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PSYCH 2320A/B (70)

Elizabeth Hayden (10)

Chapter 4

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

by OC64854

School

Western University

Department

Psychology

Course Code

PSYCH 2320A/B

Professor

Elizabeth Hayden

Chapter

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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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