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slk 310 - child > Chapter 4: Assessment, Diagnosis and Treatment > Flashcards

Chapter 4: Assessment, Diagnosis and Treatment Flashcards

1
Q

Clinical assessments

A

Use systematic problem-solving strategies to understand children with disturbances and their family and school environment.

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2
Q

Ultimate goal of clinical assessments?

A

Achieve successful solutions to problems.

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3
Q

What does strategies do?

A

Form the basis of hypothesis testing regarding the nature of the problem, its causes, and the likely outcomes if the problem is treated.

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4
Q

Strategies typically include an assessment of the child’s:

A
  1. Emotional
  2. Behavioural
  3. Cognitive functioning
  4. Role of environmental factors
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5
Q

On what is the focus of a clinical assessment?

A

Idiographic case formulation

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6
Q

Idiographic case formulation

A

Obtain detailed understanding of the individual child or family as an entity.

Tendency to specify

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7
Q

Nomothetic formulation

A

Emphasises broad general inferences that apply to large groups of individuals.

Tendency to generalise

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8
Q

What must one be sensitive towards when assessing a child and their family?

A

Age, gender, cultural background and have normative information typical and atypical development.

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9
Q

When it comes to AGE, why must one recognise the diversity within children’s developmental functions and capacities at various ages?

A

A child’s age implicates judgements about deviancy and for selecting the most appropriate assessment and treatment methods.

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10
Q

Explain why GENDER also has implications for assessment and treatment?

A
  • BOYS are more likely to display early-onset disorder such as autism spectrum disorder (ASD) or ADHD
  • Overactivity and aggression are more common in boys.
  • GIRLS are more likely to display disorders with onset at adolescence such as depression and eating disorders.
  • Girls express emotion in less observable ways
  • Girls show aggression more indirectly = rational aggression
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11
Q

What are CULTURAL FACTORS based on?

A
  • Cultural identity
  • Cultural concepts of distress
  • Psychosocial stressors and cultural features of resilience
  • Cultural aspects of relationships
  • An overall cultural assessment and appropriate plan for treatment.
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12
Q

CULTURAL SYNDROMES

A

A pattern of co-occuring, relatively invariant symptoms associated with a particular cultural group or community.

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13
Q

Normative information

A

Knowledge, experience and basic information about norms of child development and behavior problems is crucial to referrals and treatment.

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14
Q

What can define childhood disorder?

A
  • Age appropriateness -
  • Severity -
  • Pattern – of symptoms
  • Extent to which symptoms result in impairment
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15
Q

Purposes of assessment

A

Children & families are assessed for one or more purposes ; these purposes guide the assessment process ; including decisions made about particular assessment methods.

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16
Q

3 common purposes of assessment:

A
  1. Description and diagnosis
  2. Prognosis
  3. Treatment planning and evaluation
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17
Q

1.) Description and diagnosis

A

First step in understanding a child’s problem is to provide a CLINICAL DESCRIPTION.

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18
Q

Clinical description

A

Summarizes the unique behaviours, thoughts, and feelings that together make up the features of the child’s psychological disorder.

  • It attempts to establish basic information about the child’s concerns at presentation ; especially how the child differs from other children the same age, sex, socioeconomic, and cultural background.
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19
Q

CLINICAL DESCRIPTION PROCESS:

A

STEP 1 – assessing and describing the intensity, frequency and severity of their problem.

STEP 2 – describe the age at onset and duration of their difficulties.

STEP 3 – you would want to convey a full picture of their different symptoms and their configuration.

STEP 4 – determine whether this description meets the criteria for diagnosis for one or more psychological disorders.

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20
Q

Diagnosis

A

Analysing information and drawing conclusions about the nature or cause of the problem, or assigning a formal diagnostic label for a disorder.

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21
Q

Taxonomic diagnosis

A

Focuses on the formal assignment of cases to specific categories drawn from a system of classification (e.g., DSM-5) or from empirically derived traits or dimensions.

