Assessment in Child and Adolescent Psychiatry

Strategic Plan Presentation
March 6, 2019
Pediatric Screening, Treatment, and Parents Role in Mental Health
March 6, 2019

Assessment in Child and Adolescent Psychiatry

The assessment process of children and adolescents in psychiatry is vastly different than that of adults. Why is this? Oftentimes, children have the same emotional, cognitive, and behavioral deficits. In children and adolescents, however, the justification for behaviors isn’t always as easy to determine. Per the NIMH (2019), children are more difficult to diagnose because of their lack of understanding of their symptoms, withdrawn demeanor, and influence of external factors on their behaviors. Because of this, specific assessment tools are employed that differentiate child/adolescent assessments from that of adults.

Why a Development Assessment of Children and Adolescents is Important

Bellman, Byrne, and Sege (2013) suggest that behavioral deficits in adulthood are often correlated to developmental delays in childhood.  Likewise,  Shogren, et al. (2015) discussed a direct correlation to emotional support needs in children and adolescents with developmental disabilities and behavioral deficits in adulthood. Developmental delays aren’t always cognitive in nature. Developmental delays in children and adolescents can be cognitive, such as those caused by chromosomal disorders, or seizure disorders. Developmental delays can be social, emotional, or behavioral–such as autism disorder or attention-deficit hyperactivity disorder.  With certain developmental delays, alterations in brain development can affect the way these individuals process and react to information—causing difficulties in learning, communication, and interpersonal interactions (NYU Langone Health, 2019). Understanding which delays are present, if any, can assist in determining viable treatment options and potential behavioral concerns that may manifest.

Two Assessment Instruments and Justification for Use in Children/Adolescents but Not Adults

Two screening tools unique to the treatment of adolescents and children are as follows: The C-GAS and the HEADSSS questionnaire. The C-GAS, or Children’s Global Assessment Scale, is used for children and adolescents, ages 4-16, to determine any functional impairments that may exist (NSW Department of Health, 2015). This scale is not utilized in adults, because it specifically measures the child’s level of functioning in areas such as school, with peers, emotional functioning, and functioning within society (NSW Department of Health, 2015). The HEADSSS questionnaire, however, was developed to determine adolescent risk factors in the following areas: home, Education/employment, activities, drugs, sexuality, suicide/self-image, and safety (Heard Alliance, 2011). This assessment tool is used for adolescents only to determine specific risk factors in the child’s life. Afterall, certain risk factors can lead to at-risk behaviors. This assessment tool identifies those factors in hopes of establishing protective mechanisms.

Two Treatment Options for Children/Adolescents that are Not Used in Adults

There are several treatment modalities favored in the child/adolescent populations that are often not employed in adult mental health treatment. These include the use of parental participation and favoritism toward psychotherapy opposed to medication usage. Many psychotropic medications and other medications used in the mental health treatment of children and adolescents are based on evidence-based treatment regimens, opposed to actual pediatric dosing. In addition, side effects of medications warrant caution in younger age groups. Because of this, psychotherapy is the most highly recommended treatment option for children. Psychotherapy is equally utilized in adult psychiatric treatment. However, adult treatment is often augmented with psychopharmacological intervention. In addition, treatment for children entails frequent evaluation. For example, the NIMH (2019) proposed that the incorporation of “teaching skills” and “practicing skills” within the home are unique to child/adolescent psychiatric care. This requires frequent evalution to determine if these skills are resolving the child’s mental health concerns, whether it be improvements adacemically, improved social skills, or a decrease in disruptive behaviors.

Parental Role in Assessment and Treatment of Children/Adolescents

Parents play a major role in their child’s psychiatric care. Per Haine-Schlagel and Walsh (2015), the mental health of children and adolescents is largely influenced by their interpersonal interactions, family, and social life. A child’s family interactions and environment represents the largest contributor to childhood behavioral problems (Haine-Schlagel & Walsh, 2015). Because of this, Haine-Schlagel and Walsh (2015) discuss the importance of incorporating family, if possible, into the child’s psychiatric treatment. This can be accomplished through family therapy, or having educational sessions with the parents to discuss communication strategies, discipline strategies, and other helpful tactics. Per Haine-Schlagel and Walsh (2015), parental participation is often difficult related to feelings of “blame” or difficulty with understanding the therapeutic point of view (pg. 135). However, is is suggested that parental involvement is an evidence-based treatment modality– promoting child and adolescent treatment outcomes for a variety of disparities, including depression, defiant disorders, eating disorders, disruptive disorders, and childhood anxiety disorders.

References

Bellman, M., Byrne, O., & Sege, R. (2013). Developmental Assessment of Children. British Journal of Medicine, 346(21), 31-35. Retrieved from Walden Library databases.

Haine-Schlagel, R., & Walsh, N. E. (2015). A Review of Parent Participation Engagement in Child and Family Mental Health Treatment. Clinical Child and Family Psychology Review, 18(2), 133-150. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433419/.

Heard Alliance. (2011). HEADSSS Assessment: Risk and Protective Factors. Retrieved from http://www.heardalliance.org/wp-content/uploads/2011/04/HEADSS.pdf

NIMH. (2019). Children and Mental Health: Is This Just a Stage? Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/children-and-mental-health/index.shtml

NSW Department of Health. (2015). Children’s Global Assessment Scale (CGAS). Retrieved from http://www.thereachinstitute.org/images/CGAS.pdf

NYU Langone Health. (2019). Types of Developmental Delays in Children. Retrieved from Hassenfeld Children’s Hospital at NYU Lagone: https://nyulangone.org/conditions/developmental-delays-in-children/types

Shogren, K. A., Seo, H., Wehmeyer, M. L., Palmer, S. B., Thompson, J. R., Hughes, C., & Little, T. D. (2015). Support Needs of Children with Intellectual and Developmental Disabilities: Age-Related Implications for Assessment. Psychology in the Schools, 52(9), 874-891. Retrieved from Walden Library databases.