Assessment,

Diagnosis,
and
Treatment
Week 3
Chapter 4
Clinical Issues: The decision-making process
• How do we know if a person needs professional attention for a
psychological problem, or if she will overcome her problems on her
own?
• Like we are detectives! – analysis of many different factors
(remember the Ecological Model), check out alternative hypotheses
and plans
• With this process: think about the nature and course of the disorder
& find short- and long-term answers, consider the optimal treatment
methods
Clinical Issues: The decision-making process
• Begins with a clinical assessment
• Systematic problem-solving strategies to understand childrenwith
disturbances, their family, and school environment
• Strategies: assess child’s emotional, behavioral, cognitive functioning
& role of environmental factors
• Clinical assessment is broader than an interview or a test!
• Result in practical & effective interventions
• Assessment and intervention go hand-in-hand
Clinical Issues: The decision-making process
• Focus is to obtain a detailed understanding of the individual child or
family as a unique entity – idiographic case formulation
• E.g., you and your family
• Nomothetic formulation – emphasized broad general inferences that
apply to large groups of individuals
• E.g., children with a depressive disorder
• You have to consider both general knowledge and apply it to specific
cases while working with children, adolescents, and their families
• Assessment is not done TO a child or family, it is a collaborative work
• Rapport is important!
Clinical Issues: Developmental considerations

• We have to be careful about one’s age, gender, and culture to decide

between normal and abnormal behavior (1st week)
• What may be some consequences of school refusal for a 13-year-old
adolescent?
• Is there a difference between time-out for a 3-year-old and a 13-year-old?
• Some disorders are reported more on different genders
• Children and their family’s cultural identity, cultural concepts of
distress, psychosocial stressors, cultural features of vulnerability and
resilience, culturally appropriate plan for treatment
Clinical Issues: Developmental considerations

• Cultural sydromes – a pattern of co-occuring, relatively invariant

symptoms associated with a particular cultural group, community, or
context (APA, 2013)
• The «evil eye» (kem göz) – throughout Mediterranean & Latino communities
• A hateful look from a malicious person can cause fitful sleep, crying without
apparent reason, diarrhea, vomiting, fever in children
• Rarely fit neatly into Western diagnostic category
Clinical Issues: Developmental considerations

• Knowledge, experience, and basic information about norms of child

development and behavior problems are important points to
understand the child.
• Life experiences (what is normal for a child after her mom is hospitalized)
• Age-specific issues
• Factors that usuallu define childhood disorders:
• Age inappropriateness
• Severity
• Pattern of symptoms
Clinical • Three common purposes of assessment