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22
Q

Problem-solving analysis

A

Much broader meaning ; is similar to clinical assessment and views diagnosis as a process of gathering information that is used to understand the nature of an individual’s problem, it’s possible causes, treatment options and outcomes.

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23
Q

Comorbidity

A

when certain disorders are likely to co-occur in the same individual

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24
Q

Prognosis

A

It is the formulation of predictions about future behaviour under specified conditions.

Treatment planning and evaluation apply assessment information to generate a treatment plan and to evaluate its effectiveness

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25
Q

Treatment planning and evalution

A

Using assessment information to generate a plan to address the child’s problem and to evaluate the effectiveness of the treatment.

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26
Q

How are disorders assessed in many clinical settings?

A
  • Multidisciplinary teams are commonly used for assessment
  • Teams may comprise psychologists, physicians, educational specialists, speech pathologists, and social workers
  • Some cases may require a medical examination referral
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27
Q

Multimethod assessment approach

A

Emphasises the importance of obtaining information from different informants in a variety of settings and using a variety of methods that may include:

  • Interviews
  • Observations
  • Questionnaires
  • Tests
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28
Q

Clinical interviews

A
  • Usually conducted with the parents and child SEPARATELY or in a family interview and helps to establish a good working relationship with the child and family.
  • Useful in obtaining basic information about existing concerns.
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29
Q

The purpose of interviews

A
  • Interviews allow professionals to gather information in a flexible manner over many sessions.
  • The findings can then be integrated into a more time consuming assessment such as family observations and psychological testing.
30
Q

What does the interviewer observe during the interview?

A

nonverbal communications such as facial
expressions, body posture, voice, mannerisms.

31
Q

What do you want to do for the interview depending on the child’s age?

A

adopt an approach for the interview that fits
the child’s developmental status ; nature of the problem ; and the interview purpose.

32
Q

Developmental and family history

A

Information is obtained from the PARENTS regarding potentially significant developmental milestones and historical events that might impact the child’s current difficulties.

33
Q

Background questionnaire information: in terms of developmental and family history

A

Þ Child’s birth and related events
Þ Child’s developmental milestones
Þ Child’s medical history
Þ Family characteristics and history
Þ Child’s interpersonal skills
Þ Child’s educational history
Þ Adolescent’s work history and relationships
Þ Description of the presenting problem
Þ Parents’ expectations for assessment and treatment

34
Q

Semi structured interviews

A

These include specific questions designed to elicit information in a relatively consistent manner regardless of who is conducting the interview.

Can be administered by a computer.

They are reliable and very useful in assessing a wide range of children’s symptoms.

35
Q

Semistructured Interview Questions for an older child or adolescent with depression.

A
  • Depressed mood/ irritability
  • Loss of interest
  • Self-deprecatory ideation
  • Sleep disturbances
  • Change in school performance
  • Decreased socialization
  • Somatic symptoms
  • Loss of usual energy
  • Change it appetite &/ weight
36
Q

Behavioural assessment

A

A strategy for evaluating the child’s thoughts, feelings, and behaviors in specific settings, and then using this information to formulate hypotheses about the nature of the problem and what can be done about it.

37
Q

Purpose of behavioural assessment?

A

To obtain the most complete picture possible to develop and implement an appropriate treatment plan – within the limits of available resources.

38
Q

Target behaviours

A

The primary problems of concern, with the goal of then determining what specific factors may be influencing these behaviors.

39
Q

ABCs of assessment

A

Þ A = Antecedents, or the events that immediately precede the behaviour
Þ B = Behaviour (s) of interest
Þ C = Consequences, or the events that follow a behaviour

40
Q

Behavior analysis/ functional analysis of behavior

A

The more general approach to systematically organizing and using assessment information in terms of the ABCs.

