Assessment & Treatment of Childhood Disorders PDF

Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood Assessment & Treatment of Childhood Disorders Assessment Clinical/Psychological Assessment - Goals: o Screening o Diagnosis o Prognosis o Treatment Plann...

Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood Assessment & Treatment of Childhood Disorders Assessment Clinical/Psychological Assessment - Goals: o Screening o Diagnosis o Prognosis o Treatment Planning o Monitor Treatment Progress 4 Pillars of Clinical/Psychological Assessment Interviews Often with parents only o Depending on age and presenting problem, children may be assessed as well Purpose o Identify presenting problem(s) ▪ Current intensity, frequency & severity ▪ Age of onset and duration o Gather historical information ▪ Developmental history (e.g., pregnancy, milestones) ▪ Family variables (e.g., history of psychopathology) ▪ Cultural considerations/factors (e.g., SES, race/ethnicity) ▪ History of neglect/abuse (SI/HI - suicidal/homicidal ideations) ▪ Relevant medical history (e.g., TBI, hypothyroidism) ▪ Impairment (e.g., academics, social) ▪ Prior history of assessment/treatment (e.g., current medications, school services) o Conduct structured diagnostic assessment Observations During interview (informal data gathering) Role play simulation (e.g., p-c interactions) Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood Naturalistic observation o Setting(s) where impaired Goal: inform functional analysis of behavior Norm-Referenced Testing Allows for comparison against other same age/gender children Standardized administration & scoring procedures Types o IQ o Achievement o Personality/Social-Emotional IQ Testing Weschler Intelligence Scale for Children o Full-scale IQ ▪ M = 100 | SD = 15 ▪ Average range = 85 – 115 o 5 sub-indices: ▪ Verbal Comprehension Verbal reasoning based on word knowledge Use of verbal information to express oneself and to solve problems ▪ Fluid Reasoning Ability to organize and interpret visually presented material and to engage in visual-spatial problem solving ▪ Visual-Spatial Reasoning ▪ Working Memory Ability to attend to visual and auditory information, retain and manipulate it in memory, and to apply it when necessary ▪ Processing Speed Capacity to visually scan and process nonverbal information quickly and accurately Achievement Testing Examine academic knowledge acquired in reading, mathematics and written expression Examples: o Woodcock-Johnson o Wechsler Individual Achievement Test Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood Difference between score(s) on achievement testing and IQ testing may be evidence in favor of learning disability Informal Data Gathering Functional Analysis of Behavior Antecedents o Child does not understand assignment, cannot read directions, does not know what to do Behavior o Child leaves seat, talks with classmates, disrupts teacher Consequences o Child is positively reinforced by teacher’s attention and classmate’s giggles; child is negatively reinforced by avoiding the assignment Social/Behavioral Functioning Self-report o Typical with depression (CDI) and anxiety (RCMAS) o Not optimal for assessing ADHD/ODD/CD Parent/Teacher Report o Typical with ADHD/ODD/CS (e.g., ASEBRA CBCL) o May be helpful with internalizing, but not enough Diagnoses Diagnosis and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) o Advantages ▪ Professional communication ▪ Prediction ▪ Treatment planning ▪ Service acquisition o Disadvantages ▪ Too parsimonious (simplistic) Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood ▪ Unclear boundaries between diagnoses ▪ Stigma ▪ More adult focus than child focus ▪ Not enough consideration of environmental influences Research Domain Criteria (RDoC) Goal: develop diagnostic classification system based on underlying causes of symptoms o May lead to more effective interventions if treating root cause of symptoms vs symptoms themselves Domains: o Positive/negative valence systems o Cognitive system o Social processes o Arousal/regulatory systems o Sensorimotor systems Treating Children/Adolescents/Families Unique Features of Treating Children Children do not refer themselves, parents/teachers do o So, may be unmotivated to change Treatment expectations/goals, delivery methods need to take into account cognitive, social emotional, and behavioral maturity o You are NOT treating little adults Ethical considerations: o Determining when a minor is competent to make their own decisions o Balancing their rights to confidentiality against the rights of the parents Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood Core Methods of Efficacious Psychosocial Therapy with Children and Adolescents Behavior Therapy Child/parent is client Theory of Change: o Behavior is driven by ▪ Antecedents ▪ Consequences o Functional analyses critical o Altering how, or in what form, antecedents and contingencies are in place may encourage more adaptive behavior Cognitive Therapy Child is client Theory of Change: o Distress is driven by cognitive biases/distortions, irrational beliefs o Therapists help clients identify these errors and adopt more realistic ways of thinking Combination of cognitive and behavioral therapies (CBT) is evidence-based treatment for numerous childhood disorders o In addition to challenging negative automatic thought, focus also on altering behaviors associated with emotional distress ▪ e.g., behavioral activation for depression Interpersonal Therapy Child is client Theory of Change: o Psychopathology results from disruption in interpersonal relationships ▪ e.g., transition periods, loss of loved one Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood o Strengthening relationships with others may resolve mental health difficulties Family Systems Therapy Family is client Theory of Change: o Altering behavior of one member of family will alter behavior of family Structured family therapy o Strengthening alliances and role boundaries between parents and children How Does Therapy Work with Children and Adolescents? Evidence-Based Treatments and Practices EBTs are clearly specified treatments shown to be effective in controlled research with specific populations EBP involves the use of the best available scientific evidence combined with good individual clinical expertise Good News Weisz and colleagues (2017) o Review of 450 therapy studies including 30,000 children as participants ▪ Average effect of treatment moderate (noticeable) ▪ 63% of youth receiving treatment fare better than those in control condition Across internalizing and externalizing conditions Girls and boys, pre-adolescents and adolescents Bad News Weisz and colleagues (2017) o Effects vary depending on problem being treated ▪ Moderate effects for anxiety and conduct problems, as well as ADHD ▪ Small effects for depression Lecture Notes Assessment & Treatment PSY 3430 | Psychological Disorders of Childhood ▪ No effect for treating multiple problems concurrently, or when asking teachers for whether they saw change o Impairment reduction less common o Effect of EBTs delivered in communities less well understood ▪ Efficacy vs Effectiveness Future Direction Translate and disseminate evidence-based assessment and treatment practices into real- world settings so as to improve access by significantly reducing the personal, social, and economic costs of children’s mental health problems and related conditions, at both the individual and societal levels