Clinical Assessment

November 10, 2011
PSY 270

Introduction and Background Mr. and Mrs. Lawson brought their 4-year-old adopted daughter, Clara, to see Dr. Mason, a psychiatrist. Clara was polite in greeting Dr. Mason, but did not smile and kept her gaze down as she took a seat. Mr. and Mrs. Lawson sat next to Clara and began explaining their concerns. They described Clara as a quiet child who has recently begun throwing temper tantrums, during which she is inconsolable. Her sleep and eating patterns have changed, and she no longer wants to go to preschool. Interview Questions
Since Clara is only four years old, I would want to talk to the parents alone. This would give me a chance to obtain some information that would help me when working with Clara. Some of the questions I would ask would be: 1. Have there been any major changes recently that have affected the family? 2. How old was Clara when she was adopted? 3. Did her biological parents have any contact with her before the adoption? 4. How and when did the changes in her sleeping and eating occur? 5. Has she been to her doctor concerning these changes? If so, what did the doctor have to say? Did the doctor put her on any medication? 6. Have the parent noticed anything that seems to trigger the tantrums? 7. What does Clara say about school and her teacher? 8. How long ago did Clara begin preschool?

Assessment Tools Once I had gathered this information from the parents, I could determine a plan on approaching Clara and talking with her. One form of assessment I would consider using would be the Preschool Age Psychiatric Assessment (PAPA). This assessment offers direct questioning to the parents in order to use a diagnostic measure for a child’s pathology. This would be an appropriate tool in this case because this is the first time in this child’s life that she has had structured social interaction and Clara could possibly be exhibiting early signs of a social phobia or other pathology. I would also want to administer an assessment that is given directly to the child, so I would use the Dominic Interactive Assessment. This assessment can identify tendencies toward separation anxiety disorder (SAD), generalized anxiety disorder (GAD), major depression/dysthymia (MDD), oppositional defiant disorder (ODD), conduct disorder (CD), and attention deficit hyperactivity disorder (ADHD). The data in this assessment is obtained directly from the patient instead of going through the parents; therefore this would be an effective tool. Also, it can point the way to treatment, or the need for more detailed testing. Another tool that can be use with Clara is Behavioral observation. From the behavioral observations I could discover how Clara acts? Is she nervous, calm, or shy? What does she do and not do? Does she make and maintain eye contact? How close to you does Clara sit? Often, behavior observations are some of the most important information you can gather. Since Clara is a young child, Projective tests like the (Comer, 2006) Thematic Apperception Test (TAT) in which Clara would have to make up stories based upon the black and white photos and/or open instructions for drawing would (Comer, 2006) allow Clara to interpret the stimuli provided and/or to project their feelings and emotions (p. 72). While drawing might elucidate (Comer, 2006) the unconscious drives and conflicts Clara has, projective tests might be the most suitable due to her age (p. 72, 73).
Making a Diagnosis
Several factors would play into the diagnosis of Clara. These factors may include if there was a diagnosed pathology of any type, if a traumatic event has occurred, the stability of the family situation, the willingness of the parents to pursuing suggested options, and whether Clara is open to therapy or treatment. In preparing a diagnosis for Clara, I would refer to the DSM-IV classification system to evaluate her condition on five separate axes. The information that would go into each axis is as follows:
Axis I: Primary disorder: changes in eating/sleeping habits, sullenness. Major symptoms that were found.
Axis II: Personality Disorder: possible "trigger event" for the primary disorder. The possibility of underlying mental retardation or paranoid personality disorder.
Axis III: Medical/Neurological: A medical condition that might simulate or cause psychological conditions, such as asthma that can manifest with symptoms similar to a panic attack.
Axis IV: Psychological Stressors: Any major change in the patient’s life, such as death in the family, divorce, abuse or neglect at home or school. For this patient it could even be the change in attending preschool or the adoption process. Axis V: Level of function: The level of interference the problems have on “normal functioning” would determine the score. From what has been gathered, it does not appear that there may be enough information to conduct an informed clinical assessment of Clara’s emotional problems and determine their causes. Since Clara’s tantrums and behavioral changes all appeared after she started preschool, more information is needed in order to determine whether further assessments and/or interventions should be engaged. For all of these reasons, the clinical interview discussed in the original scenario is deficient and delimits diagnostic accuracy. However, it would be beneficial to Clara and her parents to have a diagnosis, particularly if the problem turns out to be a singularity such as a single trauma this not likely to occur again. Also, if there is an underlying disorder, it is easier to begin therapeutic treatment with a child rather than an adult. As young as Clara is a diagnosis of a disorder such as ADHD could lead to over-treatment with medication, and a self-fulfilling behavior pattern. Caution should be exercised with such a diagnosis.

References

Cherry, Kendra. What Is the DSM-IV TR? Retrieved on November 8, 2011, from http://psychology.about.com/od/psychotherapy/f/faq_dsm.htm
Comer, Ronald J. (2006). Abnormal Psychology & Scientific American Reader for Comer. Worth Pub.

Luby, Joan L.; Xuemei, Su ;Belden, Andy C.; et.al.(August 2009). Preschool Depression Homotypic Continuity and Course Over 24 Months. Retrieved on November 8, 2011, from http://cel.webofknowledge.com |