Chapter 4: Assessment, Diagnosis, and
Case study of Felicia, 13, referred to a clinician because of
depression, school refusal, social withdrawal at home and school,
and sleep disturbance.
Clinical assessments: Use systematic problem-solving strategies
to understand children with disturbances and their family and
o Ongoing process of hypothesis testing regarding the nature
of the problem, its causes, and likely outcomes if it is left
o This process uses strategies, including an assessment of the
childs emotional, behavioral, and cognitive functioning, as
ell as the role of environmental factors.
o Clinical assessments are only meaningful to the extent that
they result in practical and effective interventions. These
are not separate processes.
Idiographic case formulation: To obtain a detailed
understanding of the individual child or family as a unique entity.
Nomothetic formulation: Emphasizes broad general inferences
that apply to large groups of individuals (ie all children with
o A clinicians nomoethetic knowledge will result in better
hypotheses to test at the idiographic level.
Clinical interview, behavioral assessments, and psychological
testing help with the decision making.
Age, Gender and Culture:
A childs age has implications not only for judgments about
deviancy, but also for selecting the most appropriate assessment
and treatment methods.
There are gender diffs in the rates and expression of childhood
Most childhood disorders are defined by adults, who find the
symptoms salient or troublesome.
Overt displays of overactivity and aggression are more common in
boys, who are referred for treatment as showing off or clowning (parents) or disturbing other pupils (teachers).
o Girls may be overlooked because of their less visible
o Girls and boys should be studied as distinct groups in their
o In girls, relational aggression and physical aggression are
the strongest predictor of future psychological-social
When adjustment problems are studied in relation to
issues most salient for girls, it has been shown that
girls do experience significant problems during
Cultural patterns reflect learned behaviors and values shared
o Ethnic minority youth have a greater risk of being
misdiagnosed, of not receiving treatment.
o A clinical assessment should include a systematic review of
the child and familys cultural background, the role of
culture in the expression and evaluation of the childs
symptoms, and the impact of culture on the childs
Culture-bound syndromes: Refer to recurrent patterns of
maladaptive behaviors and/or troubling experiences specifically
associated with different cultures or localities.
o How a childs adjustment is defined is embedded in culture,
and identifies certain coping styles as acceptable, or certain
behaviors as problems. What is considered abnormal varies
o In some cultures, mental health issues are seen as taboo,
and intervention into personal family matters by strangers is
Generalizations about cultural practices rarely capture regional,
generational, SES and lifestyle differences.
o SES is a major confound in findings of differences in
psychopathology rates between cultures, because ethnic
minority cultures are overrepresented in low SES
o Acculturation level also impacts assessment: the lower the
acculturation level, the higher you score on
psychopathology, especially in conjunction with low SES and
Children can be matched with clinicians of the same ethnicity, or
therapy can customize treatment to specific cultural beliefs,
values and customs, or ethnic and cultural narratives and role play
can be incorporated into therapy. o Understanding the cultural context is important for
identifying treatment goals in relation to what is defined as
optimal functioning for children in particular cultural groups.
Felicias school refusal and sad mood started to occur after her
mothers hospitalization. We need to know whether this is a
normal reaction to a stressful live event from an individual of her
age, gender, and culture.
Parents must determine whether difficulties are chronic versus
common and transient, and must decide when to seek advice from
others and what treatment is best.
What defines childhood disorders is the age inappropriateness and
pattern of symptoms, and the extent to which symptoms result in
impairment in the childs functioning.
o Problems displayed by children referred for treatment occur
in less extreme forms in the general pop/in other young
children, such as sadness, difficulty concentrating,
inattentive, temper, etc.
Purposes of Assessment:
Three common purposes of assessment:
o 1) Description and diagnosis
o 2) Prognosis
o 3) Treatment
Description and Diagnosis:
Clinical description: Summarizes the unique behaviors,
thoughts, and feelings that together make up the features of the
childs psychological disorder.
A clinical description attempts to establish basic info about
childrens and parents presenting complaints, esp how their
behavior/emotions are different from/similar to those of other
children of the same age, sex, socioeconomic and cultural
o First, you assess and describe the intensity, frequency and
severity of a problem.
o Second, you describe the age of onset and duration of the
difficulties (relative to what is considered normative for a
o Third, you want to convey a full picture of all symptoms and
Diagnosis: Analyzing info and drawing conclusions about the
nature/cause of the problem, or assigning a formal diagnosis.
Diagnosis has two separate meanings: o Taxonomic diagnosis: Focuses on the formal assignment
of cases to specific categories drawn from a system of
classification like the DSM-IV-TR or from empirically derived
o Problem-solving analysis: Similar to clinical assessment,
views diagnosis as a process of gathering info used to
understand the nature of an individuals problem, its
possible causes, treatment options and outcomes.
Felicias assessment will involve a complete diagnostic
She may receive a formal diagnosis of MDD, and
maybe a secondary diagnosis of an anxiety disorder
because comorbidity of depression and anxiety is
common among girls her age.
Prognosis and Treatment Planning:
Prognosis: The formulation of predictions about future behavior
under specified conditions. (ie: What will happen to Felicia if she
does not receive help?)
Treatment for children often focuses on enhancing the childs
development rather than merely removing symptoms or restoring
a previous level of functioning.
Treatment planning and evaluation: Using assessment info to
generate a plan to address the childs problem and evaluate its
o This may involve further specification and measurement of
possible contributors to the problem, determination of
resources and motivation for change, and recommendations
for treatments likely to be the most feasible, acceptable and
effective for the child +family.
Multidisciplinary teams: May include a psychologist, a
physician, an educational specialist, a speech pathologist, and a
Multimethod assessment approach: Emphasizes the
importance of obtaining info from different informants in a variety
of settings and using a variety of methods that include interviews,
observations, questionnaires and tests.
o Methods must be reliable, valid, cost-effective, and useful
o Deciding which assessment method to use depends on
whether it is for diagnosis, treatment planning, or treatment
Purpose: To obtain the most complete picture possible to develop