SLK 310 Chapter 4
Erin Polyblank
CHAPTER 4: ASSESSMENT,
DIAGNOSIS, AND TREATMENT
Most childhood disorders involve breakdowns in normal development.
o Eg. Felicia is having difficulty coping with the demands of adolescence
gaining autonomy from her parents, getting along with peers, performing
well in school, establishing her self-identity, and regulating her emotions.
o Felicia also experienced the added stress of her mother's hospitalization for
pneumonia.
The clinician who sees Felicia will need to evaluate how well Felicia can
cope with life events; her appraisal of the events; her physical status,
cognitive abilities, behavioural skills, and personality; and support from
her parents, teachers, or peers.
CLINICAL ISSUES
THE DECISION-MAKING PROCESS
Mental health clinicians have to systematically consider many important
questions to understand a child's basic problems) and to make diagnoses and
devise treatment plans.
o This process requires sorting through the many factors that bring a child or
adolescent to the attention of professionals and checking out alternative
hypotheses and plans.
The ongoing decision-making process is aimed at finding answers to both
immediate and long-term questions about the nature and course of the child’s
disorder and its optimal treatment.
The decision-making process typically begins with a clinical assessment.
Clinical assessments use systematic problem-solving strategies to
understand children with disturbances and their family and school
environments.
o Strategies typically include an assessment of the child's emotional,
behavioural, and cognitive functioning, as well as the role of environmental
factors.
1
,SLK 310 Chapter 4
Erin Polyblank
These strategies form the basis of a flexible and ongoing process of
hypothesis testing regarding the nature of the problem, its causes, and
the likely outcomes if the problem is treated as opposed to leaving it
untreated.
The ultimate goal of assessment is to achieve effective solutions to the
problems children and their families face, and to promote and enhance their
well-being.
o Clinical assessments are meaningful to the extent that they result in
practical and effective interventions.
A close and continuing partnership between assessment and
intervention is vital; they should not be viewed as separate processes.
The focus of clinical assessment is to obtain a detailed understanding of the
individual child or family as a unique entity, referred to as idiographic case
formulation.(The tendency to specify)
o This is in contrast to a nomothetic formulation, which emphasizes broad
general inferences that apply to large groups of individuals (e.g., children
with a depressive disorder). (The tendency to generalise)
A clinician's nomothetic knowledge about general principles of
psychological assessment, normal and abnormal child and family
development, and specific childhood disorders is likely to result in
better hypotheses to test at the idiographic level.
Within the decision-making process, one must be familiar with fundamental
information in areas such as childhood depression or specific learning
disorders and then be able to integrate this knowledge in new ways to make
it applicable to help solve a particular problem.
Clinicians begin their decision making with an assessment, which can range
from a clinical interview with the child and parents to more structured
behavioural assessments and psychological testing.
o Because adults play a critical role in defining the child's problem and
providing information, it is particularly important to establish a rapport with
them, and active family and teacher involvement are important for both
assessment and intervention.
DEVELOPMENTAL CONSIDERATIONS
2
,SLK 310 Chapter 4
Erin Polyblank
In assessing children and families, one needs to be sensitive to the child's
age, gender, and cultural background as well as to normative information
about both typical and atypical child development.
o Such knowledge provides the clinician with a context for evaluating and
understanding the behaviour and circumstances of an individual child and
family.
AGE, GENDER, AND CULTURE
A crucial building block for assessment and treatment is recognizing diversity
within children's developmental functions and capacities at various ages.
A child's age has implications not only for judgments about deviancy but also
for selecting the most appropriate assessment and treatment methods.
o Eg. At what age can a child provide reliable information in an interview?
With respect to treatment, how might time-out for misbehaviour for a
3-year-old differ from time-out for a school-age child?
Gender Patterns for selected problems of childhood and adolescence:
More commonly reported among males
Attention-deficit/hyperactivity Autism spectrum disorder
Language disorder disorder
Specific learning disorder Childhood conduct disorder
Enuresis Intellectual disability
More commonly reported among females
Anxiety disorders Eating disorders
Adolescent depression Sexual abuse
Equally reported among males and females
Adolescent conduct disorder Feeding disorder
Physical abuse and neglect Childhood depression
Some childhood disorders and conditions are more common in males than in
females, others are more common in females than in males, and still others
are equally common in the two sexes.
o In general, boys are about three to four times more likely than girls to
display early-onset disorders such as autism spectrum disorder (ASD) and
attention-deficit/hyperactivity (ADHD), whereas girls are more likely than
boys to display disorders that have their peak onset in adolescence, such
as depression and eating disorders.
