Chapter 4 – Assessment, Diagnosis, and Treatment
Clinical issues
Clinical assessments: a process of differentiating, defining, and measuring the behaviors,
cognitions, and emotions that are of concern, as well as the environmental circumstances that
may be contributing to these problems.
• Ultimate goal: achieve effective solutions to the problem children and their families face,
and to promote and enhance their well-being.
• “Clinical assessments are meaningful to the extent that they result in practical and
effective interventions”.
Idiographic case formulation: the focus of clinical assessments, namely, to obtain a detailed
understanding of the individual child or family as a unique entity.
Nomothetic formulation: emphasizes broad general inferences that apply to large groups of
individuals.
Age, gender, and culture
A child’s age has implications for the judgments about deviancy and for selecting the most
appropriate assessment and treatment methods. This also goes for the child’s gender.
Gender differences:
• Boys: 3-4 times more likely than girls to display early-onset disorders, like autism
spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).
• Girls: more likely than boys to display disorders that peak in adolescence, like
depression and eating disorders.
Gender differences in emotional expression and behavior have been shown to vary depending
on:
1. The age of the child
2. The interpersonal context in which the child is observed
3. The personal relevance and demands of the situation
Cultural syndromes: a pattern of co-occurring, relatively invariant symptoms associated with a
particular cultural group, community, or context. These syndromes rarely fit neatly into one
Western diagnostic category.
à It is important that clinicians assess the extent to which a child’s cultural background and
context affect the expression of both individual symptoms and clinical disorders.
Purposes of assessment:
1. Description and diagnosis
2. Prognosis
3. Treatment planning
Clinical description: summarizes the unique behaviors, thoughts, and feelings that make up the
features of the child’s psychological disorder.
- First: assessing and describing the intensity, frequency, and severity à sense of how
excessive or deficient her behavior is.
- Second: describe the age of onset and duration of her difficulties.
- Finally: convey a full picture of her different symptoms and their configuration.
Diagnosis: the identification of a disorder from an examination of the symptoms.
2 separate meaning of diagnosis:
1. Taxonomic diagnoses: focuses on the formal assignment of cases to specific categories drawn
from a system of classification, like DSM-5 or from empirically derived traits or dimensions.
1
, 2. Problem-solving analysis: 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.
Prognosis: the formulation of predictions about future behavior under specified conditions (e.g.
“Will the problems diminish as she gets older, or will it get worse?”).
Treatments planning and evaluation: using assessment information to generate a plan to
address the child’s problem and to evaluate the effectiveness of the treatment.
Clinical Issues – Section Summary
- Clinical assessment is directed at differentiating, defining and measuring the child’s behaviors,
cognitions, and emotions of concern, the environmental circumstances that may contribute to
these problems, and the child’s strengths and competencies.
- Assessments are meaningful to the extent that they result in effective interventions; a close and
continuing partnership must exist between assessment and intervention.
- Age, gender, and culture influence how children’s symptoms and behavior are expressed and
recognized and have implications for selecting the most appropriate methods of assessment and
treatment.
- The age inappropriateness, the severity, and the pattern of symptoms, rather than individual
symptoms, usually define childhood disorders. The extent to which the symptoms result in
impairment in the child’s functioning is also a key consideration.
- 3 purposes of assessment are:
1. Description and diagnosis that determine the nature and possible causes of the
child’s problem;
2. Prognosis that predicts future behavior under specified conditions;
3. Treatment planning and evaluation.
Assessing disorders
Multimethod assessment approach: emphasizes the importance of obtaining information from
different informants in a variety of settings and using a variety of methods that may include
interviews, observations, questionnaires and tests.
Goal: obtain the most complete picture possible in order to develop and implement an
appropriate treatment plan, within the limits of available resources.
Initial assessments often include developmental history or family history: information is
obtained from the parents regarding potentially significant developmental milestones and
historical events that might impact the child’s current difficulties. Important information:
• The child’s birth and related events (pregnancy, birth complications, mother’s use of
substances, etc.)
• The child’s developmental milestones (age of walking, use of language, etc.)
• The child’s medical history (injuries, accidents, operations, illness, prescribed
medications)
• Family characteristics and family history (age, occupation, culture, mental health
history)
• The child’s interpersonal skills (skills with other children, play and social activities)
• The child’s educational history
• The adolescent’s work history and relationships
• Description of the presenting problem
• The parents’ expectations for assessment and treatment of their child and themselves
2
Clinical issues
Clinical assessments: a process of differentiating, defining, and measuring the behaviors,
cognitions, and emotions that are of concern, as well as the environmental circumstances that
may be contributing to these problems.
