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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Per the NIMH (2019), children are more difficult to diagnose because of their lack of understanding of their symptoms, withdrawn demeanor, and influence of external factors on their behaviors.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.
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.
Pediatric Screening, Treatment, and Parents Role in Mental Health
The human brain is amazing. Our brains continue to grow as we age, learn, and interact with our environment. The human brain is not fully formed until one’s early 20’s (Giedd, 2004). This means the brain appears different on imaging during different stages of childhood and adolescents. A child could be developing on time, then start deteriorating and losing milestones it once had. An assessment would be needed to identify areas the child was no longer developing on par in. The assessment would identify what is wrong, give a diagnosis which could open means to fund treatment and get the child back on course. Children and adolescents think differently from each other and adults. It is important to speak to these kids at their level, which is impossible to do unless the provider does a brief assessment of where the client is intellectually and emotional and developmental age. Then the provider can alter their approach to meet the client where they are at. How these kids think influences the approach to treatment.
Pediatric Assessments and Screening Tools
The Vanderbilt Assessment Scale Parent Informant helps providers identify symptoms of ADHD. The questions listed address specific symptoms that occur in childhood ADHD, like climbing on things and running around when supposed to be sitting. If this tool was used on adults, adult ADHD could be missed because the Vanderbilt Assessment Scale Parent Informant does not target adult ADHD’s symptoms thus missing key symptoms of ADHD in adults. Adults might not climb on the furniture, but they may be forgetful and disorganized a lot.
CRAFFT is a screening tool for risky behaviors associated with substances. This tool addresses risky behavior teens may take part in. Alcohol is illegal for teens to consume, but adults can legally drink. What is considered a risky behavior for teens may not be for adults. CRAFFT is not ideal for adults. There are other assessment tools specific to the risky behaviors adult present. Leslie (2008) stressed the importance of routine screening for substances and risky behavior among teens. CRAFFT was found to be a valid screening tool to identify substance-related problems and disorders (Knight, Sherritt, Shrier, Harris, & Chang, 2002).
Pediatric Treatment Options
Play therapy is a type of therapy targeting the developmental age of the client. One large meta-analysis found play therapy to be efficacious and equally effective across ages, gender and presenting problems (Bratton, Ray, Rhine, & Jones, 2005). The greatest improvement was seen when parents were involved with play therapy (Bratton et al., 2005).
Many studies use elementary school as the medium or location to treat children. Prevention of negative outcomes is a common theme in schools. Children have little to no control over their home environment. So public schools have made changes to help students have higher chances of succeeding. Mental health problems prevention strategies can be implemented in schools. There is often a psychotherapist in the school and a free period at school to allow teens to make up homework that was not done at home. Tol, Komproe, Susanty, Jordans, … & De Jong (2008) conducted multiple control trials with interventions targeting mental health in schools for kids affected by political violence. The unique aspect of providing interventions and treatment in school is it is a safe, consistent, structured environment the child attends on a regular basis. And there are plenty of adults in the school that may be able to help with the interventions.
School is an ideal location to promote healthy development in children and provide prevention interventions to help children have positive outcomes. Adults are not treated like this. There is not one location nearly everyone goes to on a regular basis, which is a consistently safe environment. Adults work at different businesses and on different days. Often, mental health prevention is not addressed in adults to the degree it is in children and adolescents.
Parent’s Role in Treatment
Parents are vital when working with children and adolescents. When parents are involved and support their child, the child has better chances of succeeding and healing. One way parents can help is by providing information to practitioners in the form of screening and assessment dah data. Parents may need to give feedback because the client lacks insight, awareness, ability to express or even define complex feelings. The parent can provide assessment tools or screening tools to the child’s teacher, thus allowing for more data to be gathered in another environment the child is in.
Parents can also encourage teens to participate in the assessment. Parents may bring up symptoms or events the teen or child does not want to talk about, allowing for more data or an alternate perspective on their situation. Information gathered from parents of adolescents may or may not be accurate because teens often filter details of their lives to parents.
Parents can help children and teens follow through getting needed treatment, provide reminders and transportation to their children, and refill prescriptions.
Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 376.
Giedd, J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the new york academy of sciences, 1021(1), 77-85.
Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of pediatrics & adolescent medicine, 156(6), 607-614.
Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J., Macy, R. D., & De Jong, J. T. (2008). School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial. Jama, 300(6), 655-662.Leslie, K. (2008). Youth substance use and abuse: challenges and strategies for identification and intervention. Cmaj, 178(2), 145-148.