Chapter 4 Objectives O1 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 hypothesis Diagnosis guides treatment Ongoing process Reduce BOTH symptoms AND impairment Case formulation Nomothetic Scientific evidence large samples Informs initial hypothesis Idiographic Child specific information Continually test and refine hypothesis AGE versus 15 GENDER CULTURE 3 part definition Referral rate Symptom expression Predictive value of symptoms Risk of misdiagnosis Clinicians cultural lenses Value of cultural knowledge Rapport motivation Compatible treatments Importance of cultural context O3 How do demographic factors e g age gender and culture influence diagnostic and treatment decisions Significance of the problem bed wetting at age 3 vs 12 fear of being alone at age 5 The child s ability to report symptoms vs parents Likely response to treatment 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 complains about stomach pains She also does Felicia s homework Felicia example Felicia s mother keeps her daughter home from school when 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 step Then use more structured methods Topic areas Separate child and parents Confidentiality comfort level observe interactions O7 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 balance Behavioral 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 behavior Ex feelings of anxiety about going to school B 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 reporters Standardized Diagnosis specific or more general CBCL Child Behavior Checklist Ages 6 18 Also observation and interview forms 8 major symptom categories Quantifies 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 Standardization Consider the reference group Important to avoid bias Context and validity Developmental tests Timing developmental milestones Compared to peers Pattern of impairment Strengths and weaknesses Screen vs diagnostic test Intelligence tests Diagnostic utility What is the source of the observed impairment How do symptoms and intelligence interact Wechsler intelligence scale for children 10 subtests 6 supplemental Age 6 16 Highly trained tester Subscales vs full scale IQ BIG FIVE PE NE EC Extraversion Agreeableness Openness to experience Conscientiousness Neuroticism Neuropsychological testing Used to infer brain behavior relations Not used for diagnosis Can indicate functional consequences of a disorder The overall capacity of an individual to understand and cope with the world around him Personality testing present child with ambiguous stimuli such as inkblots or pictures of people and asked to describe what he she sees 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 treatment O14 What is the key feature of a categorical system of classification Dimensional Pure categories dimensional approach research vs treatment still an open question O15 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 system Axes 1 most disorders 2 Permanent conditions e g intellectual disability why separated 3 General Medical Condition Could CAUSE axis 1 OR could BE CAUSED by axis one Think about temporal precedence 4 Environmental stressors Important to prognosis on axis 1 2 5 Overall function O16 What valid criticisms are made against DSM IV TR Symptoms are interrelated less attention to children little emphasis on context can impede service provision especially for children O17 Define intervention prevention How do cultural factors influence treatment Intervention procedure