Lecture 4 Flashcards
Clinical assessment
Mental health clinician- try and understand child’s basic problems to inform diagnosis and treatment plan
Sort through many factors and decipher if they ontribute to the problem
Form hypothesis on diagnosis
Use systematic process to differentiate define and treat participants emotions and cognitions
Assess environmental and social contributing factors
Testing the hypothesis
Series of educated guess and check
Goal- inform effective solutions to child and families problems
Intervention and assesment go hand in ad
Idiographic and Nomothetic Approaches
Combine the two approaches
Idiographic- focus on specific child, family focus on individual case, focus of clinical assessment
Nomothetic- broad assessment on children and this diagnosis- inform hypothesis and Eli build it
Developemental considerations
Need to consider these factors as well as individual factors
Nomothetic factors- inform on abnormal development and treatment
age abnormality, treatment methods- some help younger better than older
Informs what qualifies as abnormal behaviour attachment anxiety- infant vs 7 year old, indicate problem
Gender- research suggests gender differences in disorders
Boys- higher externalizing behaviours
Difference in prevelance rates, aggression= more common in males
Informs how the problems present and how to treat it
Culture-
Defines abnormality and assesment
Minorities at greater risk for undiagnosed and false diagnosis- knowlegdhe of this helped treat minorities better, syndromes dedicated to culture- don’t match western syndromes
Medicine- based on western principles- dont focus on different cultures
Match families with someone of same ethnicity
Take culture into context
Normative info
Need to understand norms of child development
Isolated symptoms show little correspondence with children’s overall adjustment
Age inappropriateness
Severity
Pattern of symptoms
Impairment
Consider what is normal development- understand normal development
Combination of factors that differentiate disorders
Need to consider more than just individual symptoms
Children referred often exhibit the following
Cant concentrate, poor schoolwork, stubborn, sulks, nervous, demands attention
3 main purposes of assesment
Diagnosis Forming a clinical description
Intensity, frequency, and severity
Age at onset and duration
Different symptoms and their configuration- understanding strengths and weaknesses
Informs course, outcomes and treatments
Summaries child’s thoughts behaviours feelings
Establish basic info on concerns of child- nature nad cause- can result in informal diagnosis
Understand intensity- informs deficiency of child and severity of problem
Understand the development of the problem
Prognosis predicting future behaviour Where child will be with or without treatment
Will it get worse, better
Wetting the bed- will likely go away
Helps parents understand importance of acting now and reduces later problems
Treatment planning Generating a treatment plan
Evaluating its effectiveness
Previous steps Informs treatement- reduces symptoms and promotes strengths
Restore previous functioning and then some
Want them to exceed baseline
Involves meausring other factors- how to make change and problems you may run into
Clinical assessment information sources
Information is obtained from:
Different informants
Different settings
Different methods
Multi method assessment strategy
Goal- provide an image of the child problem and strengths
Different assessment methods
Clinical interviews Include a developmental or family history
Mental status exam
Most universally used
Provide lots of info in short time
Separate child and parent or together
Establish family and child dynamics
Understand family and developmental history- Menta status exam- looks at children’s functioning- helps form hypothesis- pay attention to appearance, behaviour, thought process
Differed in structure
Unstructured- informal flexible, child is guide, general wuations
Semi structured- specific questions asked to elicit response but allows participant to add detail
Structured- specific questions to guide answers
Pro- unstructured- help learn edition all info understand child’s thoughts better
Supports natural interview process, helps ease child’s anxiety
Semi structures- pro- focus more on specifics, best of both, keeps child more on topic, allows you to answer specific questions
Cons- reliability, replicability
Con structured- loss of spontaneity, hard to build trust, miss info
Structured interview questions for older children Depressed Mood/Irritability
Do you feel sad?
Do you get moody?
Loss of Interest
Have you lost interest in doing things, like your hobbies?
Is there anything you look forward to doing?
Self-Deprecatory ideation
Do you feel that you are worthless?
Have you thought about committing suicide?
Tap into symptoms
Yes or no questions- reliable and standard but don’t undeerstand full context
Useful to balance direct questions with open questions- child can expand
Clinical interview= starting point
Behavioural assessment Evaluating the child’s thoughts, feelings, and behaviors in specific settings
“ABCs of assessment” are to observe the:
Antecedents- prior to behaviour
Behaviors- focus behaviours
Consequences of the behaviors
Next step
Aim to get understanding of child’s everyday behaviour and feeling
Follows abcs of assesment
Goal to identify as many as you can
Behavioural, functional analysis, ABC
Understand why behaviour occurs
Understand circumstances that lead to inappropriate behaviour
Behaviour- disruptive action
Important to focus on enviroment- trigger for inappropriate behaviour
Teahcer calls student up to board to finish problem- student refuses and teacher continues to push causing student to curse out teacher
an event= ask to go up to board
Behaviour- curse out teahcer
Consequence- get sent to social worker
More data= the better
METHODS FOR BEHAVIORAL ASSESSMENT
1.
Behavior Checklists and Rating Scales
2.
