normal distribution. Approximately 68% of people earn scores within one standard deviation from the mean. Approximately 95% of people earn scores within two standard deviations from the mean. Raw scores can be transformed into standard scores to make them easier to understand.

14. Intelligence & Achievement Tests
Wechsler Intelligence Scales
Stanford-Binet
Intensive Achievement tests
Wechsler Achievement Test
Woodcock-Johnson Achievement Test
Intelligence generally measures inherent potential, whereas achievement measures what you have learned (yes there is overlap between the two constructs). The above mentioned tests are interactive and comprehensive, in that they usually take at least 2 hours to complete.
Common IQ tests include the Wechsler Intelligence Scales and the Stanford-Binet. The Wechsler, including the Wechsler Intelligence Scales for Children (WISC-IV) are probably the most common. The WISC-IV has a number of subscales and assess a number of domains of functioning (see following slides).
Administration procedures and scoring procedures are very particular, in order to maximize standardization. You need a good amount of training and need to following a very specific script when administrating.

15. WISC-IV: Verbal Comprehension SubtestsIV:
Verbal Comprehension reflects knowledge gained through formal and informal educational experiences and reflects the application of verbal skills to new situations. Everyday tasks that require verbal comprehension include providing factual information, defining words, and understanding verbal analogies.

16. The WISC-IV: Perceptual Reasoning Subtests
The WISC-IV: Perceptual Reasoning reflects the ability to organize and interpret visually presented material and to engage in visual-spatial problem solving. Everyday tasks that require perceptual reasoning include solving puzzles and mazes, manipulating geometric shapes, and understanding patterns.

17. WISC IV: Working Memory Subtests
Working Memory reflects the ability to attend to information, retain and manipulate information in memory, and apply information when necessary. Everyday tasks that require working memory include remembering someone’s telephone number and solving arithmetic problems in one’s head.

18. WISC IV: Processing Speed Subtests
Processing Speed reflect the capacity to visually scan and process nonverbal information quickly and accurately. Tasks that require processing speed include scanning a supermarket aisle for a specific product, or activities that require matching and sorting.

19. This is an example of one of the commonly administered standardized achievement tests- the Woodcock-Johnson III tests of Achievement. Like the WISC, it is standardized and administered individually (not like the group tests that most of you took in grade school).

20. Neuropsychological Tests: Trail Making Test
Numerous neuropsychological tests can be administered depending on the referral question. The trail making test measures a component of frontal lobe functioning. Above is an example of one of the tasks on the trail making test. In part A, the participant has to connect the dots in numerical order 1-2-3… In the second task, the participant has to go from number to letter in numerical and alphabetical order 1-A-2-B-3-C… The latter task is particularly difficult for people with frontal lobe damage as it requires switching from one cognitive set (numbers) to another (letters).

21. Checklists & Self-Report Measures
General symptom checklists
Example: BASC-2 (see next slide)
Example: CBCL (see attached link)
As you might imagine general symptom checklists screen for a variety of symptoms. The most common are the BASC and the CBCL. In both cases there are parent report versions, teacher report versions, and depending on age, child-self report. These supplement other assessment information collected. Again, standardized scores are collected (T scores). One can compare responses to a normative population. For example, elementary school-aged children are typically active, but you want to know if a child is hyperactive and more impulsive relative to same-aged peers. If the parents and teacher report that the child is in the 99th percentile for hyperactivity and impulsivity relative to same aged and gendered peers? This may indicate possible ADHD.

22. Sample BASC profile. Again scores are related to same aged peers
Sample BASC profile. Again scores are related to same aged peers. T scores are used, and elevated is defined by 1 standard deviation above the mean. Can you interpret his profile? It looks like what we call externalizing problems (aggression, hyperactivity), school problems, but no elevations in internalizing problems (anxiety, depression, etc.).

23. Checklists & Self-Report Measures
Children’s Depression Inventory
Subscales
Emotional Problems
Negative Mood/Physical Symptoms
Negative Self-Esteem
Functional Problems
Interpersonal Problems
Ineffectiveness
In addition to basic check lists, there are a number of self-report or parent measures that assess specific categories of symptoms. These tests can add to the assessment by (1) giving additional information about specific categories of symptoms, (2) getting a relative sense of symptom severity when compared to clinical populations and normative populations, and (3) helping us track symptom severity over time with objective data (e.g., to assess the actual changes in the scores over time).
The above example is the Children’s Depression Inventory. In addition to a total score you have 2 subscales, which are further divided into two additional subscales. I once assessed a girl, around the age of 10. She was showing signs of depression and I gave her the CDI. She showed a clear elevation (above any other elevation) on the Interpersonal Problems subscale. This was not readily apparent during the basic interview. This gave me a specific direction in which to follow-up and to target treatment.