SLK 310
Chapter 4 Assessment, Diagnosis and
treatment
Cinical issues:
Clinical strategies and methods used to assess children with psychological and behavioral problems.
The decision-making process:
This requires sorting through the many factors that bring a child or adolescent to the attention of
professionals and checking out alternative hypotheses and plans.
This 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 uses systematic problem-solving
strategies to understand children with disturbances and their family and school environments.
Strategies typically include an assessment of the child’s emotional, behavioral, cognitive functioning as
well as the role of environmental factors.
Ultimate goal: to achieve effective solutions to the problems children and their families face and to
promote and enhance their well-being.
Focus: to obtain a detailed understanding of the individual child or family as a unique entity, referred to as
idiographic case formulation.
Nomothetic formulation emphasizes broad general inferences that apply to large groups of individuals.
A clinician’s nomothetic knowledge about general principles of psychological assessment, normal and
abnormal child and family development and specific childhood disorders, they are more likely to result
better hypotheses to test at the idiographic level.
Clinicians begin their decision making with an assessment, which can range from a clinical interview with
the child and parents to more structured behavioral assessments and psychological testing.
Adults play a critical role in defining the child’s problem and providing information, it is therefore
important to establish a rapport with them. Active family and teacher environments are important for
both assessment and intervention.
Developmental considerations:
Age, gender and culture:
A child’s age has implications not only for judgement about deviancy but for selecting the most
appropriate assessment and treatment methods.
A child’s gender also has implications for assessment and treatment.
Boys are about 3-4 times more likely than girls to display early-onset disorders such as autism spectrum
disorder (ASD) and attention deficit/hyperactivity disorder (ADHD), whereas girls are more likely than boys
to display disorders that have their peak onset in adolescence such as depression and eating disorders.
Overactivity and aggression are more common in boys than in girls. Girls tend to express their problems in
less observable ways (fear, sadness and shame).
Boys may receive an excess of referrals and girls may be overlooked because of their less visible forms of
suffering.
When angry, girls show their aggression indirectly through verbal insults, gossip, ostracism, getting even or
3rd-party retaliation, referred to as relational aggression. As girls move into adolescence, the function of
their aggressive behavior increasingly centers on group acceptance and affiliation.
, Girls experience significant problems during childhood:
Relational aggression
Self-serving behaviors
Behaviors directed outward
Behaviors intended to physically harm others
This combination or relation and physical aggression is the strongest predictor of future psychological-
social adjustment problems in girls.
Cultural factors must be carefully considered during assessment and treatment.
The DSM-5 includes a framework for developing a cultural formulation of the child’s disorder based on the
child and family’s cultural identity, their cultural concepts of distress, psychological stressors and cultural
features of vulnerability and resilience and an overall cultural assessment including a culturally appropriate
plan for treatment.
The DSM-5 also contains a cultural formulation interview, with a module for children and adolescents, to
gather information about the impact of culture on the child’s presenting problems and implications for
treatment.
Cultural patterns reflect learned behaviors and values that are shared among members, are transmitted to
group members over time and distinguishing the members of one group from those of another group.
Culture includes:
Ethnicity
Language
Religious or spiritual beliefs
Race
Gender
Socioeconomic status (SES)
Age
Sexual orientation
Geographic origin
Group history
Education and upbringing
Life experiences
Children who form part of ethnic minorities may have a greater risk of being misdiagnosed or
underdiagnosed.
A cultural formulation is necessary to establish a relationship with the child and family, motivate family
members to change, obtain valid information, arrive at an accurate diagnosis and develop meaningful
recommendations for treatment.
Ethnic identity and racial socialization are key factors to consider in the assessment of all children and
families, including those from the dominant culture.
Cultural syndromes refer to a pattern of co-occurring, relatively invariant symptoms associated with a
particular cultural group, community or context.
It is important that the clinician assesses the extent to which a child’s cultural background and context
affect the expression of both individual symptoms and clinical disorders.
The lower the level of one’s acculturation, the higher one scores on measures of psychopathology,
particularly in conjunction with low SES and education level.