Behavioral Observation and Recording
Checklist and rating scales Allow for comparisons with with a known reference group
Economical- easy to administer and score, provide different reporters
Lack of agreement- not an issue provides info on different settings and contexts
Get understanding of wide variety of behaviours and their severity and occurance
Standardize- compare child to reference children, provide comparison to normal development
THE CHILD BEHAVIOR CHECKLIST (CBCL)
Most common
Used for ages 6-18 in treatment and school setting, good reliability and validity
Parent teahcer and clinician version
Culturally relevant
Helps understand different domains of functioning
Behavioural observation Parents or other observers record baseline data to provide information about behaviors in real-life settings
Recordings may be done by parents or others
Clinician may set up role-play simulations- see hoe child and family behave
Not all children can report on wn behaviour- use observation and recording
Parents and servers report behaviour before intervention
Different methods to ensure participation- phone reminders
Pro- gather ongoing image of behaviour in real life settings, help support observers attentiveness to child, provide patient with info ion child severity
Con- children know when being washed, nature of problem, family context can bias results
Psychological testing
Tests: tasks given under standard conditions
The purpose is to assess some aspect of the child’s knowledge, skill, or personality
A child’s scores are compared with those of a norm group- compare to children of similar scenario to understand extent child’s score deviates from norm
Code of Fair Testing Practices- gives specific guidelines for the tasks
Standardized
Contain set off standardized tasks- to gain info on child’s intelligence skill and personality
May not be the best for different cultures- were tested with western culture this is beginning to change
Psychological testing methods
Developemental tests Screening- identify at risk child, diagnosis, and evaluation
Used with very young children
Screening- esp important- methods have become better over the years
Caresetting provide screening for ASD- brief and easy, not use to diagnose but recommend further screening
Evaluates a child’s intellectual and educational functioning
The Wechsler Intelligence Scale for Children (WISC-IV) most popular, scores many different functions- WM. Kaufman Assessment Battery for Children (K-ABC-II)-Ages 3-18
Intelligence tests Behavipoural and emotional problems can cause impairement in intellect
Learning deficiency can be apart of the problem
Not one definition of intelligence
Intelligence tests- identify children with problems in school setting
Non-verbal (“culturally fair”) intelligence tests
Raven’s Progressive Matrices (RPM) non- verbal estimate of fluid intelligence- more culturally fair- look at shapes- different rules for rows and columns, pick response that best completes pattern
60-item test used in measuring abstract reasoning
Projective testing
Present ambitious stimuli and ask them to describe what they see
Child will project personality, fear and conflict unconsciously onto image- expose unconscious thoughts and feelings
Controversial- some see them as useful and some don’t
Frequently used assesment tool
Focuses on perception
Play therapy Using Play for Diagnostic Purposes
Example: MacArthur Story Stem Battery (MSSB)
Narrative based task
Experimenter introduces narrative using dolls and asks child to complete it
Mother doll takes hot cookies and tells child to wait for cookie, child tries cookie and burns the self and child is asked to complete story
The narrative of the child taps into family relationships, personality
Personality tests Central dimensions of personality:
Timid or bold
Agreeable or disagreeable
Dependable or undependable
Tense or relaxed
Reflective or unreflective
Personality- described as stable trait
Shaped by experiences somewhat and changes over time
To assess personality- interview, self report, tests
Measuring the self
The Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (Ages 4 to 7 young children respond well to pictures- displays pictures of child with high vs low compentency and child chosses which is most like them
Harter & Pike (1983)
Harter scales Self-Perception Profile for Children (Ages 8 to 13)
This instrument taps five specific self-concept domains: Scholastic Competence, Athletic Competence, Social Competence, Physical Appearance, and Behavioral Conduct.
In addition, a separate, sixth subscale, taps Global Self-Worth (or self-esteem). There are a total of 36 items, six for each subscale.
Neuropsychological tests Attempts to link brain functioning with objective measures of behavior known to depend on an intact central nervous system
Involves use of comprehensive batteries
Assesses a full range of psychological functions
Assesses multiple factors- attention, intelligence, memory
Can be used to make inferences abt CNS dysfunction
Strop test
Classification and diagnosis
Classification: a system for representing the major categories or dimensions of child psychopathology
When diagnose- assign case to one or more categories of classification systems
Involve these two strategies
Ideographic- understand child’s unique experiences/ situation
Nomothetic-benefit from accumulated knowledge, understand treatment, outcome
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
ICD-10
International Classification of Diseases, 10th Edition
Categorical classification systems
Assume every diagnosis has underlying cause and each disorder is unique and independent from other
Used to make hypothesis on disorders
Building understanding of disorder
2 Approaches to diagnosis
Categorical- individual cases org into individual categories
Symptom requirements
Based on current understanding of symptoms and abnormal behaviour
Dimensional— disorder has behaviours and all with disorder exhibit symptoms on a continuum- severity of disorxer
Pros- categorical- easier to diagnose, know what category they fall int0- can assess based on that, used for qualification of services- also con
Helps communication bw clinicians
Cons- children’s disorders don’t fall into perfect categories
Pro- dimensional- good for research, accounts for individual differences in disorder
Research domain criteria
Current classification systems focus on observable behaviors
RDoC focuses on the underlying biology of the disorder
Five domains of functioning are included in this system:
Negative Valence
Positive Valance
Cognitive
Systems for Social Processes
Develop future classifications based on underlying biology of disorder
Not intended to be used as diagnostic guide- aim is to improve understanding on mental health and their biological factors
Arousal/Regulatory
