Ch 4 Assessment Diagnosis and Treatment 1 Be familiar with Felicia s case presentation p 82 more details throughout the chapter a Felicia i Presenting problem 1 Depression school refusal social withdrawal at home school and sleep disturbance ii Family environment 1 Mother hospitalized for pneumonia iii School iv Self report 1 13 yr old 8th grade 1 No one liked her she couldn t do anything well her life was hopeless 2 What are the main questions in the diagnostic process and how are they addressed a What treatment is needed i Clinical assessment systematic problem solving strategies to understand children with disturbances and their family and school environments 1 Symptoms in context 2 Symptom types cognitive behavioral emotional 3 Many information sources ii Test revise the hypothesis 1 Question can not be definitively answered 2 Not a decision that is made and done with need to re evaluate if wrong iii Diagnosis guides treatment what treatments have evidence that it works 1 Ongoing process 2 Reduce both symptoms impairment b Case Formulation i Nomothetic emphasizes broad general influences that apply to large groups of individuals i e children with a depressive disorder 1 Scientific evidence large samples of people that have that diagnosis a i e Formal assessment measure broadly what you know about normal abnormal development 2 Informs initial hypotheses ii Idiographic focus of clinical assessment is to obtain a detailed understanding of the individual child or family as a unique entity 1 Child specific information 2 Continually test and refine hypotheses 3 How do demographic factors e g age gender and culture influence diagnostic and treatment decisions a Demographic Age i Significance of the problem 1 Bed wetting at age 3 vs age 12 2 Fear of being alone at age 5 vs age 15 ii Ability to report symptoms iii Likely to respond to treatment b Demographic Gender i Referral rate 1 Boys externalize more 2 Girls internalize more ii Symptom expression 1 People are becoming more aware to ways inattention is expressed 2 The prevalence rate changes its not necessarily a change in the amount of people that have it we re just more aware iii Predictive value of symptoms c Demographics Culture i Three part definition 1 Patterns of learned behaviors and values 2 Shared among members 3 That distinguish one group from others a i e ethnicity SES ii Risk of Misdiagnosis 1 People differ in what diagnosis they will receive and the prevalence of seeking treatment iii Clinician s cultural lenses 1 We all have some sort of culture your cultural experience is a lens through which you see everything 2 Need to ask am I thinking of the child s culture context iv Value of cultural knowledge 1 Rapport close connection motivation 2 Compatible treatments a Have a treatment that works for a disorder but is it compatible with cultural context v Importance of cultural context d Normative Information i Pathological cause by or evidence a mentally disturbed condition vs Just Problematic Is there a good reason for the clingy behavior 1 2 What about sleep disturbance ii Isolated symptoms behavioral emotional problems generally show little correspondence with child s overall adjustment iii Pattern symptoms or age inappropriateness define childhood disorders iv Many symptoms are common 1 Important to ask about quantity a How often intense v Patterns age inappropriateness 4 Name and describe key features of three purposes for which assessment may be used a Clinical Description summarizes the unique behaviors thoughts and feelings that together make up the features of the child s psychological disorder i Symptom types ii Multiple reporters iii Appropriate reference group background iv Main components 1 Compare child to similar age sex SES cultural 1 Quantify intensity frequency severity 2 Time course when did it start age of onset duration 3 Apparent relations is there 1 or 2 things that can account for that different symptoms their configuration b Diagnosis analyzing information drawing conclusions about the nature or cause of the problem or assigning a formal diagnosis i Taxonomic apply a label focuses on formal assignment of cases to specific categories drawn from a system of classification such as the DSM IV TR or from empirically derived categories ii Problem solving analysis much broader meaning similar to clinical assessment and views diagnosis as a process of gathering information that is used to understand the nature of an individual s problem its possible causes treatment options and outcomes 1 Nature of the problem 2 Likely causes hypothesis 3 Treatment options c Prognosis Treatment Tx Planning i Prognosis evidence based prediction of outcomes with or without specific treatment formulation of predictions about future behavior under specified conditions ii Cost of wrong answers 1 This is just a stage it will pass doesn t need treatment iii Ongoing process not single decision iv Continue measuring symptoms v Treatment planning evaluation information to generate a plan to address the child s problem and evaluate its effectiveness using assessment 5 What is the multi method approach to diagnostic assessment and what are three key components a Multi method Approach emphasizes the importance of obtaining information from different informants in a variety of settings and using a variety of methods that include interviews observations questionnaires and tests i Multiple informants settings measure types ii Each has specific strengths iii Symptom may indicate one or another 6 What is a clinical interview Its strengths and weaknesses a Clinical Interviews i Broad first step interview figure out what is important ii Next use more structured methods teacher parent testing report iii Topic areas iv Separate child and parent s 1 Confidentiality comfort level observe interactions v Weakness engaging unwilling children may be difficult Some children and adolescents may not feel they have a problem and see no need to be interviewed 7 What information is usually included in a developmental or family history a Developmental History i Major child or family events 1 What about the child s birth 2 Physical developmental milestones 3 Family history Education work illnesses ii Hypotheses about risk protective factors iii Later test these during treatment 8 What are the features of the following methods of gathering diagnostic information a Semi structured Interview includes specific questions designed to elicit information in a