3
, SLK 310 Chapter 4
Erin Polyblank
Overactivity and aggression are more common in boys than in girls; girls tend
to express their problems in less observable ways such as sadness, fear, and
shame.
o Among the symptoms that best distinguish boys who are referred for
treatment are "showing off or clowning" (as reported by parents) and
"disturbing other pupils" (as reported by teachers).
Thus, boys may receive an excess of referrals, and girls may be
overlooked because of their less visible forms of suffering.
In considering gender differences, it is critical to keep in mind that there is
great variability not just between boys and girls but also within each group.
o Gender differences in emotional expression and behaviour have been
shown to vary depending on the age of the child, the interpersonal context
in which the child is observed, and the personal relevance and demands of
the situation.
It is also extremely important to study both girls and boys as distinct groups
in their own right.
o An exclusive focus on sex differences could delay careful study of the
expression of and underlying processes associated with specific disorders
in one group or the other.
Eg. Studies into social aggression in girls have found that when angry,
girls show aggression indirectly through verbal insults, gossip,
ostracism, getting even, or third-party retaliation-referred to as
relational aggression.
As girls move into adolescence, the function of their aggressive
behaviour increasingly centres on group acceptance and affiliation.
o When adjustment problems are studied in relation to the issues most
salient for girls (e.g., relationships, body image), it has been shown that
girls experience significant problems during childhood.
These problems include relational aggression and also behaviours that
are self-serving, directed outward, and intended to physically harm
others.
This combination of relational and physical aggression is the
strongest predictor of future psychological-social adjustment
problems in girls.
Children who engage in forms of social aggression that are not typical of their
sex (overtly aggressive girls and relationally aggressive boys) are significantly
4
Erin Polyblank
CHAPTER 4: ASSESSMENT,
DIAGNOSIS, AND TREATMENT
Most childhood disorders involve breakdowns in normal development.
o Eg. Felicia is having difficulty coping with the demands of adolescence
gaining autonomy from her parents, getting along with peers, performing
well in school, establishing her self-identity, and regulating her emotions.
o Felicia also experienced the added stress of her mother's hospitalization for
pneumonia.
The clinician who sees Felicia will need to evaluate how well Felicia can
cope with life events; her appraisal of the events; her physical status,
cognitive abilities, behavioural skills, and personality; and support from
her parents, teachers, or peers.
CLINICAL ISSUES
THE DECISION-MAKING PROCESS
Mental health clinicians have to systematically consider many important
questions to understand a child's basic problems) and to make diagnoses and
devise treatment plans.
o This process requires sorting through the many factors that bring a child or
adolescent to the attention of professionals and checking out alternative
hypotheses and plans.
The ongoing decision-making process is aimed at finding answers to both
immediate and long-term questions about the nature and course of the child’s
disorder and its optimal treatment.
The decision-making process typically begins with a clinical assessment.
Clinical assessments use systematic problem-solving strategies to
understand children with disturbances and their family and school
environments.
o Strategies typically include an assessment of the child's emotional,
behavioural, and cognitive functioning, as well as the role of environmental
factors.
1
,SLK 310 Chapter 4
Erin Polyblank
These strategies form the basis of a flexible and ongoing process of
hypothesis testing regarding the nature of the problem, its causes, and
the likely outcomes if the problem is treated as opposed to leaving it
untreated.
The ultimate goal of assessment is to achieve effective solutions to the
problems children and their families face, and to promote and enhance their
well-being.
o Clinical assessments are meaningful to the extent that they result in
practical and effective interventions.
A close and continuing partnership between assessment and
intervention is vital; they should not be viewed as separate processes.
