BLACKWELL’S NEUROLOGY AND PSYCHIATRY ACCESS SERIES EXAM WITH COMPLETE SOLUTIONS RATED A+ 2023|2024 UPDATE

3 CHAPTER 1 Psychiatric Examination and Diagnosis in Children and Adolescents Myla Harrison, MD and Jeffrey Newcorn, MD and adolescents, assessment of developmental function- ing is of utmost importance. The physician must under- stand normal development in children of different ages, genders, and sociocultural backgrounds. Children and adolescents of different ages and developmental stages differ in their physical, cognitive, and emotional capaci- ties. Therefore, the clinician must carefully assess the ways a patient’s problems reflect or deviate from normal devel- opment. The breadth of normality and the large amount of individual variation must be emphasized. For example, temper tantrums in a 2-year-old child are considered a normal part of development. However, continued temper tantrums at age 13 likely indicate a significant problem. Fears of the dark and of monsters are relatively common in children aged 4–6, and one generally does not diagnose a phobic disorder in a child of this age. In adolescents, questions regarding identity development and separation from the family are important developmental processes and should not necessarily be viewed as symptoms of psy- chiatric disturbance. The fact that childhood and adolescence entail con stant change also contributes to the complexities of the assess- ment. The presence of delays relative to peers or areas of precocious functioning should be identified, and the physi- cian must decide whether intervention is useful or warrant- ed. The physician must appreciate the difference between variations that fall within the “normal” or “typical” range of development and variations that indicate developmental delays (Chapters 5 and 6). When developmental delays are suspected, referral for further evaluation is recommended since developmental delays that are unaddressed can con- tribute to further complications (American Academy of Child and Adolescent Psychiatry, 1998). The child is a valuable source of information for the physi- cian, and he is interviewed as part of the assessment. How- Introduction Psychiatric assessment of children and adolescents is a multifaceted process that includes interviewing parents, children, and families, obtaining current information and histories from other sources, assessing the severity of symp- toms and overall levels of functioning, and synthe sizing this information into comprehensive psychiatric formula- tions and treatment plans (for the American Academy of Child and Adolescent Psychiatry’s practice parameters on assessment, see King, 1997; Thomas et al., 1997). The goals of this chapter are to describe the content and process of a psychiatric assessment, as well as to provide an over view of the diagnostic formulation and treatment plan ning process with children and adolescents. The psy chiatric examination and diagnostic process are closely interwoven. Even though an accurate diagnosis depends on information collected in the psychiatric interviews and the mental status examina- tion, knowledge regarding diagnostic categories affects the content and flow of clinical data collection. Nevertheless, for purposes of exposition, the clinical and diag nostic processes are described separately. This chapter considers assessment from the perspective of the child and adolescent psychia- trist, and it is intended for phy sicians who want to improve their skills in the evalua tion of mental health functioning in children and youth. It also includes a section on the role of the primary care physician in psychiatric screening and assessment. Complexities of assessment in child and adolescent psychiatry There are several complex features of the psychiatric as- sessment of children that differ from the assessment of adults and that warrant special consideration. In children Introduction Complexities of assessment in child and adolescent psychiatry The psychiatric examination Interview with the child or adolescent Diagnostic formulation and treatment planning Psychiatric diagnosis in children and adolescents Child psychiatry and the primary care physician Summary OUTLINE