41
Q

Checklists and rating scales

A
  • Global behavior checklists are used to ask parents, teachers, sometimes the youths, to rate the presence or absence of a wide variety, frequency & intensity of child behaviors.
  • Informants may differ in views, this is good since it informs the clinician on possible range of behaviors, circumstances that increase or decrease target behaviors and possible unrealistic demands placed on the child.
42
Q

The child behaviour checklist

A
  • a leading checklist for assessing behavioral problems in children & adolescents ages 6-18;
  • used in treatment settings and schools ;
  • gives clinician an overall picture of the variety and degree of the child’s behavioral problems
  • reliability & validity has been documented in numerous studies
43
Q

Behavioral observation and recording

A
  • Parents or other observers record baseline data to provide information about behaviors in real-life settings
  • Recordings may be done by parents or others
  • May be difficult to ensure accuracy
  • Clinician may set up role-play simulation to observe children and their families
44
Q

Psychological testing

A

A task or set of tasks given under standard conditions with the purpose of assessing some aspect of the child’s knowledge, skill or personality.

Child’s scores are compared with those of a norm group.

45
Q

What do clinicians commonly use in terms psychological testing?

A
  • Devlopmental scales
  • Intelligence and educational tests
  • Projective tests
  • Personality tests
  • Neuropsychological tests
46
Q

Developmental test

A

Used to assess infants and young children, and are generally carried out for the purposes of screening, diagnosis, and evaluation of early development.

47
Q

Screening

A

Identifying children at risk, who are then referred for a more thorough evaluation.

  • Infants and children at risk of developing mental problems later in life are now being assessed
  • Screening tests are brief, a more thorough assessment of a young child’s development and risk for psychopathology is also needed.
  • Early screening of children with ASD in primary care settings is now a key to early intervention

Griffiths Scales of Child Development

48
Q

Intelligence testing

A

Evaluating a child’s intellectual and educational functioning.

  • We might want to assess for the child developmental capacities or intelligence.
  • For many children problems in thinking and learning may be part of the disorder itself.
49
Q

Wechsler Intelligence Scale for Children (WISC-5)

A

Þ Made up of 10 mandatory and 6 supplementary subtests that span the age range 6-16
Þ One of the most frequently used intelligence scales.
Þ Emphasizes fluid reasoning abilities, higher order reasoning, and information processing speed
Þ Tells us about a child’s verbal, cognitive and intellectual abilities.

50
Q

What are the 5 primary index scales of the WISC-5?

A
  1. Verbal comprehension index (VCI) - Measures verbal concept formation, verbal reasoning, and knowledge acquired through experiences and learning.
  2. Visual spatial index (VSI) - Measures spatial processing, attentiveness to detail, visual perception and organization, and visual-motor integration.
  3. Fluid reasoning index (FRI) - Measures novel problem solving and interpret patterns and sequences.
  4. Working memory index (WMI) - Measures attention, concentration, and mental control.
    - Digit span
    - Picturespan
    - Letter-numbering sequencing
  5. Processing speed index (PSI) - Measures ability to complete a series of rote tasks involving motor coordination, visual processing, and search skills quickly and accurately.
    - Coding
    - Symbolsearch
    - Cancellation (identify visual information from random and non-random arrangements)
51
Q

Projective testing

A

Present the child with ambiguous stimuli such as inkblots or pictures of people, and the child is asked
to describe what they see.

52
Q

Projective techniques used include:

A
  • Rorschach inkblot test
  • Thematic picture test
  • Human figure drawings
53
Q

The hypothesis of the Rorschach inkblot test?

A

The child will project their own personality - unconscious fears, needs, and inner conflicts – onto the ambiguous stimuli of other people or things.

54
Q

PERSONALITY TESTING

A

An enduring trait or pattern of traits that characterize the individual and determine how they interact with the environment.

Minnesota Multiphase Personality Inventory - Adolescent (MMPI-A)

55
Q

NEUROPSYCHOLOGICAL ASSESSMENT

A

Attempts to link brain functioning with objective
measures of behavior known to depend on an intact central nervous system.

Delis-Kaplan Executive Functioning System, the D-KEFS (known to be located in the prefrontal cortex of the brain)

56
Q

Delis-Kaplan Executive Functioning System, the D-KEFS

Assesses a full range of psychological functions?