The focus of clinical assessment is to obtain a detailed understanding of the
individual child or family as a unique entity, referred to as idiographic case
formulation.(The tendency to specify)
o This is in contrast to a nomothetic formulation, which emphasizes broad
general inferences that apply to large groups of individuals (e.g., children
with a depressive disorder). (The tendency to generalise)
A clinician's nomothetic knowledge about general principles of
psychological assessment, normal and abnormal child and family
development, and specific childhood disorders is likely to result in
better hypotheses to test at the idiographic level.
Within the decision-making process, one must be familiar with fundamental
information in areas such as childhood depression or specific learning
disorders and then be able to integrate this knowledge in new ways to make
it applicable to help solve a particular problem.
Clinicians begin their decision making with an assessment, which can range
from a clinical interview with the child and parents to more structured
behavioural assessments and psychological testing.
o Because adults play a critical role in defining the child's problem and
providing information, it is particularly important to establish a rapport with
them, and active family and teacher involvement are important for both
assessment and intervention.
DEVELOPMENTAL CONSIDERATIONS
2
,SLK 310 Chapter 4
Erin Polyblank
In assessing children and families, one needs to be sensitive to the child's
age, gender, and cultural background as well as to normative information
about both typical and atypical child development.
o Such knowledge provides the clinician with a context for evaluating and
understanding the behaviour and circumstances of an individual child and
family.
AGE, GENDER, AND CULTURE
A crucial building block for assessment and treatment is recognizing diversity
within children's developmental functions and capacities at various ages.
A child's age has implications not only for judgments about deviancy but also
for selecting the most appropriate assessment and treatment methods.
o Eg. At what age can a child provide reliable information in an interview?
With respect to treatment, how might time-out for misbehaviour for a
3-year-old differ from time-out for a school-age child?
Gender Patterns for selected problems of childhood and adolescence:
More commonly reported among males
Attention-deficit/hyperactivity Autism spectrum disorder
Language disorder disorder
Specific learning disorder Childhood conduct disorder
Enuresis Intellectual disability
More commonly reported among females
Anxiety disorders Eating disorders
Adolescent depression Sexual abuse
Equally reported among males and females
Adolescent conduct disorder Feeding disorder
Physical abuse and neglect Childhood depression
Some childhood disorders and conditions are more common in males than in
females, others are more common in females than in males, and still others
are equally common in the two sexes.
o In general, boys are about three to four times more likely than girls to
display early-onset disorders such as autism spectrum disorder (ASD) and
attention-deficit/hyperactivity (ADHD), whereas girls are more likely than
boys to display disorders that have their peak onset in adolescence, such
as depression and eating disorders.
3
, SLK 310 Chapter 4
Erin Polyblank
Overactivity and aggression are more common in boys than in girls; girls tend
to express their problems in less observable ways such as sadness, fear, and
shame.
o Among the symptoms that best distinguish boys who are referred for
treatment are "showing off or clowning" (as reported by parents) and
"disturbing other pupils" (as reported by teachers).
Thus, boys may receive an excess of referrals, and girls may be
overlooked because of their less visible forms of suffering.
In considering gender differences, it is critical to keep in mind that there is
great variability not just between boys and girls but also within each group.
o Gender differences in emotional expression and behaviour have been
shown to vary depending on the age of the child, the interpersonal context
in which the child is observed, and the personal relevance and demands of
the situation.
It is also extremely important to study both girls and boys as distinct groups
in their own right.
o An exclusive focus on sex differences could delay careful study of the
expression of and underlying processes associated with specific disorders
in one group or the other.
Eg. Studies into social aggression in girls have found that when angry,
girls show aggression indirectly through verbal insults, gossip,
ostracism, getting even, or third-party retaliation-referred to as
relational aggression.
As girls move into adolescence, the function of their aggressive
behaviour increasingly centres on group acceptance and affiliation.
o When adjustment problems are studied in relation to the issues most
salient for girls (e.g., relationships, body image), it has been shown that
girls experience significant problems during childhood.
These problems include relational aggression and also behaviours that
are self-serving, directed outward, and intended to physically harm
others.
This combination of relational and physical aggression is the
strongest predictor of future psychological-social adjustment
problems in girls.
Children who engage in forms of social aggression that are not typical of their
sex (overtly aggressive girls and relationally aggressive boys) are significantly
4
