PSYC 412 Chapter Notes -Separation Anxiety Disorder, School Refusal, Educational Specialist

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19 Apr 2012
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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.
oOngoing process of hypothesis testing regarding the nature
of the problem, its causes, and likely outcomes if it is left
untreated.
oThis process uses strategies, including an assessment of the
child’s emotional, behavioral, and cognitive functioning, as
ell as the role of environmental factors.
oClinical 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).
oA clinician’s 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 child’s 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’
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(parents) or ‘disturbing other pupils (teachers).
oGirls may be overlooked because of their less visible
symptoms.
oGirls and boys should be studied as distinct groups in their
own right.
oIn 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.
oEthnic minority youth have a greater risk of being
misdiagnosed, of not receiving treatment.
oA clinical assessment should include a systematic review of
the child and family’s cultural background, the role of
culture in the expression and evaluation of the child’s
symptoms, and the impact of culture on the child’s
relationships.
Culture-bound syndromes: Refer to recurrent patterns of
maladaptive behaviors and/or troubling experiences specifically
associated with different cultures or localities.
oHow a child’s 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.
oIn 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.
oSES is a major confound in findings of differences in
psychopathology rates between cultures, because ethnic
minority cultures are overrepresented in low SES
populations.
oAcculturation 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.
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oUnderstanding 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:
Felicia’s school refusal and sad mood started to occur after her
mother’s 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 child’s functioning.
oProblems 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:
o1) Description and diagnosis
o2) Prognosis
o3) Treatment
Description and Diagnosis:
Clinical description: Summarizes the unique behaviors,
thoughts, and feelings that together make up the features of the
child’s psychological disorder.
A clinical description attempts to establish basic info about
children’s 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.
oFirst, you assess and describe the intensity, frequency and
severity of a problem.
oSecond, you describe the age of onset and duration of the
difficulties (relative to what is considered normative for a
given age).
oThird, 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:
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