In the previous blog we read about how childhood disorders can be detected in children through the various Influencers of Problematic Child Development, now we can move on to Assessment, Diagnosis, and Treatment of Childhood Disorders.
When a child is referred to a psychologist because of various problems they have been going through, what are the appropriate steps that should be taken to help them? Let’s read a case study to understand the process of assessment, diagnosis, and treatment of childhood disorders.
A Case Study: Krisha
Krisha, a 14-year-old girl in 9th standard is having many problems including frequent low mood, sleep disturbances, and social withdrawal. These problems had been noticed right after her mother had been diagnosed with cancer.
Krisha would complain of stomach aches to avoid going to school, and she did not want to talk to anyone most of the time. She would also try to find ways to be close to her mother all the time, by asking for help with homework. Overtime, Krisha became very unhappy, experiencing excessive sleep disturbances and lack of appetite. In school, Krisha’s grades dropped significantly! She said things like “No one liked her and her life was hopeless.”
After reading this case study we can see that Krisha is facing multiple problems and it is important to try and understand each one to figure out how to proceed to the next step.
Decision Making Process
In order to take the next step, it is important to systematically consider all possible reasons for Krisha’s problems and understand how these problems came to light. “This ongoing decision-making process is aimed at finding answers to both immediate and long-term questions about the nature and the course of the child’s disorder and its optimal treatment (Mash, 2006).
Assessments are conducted in order to find effective ways to treat the difficulties one might be facing. For example, in Krisha’s case we would want to keep her parent’s, teacher’s, and school counselor informed and closely work with them in order to provide the most effective interventions. Clinical assessment aims to result in practical and effective interventions. “A close and continuing partnership between assessment and intervention is vital; they should not be viewed as separate processes (Mash & Hunsley, 2005; Youngstrom, 2013).
Assessments can range from clinical interviews to behavioral assessments to psychological testing. While assessing it is important to keep in mind the following developmental considerations:
When considering Krisha’s age, a 14-year-old girl refusing to go to school is a serious problem for her development. The age of the child will also determine whether their information is reliable. This information can help when choosing the correct assessment.
Like age, the child’s gender also has implications for assessment and treatment. Numerous studies have reported gender differences in the rates and expression of childhood disorders (Bell, Foster, & Mash, 2005). The gender of a child can have many implications on the types of treatment that need to be used. For example, overactivity and aggression are more common in boys than in girls; girls tend to express their problems in less observable ways such as sadness, fear, and shame (Chaplin & Aldao, 2013).
Culture is one of the ways that children become who they are. Learned behaviors may come from culture and these behaviors get passed on from generation to generation. A psychologist must examine their own beliefs during their practice. Treatment outcomes have a huge effect on culturally based assumptions. More importantly, to form a relationship with the child and their family, understanding their culture is important. What is considered abnormal child behavior may vary from one cultural group to the next (Serafica & Vargas, 2006).
First, we must determine the most important information from Krisha’s case, these consist of the symptoms that Krisha has like loss of appetite, sleep disturbances, low mood, and hopelessness. With this information we know that these behaviors are not normal for a girl of Krisha’s age. We will need to know other things such as the duration of these symptoms and when they started. This information can be obtained following the interview session.
Once we have the full description of Krisha and the problem she is facing, we can use the description to conclude if Krisha has one or more psychological disorders. From the information we have so far, we can determine that Krisha might have Major Depressive Disorder and is facing Separation Anxiety, as mentioned in the case study, she would find reasons to stay with her mother all of the time.
Treatment planning focuses on the overall enhancement of a child’s development. Krisha showed signs of social isolation, so intervention might focus on teaching her skills to build social relationships. Using the assessment, we need to generate a plan for Krisha that will help her and works for her family. Krisha is definitely having a hard time and it shows in her behavior. Choosing the right kind of therapy is most important for her at this stage.
When dealing with children, there are many important factors to be considered. The people surrounding the child need to find ways to collaborate with one another to improve the child’s well-being. As a clinician, it is important to bring that balance between everyone involved and come up with effective treatment plans and solutions for the child.
As you know, assessment, diagnosis, and treatment are all interconnected and they are present throughout a client’s journey with their psychologist. Next time, we will look at the Types of Therapies used for Children.
Depression, by D. J. Kolko, 1987. In M. Hersen and V. B. Van Hasselt (Eds.), Behavior Therapy with Children and Adolescents: A Clinical Approach, p. 160.
Mash, E. and Wolfe, D., 2014. Abnormal Child Psychology. 6th ed. USA: Cengage Learning.
Mash, E. J. (2006). Treatment of child and family disturbance: A cognitive- behavioral systems perspective. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (3rd ed.,pp. 3–62). New York: Guilford Press.
Mash, E. J., & Hunsley, J. (2005). Evidence- based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child & Adolescent Psychology, 34, 362–379.
Youngstrom, E. A. (2007). Pediatric bipolar disorder. In E. J. Mash & R. A. Barkley (Eds.), Assessment of childhood disorders (4th ed., pp. 253–403). New York: Guilford Press. enhance utility. Journal of Clinical Child & Adolescent Psychology, 42, 139–159.
Chaplin, T. M., & Aldao, A. (2013). Gender differences in emotion expression in children: A meta-analytic review. Psychological Bulletin, 213, 735–765.
Bell, D. J., Foster, S. L., & Mash, E. J. (Eds.). (2005). Handbook of behavioral and emotional problems in girls. New York: Kluwer.
Serafica, F. C., & Vargas, L. A. (2006). Cultural diversity in the development of child psychopathology. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Vol. 1. Theory and method (2nd ed., pp. 588–626). New York: Wiley.