• Ultimate goal: achieve effective solutions to the problem children and their families face,
and to promote and enhance their well-being.
• “Clinical assessments are meaningful to the extent that they result in practical and
effective interventions”.
Idiographic case formulation: the focus of clinical assessments, namely, to obtain a detailed
understanding of the individual child or family as a unique entity.
Nomothetic formulation: emphasizes broad general inferences that apply to large groups of
individuals.
Age, gender, and culture
A child’s age has implications for the judgments about deviancy and for selecting the most
appropriate assessment and treatment methods. This also goes for the child’s gender.
Gender differences:
• Boys: 3-4 times more likely than girls to display early-onset disorders, like autism
spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).
• Girls: more likely than boys to display disorders that peak in adolescence, like
depression and eating disorders.
Gender differences in emotional expression and behavior have been shown to vary depending
on:
1. The age of the child
2. The interpersonal context in which the child is observed
3. The personal relevance and demands of the situation
Cultural syndromes: a pattern of co-occurring, relatively invariant symptoms associated with a
particular cultural group, community, or context. These syndromes rarely fit neatly into one
Western diagnostic category.
à It is important that clinicians assess the extent to which a child’s cultural background and
context affect the expression of both individual symptoms and clinical disorders.
Purposes of assessment:
1. Description and diagnosis
2. Prognosis
3. Treatment planning
Clinical description: summarizes the unique behaviors, thoughts, and feelings that make up the
features of the child’s psychological disorder.
- First: assessing and describing the intensity, frequency, and severity à sense of how
excessive or deficient her behavior is.
- Second: describe the age of onset and duration of her difficulties.
- Finally: convey a full picture of her different symptoms and their configuration.
Diagnosis: the identification of a disorder from an examination of the symptoms.
2 separate meaning of diagnosis:
1. Taxonomic diagnoses: focuses on the formal assignment of cases to specific categories drawn
from a system of classification, like DSM-5 or from empirically derived traits or dimensions.
1
, 2. Problem-solving analysis: 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.
Prognosis: the formulation of predictions about future behavior under specified conditions (e.g.
“Will the problems diminish as she gets older, or will it get worse?”).
Treatments planning and evaluation: using assessment information to generate a plan to
address the child’s problem and to evaluate the effectiveness of the treatment.
Clinical Issues – Section Summary
- Clinical assessment is directed at differentiating, defining and measuring the child’s behaviors,
cognitions, and emotions of concern, the environmental circumstances that may contribute to
these problems, and the child’s strengths and competencies.
- Assessments are meaningful to the extent that they result in effective interventions; a close and
continuing partnership must exist between assessment and intervention.
- Age, gender, and culture influence how children’s symptoms and behavior are expressed and
recognized and have implications for selecting the most appropriate methods of assessment and
treatment.
- The age inappropriateness, the severity, and the pattern of symptoms, rather than individual
symptoms, usually define childhood disorders. The extent to which the symptoms result in
impairment in the child’s functioning is also a key consideration.
- 3 purposes of assessment are:
1. Description and diagnosis that determine the nature and possible causes of the
child’s problem;
2. Prognosis that predicts future behavior under specified conditions;
3. Treatment planning and evaluation.
Assessing disorders
Multimethod assessment approach: emphasizes the importance of obtaining information from
different informants in a variety of settings and using a variety of methods that may include
interviews, observations, questionnaires and tests.
Goal: obtain the most complete picture possible in order to develop and implement an
appropriate treatment plan, within the limits of available resources.
Initial assessments often include developmental history or family history: information is
obtained from the parents regarding potentially significant developmental milestones and
historical events that might impact the child’s current difficulties. Important information:
• The child’s birth and related events (pregnancy, birth complications, mother’s use of
substances, etc.)
• The child’s developmental milestones (age of walking, use of language, etc.)
• The child’s medical history (injuries, accidents, operations, illness, prescribed
medications)
• Family characteristics and family history (age, occupation, culture, mental health
history)
• The child’s interpersonal skills (skills with other children, play and social activities)
• The child’s educational history
• The adolescent’s work history and relationships
• Description of the presenting problem
• The parents’ expectations for assessment and treatment of their child and themselves
2