More commonly reported among males:
Chapter 4 Assessment, Diagnosis and
treatment
Cinical issues:
Clinical strategies and methods used to assess children with psychological and behavioral problems.
The decision-making process:
This requires sorting through the many factors that bring a child or adolescent to the attention of
professionals and checking out alternative hypotheses and plans.
This 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 uses systematic problem-solving
strategies to understand children with disturbances and their family and school environments.
Strategies typically include an assessment of the child’s emotional, behavioral, cognitive functioning as
well as the role of environmental factors.
Ultimate goal: to achieve effective solutions to the problems children and their families face and to
promote and enhance their well-being.
Focus: to obtain a detailed understanding of the individual child or family as a unique entity, referred to as
idiographic case formulation.
Nomothetic formulation emphasizes broad general inferences that apply to large groups of individuals.
A clinician’s nomothetic knowledge about general principles of psychological assessment, normal and
abnormal child and family development and specific childhood disorders, they are more likely to result
better hypotheses to test at the idiographic level.
Clinicians begin their decision making with an assessment, which can range from a clinical interview with
the child and parents to more structured behavioral assessments and psychological testing.
Adults play a critical role in defining the child’s problem and providing information, it is therefore
important to establish a rapport with them. Active family and teacher environments are important for
both assessment and intervention.
Developmental considerations:
Age, gender and culture:
A child’s age has implications not only for judgement about deviancy but for selecting the most
appropriate assessment and treatment methods.
A child’s gender also has implications for assessment and treatment.
Boys are about 3-4 times more likely than girls to display early-onset disorders such as autism spectrum
disorder (ASD) and attention deficit/hyperactivity disorder (ADHD), whereas girls are more likely than boys
to display disorders that have their peak onset in adolescence such as depression and eating disorders.
Overactivity and aggression are more common in boys than in girls. Girls tend to express their problems in
less observable ways (fear, sadness and shame).
Boys may receive an excess of referrals and girls may be overlooked because of their less visible forms of
suffering.
When angry, girls show their aggression indirectly through verbal insults, gossip, ostracism, getting even or
3rd-party retaliation, referred to as relational aggression. As girls move into adolescence, the function of
their aggressive behavior increasingly centers on group acceptance and affiliation.
, Girls experience significant problems during childhood:
Relational aggression
Self-serving behaviors
Behaviors directed outward
Behaviors intended to physically harm others
This combination or relation and physical aggression is the strongest predictor of future psychological-
social adjustment problems in girls.
Cultural factors must be carefully considered during assessment and treatment.
The DSM-5 includes a framework for developing a cultural formulation of the child’s disorder based on the
child and family’s cultural identity, their cultural concepts of distress, psychological stressors and cultural
features of vulnerability and resilience and an overall cultural assessment including a culturally appropriate
plan for treatment.
The DSM-5 also contains a cultural formulation interview, with a module for children and adolescents, to
gather information about the impact of culture on the child’s presenting problems and implications for
treatment.
Cultural patterns reflect learned behaviors and values that are shared among members, are transmitted to
group members over time and distinguishing the members of one group from those of another group.
Culture includes:
Ethnicity
Language
Religious or spiritual beliefs
Race
Gender
Socioeconomic status (SES)
Age
Sexual orientation
Geographic origin
Group history
Education and upbringing
Life experiences
Children who form part of ethnic minorities may have a greater risk of being misdiagnosed or
underdiagnosed.
A cultural formulation is necessary to establish a relationship with the child and family, motivate family
members to change, obtain valid information, arrive at an accurate diagnosis and develop meaningful
recommendations for treatment.
Ethnic identity and racial socialization are key factors to consider in the assessment of all children and
families, including those from the dominant culture.
Cultural syndromes refer to a pattern of co-occurring, relatively invariant symptoms associated with a
particular cultural group, community or context.
It is important that the clinician assesses the extent to which a child’s cultural background and context
affect the expression of both individual symptoms and clinical disorders.
The lower the level of one’s acculturation, the higher one scores on measures of psychopathology,
particularly in conjunction with low SES and education level.
More commonly reported among males:
