Chapter 4 ObjectivesO1. Be familiar with Felicia’s case presentation (p.82, more details throughout the chapter).Felicia (13) was referred because of her depression, school refusal, social withdrawal at home and school,and sleep disturbance.Complained of stomach pains to not go to school, wanted to be close to mother, asked for help with homework and chores. Felicia became quiet, appeared unhappy and withdrew from social activities. Her grades started slipping and she said no one liked her, she couldn’t do anything well and life was hopeless. O2. What is the main questions in the diagnostic process and how are they addressed?What treatment is needed? Clinical assessment (symptoms in context, symptom types[cog,behavioral,emotional], many information sources Test and revise hypothesisDiagnosis guides treatment Ongoing processReduce BOTH symptoms AND impairment Case formulation: NomotheticScientific evidence (large samples)Informs initial hypothesisIdiographicChild-specific informationContinually test and refine hypothesis O3. How do demographic factors (e.g., age, gender, and culture) influence diagnostic and treatment decisions? AGE:Significance of the problem : bed wetting at age 3 vs 12 , fear of being alone at age 5 versus 15 The child’s ability to report symptoms vs parents Likely response to treatment GENDER:Referral rateSymptom expression Predictive value of symptoms CULTURE:3 part definitionRisk of misdiagnosis Clinicians cultural “lenses” Value of cultural knowledge Rapport/motivation Compatible treatmentsImportance of cultural context O4. Name and describe key features of three purposes for which assessment may be used.3 purposes of assessment:1) Diagnosis: Analyzing information and drawing conclusions about the nature or cause of the problem. (Felicia example: Does Felicia meet standard diagnostic criteria for a depressive disorder and, if so, what might be the cause?)2) Prognosis: the formulation of predictions about future behavior under specified conditions. (Felicia example: If Felicia doesn’t receive help for her problem, what will likely happen to her in the future? Will her problems diminish as she gets older or will they get worse? )3) Treatment planning: Using assessment info to create a plan to address the child’s problem and evaluate its effectiveness. Felicia example: (Felicia’s mother keeps her daughter home from school when Felicia complains about stomach pains. She also does Felicia’s homework.O5. What is the “multimethod approach” to diagnostic assessment, and what are three key components?Multiple informants, settings, measure types. Each has specific strengths Symptom may indicate one or another O6. What is a clinical interview? Its strengths and weaknesses? Broad first stepThen use more structured methodsTopic areasSeparate child and parents?Confidentiality, comfort level, observe interactionsO7. What information is usually included in a developmental or family history?Major child or family events, common topics, hypothesis about risk and protective factors and test these during treatment. O8. What are the features of the following methods of gathering diagnostic information: Semi-structured interview: more reliable, less flexible, not totally scripted, must find a balanceBehavioral assessment: ongoing process of hypothesis testing O9. What is the purpose of examining antecedents and consequences of a target behavior? How is this accomplished in a systematic manner? (figure 4.1) A: Antecedents, or the events that immediately precede a behaviorEx: feelings of anxiety about going to schoolB: Behavior(s) of interest Ex: school refusal C: Consequences, or the events that follow the behavior Ex: reduction in anxiety O10. What types of paper-based behavioral measures exist? Know specifics about the CBCL.Behavioral rating scales. Various reportersStandardizedDiagnosis-specific or more general CBCL =Child Behavior Checklist Ages 6-18Also observation and interview forms8 major symptom categoriesQuantifies symptoms and compares to reference groups O11. What is psychological testing in general, and what information do various types of tests (developmental, intelligence, personality, neuropsychological) provide?Psychological testing: task or set of tasks given under standardized conditions with the purpose of assessing some aspect of the child’s knowledge, skill or personality” StandardizationConsider the reference groupImportant to avoid biasContext and validity Developmental tests:Timing developmental milestones Compared to peers?Pattern of impairmentStrengths and weaknessesScreen vs diagnostic test Intelligence tests:- The overall capacity of an individual to understand and cope with the world around himDiagnostic utilityWhat is the source of the observed impairment?How do symptoms and intelligence interact Wechsler intelligence scale for children 10 subtests + 6 supplementalAge 6-16Highly trained testerSubscales vs. full scale IQ Personality testing: present child with ambiguous stimuli such as inkblots or pictures of people and asked to describe what he/she sees.BIG FIVE (PE-NE-EC)ExtraversionAgreeablenessOpenness to experienceConscientiousnessNeuroticism Neuropsychological testing:Used to infer brain-behavior relationsNot used for diagnosis Can indicate functional consequences of a disorder O12. Why are projective tests controversial? (book only)Some clinicians see them as inadequate with respect to meeting minimum standards for reliability and validity. O13. What is classification and why is it necessary?System for representing the major categories or dimensions.. and the boundaries and relations among them Why put people in “boxes”?Research and treatmentO14. What is the key feature of a categorical system of classification? Dimensional?Pure categories, dimensional approach, research vs treatment, still an open questionO15. What is the DSM-IV-TR, and what information is provided by each of the five axes?Diagnostic and statistical manual (DSM-V now available)Text revision in 2000. Multiaxial systemAxes: 1) most disorders 2) Permanent conditionse.g intellectual disabilitywhy separated? 3) General Medical ConditionCould CAUSE axis 1 OR could BE CAUSED by axis oneThink about temporal precedence 4) Environmental stressors Important to prognosis on axis 1,2 5) Overall functionO16. What valid criticisms are made against DSM-IV-TR?Symptoms are interrelated , less attention to children ,