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Chapter 4

Psychology 2320A/B Chapter Notes - Chapter 4: Neuropsychological Assessment, Learning Disability, Conduct Disorder


Department
Psychology
Course Code
PSYCH 2320A/B
Professor
Elizabeth Hayden
Chapter
4

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4- Assessment, Diagnosis and Treatment
January-21-13
11:06 AM
CLINICAL ISSUES
Decision-Making Process
Finding answers to immediate and long-term questions abt nature and course of child's disorder and
optimum treatment
Clinical Assessment: use systematic problem -solving strategies to understand children with
disturbances and their family/ school environments
o Assessment of child's emotional, behavioural and cognitive functioning, including enviro
factors
o Testing regarding nature of problem, causes, likely outcomes if left untreated
Clinical assessment broader than interviewing/testing alone
Goal- achieve effective solutions to the problems being faced and promote and enhance their well
being
Clinical assessment meaningful to extent that they result in practical and effective interventions,
assessment and intervention NOT viewed as separate
Idiographic case Formulation: clinical assessment to obtain a detailed understanding of individual
child or family as unique entity
Nomothetic Formulation: emphasizes broad general inferences apply to large groups of individuals
Clinicians begin decision making- clinical interview, behavioural assessments, or psychological
testing, NOT something done to a child but a collaborative process where child and family play an
active role
Developmental Considerations
Age, Gender and Culture
o Childs age has implications for judgments about deviancy also selecting most appropriate
assessment and treatment methods (age 13, school refusal is imp, time-out for 3yr old vs.
school age child)
o Gender differences in rates and expression of childhood disorders (pg. 84, Table 4.1)
Boys- over activity and aggression, may be over-referred for "clowning around,
disturbing pupils"
Girls commonly overlooked for their less visible forms of suffering
Difficulty in distinguishing b/w true gender differences and differences in reporting
Social aggression in girls- insults, gossip, ostracism getting even, "relational
aggression" third party retaliation
Children who engage in social aggression not typical for their sex significantly more
maladjusted then children who engage in gender-normative forms of aggression
o Cultural patterns reflect learned behaviours and values that are shared among members,
distinguish group members of one group from another
Culture includes: ethnicity, language, religion, race, gender, SES, age, sexual
orientation geographic origin, group history, education and upbringing and life
experiences
Ethnic minority youth greater risk of being misdiagnosed- diagnosed with more
organic/mood disorders and less likely to receive treatment
Clinicians must examine their own belief systems and culturally based assumptions
guide clinical prac

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Cultural information necessary to establish relationships, obtain accurate info,
accurate diagnosis and treatment, role of culture in child's expression of symptoms
Cultural values may have impact on relationship b/w child, family and clinician - must
consider ethnic identity and racial socialization
Culture-bound syndromes: recurrent patterns of maladaptive behaviours and/or
troubling experiences specifically associated with different cultures or localities (i.e.
"evil eye")
Childs adjustment defined by child's culture, identifies certain coping styles as
acceptable or behaviours as problems, what's considered abnormal varies depending
on group
Difficult to engage parents if mental health issues seem as taboo intervention into
personal family matters is viewed negatively or causes of illness in culture seen as
physical/spiritual
Lover level of ones acculturation, higher scores on measures of psychopathology esp.
with edu/SES
Match children to same cultured clinician or customize treatment to cultural values,
beliefs & customs
Understanding cultural context essential for identifying treatment- optimal goals for
children of colour would be to moderate racial stress and adversity through
collectivism, racial/ethnic pride…
Normative Information
o Knowledge, experience, basic info about norms of child development/behaviour problems-
crucial beginning to understanding how children's problems or needs come to the attention
of professionals
o Parent face difficulty determining whether child's condition is chronic/common and deciding
when to seek help and what's the best type of treatment
More difficult for immigrant parents with children navigating two cultures
o Isolated symptoms of behavioural/emotional problems show little correspondence with
children overall adjustment
o Age-inappropriateness and pattern of symptoms rather than ind, define childhood
disorders, also extent to which symptoms result in impaired functioning
o Some behaviours occur to some extent in all children- sadness, lack of concentration,
demands for attention top.
Behaviours of referred similar to those in less extreme forms in pop'n
Purposes of Assessment
Description and Diagnosis
o First step to identifying child's problem is Clinical description: summarizes unique
behaviours, thoughts, and feelings that together make up the features of the child's
psychological disorder
Attempts to establish basic info about child's presenting complaints, especially how
child's behaviour or emotions are different from or similar to those of other children
some age, sex, SES, cultural backend
o Describe how behaviour differs from normal children:
1. Assessing and describing the intensity, frequency and severity of the problem
2. Age of onset and duration of their difficulties
3. Convey full picture of their different symptoms and their configuration (know entire profile
child's weaknesses and strengths to make informed choices about course, outcome,
treatment)

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o Next want to determine whether description meets criteria for diagnosis of 1+ psychological
disorders
o Diagnosis: analyzing info and drawing conclusions about the nature or cause of the problem,
or assigning a formal diagnosis
o Diagnosis acquired 2 formal meanings
Taxonomic Diagnosis: focuses on the formal assignment of cases to specific categories
dram from DSM-IV-TR or from empirically derived categories
Solving Analysis: broader, views diagnosis as process of gathering info used to
understand nature of ind problem, possible causes, treatments options and outcome
o Major Depressive Disorder: posses characteristics that link her to similar youths presumed
to have the same disorder
o Commodity exists when certain disorders among children/adolescents are likely to co-occur
within the same individual especially disorders that share many common symptoms
Conduct disorder and ADHD. Autism and intellectual disability, childhood depression
and anxiety
Prognosis and Treatment Planning
o Prognosis: formation of predictions about future behavior under specified conditions
Clinicians weigh probability that circumstances will remain the same improve,
deteriorate, with/without treatment & the course of treatment should be followed
Treatment focuses on enhancing child development rather than merely removing
symptoms or restoring previous level of functioning
o Treatment Planning & Evaluation: using assessment info to generate a plan to address the
child's problem and evaluate its effectiveness
Involve further specification and measurement of possible contributors to the
problem, determination of resources, motivation for change and recommendations
for treatments likely to be feasible
ASSESING DISORDERS
Clinical settings use multidisciplinary team approach to assessment- ind with specific expertise in
psychological testing/interpretation work together to generate most complete picture of child's
mental health needs
o Include: psychologist, physician, educational specialist, speech pathologist & social worker
May need medial exam to determine whether physical problem is related to disorder. EX:
psychological problem may cause bed-wetting or sleep disorder
Multimethod Assessment Approach: obtaining info from different informants in variety of
settings, using variety of methods including interviews, observations, questionnaires and tests
Deciding what assessment method is best based on whether assessment is for - diagnosis,
treatment, planning, treatment evaluation, if problem is observable or internal, child/family
characteristics and abilities
Methods used must be reliable, valid, cost-effective and useful for treatment
Clinical interviews with child/family/both help establish good working relationship with child and
family, obtaining basic info about existing concerns and directions for further inquiry
Behavioural assessments, checklists, rating scales, psychological tests used in accordance with
decision-making ape
Information attained from teachers and significant individuals who interact with child in various
settings
o Obtain most complete picture of the child
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