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Chp 4. Assesment, Diagnosis & Treatment

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PSYC 412
Melanie Dirks

Chapter 4: Assessment, Diagnosis, and Treatment Clinical Issues: Case study of Felicia, 13, referred to a clinician because of depression, school refusal, social withdrawal at home and school, and sleep disturbance. Decision-Making Process: Clinical assessments: Use systematic problem-solving strategies to understand children with disturbances and their family and school environments. o Ongoing process of hypothesis testing regarding the nature of the problem, its causes, and likely outcomes if it is left untreated. o This process uses strategies, including an assessment of the childs emotional, behavioral, and cognitive functioning, as ell as the role of environmental factors. o Clinical assessments are only meaningful to the extent that they result in practical and effective interventions. These are not separate processes. Idiographic case formulation: To obtain a detailed understanding of the individual child or family as a unique entity. Nomothetic formulation: Emphasizes broad general inferences that apply to large groups of individuals (ie all children with depressive disorders). o A clinicians nomoethetic knowledge will result in better hypotheses to test at the idiographic level. Clinical interview, behavioral assessments, and psychological testing help with the decision making. Developmental Considerations: Age, Gender and Culture: A childs age has implications not only for judgments about deviancy, but also for selecting the most appropriate assessment and treatment methods. There are gender diffs in the rates and expression of childhood disorders. Most childhood disorders are defined by adults, who find the symptoms salient or troublesome. Overt displays of overactivity and aggression are more common in boys, who are referred for treatment as showing off or clowning (parents) or disturbing other pupils (teachers). o Girls may be overlooked because of their less visible symptoms. o Girls and boys should be studied as distinct groups in their own right. o In girls, relational aggression and physical aggression are the strongest predictor of future psychological-social adjustment problems. When adjustment problems are studied in relation to issues most salient for girls, it has been shown that girls do experience significant problems during childhood. Cultural patterns reflect learned behaviors and values shared among members. o Ethnic minority youth have a greater risk of being misdiagnosed, of not receiving treatment. o A clinical assessment should include a systematic review of the child and familys cultural background, the role of culture in the expression and evaluation of the childs symptoms, and the impact of culture on the childs relationships. Culture-bound syndromes: Refer to recurrent patterns of maladaptive behaviors and/or troubling experiences specifically associated with different cultures or localities. o How a childs adjustment is defined is embedded in culture, and identifies certain coping styles as acceptable, or certain behaviors as problems. What is considered abnormal varies among cultures. o In some cultures, mental health issues are seen as taboo, and intervention into personal family matters by strangers is viewed negatively. Generalizations about cultural practices rarely capture regional, generational, SES and lifestyle differences. o SES is a major confound in findings of differences in psychopathology rates between cultures, because ethnic minority cultures are overrepresented in low SES populations. o Acculturation level also impacts assessment: the lower the acculturation level, the higher you score on psychopathology, especially in conjunction with low SES and education level. Children can be matched with clinicians of the same ethnicity, or therapy can customize treatment to specific cultural beliefs, values and customs, or ethnic and cultural narratives and role play can be incorporated into therapy. o Understanding the cultural context is important for identifying treatment goals in relation to what is defined as optimal functioning for children in particular cultural groups. Normative Information: Felicias school refusal and sad mood started to occur after her mothers hospitalization. We need to know whether this is a normal reaction to a stressful live event from an individual of her age, gender, and culture. Parents must determine whether difficulties are chronic versus common and transient, and must decide when to seek advice from others and what treatment is best. What defines childhood disorders is the age inappropriateness and pattern of symptoms, and the extent to which symptoms result in impairment in the childs functioning. o Problems displayed by children referred for treatment occur in less extreme forms in the general pop/in other young children, such as sadness, difficulty concentrating, inattentive, temper, etc. Purposes of Assessment: Three common purposes of assessment: o 1) Description and diagnosis o 2) Prognosis o 3) Treatment Description and Diagnosis: Clinical description: Summarizes the unique behaviors, thoughts, and feelings that together make up the features of the childs psychological disorder. A clinical description attempts to establish basic info about childrens and parents presenting complaints, esp how their behavior/emotions are different from/similar to those of other children of the same age, sex, socioeconomic and cultural background. o First, you assess and describe the intensity, frequency and severity of a problem. o Second, you describe the age of onset and duration of the difficulties (relative to what is considered normative for a given age). o Third, you want to convey a full picture of all symptoms and their configuration. Diagnosis: Analyzing info and drawing conclusions about the nature/cause of the problem, or assigning a formal diagnosis. Diagnosis has two separate meanings: o Taxonomic diagnosis: Focuses on the formal assignment of cases to specific categories drawn from a system of classification like the DSM-IV-TR or from empirically derived categories. o Problem-solving analysis: Similar to clinical assessment, views diagnosis as a process of gathering info used to understand the nature of an individuals problem, its possible causes, treatment options and outcomes. Felicias assessment will involve a complete diagnostic (problem-solving analysis). She may receive a formal diagnosis of MDD, and maybe a secondary diagnosis of an anxiety disorder because comorbidity of depression and anxiety is common among girls her age. Prognosis and Treatment Planning: Prognosis: The formulation of predictions about future behavior under specified conditions. (ie: What will happen to Felicia if she does not receive help?) Treatment for children often focuses on enhancing the childs development rather than merely removing symptoms or restoring a previous level of functioning. Treatment planning and evaluation: Using assessment info to generate a plan to address the childs problem and evaluate its effectiveness. o This may involve further specification and measurement of possible contributors to the problem, determination of resources and motivation for change, and recommendations for treatments likely to be the most feasible, acceptable and effective for the child +family. Assessing Disorders: Multidisciplinary teams: May include a psychologist, a physician, an educational specialist, a speech pathologist, and a social worker. Multimethod assessment approach: Emphasizes the importance of obtaining info from different informants in a variety of settings and using a variety of methods that include interviews, observations, questionnaires and tests. o Methods must be reliable, valid, cost-effective, and useful for treatment. o Deciding which assessment method to use depends on whether it is for diagnosis, treatment planning, or treatment evaluation. Purpose: To obtain the most complete picture possible to develop
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