Issues: • Description and diagnosis

Purposes of • Prognosis
assessment • Treatment planning
Purposes of assessment: Description and
diagnosis
• Clinical description: a summary of the unique behaviors, thoughts, and
feelings that together make up the features of the child’s psychological
disorder
• How the child’s & family’s behavior and emotions differ from others
• Assess and describe the intensity, frequency, and severity of the problem
• Describe the age of onset & duration
• Take a full picture of different symptoms and their configuration
• Diagnosis: analyzing information and drawing conclusions about the nature
or cause of the problem, or assigning a formal diagnostic label for a disorder.
• Taxonomic diagnosis – focuses on the formal assignment of cases to specific categories
drawn from a system of classification such as the DSM-5, or from emprically derived
traits or dimensions
• Problem-solving analysis –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
Purposes of assessment: Prognosis & Treatment
planning
• Prognosis: formulations of predictions about future behavior under
specific conditions
• What would happen in the future, if the child does not get help?
• Parents want to know short- and long-term outcomes? How many sessions??
• Assessment  poor social skill  intervention plans on improving
social skills
• Treatment planning and evaluation: using assessment information to
generate a plan to address the child’s problem and to evaluate the
effectiveness of the treatment
Assessing Disorders
• Physical assessment before we decide the problem is psychological
• The clinical assessment should rely on multimethod assessment
approach
• Obtaining information from different informants in a variaty of settings and
using a variaty of methods that may include interviews, observations,
questionnaires, and tests
• E.g., Bed-wetting may be because of a physical defect, rather than a
psychological factor
• Three main assessment strategies: Clinical interviews, behavioral
assessment, psychological testing
Assessing Disorders: Clinical Interviews
• Generally, others refer children & adolescents to treatment
• The first interview is important! – collaboration & cooperation
• Flexible, conversational style
• Minimal guidance
• Child and parent(s) separately/ together/ whole family
• Advantages/ disadvantages?
• Play as a source of interview with children
• Developmental and family history
• Semistructured interviews
• To eliminate low reliability, biases – make sure you ask the main point
Example of a
semistructured
interview
Assessing Disorders: Behavioral assessment
• Behavioral assessment: Strategy for evaluating the child’s thoughts,
feelings, and behaviors in specific settings & using this information to
formulate hypotheses about the nature of the problem and what can
be done about it
• By using behavioral assessment, the clinican identifies target
behaviors
• The primary problems of concern, with the goal of determining what specific
factors may be influencing these behaviors
• E.g., complaining of a headache every Monday – result: not going to school
Assessing Disorders: Behavioral assessment
• ABCs of assessment
• A= Antecedents/ events that immediately precede a behavior
• B= Behavior(s) of interest
• C= Consequences/ events that follow a behavior
• Behavior analysis (functional analysis of behavior): A more general
approach to systematically organizing and using assessment
information in terms of antecedents, behaviors, and consequences
 The child can be taught to relax, when she thinks
Functional analysis about going to school, in order to reduce her anxiety
of behavior  changing the antecedent
Assessing Disorders: Behavioral assessment
• Checklists and rating scales
• Child Behavior Checklist (CBCL) (Achenbach & Rescorla, 2001)
• Children & adolescents ages 6 to 18
• Respondents: Child/adolescent, parent, teacher
• Has been used in 80 or more different cultures
• Behavioral observation and recording
• Good for children not old enough or skilled enough to report on their
own behavior
• E.g., «How ofthen does your child complies with your requests?»
Assessing Disorders: Psychological testing
• Test: A task or set of tasks given under standard conditions with the
purpose of assessing some aspects of the child’s knowledge, skill, or
personality
• Scores are compared with a norm group
• Tests – particularly intelligence tests – are among the most frequently
used assessment methods with children
• Scores should always be interpreted with other assessments (child’s behavior)
 • Developmental testing
• Denver-II (until the age of 6)
• Bayley Scales (1-42 months)
• Intelligence testing
Assessing • WISC-V
• Projective testing
Disorders: • Rorschach
• CAT
Psychological • Draw-a-person/ draw-a-family
• Personality testing
testing • MMPI-A (Minnesota Multiphasic Personality
Inventory-Adolescent)
• PIC-2 (Personality Inventory for Children,
Second Edition)
• Neuropsychological assessment
Classification & diagnosis
• Idiographic vs. nomothetic approach
• DSM-5 & ICD-10
• Categorical classification – based on informed Professional
consensus, dominates the field of child & adult psychopathology
• Classical categorical approach: Every diagnosis has a clear underlying cause,
and each disorder is fundamentally different from other disorders
• Dimensional classification – assumes many independent dimensions
or traits of behavior exist, and that all children possess them to
varying degrees
• E.g., she might be on the dimension of depression and anxiety
Classification & diagnosis: Categories &
dimensions
• Disadvantages of categorical approach
• Children’s behavior seldom falls neatly into established categories  confusion
• Categories of behavior do not typically share the same underlying causes –
children who get the same diagnosis do not necessarily share the same etiology &
they do not respond to the same treatment
• Disadvantages of dimensional approach
• Dependent on age and sex of the child, sampling, method, and informant
characteristics  integrating info can be challenging
• May be insensitive to contextual influences
• Many dimensions among child & adolescent psychopathology including:
• Internalizing behaviors – anxious/withdrawn/depressed behaviors
• Externalizing behaviors – aggressive/rule breaking behaviors
 • How can we help children & adolescents to
overcome their problems?
• What is the best type of intervention for
Treatment each child?
• Most useful treatments are based on what
& we know about the nature, course,
Prevention associated characteristics, and potential
causes of a particular childhood disorder
• Data should show that our interventions
work
Treatment & Prevention: glossary
• Intervention: a concept that encompasses many different theories and
practices directed at helping the child and family adapt more effectively to
their current and future circumstances.
• Cover wide range of actions from prevention to maintenance
• Prevention: aims to decrease the chances that undsired future outcomes
will occur
• It is better to promote health and prevent problems before they occur – e.g.,
early intervention programs for children and families in adverse situations
• Treatment: corrective actions that will permit successful adaptation by
eliminating or reducing the impact of an undesired problem or outcome
that has already occurred
• Maintenance: efforts to increase adherence to treatment over time to
prevent relapse or recurrence of a problem
 • Before the adversity happened:
Treatment prevention
• After the adversity happened:
& treatment, maintenance
Prevention • Both before and after the adversity:
intervention
Treatment & Prevention: Cultural considerations

