Chapter 4 – assessment, diagnosis and treatment
Clinical issues:
Decision is making a process:
- Clinical assessments:
Use systematic problem solving strategies to understand children with disturbances and their
family and school environments child’s emotional, behavioral and cognitive functioning +
role of environment factors. To achieve effective solutions and promote and enhance their
well-being. Are meaningful to the extent that they result in practical and effective
interventions.
Idiographic case formulation: detailed understanding of the individual child or family as a
unique entity ( 1 child and the family).
Nomothetic formulation: emphasizes broad general inferences that apply to large groups of
individuals (children with depressive disorder).
Assessing children and families:
- Age, gender and culture. Everyone is different DSM-5: framework for developing a cultural
formulation of the child’s disorder based on the cultural identity. Cultural patterns reflects
learned behaviors and values that are shared among members of the group over time. Ethic
identity and socializations are key factors for assessment.
Cultural syndromes: refer to a pattern of co-occurring, relatively invariant symptoms
associated with a particular cultural groups.
- Normative information (bepaalde standard): knowledge, experience and basic information
about norms of child development and behavior problems are the crucial beginning to
understanding how children’s problems or needs come to the attention of professionals.
Purpose of assessment:
1. Clinical description: summarizes the unique behaviors, thoughts and feelings that together
make up the features of the child’s disorder:
o Intensity + frequency + severity of the problem
o Describe the age at onset and duration
o Full picture of different symptoms and their configuration
Meets the description criteria for diagnosis. Diagnosis is analyzing information and drawing
conclusions about the nature of cause of the problem, or assigning a formal diagnostic label
for a disorder.
o Meaning: taxonomic diagnosis: focus on the formal assignment of cases to specific
categories drawn from DSM-5 or from empirically derived traits or dimensions.
o Meaning: problem-solving analysis: broader meaning of diagnosis, similar to clinical
assessment diagnosis as a process of gathering information that is used to
understand the nature of an individual’s problem, causes, treatment, prompts and
outcomes.
Major depressive disorder: possesses characteristics that link to similar youths presumed to
have the same disorder.
2. Prognosis: formulation of predictions about future behavior under specified conditions
focus on future and development.
3. Treatment, planning and evaluation: using assessment information to generate a plan to
address the child’s problem and to evaluate the effectness of the treatment.
, Assessing disorders:
Clinical assessment of children experiencing difficulties relies on a multimethod assessment
approach: importance of obtaining information from different informants in a variety of settings and
using a variety of methods that may include interviews, observation, questionnaires and tests.
Methods used need to be reliable, valid, cost-effective and useful for treatment.
Initial assessments often include a developmental history of family history: information is obtained
from the parents regarding potentially significant developmental milestones and historical events
that impact the child’s current difficulties.
In the background survey, needs to be:
- Childbirth and related events
- Child’s developmental milestones
- Medical history
- Family characteristics and history
- Child’s interpersonal skills
- Educational history
- Adolescents work history and relationship
- Description of the presenting problem
- Parents’ expectations for assessment and treatment
Vaak ongestructureerde interviews lage betrouwbaarheid, semi gestructureerde interviews om op
een consistente manier info te verzamelen most important aspect of a particular disorder is
covered.
Behavioral assessment: strategy for evaluating the child’s thoughts, feelings and behaviors in specific
settings information is used to formulate a hypothesis about the nature of the problem, observing
directly identifies target behaviors: primary problems of concerns, goal of determining what specific
factors may be influencing these behaviors.
ABC’s: antecedents (A), behavior (B) and consequences (C).
Can be used to organize information in specific contexts, overall framework for assessment.
Behavior analysis of functional analysis of behavior: general approach to systematically organizing
and using assessment information in terms of ABC’s. goal to identify as many factors as possible.
Hypotheses ban be positive of negative if you change the antecedents or consequences.
Child behavior checklist (CBCL) is a checklist for assessing behavioral problems (6-18 years) great
validity and reliability. Is combined with other forms of checking. Can be used to create a profile that
gives the clinician an overall picture of the variety and degree of the child’s behavioral problems.
Rating scales provide clinician with a look at specific problems that is more focused. Some
children are too young to reflect on themselves, so they use recording the moment (parental
monitoring) valuable information
Role-play simulation: (in clinic by clinician) see how children and family behave in daily situations
problem-solving situations.
Test: is a task or set of tasks giver under standard conditions with the purpose of assessing some
aspects of the child’s knowledge, skill of personality.
Clinical issues:
Decision is making a process:
- Clinical assessments:
Use systematic problem solving strategies to understand children with disturbances and their
family and school environments child’s emotional, behavioral and cognitive functioning +
role of environment factors. To achieve effective solutions and promote and enhance their
well-being. Are meaningful to the extent that they result in practical and effective
interventions.
Idiographic case formulation: detailed understanding of the individual child or family as a
unique entity ( 1 child and the family).
Nomothetic formulation: emphasizes broad general inferences that apply to large groups of
individuals (children with depressive disorder).
Assessing children and families:
- Age, gender and culture. Everyone is different DSM-5: framework for developing a cultural
formulation of the child’s disorder based on the cultural identity. Cultural patterns reflects
learned behaviors and values that are shared among members of the group over time. Ethic
identity and socializations are key factors for assessment.
Cultural syndromes: refer to a pattern of co-occurring, relatively invariant symptoms
associated with a particular cultural groups.
- Normative information (bepaalde standard): knowledge, experience and basic information
about norms of child development and behavior problems are the crucial beginning to
understanding how children’s problems or needs come to the attention of professionals.
Purpose of assessment:
1. Clinical description: summarizes the unique behaviors, thoughts and feelings that together
make up the features of the child’s disorder:
o Intensity + frequency + severity of the problem
o Describe the age at onset and duration
o Full picture of different symptoms and their configuration
Meets the description criteria for diagnosis. Diagnosis is analyzing information and drawing
conclusions about the nature of cause of the problem, or assigning a formal diagnostic label
for a disorder.
o Meaning: taxonomic diagnosis: focus on the formal assignment of cases to specific
categories drawn from DSM-5 or from empirically derived traits or dimensions.
o Meaning: problem-solving analysis: broader meaning of diagnosis, similar to clinical
assessment diagnosis as a process of gathering information that is used to
understand the nature of an individual’s problem, causes, treatment, prompts and
outcomes.
Major depressive disorder: possesses characteristics that link to similar youths presumed to
have the same disorder.
2. Prognosis: formulation of predictions about future behavior under specified conditions
focus on future and development.
3. Treatment, planning and evaluation: using assessment information to generate a plan to
address the child’s problem and to evaluate the effectness of the treatment.
, Assessing disorders:
Clinical assessment of children experiencing difficulties relies on a multimethod assessment
approach: importance of obtaining information from different informants in a variety of settings and
using a variety of methods that may include interviews, observation, questionnaires and tests.
Methods used need to be reliable, valid, cost-effective and useful for treatment.
Initial assessments often include a developmental history of family history: information is obtained
from the parents regarding potentially significant developmental milestones and historical events
that impact the child’s current difficulties.
In the background survey, needs to be:
- Childbirth and related events
- Child’s developmental milestones
- Medical history
- Family characteristics and history
- Child’s interpersonal skills
- Educational history
- Adolescents work history and relationship
- Description of the presenting problem
- Parents’ expectations for assessment and treatment
Vaak ongestructureerde interviews lage betrouwbaarheid, semi gestructureerde interviews om op
een consistente manier info te verzamelen most important aspect of a particular disorder is
covered.
Behavioral assessment: strategy for evaluating the child’s thoughts, feelings and behaviors in specific
settings information is used to formulate a hypothesis about the nature of the problem, observing
directly identifies target behaviors: primary problems of concerns, goal of determining what specific
factors may be influencing these behaviors.
ABC’s: antecedents (A), behavior (B) and consequences (C).
Can be used to organize information in specific contexts, overall framework for assessment.
Behavior analysis of functional analysis of behavior: general approach to systematically organizing
and using assessment information in terms of ABC’s. goal to identify as many factors as possible.
Hypotheses ban be positive of negative if you change the antecedents or consequences.
Child behavior checklist (CBCL) is a checklist for assessing behavioral problems (6-18 years) great
validity and reliability. Is combined with other forms of checking. Can be used to create a profile that
gives the clinician an overall picture of the variety and degree of the child’s behavioral problems.
Rating scales provide clinician with a look at specific problems that is more focused. Some
children are too young to reflect on themselves, so they use recording the moment (parental
monitoring) valuable information
Role-play simulation: (in clinic by clinician) see how children and family behave in daily situations
problem-solving situations.
Test: is a task or set of tasks giver under standard conditions with the purpose of assessing some
aspects of the child’s knowledge, skill of personality.
