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 pneumoniaiii. School 1. 13 yr. old  8th gradeiv. Self-report1. 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 tolarge 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 hypotheses3. 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 122. 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 theprevalence 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 everything2. 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 isit 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 1. Is there a good reason for the clingy behavior? 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 childhooddisorders]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 maybe used. a. Clinical Description [summarizes the unique behaviors, thoughts, andfeelings that together make up the features of the child’s psychologicaldisorder]i. Symptom types ii. Multiple reporters iii. Appropriate reference group 1. Compare child to similar age, sex, SES, & cultural backgroundiv. Main components 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 answers1. 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 : using assessment information to generate a plan to address the child’s problem and evaluate its effectiveness5. What is the “multi-method approach” to diagnostic assessment, and what arethree 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