A
  • Cognitive functions
  • Perceptual functions
  • Motor functions
  • Emotional/executive control
57
Q

Classification

A

a system for representing the major categories or dimensions of child psychopathology, and the boundaries and relations among them.

58
Q

Clinical assessment and diagnosis involve 2 related strategies:

A
  1. Idiographic strategy – highlight a child’s unique circumstances, personality and cultural background
  2. Nomothetic strategy – attempt to name or classify the problem using existing system of diagnosis e.g., DSM-5
59
Q

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-5):

A

Used to describe homogenous subgroups with a disorder that share particular features and to communicate information that is relevant to treatment of the disorder.

60
Q

What are the DSM-5 specifiers?

A

➢ Subtypes of the disorder - inattentive presentation in a child with ADHD

➢ Co-occurring conditions - language impairment in a child with ASD

➢ Course of disorder - Onset prior to age of onset

➢ Severity of disorder - ‘mild’ ; ‘moderate’ ; ‘severe’ ; ‘profound’

61
Q

comorbid diagnosis

A

is second (or third, or more) disorder that also
meets the full diagnostic criteria that co-occurs with the primary diagnosis.

62
Q

Differential Diagnosis

A

The process of identifying all possible diagnoses and eliminating the least likely possibilities to, ultimately, arrive at the final diagnosis.
Hence, this involves differentiating between
conditions in order to decide which fits the clinical picture the best.

63
Q

Why is it important to consider psychosocial and environmental problems?

A

This may affect the diagnosis, treatment, and prognosis of clinical disorders.
Such problems include:
Þ Negative life events
Þ Family stress
Þ Lack of social support

64
Q

Pros of diagnostic labels:

A
  • Labels help clinicians summarize and order observations, which can facilitate communication among professionals and aid parents in understanding their child’s problem.
  • Descriptive labels with our natural tendency to think in categories e.g., “Hi I am Mecayla, I am a happy person”.
  • Descriptive labels help clinicians in their research.
65
Q

Cons of diagnostic labels:

A
  • Concerns about the negative effects of stigmatization when labelling a child.
  • Once labelled, others might perceive and treat the child differently.
  • Labels can negatively influence children’s views of themselves & their behaviour.
66
Q

Intervention

A

a broad concept that encompasses many different theories and practices directed at helping the child and family adapt more effectively to their current and future circumstances.

67
Q

Prevention

A

efforts directed at decreasing the chances that undesired future outcomes will occur

68
Q

Treatment

A

corrective actions that will permit successful adaptation by elimination or reducing the impact of an undesired problem or outcome that has already occurred

69
Q

Maintenance

A

efforts to increase adherence to treatment over time to prevent relapse or recurrence of a problem

70
Q

Treatment goals

A
  • Outcomes related to child functioning: Reduction or elimination of symptoms.
  • Outcomes related to family functioning: Reduction in family disfunction
  • Outcomes of societal importance: Reduction in mental health care costs
71
Q

GENERAL APPROACHES TO TREATMENT:

A
  1. Psychodynamic treatments - Focus is on helping the child develop an awareness of unconscious factors that may be contributing to their problems.
  2. Behavioural treatments - Focus is on re-educating the child.
  3. Cognitive treatments - The treatment is on changing these faulty cognitions.
  4. Cognitive-Behavioural treatments - Identifies maladaptive cognitions & replace them with more adaptive ones.
  5. Client-centred treatments - Focuses on what the client needs.
  6. Family treatments - Treatment involves a therapist who interacts with the whole family.
  7. Combined treatments - The use of two or more interventions.
72
Q

5 core principles of therapeutic change

A
  1. Feeling calm – calming techniques
  2. Increasing motivation - praise
  3. Repairing thoughts – changing biases
  4. Solving problems – goal setting
  5. Trying the opposite – breaking problems
    into smaller steps.

slk 310 - child (6 decks)

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