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Questions and Answers
A basic physical examination for a child usually includes an emphasis on the nervous system.
True
Parents should not be informed about the assessment results during the ending of the assessment.
False
Formulation usually starts with a brief statement of the child's developmental stages.
False
The psychiatrist should seek consent to contact other people involved with the child, such as teachers and social workers.
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It is unnecessary to note the child's developmental stages if it has already been done in the multiaxial diagnostic system.
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Court reports prepared by psychiatrists often focus on the child’s psychiatric disorder.
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During a physical examination, a child’s appearance, coordination, and gait should only be observed during play.
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Throughout the assessment process, the psychiatrist should discourage questions and discussion.
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Children below the age of 3 years can produce an account that can be presented in a court of law.
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Most children above the age of 6 years can use straightforward grammar and syntax adequately but may be confused by complicated questions.
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The writer's interpretation of the information from the interviews and written material should be included in the court report.
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Obtaining evidence from a child should be delayed until after any counseling has taken place.
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It is recommended to allow the child to talk freely and ask as few questions as possible when obtaining evidence.
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Children of the age to be witnesses often have an accurate sense of the sequencing and timing of events.
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The qualifications of the writer are not necessary to include in the court report.
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Children above the age of 3 years may produce detailed and accurate memories with some prompting.
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Study Notes
Physical Examination
- A physical examination may be necessary to complete the assessment, focusing on evidence of conditions that might affect the brain.
- The examination involves observing the child's appearance, coordination, and gait, at rest and during play.
- A basic physical examination may follow, with emphasis on the nervous system.
- If abnormalities are found or suspected, the opinion of a pediatrician or pediatric neurologist may be needed.
Ending the Assessment
- The psychiatrist should explain the assessment results to the parents and child, in terms appropriate to the child's age.
- The psychiatrist should explain how they propose to inform and work with the general practitioner, and seek consent to contact other people involved with the child.
- The psychiatrist should encourage questions and discussion throughout the process.
Formulation
- A formulation can help summarize key issues, starting with a brief statement of the current problem.
- The diagnosis and differential diagnosis are discussed, and recorded using the ICD-10 within a multiaxial framework.
- Aetiology is considered, including predisposing, precipitating, and perpetuating factors.
- The formulation should note the child's developmental stages, strengths, and achievements, as well as the family's problems and strengths.
- Any further assessments, treatment plans, and expected outcomes should be specified.
Court Reports
- Psychiatrists may be asked to prepare court reports about children, which should include:
- Qualifications of the writer and who commissioned the report
- Written information available and who was interviewed
- A summary of the findings from the interview
- The writer's interpretation of the information
- Comments on the options before the court
Principles for Obtaining Evidence from a Child
- Allow the child to talk freely, asking as few questions as possible.
- Obtain evidence as soon as possible after the event, and before any counseling has taken place.
- Try to complete the account on the first occasion, as subsequent accounts are likely to be less accurate.
- Be aware that the greater the pressure to remember, the less accurate the account is likely to be.
Understanding Children's Memory
- Memory varies with age, as do verbal skills required to describe what has been remembered.
- Children below 3 years seldom have the cognitive and other capacities to produce a reliable account for a court of law.
- Children above 3 years can produce detailed and accurate memories, but may not be able to describe them clearly without some prompting.
- Children above 6 years can use straightforward grammar and syntax adequately, but may be confused by complicated questions.
- Children may agree with leading questions or make up an answer in the hope that it will be correct.
- Children do not have an accurate sense of the sequencing and timing of events, and memories of frightening events are often incomplete.
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Description
Physical examination is a crucial step in assessing children's health, focusing on signs of conditions affecting the brain. This quiz covers the basics of physical examination in pediatric care.