• Be careful to the unique experiences of ethnic minority children &

families
• Different parenting values, child-rearing practices, way of describing
their child’s problems, way of seeking help, preferred interventions
• Treatment is likely to be more effective when it is compatible with the
cultural patterns of the child and family  cultural compatibility
hypothesis
• Ethnic similarity between care-giver and therapist = better treatment
outcomes
Treatment & Prevention
• Treatment goals often focus on building children’s adaptation skills to
facilitate long-term adjustment (resilience!)
• Not only eliminating problem behaviors
• Different kinds of treatments
• Psychodynamic (underlying cons & uncons conflicts)
• Behavioral (many abnormal child behaviors are learned)
• Cognitive (deficits in thinking – perceptual biases, irrational beliefs, faulty
interpretations)
• Cognitive-behavioral (faulty thought patterns &falty learning and environmental
factors)
• Client-centered (interfering with child’s basic capacity for personal growth &
adaptiveness)
• Family treatment (operating in the larger family system)
• Neurobiological (pharmacological & other biological approaches)
• Combined (use of two or more interventions)
Ethical issues
while working
with children
 • Read the case in your book: Felicia (all the sections
on the case in chapter 4)
• Read the article:
For tomorrow Kapetanovic, S., & Skoog, T. (2020). The role of the
family’s emotional climate in the links between
(Tuesday class) parent-adolescent communication and adolescent
psychosocial functioning. Research on Child and
Adolescent Psychopathology.
doi: https://doi.org/10.1007/s10802-020-00705-9
Case: Felicia
• What are the complaints of Felicia?
• Who referred her?
• In what ares do we see disruption? What are they?
• Since when she has complaints?
• What are some age-specific issues?
• What are some important events and factors for us to consider in Felicia’s
history?
• What are some personal characteristics? (Does her temperament help?)
• What may be the most effective approach in Felicia’s treatment? What
would happen if the therapist used only one approach?
Kapetanovic & Skoog (2020)
• Family’s emotional climate
• Parenting strategies that shape adolescent development (parent-
driven communication)
• Behavioral control
• Solicitation
• Adolescents’ management strategies (adolescent-driven
communication)
• Disclosure
• Secrecy
Kapetanovic & Skoog (2020)
• If parent-driven and adolescent-driven communication efforts can be
effective in terms of adolescent development in some contexts but not in
others?
• Hypotheses:
• Parent-driven communication efforts (i.e. parental solicitation and behavioral
control) and adolescent disclosure would be associated with less externalizing
problems, internalizing problems, and delinquency and more wellbeing over time.
• Adolescents’ perceptions of the family’s emotional climate would have a moderating
role in the links between parent-driven communication and adolescent psychosocial
functioning such that parent-driven communication would be linked to less
adolescent psychosocial problems (i.e. externalizing, internalizing and delinquency)
and more wellbeing, only within the context of a high family emotional climate.
Kapetanovic & Skoog (2020)
• Parent-driven communication efforts (solicitation & behavioral control)
predicted adolescents’ externalizing problems (conduct problems &
delinquency)
• Parental solicitation was linked to lower levels of adolescent conduct problems and
delinquency over time
• Parental behavioral control was linked to higher levels of adolescent delinquency
over time
• Positive emotional climate in the family  parents’ questions and requests
for information was protective against the adolescents’ externalizing
behavior
• Negative emotional climate  no protective longitudinal effects on
adolescent externalizing problems
Kapetanovic & Skoog (2020)
• Positive link between parental behavioral control and adolescent
dleinquency in families with a poor emotional climate
• Parental solicitation was negatively related to adolescent emotional
problems over time  parents’ questions about and adolescent’s
whereabouts could be protective against the development of
adolescent emotional problems
• NOT moderated by the family emotional cimate!
Kapetanovic & Skoog (2020)
• Adolescent disclosure was linked to less adolescent emotional
problems and delinquency over time; adolescent secrecy was linked
to more emotional and conduct problems, delinquency, and poorer
wellbeing over time
• Reciprocal relationship between adolescent disclosure and emotional
problems: Higher levels of adolescent emotional problems predicted less
disclosure over time
• Negative link from adolescent emotional problems to adolescent
disclosure was moderated by the family’s emotional climate
• Adolescent emotional problems predict lower disclosure within the context of
a family’s negative emotional climate